6 Tips to Get Paid by Medicare

Accepting Medicare is one of many ways in which physicians can expand their practices. (See my previous article on the Pros and Cons of Medicare for Independent Practices.) That’s because even despite often having a lower fee schedule, Medicare tends to pay consistently and promptly, making it easier for practices to grow.

However, choosing to accept Medicare isn’t a ‘one and done’ decision. Instead, it requires a thoughtful approach to ensure that practices are paid appropriately, maintain adequate cashflow, and safeguard revenue so auditors don’t try to eventually recoup that money.


Below are six tips for practices that are new to Medicare:

1. Hire a nurse practitioner or physician assistant


The cost-to-revenue ratio is significantly lower when non-physician practitioners (NPP) treat Medicare patients, says Cohen. This means it’s ultimately more profitable when NPPs see these patients. This strategy also allows physicians to fill their schedules with patients whose insurance pays more per relative value unit. This allows the practice to accept and treat Medicare patients without having to drain all of the physician’s time and resources.

2. Be strategic when scheduling patients


For example, set aside a certain number of daily slots for patients with Medicare, Medicaid, and private insurance. Because Medicare often pays the lowest, consider setting strict limitations for the number of Medicare patients seen in a single day or week, says Cohen. Balancing the schedule in this way creates a cashflow equilibrium.

3. File clean claims every time


“Do it right on the front end so you’re not subject to an audit three years down the road,” says Cohen. “Clean claims are the secret to not only making—but keeping—money in this industry.”


Filing clean claims may require physicians to hire a certified medical coder. They’ll also need to budget for that individual’s ongoing continuing education. If the physician can’t afford a certified coder, then it’s best to outsource the coding function to a reputable company, says Cohen.


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4. Establish a compliance plan—and follow it


The Office of Inspector General (OIG) provides guidance for individual and small group physician practices to help them conduct internal monitoring, implement practice standards, develop corrective action and more. Following a documented compliance plan helps physicians stay on track, and it mitigates risk for denials and recoupments, says Cohen.

5. Work with your practice management vendor


Because Medicare’s National Coverage Determinations, Local Coverage Determinations, and National Correct Coding Initiative edits are completely transparent, physicians are most successful when they work with their practice management vendors to ensure that this information is loaded on the front end. This enables practices to validate claims prior to submission. Many systems also offer coding checks that validate procedural codes and modifiers.


It’s difficult to implement this same type of checks and balances with private payers, says Cohen. “The problem with private payers is that there’s still a lot of black box editing that goes on,” he says, adding that he recently had to look 22 pages deep into a payer’s website to find its payment policy.

6. Hire an external auditor annually


Under these self-disclosure and payback policies, the government and private payers are expecting physicians to hire an external auditor, says Cohen. External auditors can easily identify billing and compliance risk that could be potentially catastrophic when left unaddressed, he adds.


Choosing to accept Medicare can help physicians grow their practices, but only when implementing a strategic approach to stay profitable. This includes careful consideration of staffing, scheduling, billing and auditing.

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Can House Calls Increase Your Revenue in 2016 and Beyond?

 

If you’re looking to bring more cash into your primary care practice, leading-edge solutions like telemedicine may look appealing to you as a way to earn extra revenue. Although telemedicine looks to play a larger role in the future, the payment details, licensing requirements across state lines, and other important issues remain to be worked out.

What can you do in the meantime? Perhaps your income booster doesn’t lie in the forward-thinking medical services of tomorrow. In fact, maybe you should look to the past for a revenue-enhancing care delivery model.

House calls may be the retro solution to some very current problems – low reimbursements for primary care services and poor access to care for the elderly.

Financial Incentives
Medicare provides a higher reimbursement for home visits than it does for in-office encounters. If your practice is hurting financially and you typically see a wealth of Medicare patients on a given day, consider setting aside one day per week in which you solely offer house calls.

Sure, many doctors argue that the incrementally increased payment rate for house calls isn’t high enough to motivate them to see patients outside the office.

“Although demand for the service is building, the number of family physicians making house calls is shrinking,” Beth Loney Oller, M.D. points out in a June 2015 post for the American Academy of Family Physicians. She adds that, in a 2010 survey of AAFP members, 19% said they made at least one house call a week. By 2013, the number had fallen to 13%, and only 3% of respondents said they made more than two house calls a week.

How much more money you collect for a house call depends on the services you provide. In 2010, a new-patient visit performed in-office earned a doctor about $37 from Medicare. The same visit rendered at a home nets the doctor around $54 – just $17 more. But while the highest-level Medicare visit typically reimburses a physician around $131, if it’s performed in a patient’s home it’s reimbursed for about $165 – $34 more.

