Are you interested in learning more about the benefits of engaging patients in your practice? Download 10 Ways to Engage Patients now.
Lea Chatham February 4th, 2016
Lea Chatham February 3rd, 2016
Getting Paid in 2016: What You Need to Know
Thursday, February 11
10:00 AM PT, 1:00 PM ET
Are you wondering how the implementation of ICD-10, dramatic changes to meaningful use and the government’s newest incentive program will affect your practice in 2016? This is no time to go into retreat mode. In this high-energy educational webinar, national speaker and author Elizabeth Woodcock highlights the key changes in payments for practices in 2016.
Take this webinar’s tactics back to your practice to improve your bottom line in 2016. You’ll come away from this event:
- With an overview the new CPT codes that will go into effect in 2016, as well as the fall-out from the October 2015 implementation of ICD-10
- Aware of the reimbursement changes to the 2016 Medicare Physician Fee Schedule, including the Advanced Care Planning codes
- Having the ground rules for participating in the government’s incentive programs for 2016 to gain incentives—and avoid penalties
- Understanding the new government incentive program—the Merit-based Incentive Payment System—and how to prepare
Register now to to join Elizabeth. We’re sure you’ll be enlightened!
About the Speaker
Elizabeth Woodcock, MBA, FACMPE, CPC is a professional speaker, trainer and author specializing in medical practice management. She has focused on medical practice operations and revenue cycle management for more than 20 years.
Lea Chatham February 2nd, 2016
Every practice strives for clean insurance claims. In other words, physicians want to ensure that the claims they generate are:
Doing so minimizes the potential for payment delays and denials. The goal is to get paid the first time around to reduce costly expenses related to appeals and resubmissions.
Many diagnosis codes are not only expanded in terms of the number of options, but they’re also more specific—requiring a level of detail that wasn’t present in ICD-9. The process of reviewing each claim prior to submission is a critical aspect of coding and billing compliance. Practices can’t afford to spend valuable time and resources chasing payments on the back end. The good news is that a robust claims scrubber can essentially ensure smooth sailing for 100% of your claims.
Make the 100% clean claim metric a reality
Unfortunately, not all claims scrubbers are created equally. Although most practice management systems include some type of claims scrubbing functionality, you need to question the validity of the scrubbing process and just how much your claims are “put through the ringer” before you send them off for payer approval.
What exactly does a robust claims scrubber include? A robust claims scrubber runs your practice’s claims against the following sources:
- National Coverage Determinations (NCD)
- Local Coverage Determinations (NCD)
- Correct Coding Initiative edits
- CPT-4/HCPCS edits
- ICD-10-CM edits
- Payer-specific requirements
- State Medicaid edits
Cleaning your procedure codes
Your claims scrubber should automatically be able to identify the following procedure code-related red flags:
- Invalid or expired for the date of service
- Incompatible with the patient’s age
- Not appropriate with the patient’s gender
- Defined as an add-on code (that requires submission of a primary procedure code as well)
- Cannot be billed using a modifier
- Modifier is not valid or active
- Modifier is not valid when submitted with this procedure code
- Is a component of another code (and requires a modifier)
- Is mutually exclusive to another code (and cannot be billed using a modifier)
- Is mutually exclusive to another code (but may be billed using a modifier)
- Duplicate code for the same date of service
Cleaning your diagnosis codes
The scrubber should also be able to identify the following diagnosis code-related red flags:
- Does not meet medical necessity for the procedure performed/coded
- Requires an additional character(s)
- Cannot be reported as a principal diagnosis because it’s a manifestation code
- Requires additional information for adjudication because it’s a trauma code
- Incompatible with the patient’s age
- Not appropriate with the patient’s gender
Scrub-a-dub-dub for demographics
In addition, the scrubber should be able to verify demographic information—for example, to ensure that a name, valid date of birth, valid SSN, and valid insurance ID number are all present on the claim. Typos can easily cause errors that are completely avoidable when scrubbing demographic information prior to submission.
Three tips to consider
Finally, enhance your claims scrubbing process with these three tips:
- Hire a certified coder. A certified medical coder can provide insight what edits are triggered and why.
