October 2015 - Capko & Morgan

Ready to take the CCM plunge?

As you may know already, I've been working on a series of papers on Medicare's chronic care management reimbursement program (CCM) for the Medical Product Guide. (Click on 'resources' after visiting the Medical Product Guide link if you're interested -- they're free.) Talking to practices that have already started working on CCM, along with others that have held back, has been a learning experience. The ability to take on CCM quickly depends a lot on your current practice set-up and, especially, your EHR. On the current set-up side, if you're working on or already have set up a medical home (PCMH), and have one or more case managers in place to support it, you may find it easy to use the same staff structure for CCM. Your case managers could become the coordinators for CCM as well -- perhaps personally contacting patients and doing the other care management tasks that contribute to the required 20 minutes per month for billing. Perhaps there will be overlap between the PCMH and CCM that could be beneficial -- if, for example, you're looking at a similar mix of conditions, that might allow for some standardized communications or tracking tools. Or perhaps you could add a group visit program that would serve patients from both programs. (A group visit program wouldn't contribute to the CCM monthly time requirement, since that's strictly non-face-to-face time, but it still could be well received, and fit with the patient engagement goal of the program.) On the other hand, if your practice hasn't yet taken on PCMH, CCM could be a stepping stone. Many primary care practices believe they're already doing many of the tasks that are meant to be compensated by CCM -- they're just not tracking them, and they haven't had a way to bill for them, either. That last problem is expressly addressed by CCM -- the key is solving the former problem of tracking. EHR vendors vary dramatically in this area. Some have already created dedicated modules that allow for templates for clinical staff contacts to be tracked, and for the time to be calculated. Others

By Morgan|2022-01-01T22:51:58-08:00October 31st, 2015|

Medley of creative practice models for physicians emerges – is one right for you?

The concierge practice emerged more than 10 years ago and centered on family practice and internal medicine. Since then, practices have adapted the model to suit their preferences and styles, and the concierge approach has even moved beyond primary care as private practice physicians of different specialties search for a more profitable and fulfilling career path. The concierge approach aims to improve patient care while collecting all or most of the practice’s revenue directly from the patient. Patients are attracted to more personalized service and less harried exams. Patients and physicians both feel better care is given and physicians find more satisfaction in their chosen career. Another practice model that evolved from the concierge approach is direct pay primary care (sometimes also called ‘direct primary care’). In this model, physicians collect all their fees directly from the patient Patients pay a subscription fee that covers most primary care services. For the practice, by eliminating the costs of dealing with private insurers such as complying insurance regulations, claims submission and managing the accounts receivable costs can be significantly reduced and services enhanced. This approach generally offers fewer frills than a true concierge practice, and so the monthly subscription fee is lower, too – usually $100 or less. The appeal of direct pay primary care is that many patients have high deductible plans and seldom, if ever, reach the threshold level where insurance kicks in each year. In effect their insurance is more like catastrophic coverage -- they pay for their doctor visits and diagnostic studies as part of their deductible. For these patients, a direct primary care subscription can offer greater access and better care for the same or even lower out-of-pocket expense. For physicians, having more time to spend with their patients allows them to develop strong bonds with them, improving communication and patient compliance with their treatment plan. It’s a win-win proposition for doctors, patients and caregivers. There are attractive benefits to alternate practice models, but converting an existing practice requires careful planning. If you are considering an alternative practice style that is not reliant on insurance payment, there

By Judy Capko|2022-01-01T22:51:59-08:00October 19th, 2015|

How empowered is your medical billing service?

Outsourcing your medical billing to a billing service has the power to make your practice much easier to manage. It can also increase your profitability. But as the world of reimbursement continues to evolve, it's important to stay involved with the process. If you've adopted a "that's off my plate now" approach to using a medical billing service, it's possible your service is too empowered. A properly utilized medical billing service will be an extension of your team. Your office staff must work well with them in order to maximize the benefit you gain from outsourcing. When everything billing-related is dropped into the billing service's lap, it's impossible for them to do their best work for you. And they may feel compelled to make decisions for you that they really shouldn't be taking on unilaterally. Here are a few examples we've seen over the past few years of billing services believing it was left up to them to make key decisions on behalf of practice clients -- leading to sub-optimal decisions as a result: A billing service for a primary care/infectious disease practice with predominantly older patients with multiple chronic conditions received documentation about the chronic care management (CCM) reimbursement opportunity from the CMS (i.e., code 99490). But the billing service already had trouble getting properly prepared claims and sufficient documentation from providers, even for office visits. Plus, the practice manager was inexperienced with billing, and typically deflected the service's questions with "you decide - that's your job." The service owner decided for the practice that pursuing CCM "wasn't worthwhile." She felt that the providers wouldn't have been willing to do additional documentation. The physician owner was unaware that the practice was likely leaving at least $120,000 of revenue on the table in 2015 -- revenue which could have helped the practice repair its difficult financial position; A pediatric practice assumed its billing service would "handle" all payer contracts. The billing service thought "handling" them meant simply dealing with information requests from payers, and alerting the practice when something needed to be done -- they certainly didn't expect to be negotiating new contracts, since that was far

By Morgan|2022-01-01T22:51:59-08:00October 11th, 2015|

Monthly Archives: October 2015

Ready to take the CCM plunge?

Medley of creative practice models for physicians emerges – is one right for you?

How empowered is your medical billing service?