MACRA facts that every clinician should know

MACRA is here and the new program is going to sunset several (un) popular programs such as Meaningful Use and the Value Based Payment Modifier model. Everybody who is anybody is busy discussing about MACRA and its ramifications. But as with any big updates the myths are jostling for space with the facts. We’ve sifted the facts from the myths for you.

Myth #1: MACRA will make maintenance of certification mandatory

Fact #1: MACRA doesn’t make it mandatory for physicians to participate in maintenance of certification. It is certainly not compulsory.

Myth #2: MACRA will affect only physician reimbursement.

Fact #2: There is a common myth that MACRA will only affect physician reimbursements. It will affect the reimbursement of all eligible clinicians. The eligible clinicians who will have to report under MIPS are physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurses and anesthetists.

Myth #3: Clinicians can choose between MIPS and  participating in AAPMs right at the outset.

Fact #3: All eligible clinicians will report under MIPS during the first year. CMS will select qualifying physicians to participate in AAPMs after evaluating their quality scores.

Myth #4: MIPS penalties are higher than the current quality measure programs

Fact #4: MIPS stream lines and consolidates 4 different programs under one umbrella. Instead of paying separate and sometimes expensive penalties for failing to meet different pay for performance programs, clinicians who report under MIPS will only have to pay a 4% penalty during the first year.

Myth #5: MACRA will penalize physicians who follow the fee for service model

Fact #5: It does not. Physicians can still choose to continue working with the FFS model can still participate in the MIPS program.

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Healthcare CFO's Top Challenges

“We really do believe much harder times are coming from a reimbursement standpoint”, Daniel Morissette, Stanford Health Care CFO.

With value based model, the most unpredictable payment reform, in their list of financial challenges, CFOs point out their threats and decision making factors.

“We’re trying to evaluate all of the different services we have and evaluate how they will fit into what we believe is the future of healthcare”, Donald Longpre, CFO, North Ottawa Community Health System

“It’s not just the fact that we’re going to get paid less for what we’re doing. We’re also seeing a shift in business,” Chris Bergman, CFO, Christ Hospital Network, Cincinnati. CMS is nipping at little things”, Bergman said on what was worrying him.

When it comes to experience:

“You need to understand the issues, test your theories, and subtly verify your assumptions along the way,” says Tom Gibney, CFO of St. Luke’s Cornwall Hospital of Newburgh, New York, when asked about how experience plays a role in decision making. “The buck stops with you,” he says. “The board is looking to you for answers”, he quoted.

Reimbursement declines, physicians shortage, healthcare reforms and other factors have forced CFO’s to use their experience in answering how to recoup the losses and improve the organization’s cash flow.

We organized the data collected from recent surveys to find out the challenges of healthcare CFOs in a value based era and the factors which influence their decision. Based on the results here’s a data driven answer.

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how our ICD-9 code conversion to icd 10 tool works

Type in the ICD-9 code you need an ICD-10 match for. Once you enter the ICD-9 code the ICD-10 mapping results will be displayed below the search box. Every ICD-9 to ICD-10 mapping is created based on thorough analysis by our certified coding experts.

There may be one-to one mapping to certain ICD-9 –ICD-10 searches or multiple mapping results. When there are multiple mappings provided, rely on your clinical documentation to arrive at the accurate code. If your search ends up in a "no record found" alert, please verify the accuracy of the ICD-9 code entered.

Source On: Medical billing star

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How CMS' EHR incentive plan is working — and what the next steps are for your practice

When family physician Christopher Tashjian attested for Stage 1 of CMS' "meaningful use" program bright and early on April 18, 2011, most other practices hadn't even picked out an EHR.

By April 2012, as few as one in five providers had attested, according to CMS' count.

The purpose of the meaningful use program, and the stimulus dollars attached to it, was to digitize America's healthcare-recordkeeping system — creating a data-based boon, say proponents, for providers and public health advocates alike. But the program got off to a slow start, and questions have emerged about the efficacy of the program and its administration by the government.

Is the incentive program working as it was intended? Let’s look at the details — past, present, and future — to find out.

