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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.

CODING

New devices, technology dominate 2021 CPT code changes

By Lisa Eramo bio There is a whole slew of new and revised CPT codes—329 changes to be exact—effective since Jan. 1. This includes 206 new codes, 54 deletions, and 69 revisions. Interestingly, the majority of changes pertaining to new technology and devices, giving medical practices the opportunity to provide high-quality patient care while also receiving reimbursement. This article summarizes three notable changes. Retinal imaging using augmented intelligence The American Medical Association (AMA) added CPT code 92229 for retinal imaging with automated point-of-care analysis and report (unilateral or bilateral). Per the AMA, this technology better supports patient screening for diabetic retinopathy, and it increases the early detection and incorporation of findings into diabetes care. What’s interesting about this procedure is that it relies on augmented intelligence (AI) technology, says Kimberly Huey,… . . . 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.

CODING

Impact of reimbursement and compliance to WRVU-based compensation

By John McDaniel bio All physician contracts including any form of WRVU based compensation may need to be reviewed and probably amended because of the increase in WRVUʹs (work relative value units) associated with E&M CPT codes effective Jan. 1, 2021. 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 physician/provider reimbursement since the WRVUs for these codes have been significantly changed. Indeed, this increase in the WRVU component will certainly affect physician compensation. While the major commercial payers have not yet announced their intention to utilize the 2021 E&M codes, those decisions will greatly impact both provider reimbursement and WRVU utilization. It should be noted… . . . 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.

BILLING & COLLECTIONS

Retaining patients as insurance landscape shifts

By Kerri Lenderman bio Walmart’s July announcement that they plan to start selling Medicare insurance should have resonated with America’s physicians as more than an interesting headline to interrupt a summer of coronavirus news.  Indeed, it should be a wakeup call and a reminder that unsettling and unconventional forces with deep pockets and consumer brand loyalty are forming a tsunami of disruption in how insurance will be marketed and influenced for years to come. Competition for Medicare market share has always been steep.  Historically it manifested in the form of aggressive health plan marketing campaigns from insurers and brokers, all trying to lock in Medicare eligibles – especially people approaching age 65.  Selecting a plan is overwhelming with dozens of plan options to choose from in a given market, including… . . . 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.

QUALITY PAYMENT PROGRAM

2019 Performance Period Suppressed MIPS Quality Measures

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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