Anthem Finalizes Beacon Health Acquisition

Mar 4, 2020 | Uncategorized

Anthem has recently finalized its acquisition of Beacon Health. This deal will allow for the expansion of critical behavioral health services, which will provide more care across the country. Read the article below for more information regarding the new changes that will come to Beacon and Anthem.nnAnthem, Inc. on Monday said it has finalized its previously announced acquisition of Beacon Health Options, the nation’s largest independently held behavioral health organization.nnFinancial terms were not disclosed for the sale of Boston-based Beacon, which had been held by Bain Capital Private Equity and Diamond Castle Holdings. The newly acquired BHO will move into Anthem’s Diversified Business Group.nnBeacon serves 36 million people and almost 3 million individuals in comprehensive risk-based behavioral programs. Indianapolis-based Anthem said the acquisition creates an opportunity to combine existing behavioral health capabilities “with Beacon’s successful model and support services in order to enhance whole-person care.”nn”We are pleased to complete the acquisition of Beacon Health Options and are excited to expand our critical behavioral health services to more people across the country as part of our focus on true whole-person care,” Anthem CEO Gail K. Boudreaux said in a media release.nn”Consumers and health plan customers alike will benefit from our ability to scale and integrate physical and behavioral capabilities in new and meaningful ways to improve lives,” she said.nnWhen the deal was first announced last June, Beacon CEO Russell C. Petrella said the acquisition would provide Beacon will scale to expand service options.nn”Together, we will expand access and enhance the quality of care for our mutual members,” Petrella said in a statement. “I am proud of the talented and committed team at Beacon, and we look forward to our future with Anthem.”nnOriginal article published on healthleadersmedia.comnn 

Cloned Notes

Mar 4, 2020 | Uncategorized

When we go to the doctor, someone puts notes into our file. If you see these notes, some entires might be strikingly similar. This is called cloned notes. Below in this week’s Industry Hot Buttons, we go over cloned notes and how they can be an issue. Read the article below to find out more!nnCloned notes, as defined by CMS, are entries in a patient’s health record that are identical or strikingly similar to other entries in the same or another patient’s health record.nnEMR’s have made the lives of health industry professionals easier in so many ways. Unfortunately, they have also created a few headaches.nnMany people may not have known him until his recent passing, but Lawrence “Larry” Tesler was one of the computer scientists who created the “copy/paste” function.nnThis function has completely changed the way that each of us uses technology every day and is a function some of us would be lost without, myself included.nnThe problem is when this is over-utilized in the medical record. It leads to contradictions in our notes, unnecessary information, and often times the needed and pertinent information is left out.nnAs far back as 2013 the OIG has had Cloned Notes on their radar. It can lead to loss of integrity of the documentation and even damage the trustworthiness of the clinicians.nnIn a recent issue of Healthcare Business Monthly from the AAPC, an article entitled “Skirting the Dangers of Cloned Notes in Healthcare Practices”, writer Terry A. Fletcher explores the issues surrounding this and the risks it puts your practices at.

Saying Goodbye to Cofinity.net

Feb 27, 2020 | Uncategorized

You may have heard that Cofinity.net is being sunset and we’ll no longer be using directprovider.com. These sites have been replaced with a new secured provider portal at firsthealth.com, a self-serve center that’ll support your network needs by offering claim search functionality, a complete client list, access to news and updates, and much more. Read the article below to find out more about this important change.nnIn just a few short weeks you’ll no longer be able to access Cofinity.net at all. Already, you might’ve noticed that the site is no longer interactive, and we aren’t processing password resets or new registration requests. We’re very proud to offer you this streamlined, self-serve, single-portal that connects you to both First Health and Cofinity network resources.nnHere’s a brief description features available on the First Health-Cofinity website:nnSecure LoginnnThe new secure login feature allows providers to access the First Health-Cofinity network portal on FirstHealth.com using their user ID and password. All providers will need to register as first-time users to access this feature.nnDemographic and TIN Updates Registered providers can submit demographic and TIN updates right on the website.nnClaim Activity ReportnnThis feature will allow providers to run ad-hoc reports for claim(s) within a specified time frame.nnClaim SearchnnThe new provider claim search functionality allows registered providers to search for claims by TIN and DOS. Providers will also be able to submit claim appeals if they are questioning the pricing. Appeals will be sent to our customer service team for review.nnClient ListnnProviders will be able to view an online list of all the clients (payers) contracted. Registered providers can even view details, like affiliations, address, and phone number for each client in the list.nnInformation provided by cofinity.net

