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CMS Contract to Ensure Physician Incentive Payments

Hewlett-Packard Awarded CMS Contract to Ensure Physician Incentive Payments

It was reported in October 2010 that Hewlett-Packard (HP) and the Centers for Medicare and Medicaid Services (CMS) had entered into a contract that called for HP to maintain CMS’s Integrated Data Repository (IDR) and thereby provide data quality services that will improve the accuracy of CMS payments. This should certainly prove to be very good news for any medical provider that depends on CMS reimbursements as part of their steady influx of revenue. Further, if a medical office is hoping to garner the federal government’s $44,000 electronic medical record incentive funding then this is very good news.

A component of the 2009 economic stimulus package signed into law by President Barack Obama is the Health Information Technology for Economic and Clinical Health (HITECH) Act. This Act serves as the genesis for the move for HP to partner with CMS in an effort to manage the following:

Provide quality analysis of data loaded into the IDR.
Maintain the existing production IDR database environment so it runs at expected performance and availability levels.
Provide CMS with guidance and recommendations on maintaining and improving data quality services.
Create automated processes to ensure that all data feeds used to populate the IDR are loaded accurately and on time.
Adhere to CMS database standards while establishing and performing database backup and recovery procedures.
Merge physical data models from separate repositories into a single, integrated data model.

At $26 million this is a substantial contract for the publicly traded HP, which has been in business since the 1930s. However, the federal government expects a significant return on investment with the contract. This contract was initiated in part to make certain that the criteria for electronic medical record incentive payments for Meaningful Use is strictly adhered to and that only those practitioners that comply will be paid. By working collaboratively with HP, the federal government plans for the HITECH Act and resulting incentive payments to be an expeditious and accurate process whereby physician get all of their money in a quick fashion.

Again, this is great news for the average physician hoping to see all of their hard work towards meaningful use of EMR to be rewarded with the aforementioned $44,000 incentive funding.

What health insurance options do seniors have?Medicare? AARP?

Health Insurance Options for the Elderly

When it comes to the health insurance needs of elderly Americans, some folks believe that Medicare is fully sufficient coverage and that no more thought needs to be given to the matter. Sadly, for many older individuals this coverage fails to substantially meet their varied medical coverage needs and additional coverage is in order.

Medicare coverage is available to those that are age 65 or older and may include hospital coverage, physician coverage and/or drug coverage. The level of benefits and coverage plan that the senior receives is dependent on the “part” that they have enrolled in. Medicare is by no means a free ride for seniors and, in fact, carries a premium expense as well as a coinsurance obligation. For those on a tight or fixed budget, these fees can prove to be overwhelming.

Medicare also does not cover all medical related services. Some services that Medicare does not cover 100% include:

•   Durable Medical Equipment
•   Medical expenses incurred during foreign travel
•   Blood transfusions
•   Dental care
•   Vision care
•   Hearing Aids
•   Preventative medical testing

Because of these gaps in coverage, more than 60% of Medicare enrollees find that the plan(s) do not completely cover their medical expenses and opt for supplementary coverage.

These supplemental plans are frequently referred to as Medigap plans. These plans must adhere to both state and federal laws and regulations concerning health insurance. While the premiums that the enrollee pays for a Medigap plan is in addition to their Medicare premium, most find that the benefits they reap are well worth the additional cost. There are twelve different styles of Medigap plans (labeled A-L) and the labeling is dependent on the cocktail of benefits offered by the various plans. Further, the Medigap programs are administered by private insurance companies.

Seniors looking for a policy should consider both premium expense and level of additional coverage when making a plan determination. AARP is one of the more popular supplemental plans and is actually administered by United HealthCare. This plan is so robust that they currently hold 29% of the market-share for Medigap plans. Other popular plans include Wellpoint and Humana.

Most of the Medigap plans have additional services that seniors find very helpful. These include nursing consultation via telephone, disease management programs, prescription drug discount programs and discounts on other health related services such as vitamin supplements or chiropractic services. These services will help senior citizens to better manage any health situation arises and allow them to feel not so alone in the process.

As individuals enter their golden years, their thoughts should rest with golfing, grandchildren, and travel. Making sure that their medical insurance needs are fully covered will provide them with much deserved peace of mind and further allow them to bask in their post-retirement activities.

How do I control my off-site billing service?

