I had the bad fortune to suffer an injury recently, but it gave me the opportunity to evaluate navigating the healthcare system as a patient. While these observations aren't meant to be a reflection on your practice, they are provided to offer a lens into our collective continual opportunity for improvement.&...
On July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) issued its payment proposal for the coming year. Focused on professional services, the Medicare Physician Fee Schedule (PFS) ruling provides a crystal ball into the expected payments for medical practices for the coming year. While it ma...
The most precious asset of a medical practice is your provider’s time. The provider’s time represents a non-inventoriable resource, and it’s critical to make the most of it. Yet most providers struggle with efficiently moving through the day, often left with significant piles of work at day&...
Staffing has always been a challenge for medical practices, so practice management solutions that can convert manual work to automated are always welcome. Building an online scheduling platform for patients to self-serve may offer this opportunity but only if it is executed effectively. Consider these tactics...
Researchers are finally supporting what you already experience every day in your medical practice – there is an overwhelming amount of patient demand. According to a national data repository, visits are up 14% over 2019’s pre-pandemic baseline. This fact, in combination with mounting evidenc...
How many times have you heard sentiments from colleagues, administrators, employees – and perhaps yourself – describing your practice? When it comes to the business of a medical practice, we often rely on anecdotal evidence to manage: If appointment lead times are rising or patients are being tur...
Payment plans permit the patient to pay off the amount they owe for a service over a period, instead of requiring a lump sum payment. Offering payment plans to patients benefits your practice – and your patients; however, execution is key. Consider these tactics for success: Put the ball in the patie...
Physicians have long expressed frustration at the lack of payment associated with the preparation time required to learn about a patient, develop insight about a patient, and nurture a relationship with the patient, all with an eye to being able to provide the highest quality care. While it may not be suffici...
On November 2, the Centers for Medicare & Medicaid Services (CMS) released the final rule for the Medical Physician Fee Schedule (PFS). The PFS conversion factor for 2024 is $32.74, a 3.4% decrease from the 2023 conversion factor of $33.89. The overall payment rate will be reduced by 1.25% based on requir...
As I was chatting with a busy pediatrician about her priorities for managing her successful practice, I realized how often she mentioned the word, “schedule.” Perhaps it’s not a surprise, as the schedule defines the delivery of the practice’s most important asset – in this case, ...
SVMIC recently held a disaster preparedness “tabletop” drill where it tested the company’s Business Continuity Plan, an exercise we wholeheartedly recommend for all our members and practices. Disaster preparedness is a topic that often falls through the proverbial cracks because it is time-...
The federal government recently released the scores for the Quality Payment Program. Feedback about your performance as reported for 2022 is provided - along with your 2024 payment adjustment. Audits are available by request; these targeted reviews must be requested by October 9, 2023, at 8:00 pm EST. The pe...
Once documented and clipped neatly to the patient’s chart, messages today primarily arrive in an electronic format. Like the days of paper, electronic messages represent a record of the patient’s request. They are inherently accompanied by the record, accessible with just a few keystrokes. The adv...
On July 13th, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2024 Physician Fee Schedule (PFS) proposed rule. The ruling is just a proposal, but history demonstrates that it closely aligns with the final policy for the coming year. Therefore, it’s worthwhile to eval...
Much like airplanes, medical practices carry a multitude of fixed expenses. When a plane takes off, the airline must pay for the pilots, flight attendants, mechanics, and gas, regardless of whether every seat is taken – or just a handful. The nature of bearing these fixed costs makes selling a ticket fo...
Due to new rights granted under the Pregnant Workers Fairness Act (PWFA) and the Providing Urgent Maternal Protections for Nursing Mothers Act (PUMP Act), employers must display a new version of workplace posters. The U.S. Department of Labor (DOL) recently released two new posters with additional info...
Medicare provides certain rights and protections to their beneficiaries related to financial liability and appeals. An Advanced Beneficiary Notice (ABN) is required to transfer potential financial liabilities to Medicare patients in certain instances to allow them to make informed decisions about their ...
Anecdotal evidence about increasing claim denials has been on the medical practice airwaves for months. Whether purposeful or not, commercial health insurers are denying claims at alarmingly high rates. A newly published analysis of claims data revealed that commercial insurers denied a remarka...
On March 16, 2023, Medicare issued MLN Matters - MM13094 which clarified language related to the January 1, 2021 rule that expanded the list of providers who can supervise diagnostic tests to include Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), Certified Nurse-Midwives (CNMs), Certified Regis...
Despite looming predictions about the economy, employment rates have still not stabilized in the health care industry. Medical practices remain challenged by staffing shortages – and high turnover rates. There is no end in sight, so it pays to brush up on recruitment and retention tactics to ensure you&...
Note: If you missed Part 1 of this article in the March 2023 Sentinel, please click here to read it. Ethical Obligations Codes of professional ethics typically address (and prohibit) the payment or receipt of kickbacks, but also may address the separate and sensitive issue of whether a provider may accept ...
