HealthLeadersMedia.com - Managed Care Contracting and Reimbursement Advisor

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

Don't throw money away with leases, too many loans

Mon, 01 Apr 2013 04:00:00 GMT

With physician practices squeezed today like never before, every dollar of revenue helps. But holding on to those dollars and not wasting them through inefficiency or poor business practices also is important.

Pathologists grow revenue through outreach to specialists

Mon, 01 Apr 2013 04:00:00 GMT

Take a lesson from pathologists: When the referrals you've depended on for years start to dry up, take matters into your own hands. Go directly to the source.

Don't forget disability coverage when reviewing insurance needs

Mon, 01 Apr 2013 04:00:00 GMT

Healthcare reform and changing economic demands are prompting new practice models and additional services for many physician practices, which could lead to a better revenue outlook in the future. In conjunction with those changes, practices should be reviewing their insurance coverage for any needed changes or additions.

Michigan doctors launch ACO for Medicare patients

Mon, 01 Apr 2013 04:00:00 GMT

More than 1,800 Michigan physicians will work together in a new accountable care organization (ACO) to tackle the challenge of providing better medical care and slowing the growth of healthcare costs, an effort that will help them care for 81,000 of their Medicare-enrolled patients.

AMGA reports growth in 2012, multiple accomplishments

Mon, 01 Apr 2013 04:00:00 GMT

The American Medical Group Association (AMGA) reports that its membership grew in 2012 as the organization addressed many public policy and regulatory issues critical to the success of physician practices.

Most physicians not meeting PQRS quality reporting requirements

Mon, 01 Apr 2013 04:00:00 GMT

A new Harvey L. Neiman Health Policy Institute study shows that fewer than one in five healthcare providers meet Medicare Physician Quality Reporting System (PQRS) requirements.