Maintaining Control of an Off-Site Service One of the big concerns that medical practices have when it comes to hiring a remote service provider for such duties as billing is worries over how to maintain control over the process. After all, if you were to have issues you would like to review with the billing service it is hard to sneak in a lunch meeting a week away if the service is located two time zones away. Thanks to email, instant messaging and even Skype businesses have come a long way when it comes to becoming more comfortable with a remote service provider. However, there is nothing quite like the personal touch to make sure that the professional relationship continues to be mutually beneficial. One way to ensure control over the process is to have a standard set of expectations from both sides. While the medical practice may think that their responsibility begins and ends with paying the billing service’s invoice on time each month, there are additional responsibilities to consider. For instance, each side should come to an agreement concerning when raw claims data will be sent to the biller’s offices. It is unreasonable for the provider to send one batch per month and still expect a 30-day turnaround time from the date of service. Further, there should be an established set of reporting each month or each week, depending on the needs and desires of the medical practice. The reporting may include claims received, claims sent to health-plans, percentage of Medicare claims, number of denial appeal letters generated, or any other data that the office deems important. Maintain Control of your money

The medical practice should also feel comfortable enough to ask the biller to produce the occasional ad hoc report as well. This may be detailed denial reports, CPT based reporting, turn-around time for payments, etc. This sort of information can prove to be very valuable should a medical practice be negotiating a renewal of their Humana or Aetna contract and wish to bring some data to the table.

Finally, the key to maintaining a sense of control over your off-site service is to have faith in their abilities coupled with open lines of communication. This starts by selecting a service that you feel is a good fit with your medical practice and continuing to work through any issues that may arise.

No Time to Wait – Implement your EMR (Sooner is better!) $$$

No Time to Wait As most medical practitioners know by now, a part of the American Recovery and Reinvestment Act of 2009 relates to the implementation of Electronic Medical Records (EMR). Further, this piece of the act offers physicians a financial incentive to the tune of $44,000 for full installation and meaningful use of the EMR system. The caveat to this enticement is that the EMR system must be implemented, functional and meet “meaningful use” criteria by the year 2012. Still, many practitioners have yet to make the first steps towards either reviewing or purchasing an EMR system for their own practice. Perhaps these physicians believe that the EMR system will prove to be too cumbersome, are reluctant to make the investment or they are simply resistant to change. Whatever the logic behind a failure to jump aboard the EMR train, those who have resisted need to start the EMR process sooner rather than later. Not only is the federal government offering the aforementioned $44,000 in incentive but in the coming years Medicare reimbursement rates will drop for those who have not yet implemented an EMR system. In fact, Medicare rates will drop by 1% by 2015 and by 2% by 2017. There are several reasons to not wait until the very last minute to fully install an EMR system in a medical office. First, it may take some time to really examine the EMR options currently on the market and select one that is a good fit for each medical practice and their related specialty Also, EMR software providers will no doubt be getting busier as the 2012 deadline approaches for the $44,000 that the federal government is offering in incentive. In order to have their full attention and time, physician offices should begin working with the EMR software provider now. Finally, it may take some time for all medical office members to get up to speed on the system and be able to meet the EMR “meaningful use” criteria as established by the government. In order for the staff to not feel pressured and to feel absolutely comfortable with the EMR system, offices should allow plenty of time for set up, implementation, training and trouble shooting.

EMR Obstacles – The Invisible Hoop

EMR Obstacles aka Jumping Through The Invisible Hoop When it comes to implementing an EMR (Electronic Medical Records) system there can be significant obstacles to the process. The primary hurdle is typically getting everyone on the same page as far as the concept itself. This can be particularly difficult in practices where the medical leadership is rather mature and less likely to buy into the whole concept of a record that they cannot feel and touch. The same folks that will be the last to Twitter or text may also be extremely hesitant to do away with the traditional medical record. However, the benefits of EMR are tremendous from a variety of perspectives, including ease of medication refill, clearer billing, sharper record tak EMR

ing, and a reduction in lost paper. Most medical practices have had to make the emergency phone call to the hospital lab or radiology department in order to get testing results that no one can find in the patient’s chart. Frequently, this is happening as an impatient patient is waiting in an exam room which then leads to decreased patient satisfaction. EMR will put an end to most of that sort of waste of time. Once the medical staff is on board with the transition to EMR, the next step is training. The timeline for this piece of implementation is dependent on the skill level of the staff members. If the physicians graduated medical school in the 21^st century it should be a piece of cake. However, if the folks in white coats received their MD when Eisenhower was in offices then the process may be a bit more sluggish. Once EMR is in place, another obstacle can be to do away with paper “just in case”. It is tempting to have this sort of back-up system, but the medical office truly does need to take a leap of faith while understanding the capability and reliability of the EMR system. Should the office have any specific concerns about the dependability of the electronic system, then they should feel free to ask the EMR software companies detailed questions about the system in question. The final obstacle to the implementation of an EMR system is more of a delay issue. If the medical provider has a large scope of services they provide or there is a large volume to data to import, then there may be a delay in full implementation of the EMR system. Whatever the timeline and regardless of any resistance to the process, the wave of the future in medical offices across the country is EMR. The quicker each office gets on board, the sooner they get back to the business of practicing medicine.

