Practice management: A rewarding time for primary care physicians
For as long as there has been a healthcare payment system, the basis for payments in that system has been like any other business – transactional. In other words, the more services provided (widgets sold), the more the purchaser pays. With the move to the Relative Value Based Systems (RVBS) or Relative Value Unit (RVU) methodology, physicians began being compensated more on a level of intensity method. We are now seeing new reward systems being developed for those providers considered primary care. Read more
Practice management: Managing Healthcare
We live in a world where true “managed care” requires communication unlike any we’ve had before and that cannot be operated in a paper oriented world.Outcomes will be part of future managed care delivery systems, whether government or privately run. Starting in 2015, CMS will begin testing and planning the introduction of a payment modifier for differential physician payments. Read more
Practice management: Independent Payment Advisory Board
As part of the Accountable Care Act (ACA), the establishment of the Independent Payment Advisory Board (IPAB) has created some of the broadest discussions. As authorized, the IPAB is an independent board housed under the executive branch and is charged with recommending savings for Medicare if the per capita growth in Medicare spending exceeds defined targets. Read more
Practice management: Looking ahead to 2013
Looking ahead to 2013, several issues relate to healthcare delivery including the need to move toward Electronic Health Records (EHRs), the potential cut in Medicare payments and continued performance reviews by the Officer of the Inspector General (OIG). Read more
Practice management: EHRs and Medicare Fee Schedule
The role of Electronic Health Records (EHR) continues to grow. Much of the current growth comes from The Medicare and Medicaid EHR Incentive Programs that came out of the Health Information Technology for Economic and Clinical Health (HITECH) as part of the American Recovery and Reinvestment Act of 2009 (ARRA). Note that this is not part of the Affordable Care Act (ACA) and is well into its second year of implementation with incentive money already being paid out to medical institutions. Read more
Version 5010 enforcement discretion period ended June 30
All HIPAA-covered entities were required to upgrade to Version 5010 by January 1, 2012. However, the Centers for Medicare & Medicaid Services (CMS) initiated an enforcement discretion period to give the industry additional time to complete testing and for vendors to complete software installation.
As of July 1, 2012, all complaints regarding any HIPAA-covered entity's non-compliance with the updated standards received in CMS' HIPAA Administrative Simplification Enforcement Tool (ASET) will be subject to enforcement action under the existing HIPAA transaction enforcement process.
If you are still experiencing issues regarding use of the Version 5010, D.0 and 3.0 standards in your transactions, you should refer to your respective clearinghouse and/or payer's website or provider service department for assistance. For information regarding these updated standards and additional information, please visit theVersions 5010 and D.0 & 3.0 page on the CMS website.
Keep Up to Date on ICD-10.
Please visit the ICD-10 website for the latest news and resources to help you prepare!
Practice management: ACOs and EMRs
On July 9, Medicare announced the number of ACOs has now doubled from the 27 shared savings model plans with 89 newly named participants. The program offers medical groups, hospitals and federally qualified health centers financial incentives for quality improvement and cost control. Much closer to home and individual practices in the process of implementing an EMR. Many groups are on board and incentive dollars paid out under the HITECH ACT (part of the American Recovery and Reinvestment Act of 2009 or ARRA) total in the billions. However, there are just about as many groups sitting on the fence when considering this step. Read more
Practice management and health system reform: HiTech Act, e-prescribing and RACIn addition to the Affordable Care Act (ACA), there are a number of other issues and opportunities we need to be considering. These include provisions in the HiTech Act (not part of the ACA), e-prescribing guidelines, continued expansion of the Recovery Audit Contractor (RAC) program, and other initiatives being instituted by commercial third party payers (BCBS, United Healthcare, etc.) Following is a rundown of some of the more significant aspects of these areas. Read more
Practice management amid health system Reform
Two significant things have occurred recently in the healthcare delivery system. The U.S. Supreme Court finished hearing arguments on the Affordable Care Act (ACA) and, the almost annual event of Alabama Medicaid running into financial problems has occurred. While the goals of making sure quality, affordable healthcare is available to all is good, the ACA is fraught with problems. The issues being considered by Supreme Court are mostly related to the individual mandate. On the Alabama Medicaid issue, there's a significant financial shortfall and while there is the need for a short term solution, this is a problem crying for a long term solution. Read more
AMA Practice Management Tips
The AMA Practice Management Center offers physicians (members and non-members) free, easy access to the AMA’s wealth of resources, tools and guidance for enhancing the operation of a medical practice.
Obtaining, uploading and utilizing your contracted fee schedules
The AMA has created a new educational resource “Obtaining, uploading and utilizing your contracted fee schedule” to help physicians understand the importance of utilizing their contracted fee schedules. This resource provides step-by-step instructions on how to upload your contracted fee schedule into your practice management system, as well as guidance on reports or spreadsheets that can help you ensure that payments you receive align with what you agreed to in your contract. If you don’t have copies of your contracted fee schedules, AMA members can access a free template letter to send to payers to request a copy of contracted fee schedules.
Avoiding Medicare/Medicaid fraud and abuse
The Office of Inspector General (OIG) recently published a compliance publication oriented toward the “new” physician called “A Roadmap for New Physicians – Avoiding Medicare and Medicaid Fraud and Abuse.” The brochure provides physicians with ways to identify certain red flags that could lead to potential liability in civil, criminal and administrative actions. It also reviews fraud and abuse risks from the perspective of relationships that the new physician might develop with payors, other physicians and providers, and outside vendors.