Potential Pluses and Minuses
As such, a well-planned day of house calls can certainly earn a physician more cash than a day of Medicare visits in the office. If that doc can additionally lower overhead expenses by paying fewer staffers to work in the office on “house call day,” the income impact can be even more significant.
Then again, seeing patients at their homes does require that you invest in portable medical equipment and pay the costs of transportation. But becoming comfortable with those expenses may now make you better prepared to earn significant house-call payments later.

A provision of the Affordable Care Act law mandated the creation of the Independence at Home (IAH) project, which CMS launched in 2012. The project goal is to look at “the effectiveness of delivering comprehensive primary care services at home” and determining if those efforts “improve care for Medicare beneficiaries with multiple chronic conditions.”

Not unimportantly, the IAH program offers incentives to participating healthcare providers who prove that they are providing quality care that reduces costs for Medicare. Practitioners who meet the CMS’ quality and patient satisfaction standards will be eligible to receive a portion of the money they help save Medicare through reduced numbers of hospitalizations, ER visits and tests. Results released in 2015 for the first year show of the practices who earned an incentive payment, the amounts ranged from $275,000 to $2.9 million.

The IAH estimates that Medicare spending could be reduced at least $15 billion a year – more than $150 billion over ten years – if the Independence at Home program were fully implemented across the country.

A New Subspecialty?
Believe it or not, the IAH may turn out to be a Medicare program that boosts payment, improves patient care and lowers costs. Even before the IAH leaves the demonstration phase, you may find that home visits are beneficial for your practice and your patients, thanks to those increased rates and increased demand discussed above.

Home care medicine is becoming a specialty, of sorts, within primary care, Steven H. Landers, MD, MPH, told Medical Economics. Especially regarding the care of homebound elderly patients, the future of home care looks bright. Increased Medicare payments, the overall aging of the U.S. population, mobile technology and data showing patients prefer home care could each contribute to the resurgence of the house call, says Dr. Landers, president and chief executive officer of VNA Health Group in New Jersey.


Map out your business plan and run some numbers to find out if house calls are right for you – you may discover that their higher Medicare reimbursements can boost your bottom line.

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How to Handle Timely Filing Claim Denials for Your Practice

 

 

Claims denied for timely filing remain a major challenge for medical billers. Each insurance carrier follows their own guidelines on what constitutes filing claims in a timely fashion.

Some insurers require claim submissions within 30 days and others allow up to two years. To cut your chances for these claim denials, follow their guidelines.

 

Reasons for Claim Denials

 

Multiple factors can contribute to submissions that end up as claims denied for timely filing. For example, insurance carriers sometimes report not receiving claims, even following timely submission. How the biller responds to these denials remains important.

 

In addition, initial mistakes on claims can cause enough of a delay that they also get denied for timely filing. A variety of factors can produce incorrect information on a claim, including a simple typo, the wrong insurance card presented by the patient at the point of care, or an incorrect transfer of patient information by the person in your office responsible for the medical billing and coding. Lots of things can go wrong.

 

On the plus side, you can still get paid for your services denied for timely filing. However, you need to know how to handle these claims effectively. Work out a strategy for handling claim denials for timely filing and just follow your protocol every time you encounter this problem.

 

Handling Timely Filing Claim Denials

Let’s say you send in a claim within the proper time frame. Then the claim returns denied because of an incorrect ID#, the misspelling of a patient’s name, submission to the wrong insurer or some other vexing reason. Your biller fixes the claim, resubmits with the correct information, and the claim returns once again, this time denied for timely filing.

 

Next you must appeal the denial.

 

Some carriers require special forms and others do not. Regardless, you should attach a copy of the claim and your proof of timely filing. Your proof should clearly show the dates for initial and later submissions. For example, produce a report for claims submitted and denied electronically. The report should show the initially incorrect information and the steps your medical biller took to correct the claim.

 

Even with paper-based claims, most practice management systems allow providers to generate a report with a timeline showing the original submission and subsequent filing dates for the claims in question.

 

In any case, insurers require electronically generated reports. In other words, they will not accept a handwritten note stating, “We submitted the claim on 1/1/2015.” In general, insurance carriers accept as proof reports generated from practice management systems because they cannot be altered.