If your medical practice offers imaging services, a recent clarification from the Centers for Medicare & Medicaid Services (CMS) requires attention. The March 16 2023 memo entitled: “Supervision Requirements for Diagnostic Tests: Manual Update” outlines the circumstances for which advanced pra...
Scribes have long been employed in medical practices as a tool to increase the productivity of physicians and practitioners by lessening the demand on their time for documentation in an electronic health record (EHR). A well trained and competent scribe does exactly that. Given the staffing challenges of rece...
CVS and Oak Street. Amazon and One Medical. Walgreens and Village Medical. Dollar General and DocGo On-Demand. The list could go on and on. Brought on by the allure of the size and stability of the health care market, retailers are partnering, acquiring, or infusing cash into health care start-up companies. W...
The federal government’s declaration of a “public health emergency (PHE)” on January 27 2020 is finally coming to an end. On May 11, 2023, the PHE concludes – following a lengthy three-year period combatting COVID-19. While there may be no end in sight to the disease that caused the wo...
“In some industries, it is acceptable to reward those who refer business to you. However, in the Federal health care programs, paying for referrals is a crime.” U.S. Dept. of Health & Human Services Office of the Inspector General, A Roadmap for New Physicians: Avoiding Medicare and Medi...
My daughter recently had out-of-network medical services, so I requested a copy of the superbill. Without so much as glancing at it, I submitted it to my health insurance company for processing towards our deductible. A few weeks later, I received a letter denying the services. Confused, I looked through the ...
On December 29, 2022, the President signed the “Consolidated Appropriations Act, 2023” into law, sparing physicians the 4.5% payment cut to Medicare announced just weeks prior. While the decline wasn’t as bad as projected, it was far from reversed. The section, “Extension of Support fo...
The deadline to submit your 2022 Quality Payment Program data is March 3, 2023, at 8 pm EST. If you are required to participate in the Quality Payment Program (QPP) based on your volume of Medicare payments or patients, submit your data for 2022. For medical practices that do not have sufficient data to subm...
Are your current office systems and processes protecting you from a lawsuit or leaving you vulnerable? Even well-established processes can break down when circumstances in your office change, such as opening an additional practice site, EHR modifications, and staff turnover. National and internal data s...
Despite declaring the pandemic was “over,” the federal government extended the public health emergency (PHE) for another 90 days last month. The PHE, which now expires on January 11, 2023, has been in place since early 2020. Now in its third year, it’s difficult to remember what flexibilitie...
Each year, the authors of the Current Procedural Terminology (CPT) Manual make changes to the code set. Some years usher in a multitude of changes; others bring few alterations to the table. The 393 changes to the 2023 CPT codes are of importance because they translate your services into billable transactions...
When is the last time you walked into a bank? Automated teller machines put banking transactions in the hands of customers years ago. Airport kiosks, gas pumps, ridesharing, self- check-out lanes, and bill payment have joined the self-service trend. Most Americans love the convenience, transparency, and flexi...
All bets are off for ideas to keep employees on staff. Consider the hotel chain in Germany that is paying for employee tattoos. Body ink may not be appropriate for your medical practice, but consider these 15 crazy good ideas that other practices have successfully deployed: Host “Open Door” mee...
Behavioral science is a growing field of science, rooted in economics as a means of understanding decision-making. People do not always make rational decisions that align with the beliefs of economists. Indeed, traditional economists had historically opined that all human determinations are made based on pric...
Simply getting through the day has been an incredible achievement over the past two years for anyone working in a medical practice. Off-the-charts staff turnover, heightened patient expectations, and the infusion of new technological tools have added to the operational pressures. Now patients are flooding in,...
VCC may sound like new college basketball conference, but it’s actually a term that could be adversely affecting your practice’s revenue without your knowledge. Moreover, there’s now something you can do about it. First, let’s define the term. The acronym, VCC, stands for “virtu...
Performing telemedicine in your practice is an operational challenge, but those challenges pale in comparison with the unknowns about its reimbursement in the long run. Prior to the COVID-19 pandemic, telemedicine was not on the radar for most medical practices, but today it’s standard industry practice...
The tumultuous environment of the past couple of years has certainly introduced vulnerability into your practice’s revenue cycle. Reimbursement success emanates from a myriad of factors, but it can be tracked by a handful of standard indicators. Take the opportunity to measure three key performance indi...
Appointment no-shows can be incredibly frustrating, but the chief negative impact is on your bottom line. Like all practices, yours carries a tremendous amount of fixed expenses. That is, you are paying for your space, employees, insurance, technology, and many other costs, regardless of how many patients you...
2022 is off to a roaring start, and it pays to be mindful of the external pressures on your practice. Start with this checklist of key trends to consider regarding your medical practice. Keep abreast regarding the dynamic nature of your market. Change abounds in the healthcare delivery system, driven by the ...
Surprise medical bills are a major concern for patients. Visits to the emergency room, and services provided by physicians who are not in the patient’s insurance network, have caused patients to incur thousands, and sometimes hundreds of thousands of dollars in medical debt. The No Surprises Act, ...
