Sounds Like a Good Idea… But Is It?
It would be better that you know that it is a good idea.nnPutting together a well thought out and honest Proforma can prove the business case of an idea…or disprove it.nnAll revenue has an expense, all expenses should have some attributable revenue. A proforma is a list of both revenue and expenses in incredible detail and granularity. If there is a business case a thorough proforma will prove it. And…as a bonus the proforma calculations can become your budget control document to keep good ideas good.nnWe do medical management proforma’s… we we do them well! Spend a few bucks to insure that you will make a lot of bucks.nn
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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.
Welter Healthcare Partners is excited to present our helpful career advancing tips and strategies to sharpen the skills prospective employers look for in a coder!nnSoft Skills: What are they exactly? And why are they so crucial to landing your dream job? Soft skills are used synonymously with interpersonal skills and are always in high demand. These are typically skills that are more social than technical like standard job-related requirements. Soft skills include a broad range of areas – here are just a few examples: communication, executive presence, gravitas, relationship-building, decisiveness, self-motivation, leadership, team work, creativity, and resiliency. Employers desire candidates with strong soft skills as these skills are invaluable to the success of any business and are imperativento fostering a dynamic workplace.
The Republican Health Bill financial analysis will reveal whether or not the bill will miss required targets, and ultimately determine if the House will have to redo the vote.nnHouse Republicans are waiting anxiously for a new financial estimate on their Obamacare repeal proposal that could force them into a do-over on the bill they barely passed early this month.nnSpeaker Paul Ryan says he is uncertain about the nonpartisan Congressional Budget Office analysis of the measure’s budget impact — critical for meeting Senate rules that would let the GOP pass it with a simple majority amid unanimous Democratic opposition.nn”We have every reason to believe we are going to hit our mark,” Ryan of Wisconsin told reporters Tuesday. Still he added, “CBO scores have been unpredictable in cases in the past.”nnFor the health plan to comply with requirements for using a streamlined Senate process called reconciliation, the CBO will have to conclude that it reduces the deficit by at least $2 billion over 10 years. If not, the House will have to redo the bill to meet that standard and vote on it again. And that won’t be easy after the weeks of negotiations and revisions that led to the American Health Care Act’s May 4 
Welter Healthcare Partners is excited to present our monthly Code Spotlight! Each month, Welter Healthcare Partners will spotlight a unique CPT or ICD-10 code to profile and discuss practice applications of the code, as well as pertinent guideline reminders. nn99211: 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.) is designated as the GO-TO Nurse/RN visit. In the majority of post-payment audits of 99211, the findings are conclusive – the code is widely misreported. The key to compliantly billing 99211 is that the documented face-to- face encounter must have an actual impact on the patient’s care. Merely doing a BP check, drawing labs, or administering an injection when the information obtained does not lead to management of a condition or illness, would not constitute a billable service. There should be clear documentation in the chart regarding patient/clinician exchanging medically significant and necessary information and there is management of the patient’s care via medical decision making (e.g. change in med regimen).
Centers for Medicare and Medicaid Services (CMS) Issues Section 1332 State Innovation Waiver ChecklistnChecklist Aims to Help Stabilize State Health Insurance Markets for 2018nnThe Centers for Medicare and Medicaid Services (CMS) released new information to help states seek waivers from requirements in the Affordable Care Act (ACA). The new tool is intended to help states complete waiver applications that allow them to establish high-risk pools/ state-operated reinsurance programs. Section 1332 waivers, generally can be used by states to opt-out of some mandated provisions under ACA.nnCMS is helping to provide guidance to states who want to pursue solutions to help lower costs and increase coverage choices for Americans struggling with unaffordable premiums and reduced competition in the insurance market, brought on by the ACA. Individuals obtaining coverage in the ACA marketplace have faced double-digit premium increases and insurance issuer exits.nnNationally, premiums on Healthcare.gov have increased by an average of 25 percent for 2017. The state of Arizona saw insurance costs go up more than 100 percent and one-third of counties in the U.S. currently only have one insurer participating in the exchange. Two insurance carriers in Iowa recently announced they were exiting the market, leaving Iowans in jeopardy of having no insurers participating in the exchange in 2018.nn“Today’s guidance addresses the ACA’s impact in driving up insurance costs and reducing choices,” said CMS Administrator Seema Verma. “State initiated waivers that implement high-risk pool/ state-operated reinsurance programs will help lower premiums, stabilize the health insurance exchange, and meet the unique needs of each state.”n
CMS published three informative resources to guide eligible clinicians participating in Merit-based Incentive Payment System (MIPS) in 2017: a fact–sheet on MIPS participation, another on MIPS data reporting for clinical improvement activities, and a list of qualified registries available for reporting MIPS data.nnWith eligible clinicians transitioning to the federal program this year, these clarifying resources will answer many lingering questions regarding MIPS reporting for the Quality Payment Program under MACRA.nnThe MIPS participation fact–sheet offers a concise overview of who is expected to participate in MIPS, what participation entails, and the guidelines for voluntary participation. Additionally, the MIPS participation fact–sheet provides information on what is expected of clinicians practicing in rural areas (RHCs) or federally qualified health centers (FQHC).nnThe fact–sheet specifies RHCs and FQHCs are not required to participate in MIPS if they are billed as such, but clinicians practicing in critical access hospitals must participate. Further, the MIPS participation fact–sheet outlines who is exempt from MIPS and all special rules for certain MIPS eligible clinicians.nnThe MIPS improvement activities fact–sheet is designed to help clinicians understand the requirements of the MIPS clinical improvement activities performance category. Given these activities are an entirely new performance category, additional information is likely welcomed by clinicians.nnThis CMS fact–sheet lists which improvement activities eligible clinicians can choose from, how to submit information for this performance category, and what the reporting criteria are for receiving credit. The fact–sheet also lays out the scoring methodology for groups including the different weights of each activity and how these weighted activities translate on the point scale.nnFinally, CMS addresses scoring for alternative payment model (APM) participants and the procedure for submitting potential future improvement activities to add to the list of existing CMS-approved improvement activities eligible clinicians can choose in the coming yearsn