Should I outsource my medical billing out of state?

From the Atlantic to the Pacific: Using an Out-of-State Medical Biller When it comes to organic produce, local is probably best. Looking for a plumber? Using a guy from your zip code is probably the way to go. However, when it comes to outsourcing medical office services such as billing and credentialing it can prove to be very cost effective to search outside of your local area. The first question medical offices may have is this: Is it even legal to use an out-of-state service? As a matter of fact, it is absolutely legal and many medical offices choose non-local service providers. When shopping for a remote medical biller, be certain to convey to the service that you expect them to be knowledgeable about any and all related statutes that may apply to your state, outside of federal guidelines.

The reasons for using an out-of-state service are varied. It may be that that you can get a more reasonable rate with a non-local company or the service level that you can receive at a distant company may be better than what you are able to get locally. Additionally, many practices would rather that their immediate medical community (including billing services) not be privy to their financial information, client base or revenue stream. In some areas these communities are fairly tight-knit and information may flow in ways in which physicians do not approve. Another reason can be the additional services that a remote company may be able to provide to your medical practice. While simply getting the billing piece out of your hair is great, perhaps you also want someone to work on credentialing, create web content or tackle other administrative duties. Frequently, wrapping up a package deal is much cheaper than using several vendors for a variety of functions. Also, an off-site company may have unique expertise in your type of specialty and utilizing them may maximize your reimbursement from payors. This may hold true for an allergist, anesthesiologist, specialty surgeon or chiropractor. In some of those cases, there can be bundling or benefit issues that a particular biller may be savvy about. Thus, using them is healthy for your bottom-line. Finally, perhaps you live in part of the country where medical billing services are not on every corner the way Starbucks are jumping out at you on every street in New York City. For those in the Upper Peninsula of Michigan, isolated Alaska or mid-South Dakota medical biller resources may just not be there. In those cases, off-site is a very logical choice.

How to Make the Most of Medicare Reimbursements in 2011

How to Make the Most of

2011 Medicare Reimbursement

Every summer, medical practice office managers as well as physicians anxiously await the release of Medicare reimbursement rates for the following year. While reports leading up to the big reveal usually let them know which way the scale will be tipping, in these tough economic times financially based predictions are something of a carnival game.

Even if the medical practice has a very low Medicare patient base as a whole (think: Pediatricians or Pediatric Sub-Specialties), many payor contracts utilize a Medicare based schedule. For instance, your contracts may provide for Medicare + 10% or something along those lines. Thus, even those contracts will be affected by fluctuating Medicare rates.

In very early 2010 Medicare Payment Advisory Commission (more commonly known simply as MedPAC) recommended to Congress a one percent increase in Medicare physician reimbursement. At first blush, this seems like a very low figure especially when you consider the cost of living yearly increase is at least triple that amount.

Thus, depending on Medicare alone to float the budget of an individual medical office is not sage financial advice. While it is true that the economy is rebounding, once Medicare rates are secured for 2011 medical offices will be stuck with those figures for 12 full months. Further, Washington lobbyists who advocate for the best interest of physicians will continue to assert that Medicare reimbursements are sub-par but even those efforts are bigger picture and will not affect your A/R in the next quarter.

As a physician practice you need to get creative with ramping up income as a way to mitigate any low Medicare rates that apply to your practice. The easiest way is to renegotiate your payor contracts. If your current contract is Medicare based, appeal with the payor to move instead to a standardized fee schedule. Some of the larger groups such as Blue Cross/Blue Shield utilize this methodology.

If you are paid via capitation, you need to make certain that the payor shows you each year what you are making as compared to Medicare. In many cases, the HMO or medical group will provide standardized reports showing the value of services the practice provided (typically affixing a Medicare rate) and compare that to capitation paid.

Be sure to look at these reports carefully and be certain that your office is being paid the capitation dollars that it deserves. If you are falling at or below Medicare then it is time to hit the table for a serious negotiation session.

Credentialing – Keeping it In-House vs. Outsourcing

Credentialing:

Keeping It In-House vs. Outsourcing

Credentialing and recredentialing can be a major headache for many medical practices. The process can be tedious, time-consuming and frustrating. Further, most offices do not have the staffing to dedicate one employee to the entire process. In some cases, these credentialing responsibilities are very “hit and miss”. It is only once claims get denied or you get a very formal looking and somewhat intimidating letter from a health-plan or your states Department of Insurance that folks start to take the process seriously.