Released on November 2, 2021, the final Medicare Physician Fee Schedule (PFS) revealed few surprises, given the foreshadowing of the previously issued proposed rule. However, it’s still a hard pill to swallow. While the changes are issued by the Centers for Medicare & Medicaid Services (CMS), the im...
On October 15, 2021, the Secretary of Health & Human Services renewed the Public Health Emergency (PHE). This move represents the seventh time the PHE was renewed since its declaration on January 27, 2020. The importance for medical practices is that the regulatory relaxations for telemedicine relat...
Open the (Digital) Door It will be many years before we determine the long-lasting impacts of the pandemic on medical practices, but there is one effect that is already crystal clear – patients’ expectations for a digital front door to their physicians. The migration to a digital interface for yo...
Ensuring the health of your revenue cycle is like self-care for your medical practice – essential to prioritize so that you can serve your community for many years to come. It’s a great idea to do a full physical on your revenue cycle every three to five years, but monthly monitoring helps keep gu...
The federal government’s proposal for the Medicare Physician Fee Schedule in 2022 features an alarming payment cut of 3.75%. This is a result of the conversion factor shifting from its current rate of $34.89 to a proposed $33.58 based on the budget neutrality required by law. This news was certainly not...
Labor shortages are creating havoc for many businesses in the United States, and medical practices are not immune. Although there may be some relief when the federal government’s bonus checks end this fall, the problem will not come to a screeching halt. Indeed, experts believe that the growth of the am...
On July 19, 2021, Xavier Becerra renewed the Public Health Emergency for 90 days starting July 20. The move by the Secretary of Health & Human Services signals the federal government's intention to extend regulatory relaxations associated with telemedicine delivery and reimbursement into the fall. The Bid...
On May 20, 2021, the Centers for Medicare & Medicaid Services announced that the hotly debated cost category will be reweighted to 0% for 2020, effectively eliminating it from scoring as part of the Merit-based Incentive Payment System (MIPS). Advocates for physicians – including the American Medica...
The Centers for Medicare & Medicaid Services (CMS) put a temporary hold on Medicare claims in March. The pause in processing resulted from pending legislation to extend the removal of the 2% sequestration cut to Medicare reimbursement. On April 13, Congress voted to continue the sequestration relief throu...
In May 2020, the Office of the National Coordinator for Health Information Technology (ONC) published the 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program Final Rule, which is designed to provide patients and providers secure access to health informat...
The Centers for Medicare & Medicaid Services more than doubled the reimbursement for COVID vaccines as of March 15, 2021; the payment rate is now approximately $40 per dose. For up-to-date information on payment rates for Medicare, see COVID-19 Vaccines and Monoclonal Antibodies | CMS . If your practice i...
On February 25, 2021, the Centers for Medicare & Medicaid Services (CMS) declared that a hardship exception would retroactively apply to all eligible clinicians for the 2020 performance year of the Quality Payment Program (QPP). The announcement, which came just weeks after the deadline for the exemption ...
‘Incident to’ billing has been a challenging topic since its creation by Medicare. The rules – which allow advanced practice providers to be reimbursed at the full physician rate by Medicare when seeing patients in an office and directly supervised by a physician – are complex and, arg...
By now, physicians have transitioned into the new rules to code evaluation and management (E/M) encounters in the office.*[1] What may not be recognized, however, is the changes to the relative value units associated with the codes. In addition to the shift in coding guidance, the American Medical Association...
On December 27, President Trump signed the fourth major COVID-19 emergency funding bills into law, providing approximately $900 billion in funding. The bipartisan agreement offers several key provisions critical to medical practices in 2021. Here is a summary of the law’s impact on medical practice reim...
The Quality Payment Program imposes a 9% reduction to Medicare payments across the board for physicians who do not participate in the federal government’s initiative. There’s one easy method to avoid the penalty in 2022, if you did not keep track of your 2020 data – or your efforts weren&rsq...
As the end of the year draws near, it is an opportune time to consider your participation in the Quality Payment Program (QPP). Launched by the Medicare Access to Care and CHIP Reauthorization Act (MACRA) in 2015, the QPP exacts mandatory participation from physicians and other eligible clinicians who meet ce...
Many practices have moved to a contactless registration process. As the term infers, the process is completed without physical interaction with the patient. Patients are seeking safe environments, and the touch-free process can offer significant benefits for your practice. Consider these strategies to achieve...
There’s no question that 2020 has forced many of us to forego our usual routines and adopt innovative, new ways of doing things – both personally and professionally. One change that many are struggling to get accustomed to is the absence of live events and the opportunity to interact face-to-face ...
As we look to 2021, it is time to begin assessing operations and developing plans for the new year. While the current environment brings new challenges and uncertainties, some things remain constant. One is the need for leadership and direction within an organization. Successful practices have a defined missi...
