Showing posts from 2021

Improving Relationships With Your Patients

Patients today expect more from their physician experience than ever before. Communication and transparency are of utmost importance to many patients, but the more fundamental aspects of the relationship should not be ignored. Patients visit physicians in varying states of vulnerability. They are looking for someone to trust, especially when sharing personal details about their health, family and history. For physicians this means balancing the ever increasing demands of their work with the ability to form meaningful bonds with their patients. A strong physician/patient relationship makes for a positive patient experience and is essential to providing quality care. The more you can make patients feel at home, the more likely you are to earn their loyalty and referrals. There are a number of ways that medical practices can make patients feel welcome, trusting and nurtured.  Relationship Skills Positive, personal engagement with patients – by physicians as well as staff – is fundamental

Providers must furnish ‘good-faith’ price estimates to self-pay patients starting next year

Regulations that would require providers to also give good-faith estimates to health plans won’t take effect in 2022 as previously scheduled. A newly issued federal rule on surprise billing includes regulations designed to improve price transparency for self-pay patients starting in 2022. The interim final rule with comment period (IFC) requires providers to ask about a patient’s coverage status at the time a service is scheduled. If the patient does not have insurance, “a good-faith estimate” of expected charges for items and services must be provided — generally within three business days. The requirement also applies if the patient has insurance but does not intend to submit a claim. The rule states that the estimate must include “any items or services that are reasonably expected to be provided in conjunction with scheduled or requested items or services and such items or services reasonably expected to be so provided by another healthcare provider or healthcare facility” along wi

Surprise Billing Regulation a Gift to Payers, Blow to Providers

Healthcare industry groups representing providers are upset with the latest surprise billing regulation detailing the independent dispute resolution process. The American Medical Association (AMA) is calling the latest in a series of surprise billing regulations “an undeserved gift to the insurance industry that will reduce [healthcare] options for patients.” The statement comes as the Biden-Harris Administration seeks to button up implementation of the No Surprises Act by the end of the year. The Act prohibits surprise medical billing in most situations by making it illegal for providers to bills patients more than the in-network cost-sharing amount for care. The latest regulation seeking to implement the ban on surprise billing detailed the independent despite resolution (IDR) process by which payers and providers will settle reimbursement rates for out-of-network care that would have resulted in a surprise bill for patients. The regulation released late last week included details,

AMA Issues CPT Codes for Pediatric Doses of Pfizer COVID-19 Vaccine

To prepare for potential FDA authorization, AMA has released new CPT codes for pediatric doses of the Pfizer COVID-19 vaccine. he American Medical Association (AMA) has issued new Current Procedural Terminology (CPT) codes for pediatric doses of the Pfizer COVID-19 vaccine. In September 2021, Pfizer and BioNTech shared the results of a Phase 2/3 clinical trial in which two doses of the vaccine elicited a strong immune response in children ages 5 to 11. Following the trial, the companies submitted the data to the Food and Drug Administration (FDA). Pfizer recently announced that they have submitted a formal request to the FDA for emergency use authorization of their COVID-19 vaccine in children ages 5 to 11. In August 2021, the FDA granted full approval of the Pfizer-BioNTech vaccine for individuals 16 and older. The AMA updated the COVID-19 vaccine CPT codes to ensure preparedness if the FDA approves Pfizer’s two-dose pediatric vaccine. The early publication may help healthcare pr

Avoiding Claims Denials in Your Practice

Why the revenue cycle is vital to exceeding patient expectations and driving financial performance July 2, 2021 Joe Polaris, MBA As physician practices look for ways to build volume and engagement, it’s critical to thoughtfully consider it all from the point of view of patients and consumers. With the COVID-19 vaccine becoming more widely adopted, the US is slowly starting to emerge from the pandemic. While some things, like in-person gatherings, are starting to go back to pre-pandemic normal, there is still a long way to go when it comes to financial recovery. This may seem especially daunting for physician practices, with gross revenue losses estimated at $67,774 per physician in 2020 . Call Today: 614.706.5206          

Why the revenue cycle is vital to exceeding patient expectations and driving financial performance

With the COVID-19 vaccine becoming more widely adopted, the US is slowly starting to emerge from the pandemic. While some things, like in-person gatherings, are starting to go back to pre-pandemic normal, there is still a long way to go when it comes to financial recovery. This may seem especially daunting for physician practices, with gross revenue losses estimated at $67,774 per physician in 2020 .

