May 16, 2014 | Uncategorized
The Centers for Medicare & Medicaid Services (CMS) has taken its first step toward improving its efforts to ensure the effectiveness, efficiency, economy, and quality of care quality for Medicare beneficiaries in through the Quality Improvement Organization (QIO) Program.nnLast week, the federal agency announced the selection of Livanta LLC and KePRO as Beneficiary and Family Centered Care (BFCC) would be responsible for the program’s case review and monitoring activities at a broader level than the traditional QIO activities taking place at a more local level.nnBetween them, the two BFCC QIOs will oversee five geographic areas — Livanta (Areas 1, 5), KePRO (Areas, 2–3) — of the United States and its territories:n
Area 1: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Puerto Rico, Rhode Island, Vermont, Virgin IslandsnArea 2: District of Columbia, Delaware, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West VirginianArea 3: Alabama, Arkansas, Colorado, Kentucky, Louisiana, Mississippi, Montana, North Dakota, New Mexico, Oklahoma, South Dakota, Tennessee, Texas, Utah, WyomingnArea 4: Iowa, Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio, WisconsinnArea 5: Alaska, Arizona, California, Hawaii, Idaho, Nevada, Oregon, Washington
nEstablished by statute in 1982, the Medicare Quality Improvement Program Program is currently in its earliest phase of transformation which CMS set in motion back in 2011 with the publishing of the 10th Statement of Work (SOW).nn“One of the most critical roles of CMS is to protect the quality and safety of care delivered to beneficiaries. Care needs to be patient-centered and directly engage patients, families, and caregivers,” Dr. Patrick Conway, Deputy Administrator for Innovation and Quality and CMS CMO, said in a public statement. “The quality of care review is essential to ensure care delivered to all beneficiaries meets professionally recognized standards.”n
nnThe next step for improving the QIO Program is expect to take place this July with the award of contracts to organizations responsible for working directly with providers and communities. Shortly thereafter, CMS will release its 11th SOW on August 1.n
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Source: www.EHRIntelligence.com; Kyle Murphy; May 13, 2014.
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May 16, 2014 | Uncategorized
ICD-10 Compliance Date
nOn April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.n
July ICD-10 End-to-End Testing Canceled: Additional Testing Planned for 2015
nCMS planned to conduct ICD-10 testing during the week of July 21 through 25, 2014, to give a sample group of providers the opportunity to participate in end-to-end testing with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. The July testing has been canceled due to the ICD-10 implementation delay. Additional opportunities for end-to-end testing will be available in 2015.nnSource: www.cms.gov; May 2, 2014.
May 5, 2014 | Uncategorized
J30.1 — Allergic rhinitis due to pollennnJ30.2 — Other seasonal allergic rhinitisnnJ30.81 — Allergic rhinitis due to animal (cat) (dog) hair and dandernnJ30.89 — Perennial allergic rhinitisnnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to contact us for all of your training and education needs!
May 5, 2014 | Uncategorized
Successful population health management is not possible without data. The form that information takes depends on the role being played by a particular player in population health management: provider, patient, or payer.nnWith passage of the Affordable Care Act and the movement toward value-based reimbursement, health plans find themselves facing challenges similar to those of the providers they’re working with in the pursuit of accountable care and population health.nn“The landscape is certainly changing and there are many changes. How payers are interacting with providers really depends on the type of structure they have set up,” says the newly-appointed IDC Health Insights Research Director Deanne Primozic Kasim.nn“In the last two to three years in particular, there have been many developments in terms of providers forming patient centered medical homes and accountable care organizations, not just with Medicare but also with some payers doing their own types of ACO arrangements,” she continues. “That has a different dynamic for the types of data being given to payers and the kinds of reimbursement coming back to providers.”nnThe challenge is made harder by the series of healthcare mergers, acquisitions, and partnerships that have an impact on reimbursement for providers and payers. ” You see these hospital systems just eating up provider practices and as their operations are being integrated there are more billing processes are in place in terms of how these groups now get reimbursed,” adds Primozic Kasim.nnIn looking for guidance in the area of accountable care in particular, Primozic Kasim admits that health plans can look to the approach taken by the Centers for Medicare & Medicaid Services (CMS) in its Medicare Shared Savings Program (MSSP) and Pioneer ACO Model, but that does not necessarily provide real clarification.nn