Five Heart-Healthy Exercises You Can Do at Your Desk

Feb 27, 2020 | Uncategorized

February is Heart Health Awareness Month, so we all wear red and talk about our hearts, but what are we doing every day to make sure we are keeping it healthy? How many hours each day, week, month do we each spend at our desks without so much as a break to get water? If you’re like us, we can sit at our desks for hours on end. So next time you open a different patient chart, or are waiting for a webinar to start or a webpage to load, here are a few exercises you can do right at your desk to promote heart health.nnJust because you’re at the office, that doesn’t mean you can’t incorporate some desk exercises to keep your cardiovascular health on track. Short bouts of exercise between conference calls and checking emails will help improve fitness levels and heart health while burning a few extra calories. In addition, a minimal amount of extra activity can help limit additional weight gain.n

Trump Administration Details Hospital Spending Plans in FY21 Proposed Budget

Feb 19, 2020 | Uncategorized

The Trump Administration has released their healthcare spending proposal for FY21. These plans are said to foster cost transparency, break down barriers impeding choice and competition, and reduce regulatory burdens. Read the article below to learn more about the Trump Administrations hospital spending plans for FY21.n

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• Hospitals cuts proposed in the FY21 budget include $117 billion in site-neutral payment cuts for on-campus hospital outpatient departments (HOPDs).

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• Hospitals would lose $87.9 billion over 10 years from limits on bad debt payment increases.

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• Hospitals would lose $47.2 billion from site-neutral payment policies for off-campus HOPDs.

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nIn what could be a 2021 preview if Republicans take control of Congress and retain the White House, the Trump administration included a range of sweeping healthcare policy proposals targeting hospitals in this week’s release of its proposed budget.nnThe Trump administration’s FY21 budget proposal emphasizes healthcare policies that would foster cost transparency, break down barriers impeding choice and competition, and reduce regulatory burdens.nnAlthough the current Congress may ignore the budget, the proposals could come back as last-minute funding sources for big budget packages or as part of major healthcare policy changes in the next Congress.nnThe budget projected savings of $844 billion over 10 years through implementation of a “Health Reform Vision Allowance,” which entailed:n

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• Reforming Medicare’s primary care service payments

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• Implementing a value-based purchasing program for hospital outpatient departments (HOPDs), ambulatory surgical centers and post-acute care facilities

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• Offering incentives to improve quality and health outcomes

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nProposed healthcare funding levelsnnThe Centers for Medicare & Medicaid Services (CMS) is projected to spend $1.2 trillion in FY21, or $47.6 billion more than in FY20. The budget proposes $1.6 trillion in CMS spending cuts over the next decade. Those cuts include $756 billion to Medicare over 10 years, which is projected to extend the Hospital Insurance Trust Fund by 25 years.nnThe budget also includes $920 billion in Medicaid cuts over 10 years, in part through increased eligibility enforcement and anti-fraud measures.nnThe budget would provide $5.7 billion for the 1,400 community health centers, which operate more than 12,000 care delivery locations and serve more than 28 million patients.nnHospital revenue would be significantly affectednnThe budget includes policies that would directly affect hospital revenue in widely varying ways, including:n

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• Limiting uncompensated-care bad debt payment increases to the consumer price index for all urban consumers (87.9 billion in savings over 10 years)

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• Requiring site-neutral payments between on-campus HOPDs and physician offices for services, such as clinic visits, commonly provided in nonhospital settings ($117 billion in savings)

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• Eliminating Medicare bad debt payments for disproportionate share eligible hospitals, exempting rural hospitals ($33.6 billion in savings)

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• Requiring all off-campus HOPDs to be paid under the Physician Fee Schedule ($47.2 billion in savings)

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• Allowing increased Medicaid copayments for nonemergency use of emergency departments ($1.8 billion in savings)

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nThe bad debt payment cuts would principally hit urban safety-net hospitals, said Chad Mulvany, a director of healthcare financial practices with HFMA.nnMeanwhile the site-neutral payment cuts would “blow teaching hospitals out of the water,” Mulvany said.nnAmong savings to Medicare more broadly, the budget projects that already-implemented changes to payment arrangements for Medicare accountable care organizations will save $2.9 billion over 10 years.nnPotential good news for hospitalsnnAmong the administration’s priorities is reducing the regulatory burden for providers. The Department of Health and Human Services (HHS) touted a reduction of $25.7 billion in regulatory burdens between FY17 and FY19.nnThe administration aims to add to that amount by requiring regulators to:n

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• By August 2020, issue finalized regulations on processes and procedures for issuing guidance documents

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• By the end of February 2021, establish a single, searchable database on the HHS website that contains, or links to, all of the agency’s guidance documents currently in effect

