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INCREASING PROFITS

Denial management: the missing ingredient in revenue cycle management

By John McDaniel The blueprint for effective Revenue Cycle Management (RCM) is complex in today’s healthcare environment. When we map out the RCM process, it includes the following steps: Patient scheduling and registration Insurance eligibility and benefit verification Collection of copayments and deductibles at time of service Claims submission Remittance processing Denial management Back‐end patient collections Denial Management Implementing an effective and efficient process for managing claim denials is likely the single most important action a healthcare organization can make to affect its revenue cycle. Denial management is by no means a simple process; in fact, it is often extremely complex. According to the American Academy of Family Physicians, the average claim denial rate across the healthcare industry is 5 to 10 percent, varying between specialties. With the average cost… . . . read more.

TECHNOLOGY

5 tech resources improving medical practice efficiency this year

By Alison Foster bio There was a notable increase in the adoption of healthcare technology by practices and providers in 2020. This continues in 2021, especially as the COVID-19 pandemic shows no signs of letting up. Many practices are short on both human and financial resources and need to increase efficiency to the maximum. Here are some forms of healthcare technology you can rely on to optimize your practice’s efficiency in 2021. Cloud computing Keeping patient data safe and accessible is critical in healthcare. Traditional methods of storing patient data often have challenging retrieval and sharing processes. Cloud computing solves many of these problems and is fast becoming the go-to choice for many practices. Electronic health records stored on the clouds means that providers and authorized personnel can access patient data… . . . read more.

CMS

Medicare payment upped for COVID-19 vaccine

The Centers for Medicare & Medicaid Services (CMS) has increased the Medicare payment amount for administering the COVID-19 vaccine. This new and higher payment rate will support important actions taken by providers that are designed to increase the number of vaccines they can furnish each day, including establishing new or growing existing vaccination sites, conducting patient outreach and education, and hiring additional staff. For COVID-19 vaccines administered on or after March 15, the national average payment rate for physicians, hospitals, pharmacies and many other immunizers will be $40 to administer each dose of a COVID-19 vaccine. This represents an increase from approximately $28 to $40 for the administration of single-dose vaccines, and an increase from approximately $45 to $80 for the administration of COVID-19 vaccines requiring two doses. The exact payment… . . . read more.

INCREASING PROFITS

The physician enterprise model: a non-employment alternative

By John W. McDaniel bio Hospitals are seeking new and innovative ways to affiliate with physicians that differ from tactics used in the 1990s, These new relationships involve a more formal type of relationship with physicians, which might reflect lessons learned through previous less‐than‐satisfactory relationships. Most hospitals have physician integration strategies as a part of their long‐range plans, but because physicians employed by hospitals lose approximately $190,000 per year, hospitals and health systems must explore alternatives to physician affiliation aside from the traditional employment model. Beyond employment Affiliation is sought for various reasons. Large hospitals seek a wider reach into communities, while small and rural hospitals seek help with physician recruitment, which has been troublesome over the past years due to 84% of senior medical residents desiring to practice in… . . . read more.

WRVUs

The new paradigm for physician compensation: payment for value/quality v. volume

By John McDaniel bio How will physician compensation arrangements be impacted by quality incentive payments with respect to determining Fair Market Value and commercial reasonability? The enactment of the Medicare Access and CHIP Reauthorization Act (MACRA) in November 2016 set forth future options for payment from Medicare, those being participation in the Merit‐Based Incentive Payment System (MIPS) or participation in one or more Alternative Payment Models (APMs). Both models will likely change how physicians are compensated. MIPS requires participating Medicare providers to be subject to payment adjustments, both positive or negative, based on their performance as determined by four measures, those being (1) quality, (2) advancing care information, (3) clinical practice improvement activities and (4) cost. While MIPS was designed to provide incentives for both quality and value improvements, it… . . . read more.