On September 8, the American Medical Association announced the addition of CPT® 99072 with the express purpose to account for the supplies and clinical staff time required for medical practices to mitigate COVID-19 transmission. Acknowledging the practice expenses related to patient safety during the pand...
There seems to be no shortage of webinars these days as everyone works through the ramifications of COVID-19. While there are important considerations depending on the impact to the practice and its response, there are still many non-COVID related challenges in running a medical practice. Managers must stay c...
The Provider Relief Fund (PRF) provided $175 billion in payments made through the Coronavirus Aid, Relief and Economic Secure (CARES) Act, as well as the Paycheck Protection Program (PPP). These funds may not require repayment, however, there are terms and conditions with which recipients must comply.[1] Thes...
Since the onset of the COVID-19 pandemic in the United States, the federal government has implemented several waves of unprecedented financial stimulus to shore up the economy. For healthcare providers, the primary sources of federal assistance to date have come by way of two programs: (1) the Paycheck Protec...
On June 15, 2020, the United States Supreme Court issued its opinion on a trio of consolidated cases regarding discrimination against LBGT employees in the workplace. In Bostock v. Clayton County, Georgia, the Court held in a 6-3 decision that Title VII, the federal law that generally prohibits discrimination...
As state and local authorities permit your practice to reopen, it is imperative that you implement processes that ensure the safety and health of your employees and patients. Our new checklist is provided in furtherance of our commitment to support you during this uncertain time. There is no one-s...
1) Contact the Medical Board in every state where you plan to treat patients. Generally, states require full licensure to treat residents and may also have requirements for telemedicine encounters. During the COVID-19 pandemic, most states have relaxed licensing requirements as well as telemedicine regul...
Telemedicine use has skyrocketed during the COVID-19 health crisis: Is it here to stay? Prior to the COVID-19 pandemic, the vast majority of patients were unfamiliar with telemedicine,[1] and relatively few medical practices offered any form of virtual care. According to a J.D. Power report released in late ...
SVMIC has proactively developed several financial programs to help with the impact of the COVID-19 pandemic on practices. The company has also developed an extensive network of resources to help policyholders and staff respond in the most rapid and efficient manner to the changes necessitated by the current s...
8:00 p.m. EST on March 31, 2020 is the final deadline for submitting your 2019 performance data for the Quality Payment Program (QPP). Many physicians participate in the QPP through the Merit-based Incentive Payment System (MIPS) track, which requires reporting on Quality, Promoting Interoperability, and Impr...
As perceptions of value becomes ever-more important to your medical practice, now is a good time to review how you and your staff handle patient concerns and complaints about scheduling, billing, and other administrative functions. There may well be little that you can do to resolve some complaints, but a wel...
President Trump’s 2020 State of the Union speech addressed an important topic currently being debated on Capitol Hill. Patients, he espoused, should never be "blindsided" by medical bills. Tackling surprise billing, which occurs when an insured patient receives care from an out-of-network provider at an...
When you think about improving your patient experience scores, you might be quick to focus on your office décor or new equipment without pausing to think about the little things that can add up to a big deal in the minds of a patient. An interaction that garners high patient experience scores may be mu...
Recently, the Centers for Medicare & Medicaid Service (CMS) revealed that the tool provided to look up participation status for the Quality Payment Program (QPP) was flawed. To ensure your participation status is correct for the current reporting year, please visit this link: &nbs...
Primary care physicians in Arkansas, Tennessee, Virginia, and 23 other states are invited to apply for Primary Care First, the latest payment model by the Centers for Medicare & Medicaid Services (CMS). Applications are accepted from practices that meet certain basic criteria, like having an electronic he...
What’s Ahead for 2020? On November 1, the Centers for Medicare & Medicaid Services (CMS) released the highly anticipated Final Rule for the 2020 Physician Fee Schedule (PFS). Although the PFS is specific to Medicare reimbursement, CMS’ dictums have significant influence over all insurers. Per...
Patients now wait 24 days to see a specialist, up 30 percent since 2014, according to a survey of specialists in the 15 largest U.S. metro areas.[1] As patients wait longer just to get open appointments to see their physicians, making them linger another 30-plus minutes in the reception area on the day of the...
On September 26, the Centers for Medicare & Medicaid Services released a Final Rule titled "Omnibus Burden Reduction." While the rule focuses on processes within health care facilities, a multitude of these changes will impact physicians practicing there. To highlight a few areas, CMS ruled: 1. Portable ...
Hiring is a constant in a medical practice. According to the Medical Group Management Association, the employee turnover rate for surgical practices is 33 percent, 25 percent, and 30 percent for reception, nursing, and billing/collections staff, respectively. Although the rate varies by position, there is no ...
While secret shoppers have long been a method of gleaning customer feedback in the retail world, the notion of using an anonymous “mystery patient” in a medical practice is certainly less common. However, since secret shoppers provide an opportunity for an objective, customer-focused evaluation, t...
Patients are seeking to interface the data you collect about them in your practice with their mobile health tracking device – a Fitbit, Apple Watch, or the like. If your practice is fielding these patient requests, you may be questioning your liability related to this information transfer. On April 18, ...
