Clinical, Financial and Administrative Insights For Physicians

EHR Interoperability & National Patient Identifier - Are they Related? If so, how?

Posted by Suzanne Prasad

With a population of more than 321,000,000 people, it’s not surprising that patient identity mix-ups continue to plague the U.S. healthcare industry. The push for electronic health record (EHR) interoperability has only magnified the problem. Without a unique national patient identifier (NPI), the likelihood for errors and patient safety implications grows significantly as providers continue to engage in larger-scale health information exchange (HIE).

This article addresses four important questions about the NPI and what it could mean for EHR interoperability.

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(Updated) Primer on Modifier -25? Use it but don't abuse it.

Posted by Suzanne Prasad

When used appropriately, modifier -25 can enhance revenue for a physician practice. That’s because reporting this modifier allows physicians to bypass an Outpatient Code Editor (OCE) edit to receive additional payment. However, physicians must understand the rules regarding this modifier—and the documentation required to support it. No physician wants to discover after the fact—during an audit—that he or she must pay the money back.

Here are some facts about modifier -25 that can help physician practices maintain compliance.

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Struggling with Practice Revenue Streams? Here are 10 top ways to revitalize them

Posted by Suzanne Prasad

Many practices are struggling to do more with less revenue, due in part to changes in the Affordable Care Act, shifts in reimbursement models, and an increase in consumerism in the health care landscape. In fact, Forbes recently reported that the average provider (across all medical specialties) is seeing top line revenue drop by over $50,000 per year since the health reform law went into effect.

If you're looking at anemic revenue streams, there are steps you can take to revitalize your existing streams and explore new options to beef up your bottom line. Here are 10 steps any practice can adapt and use to bring more revenue through the door.

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Comprehensive Guide to MACRA Implementation : Proposed Rules Simplified For You

Posted by Suzanne Prasad

Data collection in calendar year (CY) 2017 will form the basis for CY 2019 physician payments under the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) incentive regulation, according to a proposed rule released on April 27. The 900+-page rule specifies implementation details of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS has also published a fact sheet summarizing the rule.

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Cloud-based EMR vs. Client -Server based EMR - What Is Right for Your Practice?

Posted by Suzanne Prasad

The explosive growth of Software as a Service (SaaS) technology has opened the door for even small and medium-sized practices to access a full-featured EMR systems without the major investment in infrastructure that accompanies any client-server based EMR (aka server-based EMR). This makes Cloud-based EMR (aka web-based EMR) very attractive for groups who want to implement a new system or upgrade to a more robust EMR. But each of these two types has its own strengths and weaknesses, so it's important to understand how each works with your practice and your ongoing needs. Here's what you should know before you reach a final decision. 
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7 Remarkably Easy Tips to Prevent and Manage Claim Denials

Posted by Suzanne Prasad

‘Denial’ and ‘rejection’ are two words that no physician wants to hear. Yet, the unfortunate reality is that many physician practices lose money every day to claims that fail to meet payer requirements, Yvonne Dailey, CPC, CPC-I, CPB told attendees at the 24th annual HEALTHCON conference sponsored by the American Academy of Professional Coders. The conference, held in Orlando, Fla. last month, drew nearly 2,700 medical coding professionals.

During a presentation about denial management, Dailey spoke about how denials and rejections have only increased over time due to the increase in the number of carriers nationwide, each of which has its own nuances and rules for payment.

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5 Key Merit-Based Incentive Payment System (MIPS) Concepts Physicians need to know

Posted by Alok Prasad

What is MIPS?

Medicare reform—specifically the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APM)—is the number one issue affecting physicians in 2016, according to the American Medical Association.  That’s because beginning in 2019, physicians must choose to participate in either MIPS or APMs as part of a larger shift away from fee-for-service payment toward value-based reimbursement.

Although 2019 may seem far away, the reality is that many practices need to start researching their options now. Navigating through this complex payment maze takes time and effort.

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5 Key Alternative Payment Models (APM) Concepts Physicians need to know Today

Posted by Suzanne Prasad

What is APM?

After years of physician payment cuts based on a flawed Medicare sustainable growth rate, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)  establishes two payment tracks from which physicians must choose beginning in January 2019: the Merit-Based Incentive Payment System (MIPS) or an Alternative Payment Model (APM). This article focuses five concepts physicians need to understand about APMs. In a followup post next week, we will provide an explaination on MIPS. 

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7 Most Important Tips to Boost Your Revenue Cycle in 2016

Posted by Suzanne Prasad

It’s a fact: Without an effective—and efficient—revenue cycle, physician practices cannot weather the storm of ongoing reimbursement changes in today’s healthcare environment.  ICD-10, for example, has forced practices to take a closer look at their overall revenue cycle efficiencies as well as specific documentation and coding practices. Other regulatory changes, such as the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APM), continue to drive process improvement. A solid revenue cycle is the one constant amidst ongoing—and oftentimes unpredictable—change.

To ensure financial survival, practices must examine their revenue cycle regularly, looking for gaps and vulnerabilities and then taking steps to improve processes. This article provides seven tips practices can use to improve their revenue cycles in 2016 and beyond.

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Wondering What You Missed at HIMSS16? Here’s some news that you can use

Posted by Suzanne Prasad

With more than 41,000 attendees and 1,200 exhibitors in attendance, there was no shortage of activity at the annual Health Information Management Systems Society (HIMSS) Annual Conference and Exhibition in Las Vegas last week. Even though it seemed like everyone in the healthcare industry was rushing from session to session and booth to booth at the show, we realize that not all medical group professionals were able to join the frenzy in Sin City. That’s why we’re providing this round-up of the most important news from the show.

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