Friday, January 29, 2021

2021 tax changes physicians should know

As we enter 2021, it is always a good idea to take note of changes to the tax code as well as some items that remained unchanged. This will allow you to plan appropriately for the upcoming year.


Here are the adjustments made for 2021:


The Standard Deduction was increased to $12,550 for single filers and those who are married but file separately. Head of households had their Standard Deduction increased to $18,800. Married couples who file jointly saw their deduction increase to $25,100.



There was not a change to the income tax rates, but the brackets were increased slightly.




The capital gains rates also remained unchanged, but the income bracket that determines those rates increased. Those who file as married filing jointly and earn $80,800 or less will pay a 0% capital gains rate. Single filers and married filing separately earning $40,400 per year or less will pay a 0% capital gains rate and head of households earning $54,100 or less will also pay a 0% taxable gains rate. Adjusted net capital gains up to $501,600 for joint returns; $250,800 for married individuals’ separate returns; $473,750 for head of household returns; and $445,850 for single individual returns will pay a 15% capital gains rate. The capital gains rate for earnings above these amounts is set at 20%.


The maximum contribution amount an individual can put into an employer provided retirement plan remained unchanged. Individuals will still be able to contribute $19,500 and the catch-up contribution for those age 50 and older remains at $6,500. For SIMPLE retirement accounts the contribution limit remains $13,500 with a $3,000 catch up.


No changes were made to the maximum annual contribution amount someone can contribute to an Individual Retirement Account (IRA). The limit remains at $6,000 for both pretax or Roth IRAs and the catch-up for those 50 and older is unchanged at $1,000. The modified gross income (AGI) phaseout for being able to deduct contributions to a to a traditional IRA for single and heads of household who are covered by a workplace retirement plan is between $66,000 and $76,000. The income phase-out range for married couples filing jointly, in which the spouse who makes the IRA contribution is covered by a workplace retirement plan, is $105,000 to $125,000. The income phaseout for an IRA contributor not covered by a workplace retirement plan and who is married to someone who is covered, is between $198,000 and $208,000 in 2021.


The Roth IRA AGI phase-out range for singles and heads of household increased to between $125,000 and $140,000. For married couples filing jointly the phase out range increased to between $198,000 and $208,000. You can still contribute to a Roth IRA if your income exceeds these amounts, but you will need to open a nondeductible IRA and convert each contribution and move it into a Roth IRA. This is commonly referred to as a backdoor IRA.


There were additional changes to the Alternative Minimum Tax (AMT), individual tax credit, and allowances for fringe benefits, MSAs, and estates.


As a reminder, the special tax provisions enacted as part of the CARES Act, which was passed to provide relief during the COVID-19 pandemic, expired at the end of 2020. The old rules regarding distributions, loans, and RMDs are now back in effect unless extended by new legislation.


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Thursday, January 28, 2021

Best Practices for Optimizing Revenue Cycle Management: Why credentialing matters

The coronavirus pandemic has stretched practices to their limit, with increased patient demand and extra precautions putting even more strain on busy providers and their staff. While the primary focus remains on keeping patients healthy and safe, today’s providers are continually challenged with attending to the business side of their practice, too.


For many practices, improving their billing and collections procedures, and ensuring they get paid properly for their services, has remained top of mind this year, particularly as the industry evolves to value-based care. But credentialing–one of the fundamental aspects of revenue cycle management (RCM)–is often overlooked. If practices and providers are not credentialed by government and private payers, or they neglect to renew their credentials, RCM is stopped in its tracks. Without credentials, they cannot legally bill patients for services or collect revenue. It can take months to recover that revenue stream, with a very real risk of losing substantial income in the process.


RCM Credentialing: A Labor- and Time-Consuming Process


Credentialing—or the process of contracting with insurance companies and obtaining hospital and facility privileges–can take anywhere from 90 to 120 days; COVID-19 is putting more pressure on the process. Due to the pandemic, healthcare organizations have had to rapidly scale their provider networks to handle spikes in demand—but until they’re credentialed, those providers cannot start treating patients or submitting claims.


Most practices typically do not dedicate sufficient staff to this complex legal and regulatory process. The work required to manage this is considerable: each individual provider may need credentials for 25 or more payers, each of which has different requirements and renewal schedules. What’s worse, many practices may not even realize there’s a problem until denials come pouring in. Certain Remittance Advice Remark Codes (RARCs) and Claim Adjustment Reason Codes (CARCs) can signal that there are credentialing issues. Then, it’s up to the staff to dig deeper with each payer to see if it’s a simple problem, such as an error in the provider’s identification code, or worse—lapsed or no credentials—and try to fix it quickly so claims can be approved and payments can be made.


Maintaining Key Performance Indicators for RCM


Lack of credentialing not only adds work for the staff, but it also negatively impacts practice key performance indicators (KPIs), such as:


Days in Accounts Receivable (AR) – The goal for time from submission to closing of a claim should be thirty days. But without proper credentials, this time can increase significantly. It could take up to 21 days just to get notification of claim denial, and during this time that provider could have seen hundreds more patients insured by this payer, whose claims will also be denied. Not only will it take more time to fix the denial, but several months could also pass before the provider is properly credentialed, resulting in the need to write off all the claims in question.


