November 2013 - Capko & Morgan

The threads of payment reform and quality programs are coming together
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The threads of payment reform and quality programs are coming together

ACOs - Accountability Care Organizations, Affordable Care Act - Obamacare, CMS, medical practice business, Medicare, PQRS, VBPM

The threads of payment reform and quality programs are coming together

It seems like forever now that practices have been dealing with multiple, complex, incentive and penalty initiatives from the federal government: Meaningful Use, PQRI/PQRS, eRx, PCMH and, more recently, "value-based" programs (value-based purchasing for hospitals, and the upcoming value-based purchasing modifier for physicians). If you're like us, the onslaught of these programs has seemed more like a series of separate carrots and sticks (amplified by private payer programs that have built on the government's pay-for-performance approach) than a coherent strategy for driving change. Rarely do notices about these programs include helpful guidance as to how they're interrelated. (Perhaps it would just be to hard to fit those details in amongst the deadlines, bureaucratic details and confusing specs!) That is why it is at least helpful to finally be seeing -- after years of programs popping up and interrupting practice operations, demanding attention without saying why (except when why was 'get a bonus' or 'avoid a penalty') -- the outlines of inter-connectedness among all of the government's many programs. For example, Medicare's Physician Compare website provides information about a physician's participation in various quality initiatives, like PQRS and ePrescribe. (This is perhaps a good opportunity to remind you to check this -- and all -- the directories in which you or your providers are listed. There are often errors -- if contact, specialty or location data is incorrect on a key directory, it can cost you patients. And if the CMS has incorrect data about your participation in important incentive programs, you'll want to follow up on that immediately to remedy their data or your submissions. As we say all the time, this need to check goes for payer directories (!) and public directories like Healthgrades and Vitals.) Anyway, a sample of quality participation data as it is displayed on the Medicare site appears below. For some patients, knowing you're participating in these programs could make the difference in selecting your practice: Besides PQRS participation, the Physician Compare site shows participation in ePrescribe and Meaningful Use as well. Of course, the integration of this data into directories is just the beginning.

By Morgan|2022-01-01T22:52:12-08:00November 26th, 2013|

Reduce medical ID theft risk: check patient IDs at your front desk

Are your front desk staff members verifying ID and insurance cards when checking patients in? If not, they should be. Here's why: Checking ID is your first line of defense against medical identity theft -- and your patients'. By checking ID and comparing against the name in the record, you can confirm you are actually treating the patient (and not someone who stole or "borrowed" their insurance card). By asking for ID, you protect your staff against accepting fraudulently presented insurance, and protect your patients from medical identity theft. (Besides the hassle and financial consequences of medical ID theft for patients, there can be clinical consequences, too, because their records will be updated with the health information of the person using their insurance. The consequences of this can potentially be deadly -- and very difficult to fix.) Checking ID provides a convenient way to verify address at the same time. Patients may have moved and not realize how important it is to let your staff know. Invalid address information can cause claims to be denied -- especially from the CMS. This is an entirely avoidable hassle. Checking ID gives your staff a chance to ask the patient, "is this your current address?" While your staff should always check ID, it's not necessary -- or desirable -- to scan or photocopy the ID; it is best not to store this personal information in your systems. (Plus, if it is scanned one time, that might discourage your staff from checking the ID itself next time.)

By Morgan|2022-01-01T22:52:12-08:00November 26th, 2013|

Still time (but not much!) to avoid a PQRS penalty in 2015

There is still time for providers to avoid the PQRS penalty for 2013 reporting, which will mean a 1.5% deduction from Medicare reimbursements in 2015 (ouch!). The following two methods still apply for individual providers: -Submit via a qualified EHR vendor -- if your EHR is provided by a vendor that has been permitted by the CMS to submit directly, submitting data could be much easier than you think. Be sure to contact your vendor to find out what their capabilities are. Even if not qualified to submit directly, your vendor may be able to help you submit via a registry -- the second method available to not just avoid the 1.5% penalty in 2015, but also earn a .5% incentive for 2013. -Submit a single, valid measure via a single claim. You can do this! This approach will not permit you to earn an incentive this year, but you will avoid the penalty in 2015 -- and you'll have gotten your feet wet for more comprehensive compliance in 2014. (Do it now -- don't delay -- to be sure your claim is accepted and qualifies.)

By Morgan|2013-11-24T17:46:46-08:00November 24th, 2013|

The faulty statin risk calculator: more on using your website and EMR to communicate

Well, the new, evolving, confusing statin news appears to be a gift that keeps on giving. (Only practices that are fielding loads of calls from confused patients are probably considering it just the opposite. An anti-gift that keeps on giving perhaps?) In case you haven't heard yet, the New York Times reports today that the risk calculator provided by the American Heart Association and the American College of Cardiology appears to be flawed. The calculator may be significantly overstating patient risk and suggesting that millions of people who don't need statins should be considered candidates to take them. (I won't get into the details here -- the Times article does a nice job of simplifying what might have caused the problems with the calculator.) But I will take the opportunity to point out, as I did last week, that confusing and unnerving media stories like this create an opportunity for your practice to use technology to help manage contacts from confused or nervous patients while also reinforcing your practice's bond with them. Your website or social media presence can be a great way to remind people not to change their own treatment plans without advice from their physician (for example, if this is the message your physicians feel should be emphasized). And your EMR can become a helpful tool to quickly identify your subset of patients who might be confused so that you can reach out to them proactively. Imagine how grateful an anxious cardiac patient might be to hear from your practice with clarification about this news, and whether he needs to worry about it. Your EMR can make reaching out like this a lot easier (yes, an EMR can make something easier!) -- and you can possibly meet a needed Meaningful Use measure at the same time.