 

Appealing Timely Filing Denials

Claims simply submitted too late and appropriately denied for timely filing can be more challenging to appeal. However, if a valid reason resulted in the delay, you can still attempt an appeal. For instance, a patient who initially reports no medical insurance at the time of treatment later discovers he or she did, in fact, have coverage. Submitting a claim for insurance reimbursement past the typical timeframe in this case might be justified.

 

To counter a denial in this case, write a letter detailing what happened, including why the patient changed their mind about insurance coverage. You might not win the appeal in every case, but it’s worthwhile to try.

 

Despite the many and considerable challenges that can hinder the timely filing of claims, it’s important to always work toward filing claims as quickly and timely as possible.

 

With good systems in place, you will be able to appeal them quickly and efficiently and increase the likelihood of eventually getting paid for your services.

 

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MD vs WebMD: Does Online Health Info Help or Hurt?

According to research from the Pew Internet & American Life Project, 80 percent of Internet users (making up 59 percent of U.S. adults), look online for health information.

Sure, the ubiquity of Internet access in modern society has changed the way Americans seek out information, in general. But in the case of healthcare, the widespread online availability of medical information is both helpful and troubling.

Online Health Information Can Be GoodPatients have more tools than ever to investigate medical issues and become educated about their personal health. Increased awareness of such matters can enhance overall health literacy, which, on a grand scale, is critical to lowering U.S. healthcare costs.

Effective use of high-quality healthcare resources on the Internet by interested individuals can positively impact medical outcomes. Often, patient research opens up a more informed, intelligent dialogue between patient and provider.

In fact, in a 2010 Epocrates study, the majority of physicians surveyed said that they found the online health information patients brought with them to encounters was helpful and increased enhanced doctor-patient communication.

Vetted, trustworthy online health services, like the Mayo Clinic Symptom Checker or iTriage’s Symptom-to-Provider™ Pathway, are effective means for patients to not only investigate an issue, but learn what action should be taken to resolve it.

A friend of mine used online tools to investigate his abdominal pain. After a few mouse clicks, he was told to seek immediate medical attention. His appendix was removed just hours later. Had he not used the Internet, he might have waited until his symptoms were unbearable and his condition had far worsened.

Being proactively informed and educated about healthcare is very important for patients, and services that help them find and take the right medical action at the right time have the power to save lives. So… what’s the big downside?

Online Health Information Can Be BadUnfortunately, the online health information interaction model isn’t always as positive as “proactive patient wants to become better informed.” Sometimes it’s more like “hypochondriac seeks validity of invented medical condition.”

“Ordinary consumers don’t have the training to interpret the vast amounts of medical information available online,” wrote an analyst in Euro RSCG’s 2012 trendspotting report. “Some react by worrying and bugging their physician unnecessarily.”

Others may self-diagnose or self-medicate without seeking a physician’s opinion, which can allow serious conditions to go unrecognized or mistreated. Plus, the risk of “psyching” oneself out through online searching also abounds – especially when a less-than-tech-savvy patient turns to a disreputable source.

Consider a patient who opens up a piece of mail from her gynecologist’s office that reveals abnormal Pap smear results. The letter says to call the practice, but it’s after-hours. She searches Google, finding forum discussions about painful procedures and cancer diagnoses. That could be enough to scare her out of making the phone call.

So-called “cyberchondria” takes many forms. Some also say that, on the whole, the prevalence of online health information has weakened patients’ trust in the physician’s medical authority.

If a second diagnosis opinion or alternative treatment plan is just a mouse click away, how do you know that your doctor is right about your condition and care? What’s stopping you from taking matters into your own hands?

Leverage Expertise to Your AdvantageFor better or worse, the Internet, and its ever-growing mass of content, is here to stay. You can’t beat the easy access it grants your patients to online health information, but you can join it – and if you haven’t yet, you should.

The key is to become the expert outlet your patients look to for information. In the example above, consider if that letter had directed the woman to go to her gynecologist’s practice website, where she’d find an unfrightening article on the next steps to take regarding the pap test results.

Providing Internet resources on healthcare is critical to ensuring that your clinicians are perceived as the ultimate medical authority in their patients’ lives. Patients need convenient access to health information. If you don’t provide it, they can’t turn to you, and they will go to other (sometimes less reputable) sources.

Look at the wealth of helpful links, friendly blog content, and useful healthcare information provided online to patients of Women’s Care of Wisconsin for an example of what to emulate.

And during a patient encounter, resist the urge to judge or get defensive with an oversearched “cyberchondriac.”

