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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.

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.

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.

MANAGING THE OFFICE

7 free or low-cost ways to increase practice efficiency

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.

Strategic planning needs to evolve over time

By Nick Hernandez bio Some of my counterparts have a firm belief that strategic planning is a rigid process which should occur once every three to five years. The process they undertake is often done during an off-site planning session with the outcome being printed up in a large three-ring binder. In less than six months, those binders are sitting on a shelf somewhere collecting dust, never to again see the light of day. I, on the other hand, believe that strategic planning should be a continuous process involving the ongoing adjustment of means and ends. We should also view planning as an evolutionary process involving continuous adjustment and improvement. We can think of strategic planning as a solution-by-evolution rather than solution-by-engineering. We should generally not view strategic planning as trying… . . . read more.

BILLING & COLLECTIONS

5 ways to break down bureaucracies to get payer contracts

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.

BLOG

How to assess the overall health of your medical practice

By Nick Hernandez  bio
How do you know that your overall business is healthy? How do you know that the business processes you perform are…


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