By Morgan|2016-08-19T17:37:29-08:00November 18th, 2013|

The surprise statin news is a perfect use for your website or social media space

The recent, confusing, conflicting news about new statin guidelines presents a perfect opportunity for your practice to use technology to solve a pressing problem -- and engage with patients. To recap briefly, new statin guidelines were released on Tuesday by the American Heart Association and the American College of Cardiology. The new guidelines include changes to both the recommended LDL targets for patients currently on statins (potentially reducing frequent blood testing for many patients) and the types of patients who should be on statins (potentially increasing substantially the numbers of patients who could be prescribed the drugs). Additionally, the guidelines could affect the frequency of prescribing of drugs like Zetia that are intended to work alongside statins. But the new guidelines are controversial. The New York Times attempted to illuminate the many angles to these new guidelines and also pointed out that the new recommendations are controversial within the medical community. It quoted a cardiologist from the Cleveland Clinic noting that physicians may have different ideas on how to respond -- and that some may not change their recommendations to their patients. The article has already attracted nearly 700 comments -- many very forceful and signed by physicians. Now, just two days later, the Times has published a strong opinion piece against the new statin guidelines. For cardiology, primary care, and other practices that prescribe statins and treat related issues like diabetes, these reports are likely starting to prompt calls from concerned patients. Handling an unexpected flurry of these sorts of calls can be very disruptive -- and can lead to some unhappy, stressed-out patients if they're unable to get through to discuss their concerns. It's likely, though, that physicians in your practice have already begun crafting standard responses. For example, perhaps your physicians have already told staff to tell patients that call in asking, "should I stop taking Zetia?" to continue their current treatment plan but make an appointment if they would like to discuss whether changing it makes sense in their case. Sharing links to articles that your physicians believe explain the new guidelines in an appropriate and

By Morgan|2022-01-01T22:52:12-08:00November 14th, 2013|

Remember, EFT is best

Mary Pat Whaley at Manage My Practice has posted great information about payers 'encouraging' practices to accept payment by virtual credit card, instead of by check or EFT. This method of payment is not a good deal for practices. Merchant fees are deducted from credit card payments -- meaning a further reduction in the reimbursement received from health plans that use this credit card method. Additionally, it adds costs because the virtual cards have to be manually keyed (increasing potential for errors and hassles -- and usually meaning a higher merchant fee than a swiped transaction as well). If the credit cards are set aside to be keyed in batches (as it seems they would inevitably be in many busy practices), that introduces another delay in receiving payment that would already be in the bank if transmitted by EFT. And, as the AMA pointed out in its letter to the CMS objecting to the use of virtual cards for VA reimbursement, credit card remittance advices are not standardized as payer EFT remittances are -- another source of inefficiency and cost. EFT is still the best way for practices to receive payments quickly, without any extra fee deductions, and without requiring additional, costly staff handling. (Minimizing staff handling also reduces embezzlement risk.) All payers are required to meet federal standards for EFT in 2014 -- and that means that you can request EFT from any payer you work with. As you know, we always recommend that practices use EFT with every payer: no checks in the office means less chance of one 'disappearing,' less aggravation taking them to the bank, etc. Virtual credit card payments are just one more inferior alternative to EFT. As Mary Pat noted in her post, it's important to check any new contract you sign to be sure you're not inadvertently agreeing to credit card reimbursement. (And, as we're always reminding you, this is another reason for a tickler to review your contracts annually, to be sure they don't already contain language that allows changing reimbursement mechanisms. And watch those amendments and other mailings from plans, too!)

By Morgan|2022-01-01T22:52:12-08:00November 11th, 2013|

Could the ACA-mandated grace period be problematic for your practice?