Aging Claims – Ideally, practices will want to ensure at least 75% of all claims are completed within 60 days. Trying to correct credentialing issues can take much longer, with claims continuing to age during that time. By identifying credentialing issues early, and ensuring that renewal timeframes are met, practices can keep their claim aging KPI in check.


Clean Claim Rate – The goal of every practice should be to obtain reimbursement upon the first claim submission, since denied claims mean no revenue. Claims denied for credentialing are not clean. Ideally a practice strives to maintain a 90% or higher clean claim rate. But consider if your practice has credentialing issues with a major payer -- a significant number of claims will lead to additional work simply because credentialing was not up to date.


Staying Ahead of the Credentialing Process


Taking a proactive approach to credentialing is vital to the fiscal health of your practice, whether it’s reviewing new providers who were added to help with pandemic-related demand, or ensuring existing providers are still eligible to be reimbursed for the services they provide.

For new providers, make sure to take the appropriate steps to get them credentialed, which includes collecting information about contracting with desired government and private payer insurance companies and obtaining national provider identifier (NPI) numbers for the practice and clinicians. When the applications are completed, review the terms and rates of the contract, and negotiate any objectionable conditions.

Once they have been credentialed, it’s up to both the provider and your practice to ensure there are no lapses. Reminders should be set, using Outlook, Office 365 or other calendaring apps to complete recredentialing or revalidation in a timely manner. Most insurance companies will require these updates every few years. They can be very strict, not allowing for retroactive reauthorization, which could put claims at risk of non-payment.


Outsourcing Can Keep Credentialing on Track


Given the complexity and time demands associated with credentialing and managing claims, many small practices do not have the staff to keep up. In these cases, outsourcing these efforts to a third-party vendor can alleviate much of the burden.

These vendors can provide a variety of services from software to track the credentialing process to a holistic offering that includes helping practices obtain and maintain credentialing for all providers. Working with a third party that has expertise in the credentialing process can save significant time—condensing the process from 90 days to as few as 15. And it can save your practice money by having staff ready to handle the paperwork and claims denials, and ensuring that revenue streams continue uninterrupted.

In times like today’s global health crisis, it’s vital to ensure that providers’ credentials are up to date so they can continue providing the best care available to patients while maintaining the viability of the practice.


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Wednesday, January 27, 2021

Enhance cardiac patient monitoring while streamlining practice workflow

For years cardiologists have relied on traditional remote cardiac monitors. A legacy monitor either requires the patient to return the unit to the physician’s office or mail it back to a third-party service provider after a period of days and wait for results—sometimes delayed by weeks—while the third-party performs the diagnostic analysis. In a scenario where the monitor diagnosis eventually shows evidence that an arrhythmia has occurred, the delay puts the patient at risk. The delay also eliminates cardiologist control over the data review, timing, diagnosis, and care of the patient.


Now doctors can fit a patient with a device and get immediate and current full-disclosure data over a secure internet connection. If a patient remotely presses a button on the device or calls reporting experiencing symptoms, the cardiologist can quickly see the patient’s up-to-the-minute data on a cell phone, tablet, or PC and make a critical cardiac arrhythmia diagnosis instantly. This is a dramatic alternative to having a patient return the legacy cardiac monitor, to a third-party provider and wait on the results.


Changing Protocols and Workflows


Gaining clinical adoption for any change is the biggest hurdle for cardiologists. Changing clinical workflow is very complex and difficult for a process that likes routine and repeatability. Deviation finds clinicians having to stop and explain “why” ─ and they don’t have time for that. Fitting into workflows or improving them is the battle cry for vendors. Yet even if you have a better workflow, the technology must work. The task: make a clinician’s job easier, provide a way to provide safe and effective care with less worry on the technology and more focus on the patient. Cardiologists want total control over the device, feedback, and diagnosis for patient outcomes.


Electrophysiologist Michael Mazzini, MD, shared his cardiology practice’s experiences adding a full-disclosure remote monitoring device (RMD) to their testing protocol.

“One of the concerns that we initially had, especially in our busy, independent practice, was a potential disruption in workflow for our staff; however, it has been very easy to on-board people and has streamlined our workflow quite a bit. For example, if we have a patient who has never had any telemetry monitoring, we can start Holter monitoring, and if the Holter is nondiagnostic, we can transition them to event monitoring or MCT with just the click of a button. This has made things remarkably easy for the physicians and staff. It eliminates making a patient turn in an old unit to check out a different one or wait a period of time before they get a different unit.”

Looking Ahead


As a result of the COVID-19 pandemic, many families are encouraging and setting their older family members up with the connectivity and the devices they need to take advantage of a telehealth visit. In many cases the patient may be able to avoid a trip to the emergency room while a phone call or video call may direct the patient to visit the hospital immediately.

In order to make telehealth accessible to everyone, we must implement connectivity for patients in urban, suburban, and rural areas. Finally, physicians must have the information they need which requires access to patient data in real-time—from monitoring devices, testing platforms, and laboratory systems.


The future of cardiac patient care is in elimination of redundant processes experienced when using a third party to provide monitoring services—while providing real-time, fast diagnosis, and revolutionary cardiac arrythmia care.


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