The EHR incentive: a look back

CMS published the final rule for its Medicare and Medicaid EHR incentive programs to the Federal Register on July 28, 2010. Enacted in the Health Information Technology for Economic and Clinical Health (HITECH) Act — part of the American Recovery and Reinvestment Act of 2009, aka the federal stimulus — the nearly 300-page rule outlines how "eligible professionals" (EP) and hospitals can qualify for incentive payments for demonstrating meaningful use of a certified EHR.

The first step in receiving the money (a maximum of $44,000 paid over the course of five years) is to attest that during a 90-day reporting period, providers used their EHR in a meaningful way by fulfilling 15 core requirements (such as maintaining an active medication-allergy list for more than 80 percent of patients), five out of 10 menu set objectives (such as implementing drug-formulary checks), and six clinical quality measures (such as adult weight screening and follow-up).

This represents just Stage 1 of the three-stage program. To receive the full financial incentive, CMS requires the completion of all three stages. (CMS has also outlined a separate program for providers who wish to qualify through Medicaid.

To help small practices, the government's Office of the National Coordinator for Health Information Technology (ONC), has so far awarded more than $720 million through 62 Regional Extension Centers. The RECs provide free and low-cost assistance to qualifying practices to ease their EHR transition and help them achieve meaningful use.

EHRs by the numbers

What does CMS have to show for all of this effort? The government's figures show it is now meeting its objectives, despite getting off to a slow start.

CMS finished 2011 well below its stated objectives of at least 40,000 meaningful users attesting via the Medicare program and 21,100 meaningful users via Medicaid. The actual numbers at the end of last year: 15,361 for Medicare and 15,439 for Medicaid. But the government says it has already closed the gap between its projections and the reality: As of May 31, 2012, 110,000 providers (roughly one out of five eligible for the program) have received some portion of the more than $5.7 billion paid out so far to hospitals and providers under one of the two programs, according to CMS. How did CMS go from about 30,000 meaningful users to more than 110,000 in only five months? It did not respond to our request for an explanation, but if its most-recent data are correct, then it is now on track to meet its goals of between 48,700 and 154,700 meaningful users under Medicare, and between 34,000 and 93,700 under Medicaid by the end of 2012.

If it meets its most ambitious objectives, about half of America's eligible providers will be meaningfully using an EHR by the end of the year.

 
Source from Physicians Practice.

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Basic Medical Terms Your Practice Staff Should Know

Get the most benefits at the least costs !

Last week, we talked about the difference and definitions of major insurance types in "Medical Insurance Primer for Practice Staff." A fellow blogger pointed out that many patients are also not aware of the differences between copay, co-insurance, and a deductible. Below are some additional terms for your staff to have that will easily explain these differences to your patients.

Allowed Amount: Amount of the billed charge the insurance company deems is payable by the plan.

(MORE: Medical Insurance Primer for Practice Staff)

 

Assignment of Benefits: The patient or guardian signs the Assignment of Benefits form so that the physician or medical provider will receive the insurance payment directly.

Authorization: Approval by the health plan if the physician wants to refer the patient to a specialist.

Bundling: Method by which the insurance company decides to combine payment for two or more medical services.

Capitation: Payment methodology in which the physician is paid a set dollar amount determined by a per member, per month calculation to deliver medical services to a specified group of people (like an IPA).

Carve‐Out: Medical services that are separated from a contract and paid under a different arrangement.

Case Management: A method by which a health plan attempts to control costs by directing all of the procedures for the care of an individual through a nurse or other healthcare professional.

Claim: Request for payment by a medical provider for a given medical service or item.

Consolidated Omnibus Budget Reconciliation Act (COBRA): Continuation of medical benefits once a member has left their employer.

Co‐Insurance: A percentage the patient is responsible for on a given insurance claim.

Contracted Provider (Participating): Provider that has an agreement with a health plan to accept their patients at a previously agreed upon rate for payment. They are deemed as "in‐network."

Copayment / Copay: A fixed dollar amount an insured person must pay when medical service is received.

Deductible: Set dollar amount which must be satisfied within a specified timeframe before the health plan begins making payments on a claim.

Explanation of Benefits (EOB): Summary of the payment made by your health plan to the medical provider.

Fee-for-Service: Method of payment for medical services rendered.

Fee Schedule: List of CPT codes and dollar amounts an insurance company will pay.