Many practices already suffer losses from surprise payment retractions by health plans. These can occur when patients attempt to exploit system update lags after leaving their employer (and therefore the employer's plan) or the grace period after failing to maintain payments on their own policy. (So, the patient knows he's not paid his premium or that he's left the employer plan, but also knows he's still "covered" because of payment grace period or because of the 30-day window to elect COBRA coverage -- even though the coverage will eventually be retroactively cancelled to the last paid day.) Any retraction of payment for services already rendered is a blow for providers and their practices, but most state policies regarding timely payment of claims and premium grace periods help limit the exposure for retraction of reimbursement to 30-45 days. However, the Affordable Care Act (ACA) contains a provision that mandates a much longer grace period -- 90 days -- for subsidized plan participants. The ACA authors intended that plan members who receive subsidies be allowed more leeway for missing payments because of lower incomes and possible hardship -- but, the longer grace period also creates opportunity for abuse and financial exposure for practices. Hospital and physician groups made note in the ACA comment period of the potential for the grace period to result in uncovered services being rendered. Extending the grace period increases the likelihood that significant services can be provided before a plan can be cancelled for unpaid premiums. Providers argued that plans should have to bear these costs -- especially in the case of subsidized membership, since plans would presumably be receiving at least part of the premium cost from the government. However, in the final rule, the CMS allowed plans to deny claims in months two and three of the grace period. This means that payments already issued to providers could be retracted -- leaving practices and hospitals on the hook for the cost of care already provided. How can practices prepare for and protect themselves from these unexpected costs? A few things to evaluate: Has your state negotiated

By Morgan|2013-11-09T18:08:14-08:00November 11th, 2013|

Obamacare scam alerts: a great use for your site and social media

A few days ago, Megan McArdle of Bloomberg offered a helpful introduction to the emerging scams inspired by Obamacare. Scary stuff. Spreading the word about these risks is a great way to connect with patients and reinforce that you're watching out for them. And it's a great use of your practice's Facebook page or blog -- a quick post takes just seconds, but will immensely benefit patients who follow your feeds.

By Morgan|2022-01-01T22:52:12-08:00November 9th, 2013|

Medicare Advantage plans dropping doctors: what does it mean?

News reports have been trickling in over the past couple of weeks -- growing in number -- about Medicare Advantage (MA) plans dropping doctors. First, we heard about UnitedHealthcare in CT dropping doctors -- then news came out about the same carrier dropping patients in NY, FL, RI, NJ, and, just yesterday, OH. Sam Unterricht, MD, the head of the State Medical Society of New York, said in a Fox Business interview a few days ago that other plans like Empire Blue Cross and Emblem were following UHC's lead in his state -- and that he expects this MA plan activity to spread nationwide. What's driving this (by all accounts, extremely sudden) behavior on the part of MA plans? The Tampa Bay Times reports that UHC attributes it to quality ratings ("[providers that] demonstrate the highest quality at the greatest value will be rewarded for their efforts.") But, the effort to trim MA costs as part of the funding plan for the ACA probably plays a role. Unterricth said that one of the plan representatives he spoke with said that an anticipated 8% reduction in reimbursements to MA plans from Medicare as part of the ACA was at least partly behind all the physician cuts. The timing -- coming on the heels of news of thousands of patients dropped from individual health plans -- does suggest a connection to ACA-mandated changes in 2014. Certainly, UHC's statement that quality ratings drove the decisions isn't incompatible with Unterricht's view that ACA cuts to MA reimbursement were behind them. After all, if reimbursements to MA plans from the CMS are going to decline, then quality related bonuses are going to be that much more important to plans going forward. It makes sense that they would try to goose their rankings to make up lost ground on reimbursements through bonuses. What does this mean for practices that serve MA patients? Some practices in some markets might have argued that MA is a pain: it's like the restricted, non-negotiable reimbursement of Medicare combined with the hassles of dealing with a private payer. But, we suspect

By Morgan|2022-01-01T22:52:13-08:00November 5th, 2013|

Time to update your practice’s cash fee schedule?

As independent professionals, the partners at Capko & Morgan have purchased insurance privately for many years. I've been a member of my HMO for 20 years, and have been paying for it myself as a small businessperson/independent professional since 2001. I had a good plan that seemed to generously exceed all of the ACA requirements, and then some -- I was very satisfied with it. Unfortunately, that wasn't sufficient to protect me from cancellation. I was notified about a month ago that I had been shifted into an exchange plan that is significantly more expensive, with huge increases in copays and deductibles, and numerous excisions of benefits I valued that I would now have to pay for 100% out of pocket. Now, lest you think this little anecdote has nothing to do with the headline for this post, let me get to the point. Like so many others in my predicament, I'm pressed to look at options. I have never in my adult life contemplated doing without a comprehensive health plan. But, I have heard from others in my position that they're considering 'going naked.' The logic? Paying for coverage that doesn't really kick in until you've paid about $11K into the system might make less sense than paying cash, then signing up for coverage in the unfortunate event you'll actually need to use it. For some people who lost much lower-priced, catastrophic-only coverage, the financial realities are even more stark -- they just may feel they cannot afford to pay thousands of dollars more each year for coverage, even though they may receive considerably greater benefits in return. If a significant proportion of the independently insured population opts to pay the ACA penalty instead of purchasing or continuing to purchase coverage, what might that mean for your medical practice? One possibility is that more people will want -- or need -- to pay cash for services. For primary care and urgent care practices, this means it's more important than ever to set up your cash-only fee schedule -- and to let patients know that it's available. Cash pay could be a real opportunity for primary care practices -- and you

By Morgan|2022-01-01T22:52:13-08:00November 2nd, 2013|

Monthly Archives: November 2013