- Incorporate data mining. Some claims scrubbers continually re-evaluate the adjudication rules of different payers, thereby constantly improving the quality of the scrubbing process. This is particularly helpful in ICD-10 as payers continue to update LCD policies and capitalize on the greater specificity inherent in the new code set. When reviewing various products, ask potential vendors whether they have the capability to update processes in real time to keep up with changes in payer guidelines.
- Monitor your processes. Are errors resolved in a timely manner? Monitor repetitive errors, and follow up with staff members directly.
A 100% clean claim rate may seem far-fetched, but with the right claims scrubber—and a process for ongoing monitoring—you can achieve this goal, or get close to it, and then reap the rewards of an improved cash flow.
If you are looking for ways to improve you medical billing, use this Billing Best Practice Checklist to establish goals for best practices.
Lea Chatham January 27th, 2016
By Beth Onofri
“What the heck is going on with Meaningful Use,” is a phrase that is probably popping up for a lot of people right now thanks to the huge number of conflicting articles that are flooding our inboxes. Is Meaningful Use (MU) ending or not? Even Andy Slavitt, CMS Acting Administrator, tweeted “In 2016, MU as it has existed—with MACRA—will now be effectively over and replaced with something better.” A week later, an article was released to clarify his statements.
There are a number of other programs that will see changes too—PQRS, Value-Based Modifiers, and clinical quality measures. The overall goal is to align all these programs, using the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as a foundation.
Less than a decade ago, the MU initiative began with the objective to bring technology into the healthcare system. Initiatives encouraged providers to collect data electronically. The phased approach allowed us to move into connecting with one another, sharing the information we collected, and beginning the process of outcome measurement.
MACRA focuses on quality, cost, and clinical practice improvement when calculating how Medicare physician payments are determined. In other words, a shift to focusing on patient care and reimbursement for the quality of that care. It is important to point out that this realignment is strictly for Medicare reimbursement and not for Medicaid. Medicaid physicians will continue to be reimbursed in line with the previously established program.
So, What the Heck Is Going on with MU?
Many of you are wondering what does this mean for me and what should I do now. The answer is: Continue with the MU program. If you have not begun Meaningful Use, begin in 2016. The MU program may be replaced at some point, but the concepts, in particular e-prescribing, interoperability, and clinical quality measures, will continue whatever the initiative may be called.
If you have successfully attested to Meaningful Use, continue collecting the necessary data. The October 6, 2015 CMS rule streamlined Stage 1 and Stage 2 into one stage, Modified Stage 2, with ten (10) objectives. All providers use one set of objectives, no differences for the number of years in the program. Additionally, these objectives will remain basically the same for the next two years, through the 2017 attestation year.
Both new and returning participants should take a closer look at the MU clinical quality measures (CQMs) and the Physician Quality Reporting System (PQRS) measures. Although there has been some attempt in the past to align these two programs, they have been relatively distinct. However, these programs will be aligned, and hopefully consolidated, with the coming changes. Providers should begin to look at the results as well, and not just the collection of information. Trending of outcomes is not far in the future.
Watch for more details and updates on MU coming soon.
Lea Chatham January 26th, 2016
Bad online reviews can happen to any business at some point. So negative reviews are always a looming threat to the marketing and reputation of a medical organization. And while this can hang like a dark cloud over providers, it’s important to understand the best practices to respond when this type of consumer content comes across our profile pages.
The first step is to make a request to the website that the negative review be removed, but most first attempts that I’ve seen don’t succeed. That is why it is important to understand these five tips to handling negative reviews before requesting removal:
- You will, in all likelihood, only get one shot at requesting a review be removed, so it’s critical to have a strategy before contacting the review site.
- Reading the Terms of Service (TOS) from that review site will go a long way in helping to determine what that strategy should be. It’s common for these review sites to publish in bullet points what types of content they do not allow, for example mentioning a competing company, naming one of your employees specifically, using profanity, etc.
- Once it’s determined that a review could violate one or more of the terms, write that in the subject line of the email to the review site, “Violation of Your Terms of Service,” or “This Review Violates Your Terms of Service.” This will often bring your review removal request to the front of the queue.
