Mar 15, 2018 | Uncategorized
CTCi group, the center for transformative coaching, is offering two sessions to help management teams and other professionals understand the importance of effective management. These web based sessions are developed in a way to help you and your employees succeed!nnnRead more about each individual program and click the link below each description for more information or to register.nn nn
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12-week, Virtual Course — “Coach-Approach™” to Effective Management
nLike two wings of a plane; one being technical skills and the other people skills, we oftentimes focus so much on the technical skills that we fail to develop our staff in the “people skills of good business”. And yet, it takes both wings to fly a plane or both skill sets to build a “good to great” organization. Ironically, it is the failure in people skills that typically “brings the plane down” (or the major project!). But it doesn’t have to be this way!nnInvest in yourself and/or your managers today by taking CTCi’s “Coach-Approach™” to Effective Management 12-week, virtual course. Learn the 11-Core Competencies of coaching and discover how to draw out the “greatness and giftings” of your staff to build high-powered; synergistic teams. What should you do next?n
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- Click here to find additional, detailed, information including the date and time of the next available cohort.
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30 Minute FREE Webinar — Why Professionals Hire a Coach, and Why They Don’t!
nCoaching is one of the fastest growing professions with revenues in excess of $2B annually. But why? Why are professionals oftentimes hiring coaches and perhaps just as importantly, why are many not? In this 30-minute live webinar, John Seville, CEO of CTCi Group, will explore these questions and host a dynamic Q&A session with attendees. If you’re considering hiring a coach, this is a “must-attend” webinar you don’t want to miss!n
Mar 7, 2018 | Uncategorized
Health and Human Services Secretary Alex Azar said Monday that value-based healthcare “needs to accelerate dramatically” in the U.S., calling for a range of changes to the healthcare system that he said would provide more tools to give consumers more control over their care.nn“This is no time to be timid — today’s healthcare system is simply not delivering outcomes commensurate with its cost,” said Azar, speaking at the public policy conference for the Federation of American Hospitals in Washington.nnAzar’s speech focused on value-based care, an approach in which doctors and hospitals are reimbursed by private health insurance and the government for how well patients emerge after a medical procedure versus the amount of care provided. That method was also cited by the Obama administration as a priority, and Azar during his speech called out that work, saying that value-based care was “taken seriously by President Barack Obama’s administration as well.”nnHe noted that while policymakers had been discussing such potential changes since the early 2000s, the shift was just getting started and was “still far from reaching its potential.”nnHe laid out areas the Trump administration plans to emphasize, promising to deliver “disruptive” changes in healthcare, including giving consumers more control over their health information, encouraging more transparency from healthcare providers and payers, using experimental models in Medicare and Medicaid, and removing government burdens.nn
Azar stressed the need for patients to better understand what medical care will cost them, citing examples such as knowing the price of a medical procedure or a prescription drug. He also cited examples in which providers spend an extensive amount of time reporting their outcomes, which can limit the amount of time they can deliver care.nn”Our current system may be working for many, but it’s not working for patients and it’s not working for taxpayers,” Azar said.nnAzar was sworn in as secretary five weeks ago and will be speaking at the policy conference for America’s Health Insurance Plans on Wednesday. Chip Kahn, president of the Federation of American Hospitals, called Azar the “perfect pick for the times” in remarks ahead of Azar’s speech.nnHe reiterated his overall priorities Monday were to focus on value-based care, combat the opioid crisis, bring down the cost of prescription drugs and to lower the cost of health insurance for people who do not receive coverage through the government or through work.nn“This administration, and this president, are not interested in incremental steps,” Azar said. “We are unafraid of disrupting existing arrangements simply because they’re backed by powerful special interests.”nnThis article originally posted on washingtonexaminer.com.
