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Patients Want More Out of the Data You Collect About Them

August 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Patients are seeking to interface the data you collect about them in your practice with their mobile health tracking device – a Fitbit, Apple Watch, or the like. If your practice is fielding these patient requests, you may be questioning your liability related to this information transfer. On April 18, ...

2020 Proposals for Medicare Released

August 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

The federal government recently issued important Medicare proposals for 2020. While you can certainly take a deep dive into the 1,704-page document if time permits, we compiled this article to highlight key proposals that may impact you. The Quality Payment Program – in which many physicians participat...

Is a Medicare Appeal Worthwhile?

July 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

If you are dissatisfied with a denial of payment by your Medicare contractor, you can appeal the decision. The Centers for Medicare & Medicaid Services (CMS) recently announced attempts to streamline the process by no longer requiring signatures, thus enabling documents to be submitted in a more efficient...

MIPS Audits Begin

July 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

In June, the Centers for Medicare & Medicaid Services (CMS) announced the commencement of audits for the Merit-based Incentive Payment System (MIPS). The contract was awarded to Guidehouse, formerly known as the US Public Sector of PricewaterhouseCoopers. Guidehouse is transmitting notifications of audits...

MIPS Scores Are In

July 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, you can now view your results. The Centers for Medicare & Medicaid Services (CMS) released the performance feedback, final scores, and payment adjustments for 2018 MIPS program participants. CMS reports that 98% of practices w...

Turn the Daily Grind into a Successful and Satisfying Future

June 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Managing a medical practice is an experience that can’t be meaningfully compared to anything else. Daily operations often border on chaotic: Effective deployment of people, space and supplies is essential to success, but it can also be overwhelming. Most importantly, your patients’ lives depend on...

Buzz Word Alert: SDOH

June 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Even if you aren’t already familiar with the acronym SDOH, you have likely encountered the notion of “social determinants of health.” The term is splashed all over the health care media as it relates to value-based reimbursement. It’s a fancy term for a topic that your practice has bee...

Billing for Chronic Care Management

June 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Chronic Care Management (CCM) Services offer an opportunity to be paid for services you perform outside of the face-to-face patient encounter. Billing for CCM services may seem daunting, but the Centers for Medicare & Medicaid Services (CMS) offers extensive guidance about reimbursement protocols for Medi...

Medical Practice Services Announces Advanced Practice Seminar

June 2019  |  Stephen A. Dickens, JD, FACMPE

The healthcare landscape is rapidly changing!  These changes can be overwhelming to say the least. Do you know there are groups that are not only embracing change but are doing so successfully? Do you want to lead your group by successfully navigating these changes, but you are not sure where to start? J...

Take a Gemba Walk

May 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Gemba is a Japanese term meaning “the real place.” In medical practices across the country, administrators are taking the walks to the “real places” in their practices – the front office, the exam rooms, the business office, and throughout the halls of their practices. Administra...

Finding - and Resolving - Problems in the Billing Office

May 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

As a business, there’s a lot of money at stake in a medical practice. When mistakes occur in the billing office, it is easy for you to get frustrated. If you’re consistently spending time handling the aftermath of blunders, then it is time to shift your focus from problem resolution to problem pre...

Spring Cleaning: Seven Strategies for Your Practice

April 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

The spring offers a chance to shake off the winter blues – and get started on an improvement initiative for your practice. Make a commitment to focus on one area in your practice. Select a task, create a workgroup, pledge to meet once or twice a month, maintain a written agenda, and document an action p...

Transparency Revealed: How to Make Payments More Transparent to Patients

April 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Medical practices and price transparency haven’t exactly gone hand in hand in the past. With complex reimbursement systems and the real need to focus on other tasks, practices have not always been up front with patients when it comes to revealing the payment due until long after the service is rendered....

Don't Say "Sorry"

March 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

When your practice is running late, it is easy to greet the next patient with an “I’m sorry” instead of making a more meaningful connection. Although acknowledging the time and the patient’s frustration is a noble intention, a basic “I’m sorry” can actually start your...

