Physician Practices Pursue Four Financial Strategies To Survive Pandemic
nnThe COVID-19 pandemic has posed many challenges around the globe, but one major setback this virus has created is the lack of finances within physician practices. In order to combat this issue and keep healthcare resources at it’s finest, below are some strategies that can be used to save your funds.nnThe COVID-19 crisis has been a financial fiasco for physician practices, including decreased patient volume and canceled elective surgeries.nnThere are strategies physician practices can pursue to weather the financial storm associated with the coronavirus pandemic.nnNinety-seven percent of physician practices experienced a negative financial impact from the coronavirus disease 2019 (COVID-19)nnpandemic, according to a Medical Group Management Association survey published in April. The financial hits have included decreased patient volume and loss of income associated with the canceling of elective surgery.1qnnThe COVID-19 pandemic poses an existential threat to the primary care sector, says Ann Greiner, president and CEO of the Primary Care Collaborative in Washington, D.C. “If we do not respond to the financial challenges that primary care is facing, we are going to see an already damaged foundation of our healthcare system crumble.”nnPhysician practices can pursue four primary strategies to keep their business finances afloat, says Al Crawford, chairman, CEO, and co-founder of Davie, Florida–based Bankers Healthcare Group.nn1. HOLD ON TO CASHn”Do not spend if you do not have to spend. You should just hoard cash. The more access you have to cash, the better,” Crawford says.nnDuring the COVID-19 pandemic, physician practices should limit new spending to practice enhancements related to the pandemic such as air purification systems, he says. “There are expenses required during the COVID-19 pandemic, but I recommend that you do not go beyond those required expenses in an environment like this. We are inthe middle of a pandemic, and what you do not need you should not buy.”nn2. DON’T PAY OFF DEBT, YETn”I would not be looking to pay down debt right now because of the No. 1 principle—cash is king,” Crawford says.nnMedical professionals should be careful about taking cash and paying down debt, he says. “For the next 90 to 180 days, I would try to stay cash-rich. If we’rennall back to work, there is a vaccine in the fall, your practice business is good, and you have saved a lot of money by being ultraconservative, then I would look at paying my debt down.”nnAlthough the Federal Reserve System has been taking actions to promote lending, physician practices cannot count on finding a lender if they experience a cash crunch, Crawford says. “You do not want to pay debt off, then something does not go right, and you go back to the banks and the banks are not lending. Then you do not have access to capital and that can kill your business.”nn3. USE GOVERNMENT ASSISTANCEnCrawford is bullish on the U.S. Small Business Administration’s Paycheck Protection Program (PPP).nn”You have an interest-free period for 24 weeks, which is fantastic. It is probably one of the best gifts that the U.S. government has ever given. If you follow the rules, such as spending 60% of your funds on payroll, and you get the loan forgiven at the end of 24 weeks, it is a home run,” he says.nnEven if a physician practice cannot get a PPP loan forgiven, the debt terms are a bargain, Crawford says. “If you can’t get the loan forgiven or you can’t pay your rent, it is an inexpensive loan. It is a 1% interest rate loan. So, it may make sense to do the 30-month payback and carry the loan if you can’t financially afford to bring your staff back.”nnFor physician practices that have gotten PPP assistance, the funds should be kept in a dedicated account to pay for program-approved expenses such as payroll and rent, he says. “When a practice pays for insurance or pays for payroll, they should reimburse out of the separate PPP account for the exact, specific payments. If they are making specific payments for rent, insurance, or payroll, they will have the proof for the bank and for SBA that the PPP funds were used for the purposes outlined.”nnPPP has been a lifeline for the Brownsville, Texas–based general surgery practice of Carlos Barba, MD. The cancellation of elective surgery in Texas hit the practice hard, Barba says.nnThe general surgery practice has a 10-member staff, including another surgeon and a physician assistant. “Fortunately, the federal government created the small business assistance program. We applied to that program, and I was able to get a loan. I did not have to reduce hours or cut my staff,” he says.nn4. APPLY FOR PRIVATE LOANS
