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You are here: Home / Archives for topics / Increasing profits
CODING

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

October 13, 2020 by

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.

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QPP

Deadline Oct. 5 to ask for MIPS targeted review

September 7, 2020 by

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.

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MANAGING THE OFFICE

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

June 10, 2020 by

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.

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PRODUCTIVITY

Five ways to boost practice efficiency on a shoestring budget

June 10, 2020 by

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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MANAGING THE OFFICE

7 free or low-cost ways to increase practice efficiency

June 9, 2020 by

By Jeremy Gilman bio It is a question practice managers ask themselves daily: ‘How can I accomplish more tasks using the same—or even fewer—resources?’ Times are tough. For many providers, increased access to healthcare care under the Affordable Care Act has translated to increased patient volume, and not every practice is equipped to handle the demands. Couple this with ever-changing regulations, stringent documentation requirements, burdensome prior authorization requests, and increased payer scrutiny, and practice managers have a potential recipe for disaster on their hands. Unless, of course, they do something about it. The good news is that “doing something about it” doesn’t necessarily mean putting in dozens of extra hours every week or doling out thousands of dollars to hire workflow consultants or purchase expensive technology. Ultimately, it is about… . . . read more.

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QUALITY PAYMENT PROGRAM

2019 Performance Period Suppressed MIPS Quality Measures

May 27, 2020 by

In the 2019 Physician Fee Schedule Final Rule (83 FR 59847), the Centers for Medicare & Medicaid Services (CMS) established a policy that provides for the suppression of measures in certain circumstances. Starting with the 2019 performance period, for measures significantly impacted by clinical guideline changes or other changes where the CMS believes that adherence to guidelines in the existing measures could result in patient harm or otherwise cause misleading results as to what is measured as good quality of care, we will reduce the denominator of available measure achievement points for the quality performance category by 10 points for each impacted measure that is submitted by MIPS eligible clinicians and groups. Such policy will “hold harmless” any clinician or group submitting data on a suppressed measure. The measures identified… . . . read more.

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CMS QPP

MIPS data submission deadline extended to April 30

April 13, 2020 by

The 2019 Merit-based Incentive Payment System (MIPS) data submission deadline has been extended by 30 days to April 30, 2020. In general, if you have already submitted MIPS data or if you submit MIPS data by April 30, 2020, you will be scored and receive a MIPS payment adjustment based on the data you submit. Many MIPS eligible clinicians have performed very well in the MIPS program in previous years, says the CMS. If you need to revise any data that has already been submitted you can still make changes by logging into qpp.cms.gov by the new deadline. 2019 MIPS Extreme and Uncontrollable Circumstances Policy Update MIPS eligible clinicians who have not submitted any MIPS data by April 30, 2020 do not need to take any additional action to qualify… . . . read more.

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CORONAVIRUS

CMS to provide accelerated and advanced payments during patient surge

April 13, 2020 by

In response to the COVID-19 pandemic, CMS will provide accelerated payments to requesting providers and advance payments to requesting suppliers, including physicians and non-physician practitioners, who submit a request to the appropriate Medicare Administrative Contractor (MAC) and meet the criteria: CMS intends to provide assistance first to those providers and suppliers that experience increased demand and surge in patients. MACs responsible for processing accelerated/advance payment requests for different states, will prioritize those states that were hit the hardest (currently, these states are reported to be California, New York, and Washington). Most providers and suppliers will be able to request up to 100% of the Medicare payment amount for a three-month period. However, Inpatient acute care hospitals, children’s hospitals, and certain cancer hospitals are able to request up to 100% of… . . . read more.

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QUALITY PAYMENT PROGRAM

MIPS 2020 payment adjustments in effect based on 2018 performance

January 14, 2020 by

In July 2019, each Merit-based Incentive Payment System (MIPS) eligible clinician received a 2018 MIPS Final Score and associated payment adjustment factor(s) as part of their 2018 MIPS performance feedback, available on the Quality Payment Program website. 2020 MIPS payment adjustments, based on each MIPS eligible clinician’s 2018 MIPS final score, will now be applied to payments made for Part B covered professional services payable under the Physician Fee Schedule. Payment adjustments are determined by the final score associated with your Taxpayer Identification Number (TIN)/National Provider Identifier (NPI) combination. MIPS eligible clinicians, identified by TIN/NPI combination for the 2018 performance period, will receive a positive, neutral, or negative MIPS payment adjustment in 2020 if they: Were a clinician type that was included in MIPS; Enrolled in Medicare prior to Jan…. . . . read more.

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BILLING & COLLECTIONS

5 ways to break down bureaucracies to get payer contracts

January 4, 2020 by

By Steve Selbst bio It is important to remember that payers are large companies, with protocols, policies and business practices. As with any large company, there are bureaucracies, and they are necessary to maintain the order and success of these organizations. Therefore, the first tip is to understand that to get contracted you need to identify the right department and right person to send your request to get contracted. This is usually the payer contracting department and payer contracts’ manager. Generally, you will be sending your requests to the payer contracts’ manager in your state. A common mistake is to—instead—send these requests to provider relations or to another department. This brings us to our second tip. That is, figure out the approach the payer is using to establish its fee… . . . read more.

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