Supreme Court To Rule On ‘Obamacare’ Tomorrow
THIS WEEK — The Supreme Court of the United States should be ruling on four separate issues:n
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- If the court should even consider the case in the first place, there is a possibility the justices will rule the constitutionality of the law cannot be challenged until individuals are actually subjected to the individual mandate in 2014.
- If the law’s individual mandate, which requires most adults to either buy insurance or pay a fee that would reach $695 by 2016, is constitutional
- If a directive requiring states to expand Medicaid coverage, at risk of losing federal grants, is constitutional.
- If the court eliminates the individual mandate, the justices must decide if it can be separated from the law or if the entirely of the legislation goes down with it.
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nThe Supreme Court will announce its decision on Thursday, June 28, 2012.nnSource: www.examiner.com; David Phillips, June 25, 2012.
Credentialing is NOT just filling out paper work…nCredentialing IS an increasingly complex and time sensitive process where the right information has to get to the right place, correctly, (even in the right color ink) and on-time in order for you to be paid correctly and consistently!nnFailure to properly fill out the “paper work” will cause, and has been causing disruptions in payment, inability to obtain referrals, improper co-pay and deductibles being applied and even regulatory audits (when a provider is mis-categorized and loaded improperly in the payer’s system!).nnIf your practice is experiencing:n
Some practices may find that they cannot increase revenue as easily as they can decrease expenses. Both or a combination of the two can make a practice more profitable.nnExpenses:nRent, personnel, supplies, equipment, etc. What if you could lower the cost of one or more, maybe all of these?nnRent:nIf space is not needed don’t rent it! If you can out source a function that takes up space, it may be worth it.nnPersonnel:nThese days no one wants to be laid off or suggest that there be a reduction in staffing, but if it makes sense to do so, you have got to do it. Health care is complicated and new regulations and challenges may require new/different people and processes. Maybe even less people but higher skilled.nnSupplies:nGet tough, get what you pay for, get lean. There is a lot of competition out there to supply your office. With that competition come JIT (Just In Time) delivery. You may be paying for space to store supplies when you could get the supplies cheaper and delivered with a day of need!nnEquipment:nSome things you have to have. But when it comes time to replace them don’t be afraid to be creative. Look carefully at leasing. Like supplies, there is a lot of competition for your business. Computers and anything electronic is coming down in price, but be careful – often times paying a little more may get you a whole lot more. Consider outsourcing your IT hardware, especially server needs!nnCall us! We can help with all of the above. Spending money is okay if it is done with strategy and with a plan to bring down overall Expenses. You don’t have to just increase revenue to increase your profitability!
The payer and provider communities are still dealing with HIPAA 5010, and trying to shift attention to ICD-10 is tough,” says Craig Collins, division chair for revenue cycle and administrative lead of the ICD-10 transition at the Rochester, Minn.–based Mayo Clinic. “We put together a strategic plan and process map because we’re trying to be first to the plate to do the ICD-10 testing with the payers. Our hope is that in early 2013 we can begin testing with larger payers.”nnThe Mayo Clinic, like many other healthcare organizations, is making strides to prepare for the largest overhaul of healthcare codes in the past 30 years. The process—regardless of Health and Human Services’ decision to extend the ICD-10 transition deadline to October 2014—includes a process map of the revenue cycle in the hopes of keeping this project revenue neutral.nnAlthough the code set change is intended to be revenue neutral, ICD-10 includes more than 155,000 codes, a significant expansion from the current 17,000 codes in ICD-9. The transition touches nearly every member of a hospital or health system: physicians, clinicians, coders, IT, HIM, and finance. The mandated coding expansion influences documentation, productivity, contracts and business processes, HIM, practice management, budgets, payment conversions, claims edits, and disease and utilization management.nnICD-10 is expected to have significant impact on the revenue cycle. Nearly half of healthcare leaders (46%) expect to lose money while shifting to the new system, according to the July 2011 HealthLeaders Media Intelligence Report, ICD-10 Puts Revenue at Risk. An important step to avoid revenue hits is completing a process map that digs into the effect the transition will have on the revenue cycle.nnThe process map is work flow plan driven by multiple repositionable notes created to give an accurate picture of all the activities connected to the current and future processes at an organization. It is a full structural analysis of how all processes flow and connect to each other. The map can show gaps in specific areas that are preventing optimal performance or, in the case of ICD-10, areas that will require special attention to prevent an impact on the organization’s revenue.nnWith some 212 IT systems and 80 geographical sites across Minnesota, Arizona, and Florida that include physician practices and several hospitals, the Mayo Clinic finds the process map to be essential for a successful ICD-10 conversion—and that starts with the right team and clear accountability. 
he right to withhold payment and request refunds for improperly coded services.nn99211 is a minimal level service, but it is still governed by the same billing and documentation rules that ALL E&M codes have.nnAs with all services billed to Medicare, code 99211 services must be reasonable and necessary for the diagnosis or treatment of an illness or injury. Unlike the other E/M CPT codes, the CPT book does not specify completion of particular levels of work for code 99211 in terms of key components or contributory factors. Also, unlike the other E/M codes, CMS did not provide documentation requirements for CPT code 99211 in the “E&M Documentation Guidelines”.nnAmong other reasons, code 99211 should not be used to bill Medicare/Secure Horizons:n