The federal government recently issued important Medicare proposals for 2020. While you can certainly take a deep dive into the 1,704-page document if time permits, we compiled this article to highlight key proposals that may impact you. The Quality Payment Program – in which many physicians participat...
If you are dissatisfied with a denial of payment by your Medicare contractor, you can appeal the decision. The Centers for Medicare & Medicaid Services (CMS) recently announced attempts to streamline the process by no longer requiring signatures, thus enabling documents to be submitted in a more efficient...
In June, the Centers for Medicare & Medicaid Services (CMS) announced the commencement of audits for the Merit-based Incentive Payment System (MIPS). The contract was awarded to Guidehouse, formerly known as the US Public Sector of PricewaterhouseCoopers. Guidehouse is transmitting notifications of audits...
If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, you can now view your results. The Centers for Medicare & Medicaid Services (CMS) released the performance feedback, final scores, and payment adjustments for 2018 MIPS program participants. CMS reports that 98% of practices w...
Managing a medical practice is an experience that can’t be meaningfully compared to anything else. Daily operations often border on chaotic: Effective deployment of people, space and supplies is essential to success, but it can also be overwhelming. Most importantly, your patients’ lives depend on...
Even if you aren’t already familiar with the acronym SDOH, you have likely encountered the notion of “social determinants of health.” The term is splashed all over the health care media as it relates to value-based reimbursement. It’s a fancy term for a topic that your practice has bee...
Chronic Care Management (CCM) Services offer an opportunity to be paid for services you perform outside of the face-to-face patient encounter. Billing for CCM services may seem daunting, but the Centers for Medicare & Medicaid Services (CMS) offers extensive guidance about reimbursement protocols for Medi...
The healthcare landscape is rapidly changing! These changes can be overwhelming to say the least. Do you know there are groups that are not only embracing change but are doing so successfully? Do you want to lead your group by successfully navigating these changes, but you are not sure where to start? J...
Gemba is a Japanese term meaning “the real place.” In medical practices across the country, administrators are taking the walks to the “real places” in their practices – the front office, the exam rooms, the business office, and throughout the halls of their practices. Administra...
As a business, there’s a lot of money at stake in a medical practice. When mistakes occur in the billing office, it is easy for you to get frustrated. If you’re consistently spending time handling the aftermath of blunders, then it is time to shift your focus from problem resolution to problem pre...
The spring offers a chance to shake off the winter blues – and get started on an improvement initiative for your practice. Make a commitment to focus on one area in your practice. Select a task, create a workgroup, pledge to meet once or twice a month, maintain a written agenda, and document an action p...
Medical practices and price transparency haven’t exactly gone hand in hand in the past. With complex reimbursement systems and the real need to focus on other tasks, practices have not always been up front with patients when it comes to revealing the payment due until long after the service is rendered....
When your practice is running late, it is easy to greet the next patient with an “I’m sorry” instead of making a more meaningful connection. Although acknowledging the time and the patient’s frustration is a noble intention, a basic “I’m sorry” can actually start your...
Medicare remittances began arriving for 2019 services in mid-January. Unless an exemption applies, physicians and other eligible clinicians will see a bonus – or penalty – attached to each service. The claim adjustment reason code (CARC) for a positive payment adjustment is CO144; the negative adj...
Overtime is common in medical practices, so it is important to understand the regulations associated with it. On March 7, the Department of Labor (DOL) announced an overtime update that could impact your practice. The DOL’s proposal raises the salary threshold for exempt employees from $23,660 to $35,30...
As patient financial responsibility grows, it’s business critical to have an effective process to collect outstanding debt. It’s an opportune time to review your entire collection workflow, to include making collection calls. These steps are aimed to boost your success rate, while preserving patie...
Physicians, nurses, support staff and anyone else in a practice have all witnessed this scenario too many times: a patient gets frustrated and takes his or her anger, confusion, or worry out on you. How you handle an upset patient can quickly determine the difference between a successful or disastrous outcome...
A single bad hire can cost you more than $50,000 according to a CareerBuilder survey. If you have a position open, take the opportunity to hire right – the first time. Consider these proven techniques to get the best candidate for your practice. Listen. While it’s difficult to schedule multiple r...
The federal government's Quality Payment Program (QPP) is now in its third year, although 2019 is the initial annum for the program's payment adjustments. For those of you who achieved perfect performance in 2017, your current Medicare remittances should reflect a 1.88% boost; a decline of 4% is the reality f...
On November 1, the Centers for Medicare & Medicaid Services (CMS) released the Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2019. This highly anticipated, hefty 2,378-page federal ruling outlines key reimbursement changes for 2019 – a...
Automation can create opportunities to enhance patient flow, but sometimes it’s the little things that make the day run better for you and your patients. None of these tips require any fancy equipment, and most can be done for a few dollars – or no expense at all. Let’s review eight simple i...
