Health care reform explained in “Health Reform Hits Main Street.”nnConfused about how the new health care reform law really works? This short, animated movie — featuring the “YouToons” — explains the problems with the current health care system, the changes that are happening now, and the big changes coming in 2014.nnnnSource: www.healthreform.kff.org; Kaiser Family Foundation; September 17, 2010.
Medicare has started the 3 year effort to re-validate ALL Medicare providers!nnYou will be receiving a notification letter. You (the provider) only have 60 days to complete and submit the proper forms that must be completed.nn
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
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n…You need assistance with Credentialing!nCall us at 303.534.0388 or email us at info@WHPelter.com!nnWe have an entire credentialing department ready and willing to assist with these issues and help get your practice back on track!nnAdditional Important Credentialing Updates:nn Effective October 29, 2012 Novitas Solutions, Inc. (formerly Highmark Medicare Services) will become the new Medicare Contractor (MAC) for Colorado (no longer Trailblazer). With this transition, Novitas will REQUIRE new EFT’s (form 588) be completed and submitted for ALL practices and providers! Failure to complete an updated 588 for Novitas will result in claims denials and disruptions in your cash flow!nn Medicare has started the 3 year effort to re-validate ALL Medicare providers!n You will be receiving a notification letter. You (the provider) only have 60 days to complete and submit the proper forms that must be completed.nn All Physical Therapy Assistants must be certified by the State Physical Therapy Board by June 1, 2012 in order to work as a PTA in Colorado! To learn more, visit www.dora.state.co.us.nn Ensure your physicians/providers PECOS enrollment information is up to date! Failure to do so can result in unexpected denials of claims due to the provider being terminated from Medicare!nn Effective July 1, 2012 there will be a change in copay amounts for some Child Health Plan Plus (CHP+) State Managed Care Network members. Members will begin receiving new ID cards in June with the updated copay amount.nn Practices that employ a Surgical Assistant will be required to go through a new and more extensive credentialing process with HealthOne facilities in order to maintain privileges. The new process is more time consuming so start early! nn If you need assistance with any of the above, please call or email us!
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 following is a portion of the article “Mapping Out Revenue-Cycle Solutions” as provided by Health Leaders Magazine.nThe full version may be found here. nn
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. Click here for the rest of the article.nnSource: healthleadersmedia.com;Karen Minich-Pourshadi; May 1, 2012.
As you may be aware United Healthcare and its Secure Horizons product line has recently taken interest in the use of CPT code 99211 with a sudden increase in audit activity. Along with UHC, more and more payers are requesting notes in an effort to verify proper provider documentation, coding and claims payments.nnSecure Horizons, and any payer, has the right to audit documentation they also have t
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
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nWe urge you to use 99211 and other E&M codes when the services are rendered and documented properly.nnIf you receive a documentation request from Medicare, Secure Horizons or any other payer please fully comply as non-compliance may initiate non-payment. If your notes are reviewed and you disagree with the results, we can help you develop a strategy to appeal the finding!nnIf you need assistance please call us at 303.534.0388 or email us at info@rtwelter.com
Medicare Revalidation – Medicare requires that ALL enrolled providers and Suppliers to revalidate enrollment information every 5 years. The revalidation initiative is currently in process and will continue through March 2015. You have 60 days from the date of the revalidation notice to submit your application(s).nnProviders are required by regulation to submit updates and changes to enrollment information in accordance with specified time frames. Reportable changes include: 1) Change in legal business name, 2) Practice location, 3)Ownership, 4) Authorized/delegated official, 5) Changes in payment information such as changes in EFT information and, 6) final adverse legal actions.nnFailure to comply with any of these requirements in a timely manner may result in Medicare billing privileges being deactivated.nn nn
Exploring the New iPad – The primary update is the addition of a new high resolution ‘retina display’. This 9.7″ screen has a resolution of 2048 x 1536 which is sure to appeal to to the wider medical community. Radiologists will now be able to view images in unrivaled resolution on a mobile device. Physicians will also find the increased resolution useful when reviewing images on hospital systems. Given the importance of medical imaging in the diagnostic process, today’s announcement will help propel iPad adoption.