“What Medicare has put out there is being used as a guideline, but there is unfortunately not one roadmap,” explains Primozic Kasim. “It is a real challenge for payers in looking at the types of quality metrics they are going to use as different programs pop up, including what they do with the federal government if they choose to play there. There are so many quality metrics that they are challenged to keep up with them.”nnOne thing that is clear to payers is the need to understand individuals as consumers as well as patients where Primozic Kasim sees great potential for improvement.nn“There isn’t one-size-fits-all just like there’s not one type of consumer or patient,” she stresses. “It’s really about trying to reach people by respecting their different healthcare literacy overall, their social use of technology, their access to technology, and what’s going to hit home with them because there are different messages and cultural and demographic concerns as to how to reach people.”nnAccording to the research director, certain payers have a leg up on others in the makeup of their patient populations. “The ones that have more of a target population, such as the Medicaid and Medicare Advantage plans, have an advantage over the larger national plans because their patient population is a lot more focused and more centered geographically as opposed to those plans that are trying to cover everybody in different market segments,” claims Primozic Kasim.nnGetting to know their patient populations is leading payers toward gathering intelligence through business and clinical analytics solutions and services. Given the inchoate of healthcare analytics choosing the right vendor partner or partners is not an easy one.nn“In terms of analytics, there is not one vendor that has a complete, defining market share,” says Primozic Karim. “There are many companies out there doing everything from the backend edge server to some of the more clinical analytics and looking at population health of these exchange populations because clearly setting premiums for this is going to be key to moving forward.”nnFor value to replace volume in healthcare, premiums and reimbursements must be properly configured. Without meaningful insight into the needs of the provider and patient populations, payers will not be able to rise to the requirements of this new era in healthcare.nnSource: www.ehrintelligence.com; Kyle Murphy; April 30, 2014.
Apr 7, 2014 | Uncategorized
Why Should a Practice Outsource Their Billing? Do the Math!
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nThe cost of setting up and maintaining a billing system, including the necessary staff to properly code, scrub, bill, post payments, and pursue denied claims, is a significant expense for any medical practice. Add to that expense the cost of employee turnover (and training), employee benefits, annual support and maintenance of computer equipment, the constant need to remain diligent regarding changes in reimbursement and CPT and ICD-9 coding (soon to be ICD-10!), and the necessity of conforming to meaningful use criteria associated with your electronic medical record, and you have a perfect storm brewing that could cost you a bundle!nnDepending on your specialty and volume, estimates from sources including the Medical Group Management Association (MGMA) and other industry experts peg the average expense of internal billing to be 8 to 15% of your collected revenue.nnOutsourcing your billing will range from 6 to 10% of your collected revenue. However, a number of studies have demonstrated that collections typically improve by as much as 5 to 10% when billing is outsourced due to improvements in the rate of denied claims, timely follow-up and appeals for incorrect or no-pay claims, and familiarity and expertise in correct coding in order to maximize reimbursement. Other intangible benefits of outsourcing include eliminating the administrative hassle of having to manage systems, staff, and expense, which allows you to focus more time and intellect on the practice of medicine.nnA general guide to comparing costs of doing it yourself versus outsourcing, assuming no increase in collected revenue (plug in your own numbers), includes the following:n
Doing it yourself:
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- A practice of one to three physicians requires a minimum of one and often two full-time equivalent (FTE) staff – cost including salary and benefits – $36,000 to $48,000/FTE/year
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- Computer hardware and software expense including support and maintenance – $200/provider/month plus $500 for maintenance and support – $5,300/year
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- Claims processing costs – clearinghouse fees, billing supplies, office space, office equipment – $15,000/year
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- Total cost per year of internal billing/collections (assuming 2 FTE’s) = $116,300
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- Assume two physicians collections = $950,000/year
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nTOTAL COST OF INTERNAL BILLING = 12% ($116,300/$950,000)n
Outsourcing:
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- Staff and software expenses – $10,000/year
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- Billing service fee assuming no increase in collected revenue – 8% of collected revenue – $76,000
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- Total cost per year of outsourcing = $86,000
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nTOTAL COST OF OUTSOURCED BILLING = 9% ($86,000/$950,000)nnIncrease in revenue available for physician distribution due to outsourcing = $30,300!!n
n*limited time offer through April 30, 2014
