Billing and collections – Medical Office Manager

BILLING AND COLLECTIONS

CMS to launch new MIPS Participation Framework in 2021 Performance Period

January 20, 2020 by Barb Manning Grimm

CMS is implementing a new participation framework for the Merit-based Incentive Payment System (MIPS), called the MIPS Value Pathways (MVPs), starting with the 2021 performance period. The goal of this new framework is to move away from siloed performance category measures and activities, and move toward an aligned set of measures and activities that are more meaningful to clinicians and patient care. With the MVPs framework, CMS is aiming to connect measures and activities across the Quality, Cost, Promoting Interoperability, and Improvement Activities performance categories of MIPS for different specialties and conditions. The new framework is designed to: Simplify MIPS and reduce clinician burden; Improve value and create a more cohesive and meaningful participation experience; and Better align with Alternative Payment Models (APMs) to help ease the transition from MIPS… . . . read more.

Filed Under: articles, Billing and collections Tagged With: Billing and collections, CMS, MIPS

QUALITY PAYMENT PROGRAM

MIPS 2020 payment adjustments in effect based on 2018 performance

January 14, 2020 by Barb Manning Grimm

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.

Filed Under: articles, Billing and collections, Increasing profits Tagged With: Billing and collections, CMS, MIPS, QPP

BILLING & COLLECTIONS

5 ways to break down bureaucracies to get payer contracts

January 4, 2020 by Barb Manning Grimm

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.

Filed Under: Billing and collections, blog, Increasing profits Tagged With: Billing and collections, Blog, Increasing profits, Insight

ENFORCEMENT

Feds Take Down $2.1 Billion Medicare Genetic Test Fraud Scheme

November 18, 2019 by Jared Edis

You know that a branch of lab testing has gone from fad to mainstream when it becomes the subject of a major federal enforcement takedown. Accordingly, the newly announced breakup of a $2.1 billion genetic billing fraud scam, one of the largest Medicare frauds ever undertaken, signifies that genetic testing has officially arrived. Operation Double Helix Known as Operation Double Helix, this landmark investigation and prosecution was a joint HHS, DOJ and FBI crackdown carried out in five federal districts against 35 defendants associated with genetic testing labs (CGx) and telemedicine companies, including doctors, CFOs and CEOs that allegedly “capitalized on the fears of elderly Americans to induce them to sign up for unnecessary or non-existent cancer screening tests,” according to one of the U.S. Attorneys involved. Old Wine in… . . . read more.

Filed Under: articles, Billing and collections, Compliance, Health care reform, Risk management Tagged With: Billing and collections, Compliance, fraud, Health care reform

INCREASING PROFITS

How to make a collection call to a patient

September 27, 2019 by admin

A collection call to a patient should never be offensive. But it does need to be firm. Remember, the goal is to collect an…

READER TIPS

Missouri staff train each other on solving the day-to-day issues

September 6, 2019 by admin

The best staff training, says a Missouri manager, is the training staff give one another. At the OB/GYN office…

COMPLIANCE

5 tested ways to make your billing and coding more profitable

August 23, 2019 by admin

The health of your medical practice depends on good quality coding and billing work. One of the most important roles in the medical office that…

INCREASING PROFITS

21 easy ways to boost practice profitability fast

August 2, 2019 by admin

Simple changes to billing procedures, hiring policies, purchasing, patient relations, and other daily activities can have a positive impact on…

YOUR CAREER

Do you have the ‘right stuff’ to be a successful medical office manager?

June 21, 2019 by admin

As the office manager of a medical practice, you have an opportunity to learn, grow, and make a…

READER TIPS

A 30-day collection agency letter cuts the A/R days in Atlanta office

June 21, 2019 by admin

A four-physician surgery practice has reduced its receivables significantly with a collection approach that begins when a bill gets to be…

CMS to launch new MIPS Participation Framework in 2021 Performance Period

MIPS 2020 payment adjustments in effect based on 2018 performance

5 ways to break down bureaucracies to get payer contracts

Feds Take Down $2.1 Billion Medicare Genetic Test Fraud Scheme

How to make a collection call to a patient

Missouri staff train each other on solving the day-to-day issues

5 tested ways to make your billing and coding more profitable

21 easy ways to boost practice profitability fast

Do you have the ‘right stuff’ to be a successful medical office manager?

A 30-day collection agency letter cuts the A/R days in Atlanta office

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CMS to launch new MIPS Participation Framework in 2021 Performance Period

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tools you can use

Compliance Tool: Model In-Office Phlebotomist Agreement

TOOL: Model Employee Illness/Injury Reporting Policy

TOOL: Model Religious Accommodations Policy

Model HIPAA Privacy Reminder to Reception and Other Staff

CY 2019 List of Medicare Telehealth Services