Getting Paid Today: Challenges and opportunities for independent practices

New legislation, as well as changes in patient expectations, present a host of challenges and opportunities for getting paid for service this year. In a recent article in Physician’s Practice, we discussed the challenges surrounding getting paid for telehealth this year and beyond . This is an essential issue for independent practices, but it’s not the only one. New legislation, as well as changes in patient expectations, present a host of challenges and opportunities for getting paid for service this year. E/M Office and Outpatient Guidelines Changes For the first time in more than two decades, the AMA has revised the guidelines for office and outpatient visit evaluation and management (E/M) codes. It’s been a long time coming—effective this year, CMS has aligned E/M coding with the changes adopted by the AMA. For many providers, this means an increase in their revenue because they will finally be compensated for time spent in activities related to patient care that were previously

Key considerations for revenue cycle teams to optimize coding and maximize revenue during COVID-19

A new code for COVID-19 discharges offers a 20% bump in the assigned MS-DRG payment from CMS. Clinicians should know that a positive test result is not required to establish a COVID-19 diagnosis for coding purposes. If a patient admitted with a respiratory diagnosis then tests positive for COVID-19, coders can link the result to the respiratory illness. With new legislation such as the Coronavirus Aid, Relief and Economic Security (CARES) Act supplying grants to help stabilize hospitals and health systems, documentation and coding become increasingly vital for providers to capture the available funding. An unprecedented off-cycle adoption of code U07.1, COVID-19 , effective with discharges on and after April 1, 2020, was announced by the Centers for Disease Control and Prevention in mid-March.  As provided in the ICD-10-CM Official Guidelines for Coding and Reporting, the coding guidance for COVID-19 has unique features that all coding professionals and clinical documentation special

4 ways to keep ahead of denials amid the pandemic

Revenue cycle leaders share approaches to keeping up with new codes and evolving payment guidelines during COVID-19. Understanding all that’s required to secure healthcare payment during a pandemic — especially for services related to COVID-19 — demanded that revenue cycle teams quickly refine denials management processes to protect their organization’s financial health. It also necessitated a spirit of patience and understanding toward payers, which faced a similar learning curve, according to Richard Madison, network vice president for St. Luke’s University Health Network in Bethlehem, Pennsylvania. “It takes two parties to get this right,” Madison said. While Madison and his peers encountered many obstacles that have complicated the task of denials management — including adapting to the needs of a remote workforce and dealing with the uncertainties surrounding payment for an unprecedented volume of telehealth services — their experiences also point to key factors in protecting reven

How Providers Can Improve Patient Financial Experience

In the aftermath of COVID-19, payment flexibility, digital engagement, and transparency are crucial to improving patient financial experience, recent reports show. In the wake of COVID-19, calls for patient financing flexibility, a shift to digital payment methods, and a need for increased bill transparency have providers changing course when it comes to improving patient financial experience. Two recent reports, one from Patientco and another by VisitPay , revealed new insights on the impact of the pandemic on patient financial behaviors and preferences. Both reports concluded that patients are more wary than ever about healthcare costs. “As the pandemic forced consumers to scrutinize their finances and prioritize which bills to pay, it’s become clear that health systems must offer flexible, tailored payment options to help patients manage medical bills in ways most convenient to them,” said Kent Ivanoff, co-founder and CEO of VisitPay, in a press release . VisitPay’s report compiled

Staff Shadowing Negatively Affects Revenue Cycle Productivity

A new survey shows that staff shadowing preceding automation integration is disruptive to employees and has negative impacts on revenue cycle productivity. More than half of health systems found staff shadowing to be disruptive and to have negative effects on revenue cycle productivity, according to a national survey . The survey, commissioned by AKASA and conducted through the Healthcare Financial Management Association’s (HFMA) Pulse Survey program, included answers from over 350 chief financial officers and revenue cycle leaders at health systems across the country. Of the health systems surveyed, 68 percent had experienced staff shadowing. Revenue cycle staff shadowing typically happens ahead of implementing automation or other technology tools in order for consultants to document workflows and processes, according to the press release. About one-fourth (23.6 percent) of health systems responded that shadowing only captured a limited number of workflows and the documentation was of

Physician Retention Challenges Worsen Amid COVID-19

  A survey shows that 70% of physicians are disengaging from their employers, spelling future physician retention trouble for healthcare organizations. Physician retention is a common challenge for healthcare organizations and the COVID-19 pandemic may have made it worse, according to survey results from Jackson Physician Search. A survey of 400 practicing physicians between October 2020 and November 2020 found that about 70 percent of physicians report being actively disengaged from their employers. The same survey also found that 54 percent of physicians are planning to make an employment change, with most of these physicians (50 percent) saying they are planning to leave their current employer for another. Another 36 percent of physicians planning an employment change said they are considering early retirement or leaving the practice of medicine altogether. Yet just 30 percent of the smaller pool of healthcare administrators surveyed—86 administrators total—reported losing physicia