The financial impact of the Quality Payment Program will soon be felt. On January 1, 2019, the reimbursement for Medicare will be shifted based on your performance in 2017. Although it's too late to avoid the 2019 penalty of 4%, you have until December 31, 2018, to possibly dodge the 2020 sanction, or at leas...
Trying to comply with HIPAA can be a challenge for healthcare providers, especially when there is so much confusion about specific aspects of the Rules. On almost a daily basis, policyholders contact SVMIC for assistance with HIPAA-related issues. In fielding those calls and emails, some commonalities have be...
The Centers for Medicare & Medicaid Services (CMS) updated the 2017 Quality Payment Program (QPP) performance scores for some participants. Released in mid-September, the updated feedback will impact Medicare payments in 2019. The scores were changed based on the CMS’ review of several program varia...
Blame OpenTable®, Uber®, or ATMs, but the world of self-service is knocking on physicians’ door as patients desire self-service tools. Patient self-scheduling solutions need not encumber your practice; in fact, they can be an excellent way to reduce a burden on your already-overworked administra...
Choosing the appropriate level of an evaluation and management (E/M) codes is a daily occurrence for providers, but it’s no easy task. The “correct” code for an E/M is dictated by two guiding principles – the 1995 and the 1997 Documentation Guidelines; providers must select one or the ...
Denied claims cost your practice both time and money. Employees spend precious hours researching and processing denials, only to find that payers are unresponsive or unwilling to overturn their decision. Given the complexity of our reimbursement system, denied claims will always exist. However, there are cert...
In July, the Centers for Medicare & Medicaid Services (CMS) issued the scores for the first year of the Quality Payment Program (QPP). Your 2017 Merit-based Incentive Payment System (MIPS) scores and performance feedback reports can be retrieved from the Quality Payment Program’s website. These scor...
Perhaps no one in your practice deliberately abuses overtime. Then again, if you make overtime pay available to employees on a regular basis, who could blame them for grabbing the opportunity? Not only can overtime cost you money, but it may also bring legal liabilities if you fail to manage it with care. It...
Physician compensation in a private solo practice is simple: The physician receives any profits after expenses are paid as compensation. The physician generally takes a monthly draw and has periodic bonus distributions. When two or more physicians join the practice, the compensation variables change. Open com...
Physicians who bill more than $90,000 in total allowed Medicare Part B charges need to ensure successful participation in the Quality Payment Program (QPP). Two pathways are available: submitting data for the Merit-based Incentive Payment System (MIPS) or joining an Advanced Alternative Payment Model (APM). T...
The generations known as “Baby Boomers” and “Gen Xers” constitute the majority of your patients today; however, it’s necessary for you to be thinking about the coming wave of Millennials and Gen Zers. While addressing the needs of the new generations may concern you, the automat...
Tiering is a concept that has moved from the pharmacy to the medical practice. For years, payers have tiered medications into categories. Certain medications cost the consumer more, while others are available at lower costs. This strategy has steered patients – and ordering physicians – to generic...
The Bipartisan Budget Act of 2018 featured an extension of the physician work geographic price cost index (GPCI) floor. As the work GPCI is a component of the Medicare payment formula, this declaration positively impacts physician reimbursement. On March 20, the Centers for Medicare & Medicaid Services (C...
Electronic health record (EHR) systems are installed in most practices, yet they remain the source of daily headaches. Having worked in practice management for many years, my philosophy is that the systems were built by technology experts, not those familiar with the workflow of a physician’s office. Wh...
Of the many ways that a manager can contribute to a practice’s success, the ability to manage the physicians’ time is the most important. The time of your physicians, advanced practice providers and other billable providers is, ultimately, your practice’s most valuable asset. In addition to ...
Don’t start looking for someone to run your office until you know what the person in this position must do. While many of the qualities needed in a successful manager are universal — solution-oriented, delegator, motivator, etc. — more depend on your office’s unique needs. It might se...
The Bipartisan Budget Act of 2018 was expected to focus on immigration, however, healthcare was the prevailing theme of the law that was passed on February 9, 2018. Highlights for medical practices include: The elimination of the Independent Payment Advisory Board (IPAB), a group of 15 stakeholders who wer...
How much do you know - and truly understand - about your allowables? This is the term for the discounted price to which you agree as a participating provider for an insurance company. This price is not what the payer reimburses you, but rather the rate you agree to accept as payment in full based on the patie...
Given the recent flood of high-profile sexual misconduct claims in the news, SVMIC has received an increased number of questions surrounding the topic of chaperones in an exam room. While there are no legal requirements to do so, the goal should be to make the patient feel comfortable while also protecting th...
The Centers for Medicare & Medicaid Services (CMS) opened the reporting portal for the Quality Payment Program (QPP) on January 2. The deadline to submit your 2017 performance data is March 31, 2018. The portal provides one-stop shopping, allowing users to enter performance scores for all three categories...
In 2018, the federal government began to assess the cost of caring for Medicare beneficiaries under the Merit-based Incentive Payment System (MIPS). One of four components of the MIPS composite performance score – the cost category – counts as 10% of the overall score in 2018. While it m...