Medicare

New deadline of Dec. 13 to update APM Incentive billing info

Is your office among the clinicians that need to verify Medicare billing information by Dec. 13 in order to receive payments? The Centers for Medicare & Medicaid Services (CMS) Quality Payment Program website includes 2020 Alternative Payment Model (APM) Incentive Payment details. To access information on the incentive amount and organization paid, clinicians and surrogates can log in to the QPP website using their HARP credentials. Many eligible clinicians who were Qualifying APM Participants (QPs) based on their 2018 performance began receiving their 2020 5% APM Incentive Payments last month. If you have already received your payment, you do not need to do anything. CMS also posted a new 2020 APM Incentive Payment Fact Sheet to explain: Who is eligible to receive an APM incentive payment in 2020 How CMS determines your 2020 APM… . . . read more.

CODING

Impact of 2021 evaluation and management coding changes to WRVU based physician compensation

By John McDaniel bio As you may know, all physician contracts which include any form of WRVU based compensation will need to be reviewed and probably amended due to the increase in WRVUs (work relative value units) associated with E&M CPT codes effective Jan. 1, 2021. We recently conducted an assessment for one of our hospital clients which showed the ʺunintended consequencesʺ of increased compensation to the physicians/providers and the resultant impact to fair market value standards. This has been necessitated by CMS whereby the final decision involved eliminating CPT Code 99201 and leaving CPT Code 99211 unchanged. The changes for CPT Codes 99202‐99205 and 99212‐99215 have resulted in increased reimbursement since the WRVUʹs for these codes have increased. Indeed, the increase in the WRVU component will certainly affect physician compensation… . . . read more.

QPP

Deadline Oct. 5 to ask for MIPS targeted review

If you participated in the Merit-based Incentive Payment System (MIPS) in 2019, your performance feedback, including your MIPS final score and payment adjustment factor(s), is now available for review on the Quality Payment Program website. This final score determines the payment adjustment you will receive in 2021, with a positive, negative, or neutral payment adjustment being applied to the Medicare paid amount for covered professional services furnished by a MIPS eligible clinician in 2021. MIPS eligible clinicians, groups, and virtual groups (along with their designated support staff or authorized third-party intermediary), including APM participants, may request the Centers for Medicare & Medicaid Services (CMS) to review the calculation of their 2020 MIPS payment adjustment factor(s) through a process called targeted review. The deadline to submit your request is Oct. 5, 8 p.m…. . . . read more.

MANAGING THE OFFICE

Life science companies and healthcare providers partnering for value-based patient care

By Mal Milburn bio In the era of value-based reimbursement, healthcare professionals are constantly evaluating strategies to improve patient care while simultaneously decreasing overhead costs.   Increasingly, medical practices turning to life science reps as a critical part of the answer. According to recent research from DRG Digital Manhattan Research, 74% of physicians are looking to spend more time with life science reps, as rep partnerships have been shown to improve outcomes and reduce costs.   Outcome improvement: Life science companies are developing cutting-edge drugs and technologies at increasing rates, and their reps are equipped with the latest, most comprehensive information about these advancements. Reps are able to bring this education directly to providers in their practice, as the innovations are released. Reps also provide important updates about new drug… . . . read more.

PRODUCTIVITY

Five ways to boost practice efficiency on a shoestring budget

By Karen Mattocks bio It is every manager’s mantra: ‘Do more with the same number of staff.’ Translation? See more patients. Submit more claims. Generate more revenue—all while providing high-quality, low-cost care. How do successful managers accomplish this? They remove the organizational-level barriers that drain productivity, says Michael Mankins, co-author of Time, Talent, Energy: Overcome Organizational Drag and Unleash Your Team’s Productivity Power. ‘Organizational drag’ refers to the cumulative effect of institutional factors that drain energy and decrease output. Through his research, Mankins found that companies lose more than 20% of their capacity for productivity—more than a day each week—to organizational drag. The good news is that boosting productivity doesn’t require a huge budget or even major changes. The reality is that small steps can make a big difference in… . . . read more.


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