nnIn order to power this increased resolution, the new iPad has an A5X processor which is quad-core meaning apps will run quicker. Initial reports suggest that this iPad will ship with 1GB of RAM which means the overall ease of use, multitasking and switching between apps will be improved. Furthermore, the faster processor could help with screen sharing and remote control apps (e.g. Citrix) and remote virtual apps (e.g.OnLive) which could open up more tablet EHR options. The improved graphics processing capability will help improve 3-dimensional modelling such as that seen in the Visible Body or the NOVA anatomy apps.nnThe next major feature which will impact physicians is the introduction of voice dictation. Whilst Siri is noticeably absent from the new iPad, there is now a button which allows the user to dictate. This obviously has numerous medical applications from recording patient notes and entering data into EMRs to dictating letters. It will be interesting to see if the voice dictation feature can cope with medical terminology although regardless, data entry speed is sure to be enhanced. This introduction of voice recognition also paves the way for Siri integration in a future update.nnThere is an enhanced five MegaPixel camera in the new iPad which is similar to the one found in the iPhone 4S. The enhanced resolution of this camera combined with the improved graphics processing in the A5X chip means that the iPad has the potential for improved integration and usage in telehealth care. The new iPad has the ability to record video in 1080p HD resolution which would offer increased resolution in a telehealth care setting.nnAnother major feature announcement is that the new iPad will have high speed 4G LTE internet available on both major carriers, Verizon and AT&T, although you will have to purchase a specific iPad depending on your carrier. High speed internet combined with the increased graphics capability and camera resolution is sure to have numerous applications in telemedicine and mHealth in general.nnIn adnnThe iPad model allows healthcare providers to connect to Bluetooth-enabled medical home monitoring devices that collect patient data. Specifically, Bluetooth-enabled medical devices such as stethoscopes, blood pressure monitors and pulse oximeters can measure a patient’s diagnostics and securely transfer the data to the iPad.nnData from these medical devices can also be quickly added to a patient’s electronic health record or to a personal cloud-based health record such as Microsoft’s HealthVault, either or which can now be monitored remotely by a physician with an iPad.nnSource: www.imedicalapps.com; Tom Lewis; March 7, 2012; www.beckersasc.com
PAHCOM Shares Knowledge!nFounded in 1988, PAHCOM is a national organization dedicated to promoting professionalism in physician office practice management by providing professional development opportunities including continuing education, networking, online tools & resources, and nationally recognized certification (CMM) for health care office managers.nnOctober 16, 17, 18, 2012 Susan and Todd speak at PAHCOM’s national meeting in Clearwater Beach FloridannPAHCOM www.pahcom.com
Did you know?: Welter Healthcare Partners has several long term training affiliations with local, regional and national residency training programs. We routinely meet with the residents (1st year, 2nd year and 3rd year’s) to teach and discuss coding, contracting and business principals of healthcare. Does your residency program need industry experts to come speak to the residents?
Colorado’s Primary Care Fund provides grants to healthcare providers who care for underserved populations and meet specific qualifications. The funds are generated from the collection of tobacco taxes in accordance with Section 21 of Article X (Tobacco Taxes for Health Related Purposes) of the State Constitution.nnThe Primary Care Fund application process requires that providers must use a formula to submit the percent of unduplicated users/patients served by the applicant agency who are enrolled in Medicaid and CHP+ or medically indigent. This data must be certified (or verified) by an outside entity prior to the submission of the application.nn Welter Healthcare Partners is qualified as an outside entity to complete the certification of the numbers of unduplicated user/patient counts for the Primary Care Fund application. If you need assistance with your Primary Care Fund application, contact Welter Healthcare Partners immediately at 303-534-0388.nnFor more information, visit http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1214812846117
Did you know that Medicare is having ALL providers re-validate over the next 2 years? This has to be done right, on-time, even with the proper color ink! Don’t leave this to chance or to someone who does not have experience. Failure to do it right and on-time will cause your payments to stop. You will drop out of Medicare if this is not done properly!
We have found that CPC Certification NOW will allow for a much easier transition to ICD-10 than waiting for ICD-10 to be incorporated into the CPC exam. If you are thinking about becoming certified – do it today!
Gone are the days where we used to sit on opposite sides of the table and throw rocks at each other. The payers need the providers and the providers need the payers! We can work together. It still takes a clear understanding of data, timing and leverage to make for a good business relationship. Learn more…
Payers make mistakes – If you find that you are swimming in appeals, payment errors, loading issues, late payments, improper adjustments, etc. it may be a Credentialing issue, it may be a bad contract. We have solutions.
Todd Welter talks about the pitfalls of credentialing. Who has to do it and the services required.nn
Award winning MicroMD version 7.6 is ready! If you are on MicroMD PM and/or EMR and not on version 7.6 please call our sister company Medical Data Management Group at 303.396.6485 or log on at www.
Todd Welter talks about getting back to the basics for accounts receivable and your processes. Learn what does not work and stop doing it… Ensure each member of your team is playing a significant role in the efficiency of operating your business to run a successful practice.nn
There is a lot of activity with healthcare reform with healthcare spending 17-18% of the gross domestic product. Listen to Todd Welter talk about the healthcare reform and sustainable growth rate (SGR) method. For more information on how Welter Healthcare Partners can help your practice, contact us today.nn
As you may already know, the ICD-10 deadline has been extended for possibly up to one year. Listen to Todd Welter, president of Welter Healthcare Partners, to discover how often you use ICD-9 codes and to learn how to effectively teach your team the significance of ICD-10.nn