At some point, every practice undergoes physician transitions as physicians join, retire, merge and separate from groups. Advanced planning and communication can help facilitate the process. When physicians wait until the last minute, options are limited and decisions tend to be reactive to the market conditi...
Within just hours of the release of the Final Rule concerning the 2018 revisions to the Quality Payment Program (QPP) on November 2, the Centers for Medicare & Medicaid Services (CMS) published the ruling that governs the Medicare Physician Fee Schedule (PFS) for the coming year. Although overshadowed by ...
The number of clinicians required to heed Medicare’s Quality Payment Program (QPP) next year and beyond got smaller, thanks to new language in the program’s final rule for 2018. In issuing the rule on November 2, 2017, the Centers for Medicare & Medicaid Services (CMS) effectively raised the b...
Can I bill Medicare for Depression Screening? What is the CPT® code for Medicare’s Initial Preventive Physical Exam? How many smoking cessation sessions will Medicare cover for my patient? Do all males qualify for Prostate Cancer Screening? Which counseling services can I provide via telehealth?...
No doubt employee discipline can be one of the most challenging aspects of human resource management. Perhaps this is due to the term “discipline” and the negative connotation associated with the details of disciplinary actions. Much of the stress related to managing staff disciplinary actio...
You can apply for a hardship exemption for the “Advancing Care Information” (ACI) category of the Quality Payment Program’s Merit-based Incentive Payment System. ACI counts for 25% of the composite performance score for eligible clinicians (ECs) in the government’s new payment program....
As the patient population ages, the likelihood of encountering a patient unable to make decisions regarding his or her care will increase. Unexpected and emergency situations however can obviously affect a patient at any age, rendering the patient unable to make care decisions for themselves. Whether treatin...
On September 18, 2017, the Centers for Medicare & Medicaid Services (CMS) released the feedback reports for the Physician Quality Reporting System (PQRS) and the Value-based Payment Modifier (VBPM or VM). Both programs concluded at the conclusion of 2016, however, the impact on reimbursement continues thr...
The reimbursement of services provided by advanced practice providers is a complex issue. Guidelines may vary based on the type of APP, and the rules surrounding APPs are impacted by federal and state regulations, facility-imposed standards of care, and billing requirements. The latter may include payer-speci...
The Medicare Access and CHIP Reauthorization Act of 2015 requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. CMS will begin mailing new Medicare cards with a new Medicare number (currently called the Medicare Claim Number on cards) to your patients in April 2018. You m...
When was the last time your credit balance report was reviewed and worked thoroughly? Working the report on a regular basis is an essential step in the revenue cycle. Understandably, many practices focus on the collection of insurance and patient payments portion of the revenue cycle. Overpayments are often ...
One of the unfortunate necessities of managing any organization is the need to have meetings. As medical practice consultants, we work with practices on governance and management issues. Few practices handle their meetings well. Problems range from no regular meetings to meeting too frequently, meetings witho...
The information contained in your practice’s documents and records is one of the most valuable assets to your organization. Without this information, your practice cannot treat patients, receive compensation, or otherwise operate. With the fundamental transformation of documents from paper to digital fo...
“Extreme and uncontrollable” circumstances provide a way out of a key component of the Merit-based Incentive Payment System (MIPS) of the Quality Payment Program (QPP). The QPP Hardship Exception Application for the MIPS program year 2017 just opened on August 2, with circumstances such ...
Several years ago, the Centers for Medicare & Medicaid Services (CMS) proposed a dismantling of the coding system for surgeries. Congress stepped in to block the change, but allowed CMS to study the non-surgical activity that occurs during global periods. That research study began on July 1, 2017, encompa...
Proposed updates to the Medicare Quality Payment Program (QPP) for calendar year 2018 would provide many physicians and other providers welcome relief from several regulatory burdens imposed by the Medicare Access to Care and CHIP Reauthorization Act (MACRA). The updates also would give tens of thousands clin...
As insurers and employers are now offering health plans with higher deductibles and copayments, collecting at the point of contact is more important than ever to ensure a successful practice. While many medical practices struggle with this, it doesn’t need to be as difficult or intimidating as it might ...
Physicians struggle with the increased regulatory requirements of documenting a patient encounter in the Electronic Health Record (EHR). The majority of physicians chose medicine as a career path to take care of patients only to find that they spend an overwhelming amount of time and energy documenting patien...
Just as physician-patient confidentiality encourages frank discussions between the physician and the patient about the patient's condition without concern of involuntary disclosure of that information, documents generated within the parameters of a quality improvement committee (“QIC”) encourage m...
As you know, beginning in April 2018, CMS will start mailing Medicare cards with new Medicare Beneficiary Identifiers (MBIs) to all individuals covered by Medicare. The MBI will, after a transition period, replace the Social Security Number (SSN)-based Health Insurance Claim Number for transactions such ...