Mar 7, 2018 | Uncategorized
No is a request for informationnIn all things inter-personal, No means No. In managed care contracting, No is a request for information. In other words, if you have a reasonable request which makes sense, don’t take no for an answer. It may take time, it may take a different approach but stay on it, fight for what you believe in and keep working it until you get the desired result.nn Welter Healthcare Partners does Managed Care Contracting and we do it well. We interpret “no” from the health Plans as a request for Information.nnHealth Care Provider’s IncomenYou have to find ways to “make money while you sleep.” Being a health care provider is a great profession and all the rest of us appreciate your education, experience, skills and talents but in the current fee-for-service world and even most risked based reimbursement models you have to be working to get paid. I don’t care how much you make, it is not enough if you only get paid when you actually are working.n
Stay tuned for more Todd’s Tips!
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About R. Todd Welter • MS, CPCnFounder and President of Welter Healthcare Partners
nMr. Welter has over 25 years of healthcare industry experience assisting physicians and other providers, hospitals and other facilities with the business side of medicine. Through strategic planning and analysis, Mr. Welter’s main focus is to strategically increase revenues and profitability in this radically changing health care environment.
Mr. Welter has a Masters Degree in Organizational Leadership from Regis University in Denver where he has had an appointment as affiliate faculty in the School for Professional Studies for over ten years. In addition, Mr. Welter holds a faculty appointment at the University of Denver’s University College. In the Health Care Leadership program he teaches Macro Economics in Health Care and Innovative Strategies and Change in Health Care to graduate students.
Feb 26, 2018 | Uncategorized
nnAs many of you have been following this story, a new update has been released regarding the Anthem payment cut. Read the latest update below, including quotes from Anthem Executive Vice President and Chief Clinical Officer, Craig Samitt.nn
nnThe company had planned to reduce by 25 percent payments for evaluation and management services reported with modifier.nnAnthem has dropped its plan to reduce by 25 percent payments for certain evaluation and management codes.nnThe policy was to have gone into effect on March 1 across the company’s commercial health insurance businesses.nnThe insurer made the policy change in response to strong opposition from the American Medical Association and other physician groups, the AMA said on Friday, the same day it heard from Anthem.nnAnthem Executive Vice President and Chief Clinical Officer Craig Samitt told AMA Board Chair Jack Resneck, Jr., MD, that Anthem is rescinding plans to implement the policy to reduce payments by 25 percent for evaluation and management codes reported with a current procedural terminology modifier 25.nnAnthem had made the move to avoid duplicate payment for fixed or indirect practice expenses when physicians bill an evaluation and management service appended with modifier 25 along with a minor surgical procedure performed on the same day.nnHowever, Anthem said it believed that making a meaningful impact on rising healthcare costs required a different dialogue and engagement between payers and providers.nnAnthem plans to formally notify its contracted providers within the next few days of its decision.nn”Anthem’s decision to drop its planned modifier 25 policy is a positive step forward, demonstrating again that when doctors and health plans work together, the best outcome for patients can be achieved,” Resneck said. “This policy is one of a number of issues that the physician community has been working on with Anthem, and the AMA looks forward to continuing these efforts to find ways to collaborate on strategies to deliver affordable, high-quality, patient-centered care.”nnThe other issues include Anthem’s policies on the retrospective denial of payment for emergency room visits, restrictions on advanced imaging in hospital outpatient facilities, and the denial of payment for monitored anesthesia care or general anesthesia for cataract surgery.nn”Anthem remains committed to continuing to work with the AMA, state medical associations and national medical specialty societies to address physician concerns with the company’s policies and guidelines,” Samitt said, adding he looked forward to together tackling rising healthcare costs in a meaningful way.nnOriginal article posted on healthcarefinancenews.com.