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nThe budget proposes medical liability reforms that would save HHS $27.2 billion and the federal government $40.3 billion over 10 years. Those reforms include capping awards for noneconomic damages at $250,000, indexed to inflation.nnAnother proposal would consolidate the four hospital quality payment programs in the form of a 5% payment cut that hospitals could earn back.nnThe budget would risk-adjust payments to HOPDs and ambulatory surgical centers based on the severity of patients’ diagnoses, in a budget-neutral manner.nnA value-based purchasing program for HOPDs and ambulatory surgical centers would be implemented, with 2% of payments tied in a budget-neutral manner to performance on quality and outcome measures.nnFor primary care physicians, the budget would create a risk-adjusted monthly Medicare Priority Care payment for providers who are eligible to bill for evaluation and management services and who provide ongoing primary care to Medicare beneficiaries. That payment would be funded by a 5% cut to all nonprimary care services and procedures.nnThe budget would eliminate the requirement that physicians certify all patients at critical access hospitals (CAHs) who are reasonably expected to be discharged or transferred within 96 hours of admission.nnCAHs could voluntarily convert to an emergency hospital that does not maintain inpatient beds, while receiving the same Medicare payment rates as other emergency departments, plus an additional payment to assist with capital costs.nnImpacts on bundled payments and other value-based payment policiesnnA major cut in the budget that was not targeted at hospitals but could directly affect their performance in value-based payment models was the $101 billion in 10-years savings from the establishment of a unified post-acute care payment system across all four post-acute care settings, including long-term care hospitals.nnSuch cuts could eliminate the source of nearly all of the savings obtained by hospital-led bundled payment participants, Mulvany noted.nn”If you suddenly go site-neutral on post-acute care, I don’t know why I join joint bundles, or really any bundle; there’s no savings there at that point,” Mulvany said about how hospital finance leaders might perceive such a change.nnThe budget would incentivize participation in advanced alternative payment models (APMs) by eliminating the participation thresholds needed for physicians to qualify for the 5% APMs bonus.nnIn another proposed tweak to the physician payment system, the budget would alter the Merit-based Incentive Payment System (MIPS) to assess performance at the group practice level instead of the individual-clinician level during the performance period, to reduce physician reporting burdensnnStriving to shore up rural hospitalsnnRural providers were a big focus of the administration’s budget.nnThe administration aims to build on its 2019 temporary increase in the wage index for hospitals in low-wage areas, which are primarily rural hospitals, with a proposed pilot to implement further changes to the Medicare inpatient hospital wage index.nnThe budget also would build on the expanded use of telehealth for Medicare Advantage plans with a comprehensive package to promote rural access to care and telehealth in Medicare fee-for-service.nnRural hospitals would be exempted from the proposed site-neutral payment cut to on-campus HOPDs.nnA new Medicare prospective payment system would be established for rural health clinics, with annual updates based on a market basket derived from cost report data and rebased periodically. Those changes would save an estimated $1.8 billion over 10 years.nnRural health clinics and federally qualified health centers could become distant-site providers for Medicare telehealth and be paid at a composite rate similar to that for comparable telehealth services under the Medicare Physician Fee Schedule.nn340B targeted with oversightnnThe budget would increase scrutiny of the 340B discount drug program, which is used by about 12,000 safety-net hospitals and clinics. A new $34 million oversight initiative for 340B would be established, funded in part by a new user fee based on 340B sales.nnAnti-fraud initiatives includednnThe administration said it cut the Medicare fee-for-service improper payment rate to 7.25%, the lowest since 2010, and projected that continued savings from anti-fraud program changes will provide another $31.4 billion over 10 years.nnThe budget would garner $20 million over the decade through new administrative fees for filing Medicare appeals, which the administration said is needed due to the filing of “non-meritorious appeals.”nnThe package of program-integrity legislative proposals is projected to improve payment accuracy, enhance provider and program oversight, reduce improper payments and support law enforcement.nnOriginal article published on hfma.org

Denial Rates for Modifiers 76, 77 & 91

Feb 19, 2020 | Uncategorized

In a recent release of 2018 benchmarks regarding modifiers 76, 77 and 79, the data of payment vs denials is staggering. For instance, a total of 159 codes reported with 91 and 249 codes that were reported using modifier 77 all had a 100% denial rate. Compared to the 952 codes that were denied when reported with 76 that doesn’t seem so bad. But considering your bottom line and the time it takes your team to resubmit it adds up to money lost. nnHowever when we step back and look at the big picture we see that modifier 76 although the most reported, still had the lowest overall denial rate at just 5%.n

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n nnWatching your reporting trends and utilizing billing reports will help make sure you avoid costly denials. Be aware of National Baselines for your specialty and where you fall within them.