Quality Payment Program: 2019 Adjustments

March 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Medicare remittances began arriving for 2019 services in mid-January. Unless an exemption applies, physicians and other eligible clinicians will see a bonus – or penalty – attached to each service. The claim adjustment reason code (CARC) for a positive payment adjustment is CO144; the negative adj...

Federal HR Changes May Impact Your Practice

March 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Overtime is common in medical practices, so it is important to understand the regulations associated with it. On March 7, the Department of Labor (DOL) announced an overtime update that could impact your practice. The DOL’s proposal raises the salary threshold for exempt employees from $23,660 to $35,30...

Tips for Successful Collection Calls: Business Critical in the Era of High Deductibles

February 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

As patient financial responsibility grows, it’s business critical to have an effective process to collect outstanding debt. It’s an opportune time to review your entire collection workflow, to include making collection calls. These steps are aimed to boost your success rate, while preserving patie...

Handling an Upset Patient

February 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Physicians, nurses, support staff and anyone else in a practice have all witnessed this scenario too many times: a patient gets frustrated and takes his or her anger, confusion, or worry out on you. How you handle an upset patient can quickly determine the difference between a successful or disastrous outcome...

Hiring the Best Candidate

January 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

A single bad hire can cost you more than $50,000 according to a CareerBuilder survey. If you have a position open, take the opportunity to hire right – the first time. Consider these proven techniques to get the best candidate for your practice. Listen. While it’s difficult to schedule multiple r...

Seven Percent on the Line for Practices in 2019 for 2021 Payments

January 2019  |  Elizabeth Woodcock, MBA, FACMPE, CPC

The federal government's Quality Payment Program (QPP) is now in its third year, although 2019 is the initial annum for the program's payment adjustments. For those of you who achieved perfect performance in 2017, your current Medicare remittances should reflect a 1.88% boost; a decline of 4% is the reality f...

Changes to Evaluation & Management Coding to Have Major Impact of Government's New Ruling

November 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

On November 1, the Centers for Medicare & Medicaid Services (CMS) released the Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2019. This highly anticipated, hefty 2,378-page federal ruling outlines key reimbursement changes for 2019 – a...

Eight Simple, Inexpensive Tips to Improve Patient Flow

October 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Automation can create opportunities to enhance patient flow, but sometimes it’s the little things that make the day run better for you and your patients. None of these tips require any fancy equipment, and most can be done for a few dollars – or no expense at all. Let’s review eight simple i...

Applications for QPP Exception Due Soon

October 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

The financial impact of the Quality Payment Program will soon be felt. On January 1, 2019, the reimbursement for Medicare will be shifted based on your performance in 2017. Although it's too late to avoid the 2019 penalty of 4%, you have until December 31, 2018, to possibly dodge the 2020 sanction, or at leas...

HIPAA Myths and Misconceptions

October 2018  |  Loretta Duncan, FACMPE

Trying to comply with HIPAA can be a challenge for healthcare providers, especially when there is so much confusion about specific aspects of the Rules. On almost a daily basis, policyholders contact SVMIC for assistance with HIPAA-related issues. In fielding those calls and emails, some commonalities have be...

Some Physicians Receive Alterations to 2017 QPP Scores

September 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

The Centers for Medicare & Medicaid Services (CMS) updated the 2017 Quality Payment Program (QPP) performance scores for some participants. Released in mid-September, the updated feedback will impact Medicare payments in 2019. The scores were changed based on the CMS’ review of several program varia...

It's Due Time: Patient Self-Scheduling

September 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Blame OpenTable®, Uber®, or ATMs, but the world of self-service is knocking on physicians’ door as patients desire self-service tools. Patient self-scheduling solutions need not encumber your practice; in fact, they can be an excellent way to reduce a burden on your already-overworked administra...

Government Releases Medicare Proposed Rule for 2019

August 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Choosing the appropriate level of an evaluation and management (E/M) codes is a daily occurrence for providers, but it’s no easy task. The “correct” code for an E/M is dictated by two guiding principles – the 1995 and the 1997 Documentation Guidelines; providers must select one or the ...