Feb 22, 2018 | Uncategorized
Recent news released by The Colorado Medical Society shares the response from Anthem regarding the reduction of payment for services that are provided on the same day. Read below for more information on the correspondence between CMS and Anthem:nnThe Colorado Medical Society, American Medical Association and other state medical societies have been actively advocating against a plan by Anthem Blue Cross Blue Shield to reduce payment for significant, separately identifiable evaluation and management (E/M) services that are provided on the same day a procedure is performed or a wellness exam is conducted.nnThe company announced in December that it would reduce the size of its planned pay cut from 50 percent to 25 percent and move the implementation date to March 1, 2018. CMS sent a letter on Dec. 15, 2017, from CMS President M. Robert Yakely, MD, to Elizabeth Kraft, MD, medical director of Anthem BCBS in Colorado.nnIn her Jan. 29 response, Kraft defended the pay cut citing duplication of the fixed/indirect practice expense when performing a minor surgery and E/M service on the same day by the same provider. “To redress the duplicative payment, Anthem’s Policy reduces the office visit reimbursement by 25 percent and, thereby, reduces the double payment for fixed/indirect practice expenses.”nnYakely responded on Feb. 12 that there is no overlap of indirect practice expense and that “by providing two separate and distinct services during the same visit the physician can be more efficient, streamline care for the patient and facilitate a prompt diagnosis, potentially avoiding additional out-of-pocked expense for the patient” – particularly for those in rural areas or seeking certain types of specialty care that have long wait times for non-emergency appointments. He continued, backing up his point that codes are already adjusted by the Relative Value Scale Update Committee (RUC) and that further reductions are inappropriate.nnCMS stands by its original request that Anthem retract the new modifier 25 policy without delay. Watch for more information as this issue develops.nnNews updates provided by Colorado Medical Society, February 19, 2018.
Feb 16, 2018 | Uncategorized
Leading insurance company, Aetna has been under investigation for insurance claim reviews by former medical director for the company. Health insurance is a tough industry to navigate to ensure proper charges and reimbursement but Welter Healthcare Partners is ready to help! Contact us today to see how we can help your practice so you can get back to treating patients!nn
nn nnCalifornia’s insurance commissioner has launched an investigation into Aetna after learning a former medical director for the insurer admitted under oath he never looked at patients’ records when deciding whether to approve or deny care.nnCalifornia Insurance Commissioner Dave Jones expressed outrage after CNN showed him a transcript of the testimony and said his office is looking into how widespread the practice is within Aetna.nn”If the health insurer is making decisions to deny coverage without a physician actually ever reviewing medical records, that’s of significant concern to me as insurance commissioner in California — and potentially a violation of law,” he said.nnAetna, the nation’s third-largest insurance provider with 23.1 million customers, told CNN it looked forward to “explaining our clinical review process” to the commissioner.nnThe California probe centers on a deposition by Dr. Jay Ken Iinuma, who served as medical director for Aetna for Southern California from March 2012 to February 2015, according to the insurer.nnDuring the deposition, the doctor said he was following Aetna’s training, in which nurses reviewed records and made recommendations to him.nnJones said his expectation would be “that physicians would be reviewing treatment authorization requests,” and that it’s troubling that “during the entire course of time he was employed at Aetna, he never once looked at patients’ medical records himself.”nn”It’s hard to imagine that in that entire course in time, there weren’t any cases in which a decision about the denial of coverage ought to have been made by someone trained as a physician, as opposed to some other licensed professional,” Jones told CNN.nn”That’s why we’ve contacted Aetna and asked that they provide us information about how they are making these claims decisions and why we’ve opened this investigation.”nnThe insurance commissioner said Californians who believe they may have been adversely affected by Aetna’s decisions should contact his office.nnMembers of the medical community expressed similar shock, saying Iinuma’s deposition leads to questions about Aetna’s practices across the country.nn”Oh my God. Are you serious? That is incredible,” said Dr. Anne-Marie Irani when told of the medical director’s testimony. Irani is a professor of pediatrics and internal medicine at the Children’s Hospital of Richmond at VCU and a former member of the American Board of Allergy and Immunology’s board of directors.nn”This is potentially a huge, huge story and quite frankly may reshape how insurance functions,” said Dr. Andrew Murphy, who, like Irani, is a renowned fellow of the American Academy of Allergy, Asthma and Immunology. He recently served on the academy’s board of directors.nnClick here to read original article in it’s entirety on cnn.com.