- It’s also a best practice not to respond to the patient directly as this lowers your brand by having you “stoop to their level.”
- It is perfectly acceptable, however, to have your Office Manager respond to the review with a statement that, “This review has been flagged for violating the website’s terms of service and is awaiting moderation for removal.”
Using these strategies the next time you have a negative online review will significantly increase your chances of having it removed. However, if it isn’t removed keep in mind that the occasional negative review isn’t the end of the world, especially if you have a lot of positive reviews. They are only a problem if you don’t have many reviews.
Organically (meaning passively waiting for reviews to generate), the average medical practice can have anywhere from two to ten reviews a year. That’s far too few to aggressively recruit new patients and have a solid defense against the occasional bad review. Having just four 5 star reviews and one 1 star review means that a single disgruntled patient can drag down a 5 star practice to a 4 star practice.
Many practices are hesitant to ask for reviews because of fears around patient perception and regulatory compliance. A simple way to avoid problems and to consistently generate a healthy volume of reviews is to use practice marketing automation software that integrates into your appointment schedule. In this way, each patient who walks out the door gets a mobile-friendly email that asks them to rate their visit, which makes the feedback request more of a patient survey and not a selective “ask” for positive reviews.
The more sophisticated systems can not only integrate into popular review sites (feeding them your positive reviews) but can also detect unhappy patients and send them down an alternate path (providing private feedback to the doctor) as opposed to giving the patient a chance to write a publicly negative review.
Several studies have shown that patients are looking at reviews of healthcare providers before booking an appointment. So it is worth the investment to put a system in place to increase overall reviews and manage negative feedback.
If you are looking for more tips on managing your online reputation, download 4 Steps to Building and Managing Your Practice’s Online Reputation.
About the Author
John Sung Kim is the technology evangelist at Kareo. He was previously the CEO of DoctorBase, a practice marketing and patient engagement platform that was purchased by Kareo in 2015. He was also the founder and founding CEO of Five9 (NASDAQ: FIVN). He’s acted as a consultant to numerous startups and government organizations including RingCentral, Qualys, Odesk, the city of San Francisco and the California Public Utilities Commission.
Lea Chatham January 21st, 2016
Do you struggle with having conversations with practice customers about denial management? This short video provides helpful tips from expert Paul Bernard on how to make tough conversations like this easier.
Looking for more ways to improve and grow your billing company? Check out the resources available here.
Lea Chatham January 19th, 2016
By: David B. Mandell, JD, MBA and Carole Foos, CPA
As a physician, do you realize that, after the tax increases of recent years—between income, capital gains, Medicare, self-employment and other taxes—you likely spend between 45 and 55 percent of your working hours laboring for the IRS and your state?
Given these sobering facts, the purpose of this article is to show you four ways to potentially save and possibly motivate you to investigate these planning concepts early in the year when you can best take advantage of them. Let’s examine them now:
1. Use the Right Practice Entity/Payment Structure/Benefit Plans
These areas are where the vast majority of tax mistakes are made by doctors today—and where many of you could benefit by tens of thousands of dollars annually with the right analysis and implementations. Issues here include:
- Using the legal entity with maximum tax/benefits leverage—whether that is an S corporation, C corporation, LLC taxed as S, C, partnership, or disregarded entity.
- Using a multi-entity structure to take advantage of two types of entities and their tax/benefit advantages.
- Managing the payment of salary, bonus, distribution, and partnership flow-through to take advantage of maximum retirement benefits and minimize income, social security, and self-employment taxes.
- Considering benefit plans beyond the typical profit-sharing/401(k) with which most medical practices start and end their benefit planning.
2. Don’t Lose 17-44 percent of Your Returns to Taxes; Explore Investment Managers Who Manage with Taxes in Mind
It is quite well known that most investors in mutual funds have no control of the tax hit they take on their funds. What you might not know is how harsh this hit can be. According to mutual fund tracker Lipper, “Over the past 20 years, the average investor in a taxable stock mutual fund gave up the equivalent of 17 to 44 percent of their returns to taxes.”