July 1, 2017, is the deadline for physicians to submit a hardship application for the 2018 payment adjustment, based on the 2016 reporting period for the EHR Incentive Program. If you were eligible to participate in the program, but you did not successfully report the program’s required “meaningfu...
It is time to update your Advance Beneficiary Notice of Noncoverage (ABN). This important form issued by the Centers for Medicare & Medicaid Services (CMS) is used to communicate with patients about services for which Medicare payment is expected to be denied. The changes as of June 21, 2017 include a new...
The first visual impression a patient has of a medical practice is the lobby. Do you know what impression you are making on your patients? As a medical practice consultant, I have seen my share of lobbies through my travels. As a patient, I can recall a time that the lobby was so inviting an...
Just as physician-patient confidentiality encourages frank discussions between the physician and the patient about the patient's condition without concern of involuntary disclosure of that information, documents generated within the parameters of a quality improvement committee (“QIC”) encourage m...
July 1, 2017, is the deadline for physicians to submit a hardship application for the 2018 payment adjustment, based on the 2016 reporting period for the EHR Incentive Program. If you were eligible to participate in the program, but you did not successfully report the program’s required “meaningfu...
At first glance, the Merit-based Incentive Payment System (MIPS) may look somewhat like the Physician Quality Reporting System (PQRS), which closed its door on December 31, 2016, but appearances can be deceiving. MIPS features 271 quality measures, of which physicians and other eligible clinicians must repor...
The Occupational Safety and Health Administration (OSHA) is part of the United States Department of Labor. The mission of OSHA is to assure safe and healthful working conditions for working men and women by setting and enforcing regulatory standards. In addition, OSHA is responsible for providing traini...
The federal government granted an exclusion for many physicians to its Quality Payment Program (QPP), which features the Merit-based Incentive Payment System. Physicians – and other QPP-eligible clinicians - are omitted on the basis of billing less than $30,000 in Medicare Part B allowed charges per yea...
“The staff are not getting along” is a cry for help I frequently hear from physicians and practice executives. Staff relationships can be one of the most time consuming and mentally draining aspects of a manager’s or supervisor’s day. Staff who find it difficult to work with one anothe...
Denied claims cost your practice both time and money. Employees spend precious hours researching and processing denials, only to find that payers are unresponsive or unwilling to overturn their decision. Given the complexity of our reimbursement system, denied claims will always exist. However, there are cert...
If you did not report meaningful use in 2016 – or failed to do so successfully – the government will impose a 3% penalty in 2018 on all Medicare payments. Now is the opportune time to review government applications to try to get an exemption for that penalty. Just posted on March 7, the appl...
Once a physician has established a professional relationship with a patient, the physician has an on-going legal duty to care for that patient. The expected length of this relationship varies based the type of care being provided. If a patient is referred to a surgeon for a single procedure, the profess...
January 1, 2017, marked the commencement of the Quality Payment Program (QPP). The government’s initiative is mandated for physicians and other eligible clinicians who provide care for Medicare patients. By 2019, non-participation fines will be up to 4% of Medicare payments, so it is important to enroll...
Medicare allows a physician to bill for certain services furnished by an Advanced Practice Practitioner (APP) under what is referred to as "incident to" billing. The "incident to" rule permits services furnished as an integral part of the physician's professional services in the course of diagnosis or t...
When you work in a medical practice, you face challenging situations every day. Particularly as patients wrestle with pain, frustration and fear, you might find yourself handling a difficult circumstance from a customer service perspective. Practices that understand the importance of effectively managing thes...
Looking for $63,750 in bonus payments? That’s the sum total of the checks you’ll receive over a six-year period if you are eligible to participate in the Medicaid Electronic Health Record (EHR) Program. The days of receiving payment boosts for “meaningful use” through Medicare are long...
Chronic Care Management (CCM) services offer the opportunity to receive payment for the non-face-to-face services provided to patients by clinical staff. There are certain requirements for billing CCM, one of which is the establishment of a care plan that provides the foundation of the care provided by staff,...
Morning huddles offer an exceptional method for preparing for the day; however, it’s not uncommon for the results to fall short of one’s expectations. Even if your reminder calls went out previously, it’s likely that you’ve had a couple of cancellations that morning. Filling empty slot...
Although 2016 has come to a close, the time is now to report for the Electronic Health Record (EHR) Incentive Program. As confirmed in November, the reporting period is any 90 consecutive days during 2016. The criteria were drastically reduced from prior years, so it may be an opportune time to report even if...
Providing patients with copies of their medical record is not a new concept for medical practices. However, processes in place for doing so may need some significant updates based on guidance issued by the U. S. Department of Health and Human Services (HHS) in 2016. In this guidance, which is based on 45...
If you rely on film-based imaging in your practice, Medicare reimbursement will change when you bill for an x-ray. Film-based imaging services billed globally, or when billing the technical component only, must be submitted with a modifier FX. The new modifier, required as of January 1, 2017, triggers a reduc...
Our team is here to answer any questions you might have or to help you fill out a quote application.