Lending from banks and brokers also can stabilize a physician practice’s finances, Crawford says.nnBankers Healthcare Group has established an “assistance loan” that ranges as high as $500,000. Borrowers do not have to make a payment on the loan for the first 89 days.nnThe terms of the assistance loan can be crafted to limit the size of monthly payments, Crawford says.nn”We are giving the medical professional a term that goes out as long as 10 years. For the borrower, the additional years lower the monthly payment. In my opinion, right now everything is about the monthly payment. If you can lower the monthly payment, increase your savings, and decrease your spend, you have a much better shot of getting the business back to running well,” he says.nnPRIMARY CARE PAYMENT REFORMnReimbursement for primary care services must be reformed, Greiner says.nn”This pandemic has laid bare that fee-for-service has been an epic failure. It is a system that is based on face-to-face visits, which obviously does not work in a pandemic when you are trying to keep both patients and clinicians safe. So, the pandemic has prompted a lot of conversation both at the national level and the state level about moving to a prospective payment system,” she says.nnDuring the pandemic, the Centers for Medicare & Medicaid Services (CMS), as well as private health plans, have moved in the right direction on advance payments, Grnneiner says. “What both CMS and private health plans have done by putting advance payments in place is help primary care practices keep their doors open. That could be a step on a path toward prospective payments, but this is a conversation that has been going on for a long time.”nnIn addition to establishing a prospective payment system for primary care, government and private payers need to provide significant and appropriate reimbursement for innovative care delivery models such as telemedicine, she says. “We have to get to a payment system that is agnostic about the way care is delivered.”nnOriginal article published on healthleadersmedia.com
This week’s coding conundrum is regarding the Modifier -25. Not all insurers will pay you for separate E/M services even if you code in compliance with CPT rules, but this code can help you get reimbursed for the extra work you do at certain visits. Read below to find out more and 
Recently, CMS has released a new set of guidelines and considerations to encourage healthcare practices and organizations to resume in-person care. Below are 8 things to know in regards to reopening healthcare facilities. Read the article below to find out more!nnCMS is encouraging healthcare organizations to reopen facilities for non-emergency care and released a new set of guidelines and considerations for them to follow.nnMany health systems suspended elective procedures in mid-March to keep patients and providers safe and ensure the capacity to care for COVID-19 patients. Efforts to restart those procedures safely are underway.nn”While telehealth has proven to be a lifeline, nothing can absolutely replace the gold standard: in-person care,” CMS Administrator Seema Verma said. “Americans need their healthcare, and our healthcare heroes are working overtime to deliver it safely. Those needing operations, vaccinations, procedures, preventive care or evaluation for chronic conditions should feel confident seeking in-person care when recommended by their provider.”nnEight things to know:n
Changes in E&M coding are important to go over including information regarding prescription drugs. This week’s coding conundrum goes over the parts of the table of risk and medical decision making. Read below to find out more!nnAs 2021 approaches and we think about the changes to evaluation & management (E&M) coding it’s more important than ever to really spend some time to break down what medical decision making (MDM) means and how to assign the correct level.nnMDM consists of 3 individual parts, but often it’s only the table of risk that is considered in choosing a level. Like for instance that if you write a prescription that is an automatic level 4. Wrong!nnIn the example of an established patient with well-controlled hypertension and allergies, they are at the clinic for a routine follow-up and prescription refill. They are feeling well with no other complaints. You review their most recent lab work which is within normal limits, write a prescription for the refill and the patient agrees to follow-up again in 6 months. This would be coded to a level 3, 99213, E&M visit.nnTo break it down, MDM part A would equal two, two stable established problems. MDM part B would equal one, review of lab work. And MDM part C would be of moderate risk for two stable chronic problems and prescription drug management.nnBased on our guidelines in CPT; “To qualify for a given type of decision making, two of three elements in Table 1 must be met or exceeded”. Below is a copy of the table referenced.nn
The Welter Healthcare Partners team is closely monitoring the payer updates for telehealth as they continue to unfold. Please do not hesitate to contact us if you have any coding or billing issues. Below is updated information regarding COVID-19 Telehealth and billing updates. 
Summer is here and many people are spending more time outside, swimming and taking vacations. It is very important to wear your sunscreen to protect yourself from the sun. Read below for more information from the American Academy of Dermatology about the importance of sunscreen!nnWith the “Official start of summer” (a.k.a Memorial Day) officially past and the reopening of many beloved outdoor activities after the shutdown from COVID-19, it’s more important than ever to remember your sunscreen.nnEspecially after so many of us just spent months indoors. The American Academy of Dermatology (AAD) has a great two-minute video as well as 5 tips for proper sun protection.nnSo get outside, enjoy your favorite activities, and do not forget to apply that sunscreen, it’s finally summer!nn