How to avoid this problem? Consider working with an investment firm that designs a tax-efficient portfolio for you and communicates with you each year to minimize the tax drag on that portfolio. In a mutual fund, you have only one-way communication—the fund tells you what your return is and what the tax cost is. Working with an investment management firm, you get two-way communication, as the firm works with you to maximize the leverage of different tax environments, offset tax losses and gains, and other tax minimization techniques.
3. Gain Tax-Deferral, Asset Protection through Cash Value Life Insurance
Above, you learned about the 17-44 percent tax hit most investors take on their investments in stock mutual funds. Similar funds within a cash value life insurance policy will generate NO income taxes—because the growth of policy cash balances is not taxable. Also, nearly every state protects the cash values from creditors, although there is tremendous variation among the states on how much is shielded.
4. Consider Charitable Giving
There are many ways you can make tax beneficial charitable gifts while benefiting your family as well. The most common tool for achieving this “win-win” is the Charitable Remainder Trust (CRT). A CRT is an irrevocable trust that makes annual or more frequent payments to you (or to you and a family member), typically, until you die. What remains in the trust then passes to a qualified charity of your choice.
This article gives you a few tax-saving ideas. For larger practices with $3-5 million or more of revenue, there are additional techniques that could offer significantly greater deductions. These are outside the scope of this article, but are mentioned in the articles on our website and are topics of our free e-newsletter. If you want to save taxes, the most important thing you can do is start looking for members of your advisory team who can help you address these issues in advance. Otherwise, you will be in this same position this April 15…and next April 15 and the one after that.
About the Authors
David B. Mandell, JD, MBA, is an attorney and author of five national books for doctors, including For Doctors Only: A Guide to Working Less & Building More, as well a number of state books. He is a principal of the financial consulting firm OJM Group www.ojmgroup.com, where Carole C. Foos, CPA is a principal and lead tax consultant. They can be reached at 877-656-4362 or email@example.com.
Readers of the Getting Paid Blog can receive a free hardcopy of “For Doctors Only: A Guide to Working Less & Building More” by calling 877-656-4362, or visiting www.ojmbookstore.com and enter promotional code KAREO027 free ebook download of For Doctors Only or the shorter For Doctors Only Highlights for your Kindle or iPad.
About the Author
David B. Mandell, JD, MBA, is former attorney, consultant and author of five national books for doctors, including “For Doctors Only: A Guide to Working Less & Building More,” as well a number of state books. He is a principal of the financial consulting firm OJM Group www.ojmgroup.com. He can be reached at 877-656-4362 or firstname.lastname@example.org.
Disclosure: OJM Group, LLC. (“OJM”) is an SEC registered investment adviser with its principal place of business in the State of Ohio. OJM and its representatives are in compliance with the current notice filing and registration requirements imposed upon registered investment advisers by those states in which OJM maintains clients. OJM may only transact business in those states in which it is registered, or qualifies for an exemption or exclusion from registration requirements. For information pertaining to the registration status of OJM, please contact OJM or refer to the Investment Adviser Public Disclosure web site www.adviserinfo.sec.gov.
For additional information about OJM, including fees and services, send for our disclosure brochure as set forth on Form ADV using the contact information herein. Please read the disclosure statement carefully before you invest or send money.
This article contains general information that is not suitable for everyone. The information contained herein should not be construed as personalized legal or tax advice. There is no guarantee that the views and opinions expressed in this article will be appropriate for your particular circumstances. Tax law changes frequently, accordingly information presented herein is subject to change without notice. You should seek professional tax and legal advice before implementing any strategy discussed herein.
Lea Chatham January 11th, 2016
By Emily Richmond, MPH
Whether one of your resolutions in 2015 was to spend more time on quality improvement or simply to take steps to make sure your income stays steady through this tumultuous time in healthcare, you’re lucky that time hasn’t run out for you to meet those resolutions just yet.