Tips to Prevent Denied Claims

July 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Denied claims cost your practice both time and money. Employees spend precious hours researching and processing denials, only to find that payers are unresponsive or unwilling to overturn their decision. Given the complexity of our reimbursement system, denied claims will always exist. However, there are cert...

2017 Scores Released: Merit-based Incentive Payment Plan

July 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

In July, the Centers for Medicare & Medicaid Services (CMS) issued the scores for the first year of the Quality Payment Program (QPP). Your 2017 Merit-based Incentive Payment System (MIPS) scores and performance feedback reports can be retrieved from the Quality Payment Program’s website. These scor...

Avoid the Overtime Blues in Your Practice

June 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Perhaps no one in your practice deliberately abuses overtime. Then again, if you make overtime pay available to employees on a regular basis, who could blame them for grabbing the opportunity? Not only can overtime cost you money, but it may also bring legal liabilities if you fail to manage it with care. It...

Physician Compensation Plans

June 2018  |  Michael Cash, MHSA, FACMPE

Physician compensation in a private solo practice is simple: The physician receives any profits after expenses are paid as compensation. The physician generally takes a monthly draw and has periodic bonus distributions. When two or more physicians join the practice, the compensation variables change. Open com...

Quality Payment Program Update

June 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Physicians who bill more than $90,000 in total allowed Medicare Part B charges need to ensure successful participation in the Quality Payment Program (QPP). Two pathways are available: submitting data for the Merit-based Incentive Payment System (MIPS) or joining an Advanced Alternative Payment Model (APM). T...

Self-scheduling: Attracting the Coming Wave of Patients

May 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

The generations known as “Baby Boomers” and “Gen Xers” constitute the majority of your patients today; however, it’s necessary for you to be thinking about the coming wave of Millennials and Gen Zers. While addressing the needs of the new generations may concern you, the automat...

Tiering: Levels of Copayments

April 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Tiering is a concept that has moved from the pharmacy to the medical practice. For years, payers have tiered medications into categories. Certain medications cost the consumer more, while others are available at lower costs. This strategy has steered patients – and ordering physicians – to generic...

Budget Act Extends GPCI Floor

April 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

The Bipartisan Budget Act of 2018 featured an extension of the physician work geographic price cost index (GPCI) floor. As the work GPCI is a component of the Medicare payment formula, this declaration positively impacts physician reimbursement. On March 20, the Centers for Medicare & Medicaid Services (C...

Managing the Challenges of Technology

March 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Electronic health record (EHR) systems are installed in most practices, yet they remain the source of daily headaches. Having worked in practice management for many years, my philosophy is that the systems were built by technology experts, not those familiar with the workflow of a physician’s office. Wh...

Managing Your Schedule is Vital to a Successful Practice

March 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Of the many ways that a manager can contribute to a practice’s success, the ability to manage the physicians’ time is the most important. The time of your physicians, advanced practice providers and other billable providers is, ultimately, your practice’s most valuable asset. In addition to ...

What Kind of "Manager" Does Your Practice Need?

March 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Don’t start looking for someone to run your office until you know what the person in this position must do. While many of the qualities needed in a successful manager are universal — solution-oriented, delegator, motivator, etc. — more depend on your office’s unique needs. It might se...

Government Shutdown Averted

February 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

The Bipartisan Budget Act of 2018 was expected to focus on immigration, however, healthcare was the prevailing theme of the law that was passed on February 9, 2018. Highlights for medical practices include: The elimination of the Independent Payment Advisory Board (IPAB), a group of 15 stakeholders who wer...

Get the Reimbursement You Deserve

February 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

How much do you know - and truly understand - about your allowables? This is the term for the discounted price to which you agree as a participating provider for an insurance company. This price is not what the payer reimburses you, but rather the rate you agree to accept as payment in full based on the patie...

Should You Use a Chaperone?

