HealthLeadersMedia.com - Managed Care Contracting and Reimbursement Advisor

ACA prompting managed care changes, physicians scrambling to respond

Mon, 01 Jul 2013 04:00:00 GMT

Physician practices are beginning to feel the changes in managed care forced by the Affordable Care Act (ACA), and many are looking for ways to stay profitable as the payer landscape shifts. In the coming 12 months, as more components of the ACA kick in, there will be increasing consolidation of practices, says John D. Fanburg, JD, managing member and head of the healthcare practice at the law firm of Brach Eichler, based in Roseland, N.J.

Referral paths will be all-important when deciding future path for your practice

Mon, 01 Jul 2013 04:00:00 GMT

How should physician practices respond to the changing face of healthcare? The first imperative is maintaining a place in the referral path, says Marc Halley, president and CEO of Halley Consulting Group in Westerville, Ohio.

Kaizen method helps multispecialty practice improve numbers in a big way

Mon, 01 Jul 2013 04:00:00 GMT

One of the nation's biggest multispecialty practice management companies is finding that the kaizen method of continuous quality improvement can create greater efficiencies and enhance revenue at just the time when those factors are most in demand. The management method could be one of the solutions for the challenges posed by today's rapidly changing healthcare business.

ACOs will change the way you practice medicine, how you get paid

Mon, 01 Jul 2013 04:00:00 GMT

Physicians are nervous about transitioning to the accountable care organization (ACO) model because it completely changes the way they get paid, says V. "Juggy" Jagannathan, vice president of research with M*Modal, a provider of clinical documentation products for physician practices based in Franklin, Tenn. He and his company work closely with physician practices in their efforts to adopt EHRs and achieve meaningful use, and also in creating new documentation processes for a practice's changing business model.

Compensation on rise, but more focus on quality for physicians

Mon, 01 Jul 2013 04:00:00 GMT

Primary care physicians reported $180,000 in median first-year guaranteed compensation, up from $175,000 in 2011, according to the MGMA's Physician Placement Starting Salary Survey: 2013 Report Based on 2012 Data.

Managed Care Contracting & Reimbursement Advisor, July 2013

Mon, 01 Jul 2013 04:00:00 GMT

Revenue optimization more challenging than ever before

Sat, 01 Jun 2013 04:00:00 GMT

The changes associated with the Affordable Care Act (ACA), electronic medical record (EMR) implementation, and new Medicare rules mean that physician practices are under increasing pressure, says Nancy Ruff, director of health advisory services for CTG Health Solutions, a consulting company in Dallas. Optimizing your revenue requires clearing some new hurdles and aggressive strategies, she says.

Physician group uses new strategies to improverevenue

Sat, 01 Jun 2013 04:00:00 GMT

A private, nonprofit hospital physician group located in the Southern United States recently sought help from Nancy Ruff, director of health advisory services, and her colleagues at CTG Health Solutions, a consulting company in Dallas. With more than 300 multispecialty providers, the group is an integral part of one of the nation's leading academic medical centers, offering the latest innovations in medical, surgical, and diagnostic techniques.

Reader question: How to use 'bill above' in reimbursement coding

Sat, 01 Jun 2013 04:00:00 GMT

Q. Are you familiar with the term "bill above" in reimbursement coding? My understanding is that services categorized as "bill above" are reimbursed for that service in addition to a capitated rate for the patient's part of capitated plans. What does it take for a service to be declared a "bill above" service?

Production not only influence on compensation levels for physicians in academic settings

Sat, 01 Jun 2013 04:00:00 GMT

Research has indicated that three primary activities influence physician compensation in academic settings: clinical effort, teaching, and research. In contrast, physicians working in other settings (private practice or integrated delivery systems) rely principally on clinical effort. The recently released Academic Practice Compensation and Production Survey for Faculty and Management: 2013 Report Based on 2012 Data, from the MGMA, highlights factors beyond the academic practitioner's primary activities that affect the physician's total compensation.

CurrentCare is first statewide HIE to exchange behavioral health data

Sat, 01 Jun 2013 04:00:00 GMT

CurrentCare, Rhode Island's Health Information Exchange, is the first statewide HIE in the nation to exchange behavioral health data electronically. The Providence Center and Gateway Healthcare, Inc., were the first organizations to submit behavioral health and substance abuse treatment information, known as 42 CFR Part 2 data, into CurrentCare, a service of Rhode Island Quality Institute (RIQI).

HHS finalizes rule guaranteeing 100% funding for new Medicaid beneficiaries

Sat, 01 Jun 2013 04:00:00 GMT

HHS Secretary Kathleen Sebelius recently announced a final rule with a request for comments that provides, effective January 1, 2014, the federal government will pay 100% of the cost of certain newly eligible adult Medicaid beneficiaries. These payments will be in effect through 2016, phasing down to a permanent 90% matching rate by 2020.

CMS and California partner to coordinate care for Medicare-Medicaid enrollees

Sat, 01 Jun 2013 04:00:00 GMT

HHS announced recently that the state of California will partner with CMS to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience, along with access to new services. Under the demonstration, California and CMS will contract with Medicare-Medicaid Plans (MMP) to coordinate the delivery of and be accountable for covered Medicare and Medicaid services for participating Medicare-Medicaid enrollees.

Managed Care Contracting & Reimbursement Advisor, June 2013

Sat, 01 Jun 2013 04:00:00 GMT

Doctors, congressmen call for end to fee-for-service

Wed, 01 May 2013 04:00:00 GMT

Former Senate Majority Leader Bill Frist, MD, a Republican and heart surgeon from Tennessee, is leading a coalition of physicians who are calling for the federal government to phase out the fee-for-service payment model within the next decade.

Internists issue plan to improve healthcare system, end 'assault' on patient-physician relationship

Wed, 01 May 2013 04:00:00 GMT

The American College of Physicians (ACP) is calling for a significant change to how healthcare is provided in the United States, particularly with regard to what it says are barriers to a productive relationship between patients and physicians.

Electronic records could cost you money instead of improving revenue

Wed, 01 May 2013 04:00:00 GMT

Several recent reports cast doubt on the potential benefits of adopting electronic health records (EHR), noting that the financial benefits and practical application of the systems may not be all that we hoped.

HHS announces 2013 agenda to bring down costs, improve quality of care

Wed, 01 May 2013 04:00:00 GMT

The government wants to see 50% of physician offices using electronic health records (EHR) by the end of 2013, according to a plan announced recently by CMS Acting Administrator Marilyn Tavenner and the National Coordinator for Health Information Technology Farzad Mostashari, MD.

DOJ and HHS announce record-breaking recoveries from fight against fraud

Wed, 01 May 2013 04:00:00 GMT

For every dollar spent on healthcare-related fraud and abuse investigations in the past three years, the government recovered $7.90, according to an announcement by U.S. Attorney General Eric Holder and HHS Secretary Kathleen Sebelius.

Managed Care Contracting & Reimbursement Advisor, May 2013

Wed, 01 May 2013 04:00:00 GMT