HCFA 1500: Standard claim form used by health plans on which to consider payment to the medical provider.

ICD‐9 / ICD-10: Standard format of identifying the illness, injury, or disease by using a three-digit to five-digit code.

Medical Necessity: Medical procedure or service must be performed only for the treatment of an accident, injury, or illness and is not considered experimental, investigational, or cosmetic.

Out‐of‐Pocket Expense: Amount the patient must pay (and not paid for by the insurance plan).

Pre‐Existing: Medical condition diagnosed prior to the effective date of the health plan.

Usual & Customary: Reduction in the payment of benefits on a claim which is justified by the insurance company as “the going rate” to be paid in that geographical area.

These are the most common ones I receive questions about, can you think of any others that might be helpful?

Keeping this list in a convenient place for your staff is a great tool for them to utilize when communicating with your patients.

Source from Physicians practice

EHR Cloud Computing Meets Moore's Law

Searching for a billing company who understands your emr ?

In an increasingly computerized world, understanding why and how computers do what they do can have a direct bearing on how you evaluate the effects on care that are the result of having the computer in the loop. Also, in the future, today's medical students are going to be making decisions about computerization and other technology. What will form the basis for their decisions — their "knowledge" of Facebook or how to text with two fingers? This raises the question: How knowledgeable, not "computer-literate," but knowledgeable are you?

Take cloud computing for example. It's the latest high-tech buzzword but do you have any idea what that is? A new national survey by Wakefield Research, commissioned by Citrix, suggests that the answer is "not really" — over half of respondents, including a majority of [supposedly computer literate] Millennials, believe that stormy weather can interfere with cloud computing.

How about Moore's Law? In 1965, Gordon Moore observed that technology seemed to be enabling the number of transistors on a microchip to double every two years. In 1970, Carver Meade dubbed this "Moore's Law." A graph of microchip production suggests that Moore was correct. Some physicists believe that Moore's Law, while it describes the past, does not predict the future. As transistors are made ever smaller they approach the size at which atomic forces come into play, effectively defining a minimum size, and hence a maximum speed, of the circuits in question. This limit may be reached in the next five years to 12 years.

Even if Moore's law should fail, faster computers are not precluded, but speed will have to be achieved in some other way such as deploying multiple processors working in parallel. I will return to Moore's Law in a moment, but first a discussion about the cloud.

The cloud is double talk — just a shorthand for computing that takes place somewhere other than inside your computer whether that be actual computations, data storage and retrieval, communications, or search. Some bright folks thought that the concept of "elsewhere" was too nebulous so. Instead they chose a term that connotes that most nebulous of things — a cloud.

The aspect of the cloud that is important to you, especially if you are considering a cloud-based EHR, is that the cloud is at the other end of a narrow pipe. Every bit of information that you send or request has got to pass through that pipe. While it is easy and cheap to buy a faster computer, it is neither easy nor cheap to buy a faster pipe. The speed and capacity of the pipe has not been doubling every two years, it has been doubling every eight years to 10 years and there is no guarantee when or if it will double again. Conclusion, connection speeds never have, and never will, experience the exponential growth of chips.

When you are using remote computing resources, the speed of your local computer is almost irrelevant — well not completely, but if it is a recent model it is. Speed is dependent on two factors: 1) how much processing capacity the remote site is willing to allocate to YOU; and 2) the bandwidth (speed) of your connection.

There is a third piece to this story — application complexity. Every time you ask your EHR vendor for a new feature or the feds add certification criteria that require additional program code, the demands placed on the system increase. If the code is running locally, you may be able to offset the increased demand with a faster processor.

If the code is running in the cloud and if it requires more data to be transferred back and forth between your location and the vendor’s site, then the performance that you experience will get progressively worse as the applications get more complex.

Since this slowdown has to do with the speed of the connection, not the speed of my computer, Moore's Law is irrelevant. If all computing is going to be cloud computing, I will never again need to buy a new computer — and I will become increasingly dissatisfied as the speed continues to degrade.

This is one of many reasons that I choose, as much as possible, to keep my computing local. You might want to carefully consider any decision to outsource your EHR to the cloud. Assuming that you choose an EHR that has the potential to "speed you up" if run locally, it could slow you down if run remotely, in the cloud.

Source from Physicians Practice