January 2018  |  Stephen A. Dickens, JD, FACMPE

Given the recent flood of high-profile sexual misconduct claims in the news, SVMIC has received an increased number of questions surrounding the topic of chaperones in an exam room. While there are no legal requirements to do so, the goal should be to make the patient feel comfortable while also protecting th...

The QPP Portal is Open: Submit Your 2017 Data

January 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

The Centers for Medicare & Medicaid Services (CMS) opened the reporting portal for the Quality Payment Program (QPP) on January 2. The deadline to submit your 2017 performance data is March 31, 2018. The portal provides one-stop shopping, allowing users to enter performance scores for all three categories...

The MIPS Cost Category: New for 2018

January 2018  |  Elizabeth Woodcock, MBA, FACMPE, CPC

In 2018, the federal government began to assess the cost of caring for Medicare beneficiaries under the Merit-based Incentive Payment System (MIPS). One of four components of the MIPS composite performance score – the cost category – counts as 10% of the overall score in 2018. While it m...

How Much Is Your Practice Really Worth?

November 2017  |  Michael Cash, MHSA, FACMPE

At some point, every practice undergoes physician transitions as physicians join, retire, merge and separate from groups. Advanced planning and communication can help facilitate the process. When physicians wait until the last minute, options are limited and decisions tend to be reactive to the market conditi...

Medicare Physician Fee Schedule 2018 Overview

November 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Within just hours of the release of the Final Rule concerning the 2018 revisions to the Quality Payment Program (QPP) on November 2, the Centers for Medicare & Medicaid Services (CMS) published the ruling that governs the Medicare Physician Fee Schedule (PFS) for the coming year. Although overshadowed by ...

CMS Unveils Numerous Changes to Quality Payment Program (QPP)

November 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

The number of clinicians required to heed Medicare’s Quality Payment Program (QPP) next year and beyond got smaller, thanks to new language in the program’s final rule for 2018. In issuing the rule on November 2, 2017, the Centers for Medicare & Medicaid Services (CMS) effectively raised the b...

Billing Medicare for Preventive Services

October 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Can I bill Medicare for Depression Screening? What is the CPT® code for Medicare’s Initial Preventive Physical Exam? How many smoking cessation sessions will Medicare cover for my patient? Do all males qualify for Prostate Cancer Screening? Which counseling services can I provide via telehealth?...

Charting Your Success in Employee Disciplinary Actions - Best Practices for Managing Staff Performance

October 2017  |  Kathy White, FACMPE, PHR

No doubt employee discipline can be one of the most challenging aspects of human resource management. Perhaps this is due to the term “discipline” and the negative connotation associated with the details of disciplinary actions.  Much of the stress related to managing staff disciplinary actio...

Hardship Application - ACI Category

October 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

You can apply for a hardship exemption for the “Advancing Care Information” (ACI) category of the Quality Payment Program’s Merit-based Incentive Payment System. ACI counts for 25% of the composite performance score for eligible clinicians (ECs) in the government’s new payment program....

Know in Advance What a Patient Wants You to Do When They Can't Tell You

October 2017  |  Justin Joy, JD, CIPP

As the patient population ages, the likelihood of encountering a patient unable to make decisions regarding his or her care will increase. Unexpected and emergency situations however can obviously affect a patient at any age, rendering the patient unable to make care decisions for themselves. Whether treatin...

2018 Penalties: PQRS and VBPM Informal Review Available Through December 1

October 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

On September 18, 2017, the Centers for Medicare & Medicaid Services (CMS) released the feedback reports for the Physician Quality Reporting System (PQRS) and the Value-based Payment Modifier (VBPM or VM). Both programs concluded at the conclusion of 2016, however, the impact on reimbursement continues thr...

Commercial Payers Changing the Rules for APP Billing

September 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

The reimbursement of services provided by advanced practice providers is a complex issue. Guidelines may vary based on the type of APP, and the rules surrounding APPs are impacted by federal and state regulations, facility-imposed standards of care, and billing requirements. The latter may include payer-speci...