“Don’t look at it if your expertise is being challenged,” says Erin Sharaf, clinical coordinator and a clinical instructor in the PA program at Northeastern University. “See it as an opportunity to have a discussion with the patient, to educate them, explore what they are thinking, and to understand their beliefs and concerns.”

How has your practice positioned its online health information offerings?

 

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Don’t Let Meaningful Use Scare You Away From EHR Gains

 

Although CMS recently announced its intention to extend deadlines for both Meaningful Use Stages 2 and 3, industry analysts expect the number of practices opting out of the EHR program to continue rising. It seems the financial burden of MU attestation is too much for physicians to carry.

 

Because the penalty for not meeting Stage 2’s stringent requirements is minimal in comparison to the initial investment required for successful attestation, many physicians are choosing to not move forward into the next phase of the program. Not to mention, the bulk of MU’s incentive payments occur during Stage 1 – a goal many practices have already accomplished.

 

Abstaining from Meaningful Use may save practices money in the short run, but not realizing your electronic health record’s full potential puts physicians at risk of missing out on substantial gains down the road.

 

ROI of EHR

One of the key benefits of an EHR is that it allows your practice to go paperless, helping your staff cut down on the amount of time it takes to rifle through patient records and other documentation. Transitioning to a paperless practice can save thousands a year in office supplies, transcription costs and file storage space.

 

Clinical documentation is another key element of EHRs that lead to increased revenue. Because government insurance providers like Medicare require extensive documentation to dole out their reimbursements, many doctors only bill for services with written evidence. Unfortunately, this has been shown to eliminate up to 15% of legitimate reimbursements every year.

 

Oftentimes, paper claims are also “downcoded” to less expensive procedures because the payer considers the claim unnecessary or unsupported. This usually happens due to a lack of documentation. Using an EHR gives doctors the added value of documenting every aspect of a patient visit, and therefore increases the amount of claim revenue they’re eligible for.

 

Clinical EHR Benefits

EHRs can also boost profitability simply by saving physicians time during each clinical encounter. This allows them to see more patients a day. Two of the many common EHR features that improve physician efficiency include:

• Pre-populated templates that let you document common patient complaints more quickly than writing everything by hand
• ePrescribing functionality that allows physicians to rapidly build care plans in just minutes

Although the time saved on a per-visit basis may be relatively small, it adds up. For instance, if the time spent with each patient drops from 20 minutes to 18, figures show that you’ll be able to treat at least two more patients each day.

Even if this only brings in an extra $100 per patient, revenue per year could potentially increase by $50,000. Likewise, reducing your staff’s workload can dramatically cut down on business expenses and allow you to focus more on revenue-generating activities.

As you can see, the benefits of an EHR far outweigh the initial income drawbacks of training and implementation. And while the next two phases of Meaningful Use incentives may not seem too appealing, EHRs inevitably contribute to increased practice revenue through other means.

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Group Without Walls: A New Breed of ACO

 

With financial difficulties and regulatory changes leading to the consolidation of medical practices across the country, it’s become increasingly difficult for private practices to compete against the multitude of services offered by large provider groups. Unfortunately, joining such groups can leave formerly autonomous physicians battling the bureaucratic demands of profit-driven administrators.

So is there a way for solo providers to realize the benefits of joining a provider group while keeping much of the independence of private practice? The answer may be in the group without walls (GWW) payment model.

GWWs are basically a grouping of small practices, typically in the same specialty, that trade under a common tax identification number while allowing each member to maintain a significant measure of independence.

Observers say recent interpretations of federal regulations, which have upheld the GWW model’s validity, joined with lower reimbursement rates and rising costs, have convinced more physician practices to consider this type of merger.

Today, we’ll take a closer look at GWWs and whether or not your practice could benefit from this payment model.

Why Integrate?

Larger practice groups usually derive significant income from supplementary services like lab work, imaging, and therapy. As it stands, small practices lose out on these services because under current federal regulations like the Stark Law unaffiliated practices are not allowed to share auxiliary services.

But under the GWW model, secondary services fall under the group practice exemption to Stark regulations because they are housed under a common tax ID number.

GWWs can also negotiate better reimbursements with payers by leveraging the power of a wider geographic area and more patients. Because GWWs are more attractive to payers, they can be a great way of bringing in new sources of revenue.

In today’s unstable healthcare market, it’s vital to take full advantage of the opportunities made available to you. Otherwise, large payers may deem your practice a nonparticipating or out-of-network provider – a situation that could cost you hundreds of patients.

GWWs are seen as less restrictive because earnings are tied to productivity goals that physicians set themselves. And in return for a relatively low administrative fee related to the size of the practice, the practice receives a number of business services at a discount.

