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 fundame...

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...

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,...

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...

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          

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 .

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...