Taking action now is very important for physicians who regularly see Medicare patients because reporting 2015 PQRS data to the Centers for Medicare and Medicaid Services (CMS) is the only way to avoid two negative payment adjustments that would impact your Medicare Part B reimbursements in CY 2017:
- 2.0% negative adjustment for PQRS
- 2.0%-4.0% negative adjustment for the Value-Based Payment Modifier
It is important to note that the 2.0%-4.0% swing in penalties associated with the Value-Based Payment Modifier is related to practice size. Solo physicians and groups with 2-9 eligible professionals are subject to the 2.0% penalty if they do not report PQRS for CY 2015. The 4.0% penalty would be applied to groups with 10 or more eligible professionals.
No one likes losing up to 6% of their income, especially when that money is taken away based on something that happened (or didn’t happen) two years prior. Unfortunately, CMS is known for this two-year lag in payment adjustments and physicians are stuck making sure they report data appropriately and in time to avoid penalties down the road. While there are multiple ways to participate in PQRS if one gets started earlier in the year, the easiest mechanism for late starters is reporting PQRS Measures Groups to CMS through a PQRS Qualified Registry.
Since the deadline for qualified registries to report PQRS data to CMS is not until March 31, 2016, physicians who have access to data from the 2015 year—either through their billing provider or their EHR—may still be able to validate this data and send it to a registry prior to the deadline. In addition, PQRS Measures Groups are the easiest way to meet reporting requirements this late in the game because physicians are only required to report data for a 20 patient sample, for each measure in the group. The following steps will maximize your chance of successful participation in PQRS for the 2015 year:
- Identify a PQRS Qualified Registry that reports measures applicable to your specialty that is still taking new customers for the 2015 reporting year.
- Download the CMS PQRS Measures Groups documentation and determine which Measures Group is applicable to your patient population.
- Review your available data sources (billing systems, EHR systems, etc.) and determine whether data is available for encounters that occurred between January 1, 2015 and December 31, 2015.
- Contact the Qualified Registry of your choice to find out how they receive data from physicians for PQRS, and if needed, reach out to your EHR vendor or billing system vendor to make sure you can access the data in the necessary format.
After you take the steps needed for reporting PQRS in 2015, be sure to keep your eyes out for information on how to participate in PQRS for CY 2016 year as well. Unfortunately the payment penalties will continue to add up, but at least you’ll have more of a head start than last year.
About the Author
Emily Richmond, MPH, is Vice President of Quality and Performance Improvement at Able Health, the pay-for-performance platform for physician organizations. She has as passion for quality improvement and health policy and has led the development and rollout of quality programs for Medicare and private payers.
Lea Chatham January 11th, 2016
Does it seem like your practice reception area transforms from Grand Central Station to Old West ghost town in the span of a few days from December to January? Do you find yourself secretly hoping for a flu epidemic to bring in some new Q1 business? If so, you’re not alone. The deductible reset has many practices scrambling to serve patients eager to be seen before December 31—and scrambling to find patients to serve after January 1.
Taking the time to promote preventive care at the beginning of the year is also an excellent way to offer patients more convenient service, while also engaging them and showing you’re concerned about staying on top of their healthcare.
The advantage of promoting preventive care at the start of the year is cost to patients—or lack thereof. Under the ACA, preventive services like annual wellness visits, well-woman OB/GYN exams, vaccines, and preventive tests like colonoscopies and Pap smears are typically covered by most health plans with no copay or deductible. (Grandfathered plans could be an exception—but a relatively rare one, since many plans covered preventive care at no out-of-pocket cost to patients even before the ACA mandated it.)
Patients may not be aware that these services can be had without opening their wallets. They also may not be aware that they’re due for screenings based on their age, risk factors and history. Best of all, they may not realize that getting an appointment at a convenient time could be easier at the start of the year because your practice has more unused capacity.
Identifying and proactively contacting patients for timely preventive services is a great way to get more value from your EHR and patient portal. I’ll be exploring this and other marketing ideas to help you weather the deductible reset and get your practice off to a strong start in 2016 in my upcoming free webinar, 4 Tips to Fill Your Schedule in 2016, on January 14. Register Now!
About the Author
Laurie Morgan is a senior consultant and partner at Capko & Morgan. She managed both start-ups and large-scale operations in the media industry before turning her focus to medical practice management. Her consulting focus is on driving and capturing revenue and operating more efficiently. Laurie has an MBA from Stanford University.