Judge Approves Sutter Health’s $575M Antitrust Settlement

The antitrust settlement will resolve allegations that Sutter Health engaged in anticompetitive practices, resulting in higher healthcare prices for self-funded plan members. A Superior Court of California judge has granted preliminary approval for a $575 million antitrust settlement Sutter Health proposed to resolve a case alleging that it engaged in anticompetitive practices that drove up healthcare prices in Northern California. The Sacramento-based health system reached the settlement agreement over a year ago with plaintiffs, including California Attorney General and current HHS Secretary nominee Xavier Becerra and the United Food and Commercial Workers International Union (UEBT). The settlement agreement will now be heard by a court for final approval on July 19, 2021. The settlement resolves a class action lawsuit brought on by UEBT in 2014 claiming that Sutter’s anticompetitive business practices caused them to pay more for healthcare items and services than necessary. Attorn

Major Hospitals Still Not Complying with Price Transparency Rule

Nearly two-thirds of the largest hospitals in the US have yet to fully comply with the new price transparency rule, with most missing payer-specific charges. Many of the largest hospitals in the country are still not complying with a new price transparency rule that went into effect on Jan. 1, 2021, according to a new analysis . Nearly two-thirds of the 100 largest hospitals in the US by certified bed count did not meet all the requirements of the new rule, including posting payer-specific negotiated charges on their websites, by early February 2021, researchers from Hilltop Institute, a nonpartisan research organization at the University of Maryland, recently reported in the Health Affairs blog. What’s more, just 22 percent of the hospitals in the analysis appeared to be fully compliant with the rule’s requirements, with some even exceeding the regulation in terms of the amount of pricing information they shared on public websites. Researchers deemed hospitals compliant if their files

CMS Boosts Medicare Reimbursement for COVID-19 Vaccinations

Medicare reimbursement rates will nearly double for the administration of single- and two-dose vaccines. CMS has significantly increased Medicare reimbursements rates for the administration of new COVID-19 vaccines in an effort to accelerate rollout, according to a new announcement. The announcement emailed to journalists earlier today states that the national average payment rate for physicians, hospitals, pharmacies, and other immunizers has risen from approximately $28 to $40 for the administration of single-dose vaccines and from approximately $45 to $80 for the administration of COVID-19 vaccines requiring two doses. Although, the exact reimbursement rate for each dose of a COVID-19 vaccine will depend on the type of entity that administers the vaccine and where the vaccination is furnished. The new rates will apply to vaccinations given on and March 15, 2021. “This new and higher payment rate will support important actions taken by providers that are designed to increase the numb

Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic — United States, January–March 2020

Summary What is already known about this topic? Use of telehealth (the remote provision of clinical care) early during the COVID-19 pandemic has not been well characterized. What is added by this report? The 154% increase in telehealth visits during the last week of March 2020, compared with the same period in 2019 might have been related to pandemic-related telehealth policy changes and public health guidance. What are the implications for public health practice? Telehealth could have multiple benefits during the pandemic by expanding access to care, reducing disease exposure for staff and patients, preserving scarce supplies of personal protective equipment, and reducing patient demand on facilities. Telehealth policy changes might continue to support increased care access during and after the pandemic.Article Metrics  Altmetric: News (2) Twitter (149) Facebook (1) Citations: Views:Views equals page views plus PDF downloads Metric Details Figure 2 References   Related Materials P

Key Strategies for Succeeding with Healthcare Bundled Payments

In order to succeed with healthcare bundled payments, providers must engage post-acute care providers, leverage data analytics, and improve their patient engagement strategies. Healthcare bundled payments are a value-based reimbursement model that uses a single, comprehensive payment to address an entire defined episode of care. This alternative payment model has become a critical stepping stone for providers as they explore risk-based purchasing. Unlike other common alternative payment models, such as accountable care organizations (ACOs) and capitation, bundled payments impose clinical and financial responsibility on providers for a single care episode for an individual rather than the ongoing outcomes of an entire patient population. If total care costs for the episode are below the bundled payment reimbursement, providers generate a profit. However, if total costs exceed the bundled payment amount, providers incur a financial loss. Additionally, providers may earn value-based ince