New Medicare Cards with New Numbers: 3 Changes You May Need to Make

September 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

The Medicare Access and CHIP Reauthorization Act of 2015 requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. CMS will begin mailing new Medicare cards with a new Medicare number (currently called the Medicare Claim Number on cards) to your patients in April 2018. You m...

Overpayments

September 2017  |  Laura Watkins, FACMPE, CPC

When was the last time your credit balance report was reviewed and worked thoroughly? Working the report on a regular basis is an essential step in the revenue cycle. Understandably, many practices focus on the collection of insurance and patient payments portion of the revenue cycle. Overpayments are often ...

Meeting Management

August 2017  |  Tom Stearns, FACMPE

One of the unfortunate necessities of managing any organization is the need to have meetings. As medical practice consultants, we work with practices on governance and management issues. Few practices handle their meetings well. Problems range from no regular meetings to meeting too frequently, meetings witho...

Minding Your Information Through Document Retention Policies

August 2017  |  Justin Joy, JD, CIPP

The information contained in your practice’s documents and records is one of the most valuable assets to your organization. Without this information, your practice cannot treat patients, receive compensation, or otherwise operate. With the fundamental transformation of documents from paper to digital fo...

Hardship Application Open for MIPS' Advancing Care Information

August 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

“Extreme and uncontrollable” circumstances provide a way out of a key component of the Merit-based Incentive Payment System (MIPS) of the Quality Payment Program (QPP). The QPP Hardship Exception Application for the MIPS program year 2017 just opened on August 2, with circumstances such ...

Kentucky Surgeons: July 1, 2017, Start of Government Research Study

August 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Several years ago, the Centers for Medicare & Medicaid Services (CMS) proposed a dismantling of the coding system for surgeries. Congress stepped in to block the change, but allowed CMS to study the non-surgical activity that occurs during global periods. That research study began on July 1, 2017, encompa...

MACRA 2.0 Proposed

July 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Proposed updates to the Medicare Quality Payment Program (QPP) for calendar year 2018 would provide many physicians and other providers welcome relief from several regulatory burdens imposed by the Medicare Access to Care and CHIP Reauthorization Act (MACRA). The updates also would give tens of thousands clin...

The New Reality of Patient Financial Responsibility

July 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

As insurers and employers are now offering health plans with higher deductibles and copayments, collecting at the point of contact is more important than ever to ensure a successful practice. While many medical practices struggle with this, it doesn’t need to be as difficult or intimidating as it might ...

If the "Scribe" Fits

July 2017  |  Sheri Smith, FACMPE

Physicians struggle with the increased regulatory requirements of documenting a patient encounter in the Electronic Health Record (EHR). The majority of physicians chose medicine as a career path to take care of patients only to find that they spend an overwhelming amount of time and energy documenting patien...

Quietly Improving Care with QICs

June 2017  |  Justin Joy, JD, CIPP

Just as physician-patient confidentiality encourages frank discussions between the physician and the patient about the patient's condition without concern of involuntary disclosure of that information, documents generated within the parameters of a quality improvement committee (“QIC”) encourage m...

Social Security Number Removal Initiative Reminder: Get Your Systems Ready

June 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

As you know, beginning in April 2018, CMS will start mailing Medicare cards with new Medicare Beneficiary Identifiers (MBIs) to all individuals covered by Medicare. The MBI will, after a transition period, replace the Social Security Number (SSN)-based Health Insurance Claim Number for transactions such ...

Meaningful Use Deadline Looming

June 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

July 1, 2017, is the deadline for physicians to submit a hardship application for the 2018 payment adjustment, based on the 2016 reporting period for the EHR Incentive Program. If you were eligible to participate in the program, but you did not successfully report the program’s required “meaningfu...

ABN Update

June 2017

It is time to update your Advance Beneficiary Notice of Noncoverage (ABN). This important form issued by the Centers for Medicare & Medicaid Services (CMS) is used to communicate with patients about services for which Medicare payment is expected to be denied. The changes as of June 21, 2017 include a new...

Business Suit or Hazmat Suit? Which Do I Wear When Visiting Your Practice?