These services often include shared accounting, health and retirement benefits, liability and malpractice insurance, and legal services to ensure compliance with federal regulations.
When physicians don’t have to worry about these administrative hurdles, they have more time to get back to what is important: treating patients.

GWW Requirements

The typical ACO usually requires practices to pool funds, align business practices, and centralize management. But GWWs are different because none of these adjustments are mandatory.
The only requirements of a GWW are a common fee schedule among participating providers, standardized employees benefits like health coverage and 401k, and equally shared ancillary service revenue.

Besides these few requirements, all other decisions are left up to the individual providers. Some GWWs chose to systemize services such as billing or accounting and others hire managers to handle issues like payer negotiations, technology implementation and human resources. However, these decisions are solely up to the leadership team of the individual GWW.

Other things to consider when looking into the GWW model include:

- Legal: The services of a healthcare attorney are strongly recommended for anyone considering the formation of a large provider group.

- Accounting: Because the entire GWW group has to file a single tax return, all practices within the group should utilize the same financial entity to streamline bookkeeping.

- Payroll: An Internet-based payroll service that allows electronic deposits is essentially required.

- Employee benefits: This is a more complex issue for businesses with more than 100 employees as additional rules apply, but consider the use of an employee benefit company offered by the payroll vendor.

- Benefits package: Typically, the group must offer the same benefits to all employees if the total number of employees is greater than 100.

- Health insurance: The ability to save on health insurance premiums is often one of the most celebrated benefits for small business owners joining a larger business group.

Again, these are just suggestions as the GWW model does not require most of them.

So if you’re in good standing with similar providers in your area and are finding it difficult to offer certain services to your patients, GWW may be the right model for you. It can lead to more satisfied patients and increased profits.

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6 Time Management Tips for Healthcare Professionals

 

Physicians are already busy, but with the impending implementation of the Affordable Care Act, they’re about to get a whole lot busier.

According to Harvard University research, there could be as many as 22.4 million new patients flooding the market once the program is up and running. With patients’ health on the line, you don’t want increased demand to lead to sloppy service, which means now’s the time to start honing your time management skills.

Here are six time management tips for healthcare professionals that should allow you to treat more patients:

1. Establish Goals

When things get busy, the last thing you want to do is run around like a chicken with its head cut off. Take time to establish goals and create a sense of purpose for your work week. Set goals for 30, 60, and 90 days. Write them down, and discuss them with your supervisor to gain additional input. Then, schedule a few moments at the beginning and end of each week to review your goals, action items, and progress.

2. Prioritize Your Work Day

It can be tough to hit the ground running when you arrive for work, but time spent drinking coffee, wandering the halls, or checking Facebook is time wasted. Write out the specific tasks you need to complete each day and the time you need to complete them by. Check your list as soon as you get to work and post it in a prominent location. Stay on track by checking your list often and adjusting it as needed. You’d be surprised how much you can complete when you keep yourself accountable to a to-do list.

3. Take Advantage of Technology

Check out CareCloud, a software technology system designed to streamline healthcare practices by optimizing practice management and organizing health records. When your practice is online and organized, you and your patients save time. There’s even a mobile app for patients that allows them to review records, make appointments, and communicate with your staff. The less time you spend juggling administrative paperwork and phone calls, the more time you’ll have for patient care.

For more information on how CareCloud can provide the right set of tools to help you provide better care, visit their website.

4. Ask Your Organization to Use Electronic Health Records

If your employer hasn’t already done so, request that the organization switch to electronic health records. Electronic records cut down on paperwork while making it easier to find pertinent patient information. The faster you can access and update patient records, the more everyone benefits.

For more information on the benefits of transitioning from paper charts to an electronic record solution,

5. Delegate When Possible

Don’t assume you can do it all on your own. If there’s extra help available, use it. Medical assistants, administrative staff, interns, and volunteers are there for a reason, so take advantage of their help.

6. Know When to Say No

Your coworkers probably know you’re busy, but that won’t stop them from asking for help. Be realistic about your workload and only agree to take on projects or patients if you have the time. You may think you’re improving yourself and your career by taking on every project that comes your way, but if you end up overwhelmed, no one benefits. Increased stress and decreased productivity aren’t goals you should strive for, so carefully consider requests and know when to turn someone down.

Did you know that one hour of wasted time each day could result in 152 days lost during your career? Look into these time-saving tips and implement the ones you find promising. As your career progresses, you’ll be glad you did.

 

 

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