The decision concerning whether to delegate this duty to a third party really depends on the staffing of each individual medical office as well as the expertise level of the contracted party. After all, what you don’t want to do is hand over this task to someone else only to have it result in the same sort of disarray as it was in the home office.

Further, should the medical office fall behind in recredentialing duties with individual health-plans then there is a great likelihood that the physician will be decredentialed from the plan. This causes not only a denial of claims, but the physician usually is required to revert back to the credentialing process. This is much more time consuming than recredentialing and will provide a serious interruption in service for patients.

The advantage to outsourcing the spectrum of credentialing duties is that the professionals have experience and volume on their side. Additionally, they have standardized methods that allow for a streamlined process. The professionals also typically have direct relationships with payors (including HMO medical groups) and those relationships can provide for expedited processing.

Of course, the advantage to keeping credentialing duties in-house is the expense of a third party company. However, if you weigh that fee against the potential loss of income due to a provider being decredentialed (coupled with the resulting denial of claims) many offices find it to be a wise investment in their medical practice.

Patient Collections in a Dicey Economy

Show Me the Money:

Patient Collections in a Dicey Economy

Anyone who has sat in the lobby of a medical office is well aware of the awkward moment at the window when the receptionist is attempting to collect for medical services rendered. The uncomfortable exchange typically ends with an agreement to bill the patient at a later date.

Most medical practice consultants roundly disapprove of this system and emphatically encourage collecting fees at the time of service. In fact, many offices have gotten into the habit of collecting copayments prior to seeing the physician. It is further recommended that clear signage is in the lobby concerning payment expectations as well as reminding them at the time that the appointment is made, “It is our office policy to collect copayments or outstanding balances prior to being seen by the physician”. This simple extra step can work wonders.

For tertiary providers such as radiologists, pathologists or anesthesiologists, collecting at the time of service simply is not an option due to the nature of their business. In those cases, billing post-service is par for the course. Further complicating matters for these specialties are their inability pre-service to determine the patient’s correct health-plan and associated financial responsibility.

With many states facing double digit unemployment, foreclosures on the rise and general financial panic abounding it seems that getting prompt patient payment for medical services is a nothing more than an urban myth. If the choice for some of these individuals is food on the table versus a CBC from a year ago, the medical bill will remain unpaid.

The key to effective medical collections is, simply, not to let the balance go to collections. The decision to send an account to a collection agency is an individual preference per medical practice. And once the bill is sent off, the physician is likely to see only a small percentage of those funds ever returned to them.

To avoid that, offices should make every effort to collect from the patient on their own. This can mean a personal, empathetic phone call to the patient. It can also mean working out an extended payment plan. For those who have no insurance or are under-insured, the physician may want to take a deep discount on their charges which brings it down to at least Medicare level. In the midst of these collection efforts, it is a sound policy to operate with compassion and understanding, in lieu of hostility and unrealistic demands.

EMR

Even with the need for an effective and trustworthy process for handling medical information, a comparatively small percentage of medical organizations have implemented electronic medical record (EMR) systems. These medical care organizations have utilized their traditional, paper-based strategies for such a long time that they really do not think that there’s a very simple approach to make the switch to electronic medical records. However, you will find loads of benefits to an electronic medical records, generous support provided by licensed & HIPAA compliant EMR companies, and that they can more than outweigh the starting costs of the EMR system.

An electronic medical record is just a digital legal medical record that may be stored on a centralized location and easily shifted to a specified location when it is needed, whether it is in a modest, local practice or a huge medical center. This type of convenience and security helps to make an EMR a good choice for today’s medical practices.
Considering the present health care product, lots of people state it’s open to human error and doesn’t generate a sufficient amount of quality or safety. It also has contributed to greater costs plus more time squandered tracking down and making paper records. An EMR will be able to do away with a great deal of these problems and assist in saving a lot of money.
It will be much simpler to enter information, standardize forms, and keep information updated with EMR’s.
Storage needed for EMR’s is minimal compared to paper documents.

CMS Contract to Ensure Physician Incentive Payments

What health insurance options do seniors have?Medicare? AARP?

How do I control my off-site billing service?

No Time to Wait – Implement your EMR (Sooner is better!) $$$

EMR Obstacles – The Invisible Hoop

Should I outsource my medical billing out of state?

How to Make the Most of Medicare Reimbursements in 2011

Credentialing – Keeping it In-House vs. Outsourcing

Patient Collections in a Dicey Economy

EMR

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