June 2017  |  Rana McSpadden, FACMPE

The first visual impression a patient has of a medical practice is the lobby.  Do you know what impression you are making on your patients?  As a medical practice consultant, I have seen my share of lobbies through my travels.  As a patient, I can recall a time that the lobby was so inviting an...

Quietly Improving Care with QICs

June 2017  |  Justin Joy, JD, CIPP

Just as physician-patient confidentiality encourages frank discussions between the physician and the patient about the patient's condition without concern of involuntary disclosure of that information, documents generated within the parameters of a quality improvement committee (“QIC”) encourage m...

Meaningful Use Deadline Looming

June 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

July 1, 2017, is the deadline for physicians to submit a hardship application for the 2018 payment adjustment, based on the 2016 reporting period for the EHR Incentive Program. If you were eligible to participate in the program, but you did not successfully report the program’s required “meaningfu...

Quality Reporting Under MIPS

May 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

At first glance, the Merit-based Incentive Payment System (MIPS) may look somewhat like the Physician Quality Reporting System (PQRS), which closed its door on December 31, 2016, but appearances can be deceiving. MIPS features 271 quality measures, of which physicians and other eligible clinicians must repor...

OSHA in a Medical Practice

May 2017  |  C. Anne Pontius, MBA, FACMPE, CHC, MT (ASCP)

The Occupational Safety and Health Administration (OSHA) is part of the United States Department of Labor. The mission of OSHA is to assure safe and healthful working conditions for working men and women by setting and enforcing regulatory standards.  In addition, OSHA is responsible for providing traini...

QPP Clinician Participation Letter

May 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

The federal government granted an exclusion for many physicians to its Quality Payment Program (QPP), which features the Merit-based Incentive Payment System. Physicians – and other QPP-eligible clinicians - are omitted on the basis of billing less than $30,000 in Medicare Part B allowed charges per yea...

Coping with "Difficult" Coworkers

April 2017  |  Stephen A. Dickens, JD, FACMPE

“The staff are not getting along” is a cry for help I frequently hear from physicians and practice executives. Staff relationships can be one of the most time consuming and mentally draining aspects of a manager’s or supervisor’s day. Staff who find it difficult to work with one anothe...

Tips to Prevent Denied Claims

April 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Denied claims cost your practice both time and money. Employees spend precious hours researching and processing denials, only to find that payers are unresponsive or unwilling to overturn their decision. Given the complexity of our reimbursement system, denied claims will always exist. However, there are cert...

Meaningful Use: Avoiding the 3% Penalty in 2018

April 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

If you did not report meaningful use in 2016 – or failed to do so successfully – the government will impose a 3% penalty in 2018 on all Medicare payments.  Now is the opportune time to review government applications to try to get an exemption for that penalty. Just posted on March 7, the appl...

It's Not Easy to Say Goodbye: Properly Discharging a Patient from Your Practice

April 2017  |  Justin Joy, JD, CIPP

Once a physician has established a professional relationship with a patient, the physician has an on-going legal duty to care for that patient. The expected length of this relationship varies based the type of care being provided.  If a patient is referred to a surgeon for a single procedure, the profess...

Just Say Yes to MIPS Participation in 2017

March 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

January 1, 2017, marked the commencement of the Quality Payment Program (QPP). The government’s initiative is mandated for physicians and other eligible clinicians who provide care for Medicare patients. By 2019, non-participation fines will be up to 4% of Medicare payments, so it is important to enroll...

Changes to Medicare "Incident To" Billing Requirements

March 2017  |  Jackie Boswell, FACMPE

Medicare allows a physician to bill for certain services furnished by an Advanced Practice Practitioner (APP) under what is referred to as "incident to" billing.  The "incident to" rule permits services furnished as an integral part of the physician's professional services in the course of diagnosis or t...

Handling Difficult Situations

March 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

When you work in a medical practice, you face challenging situations every day. Particularly as patients wrestle with pain, frustration and fear, you might find yourself handling a difficult circumstance from a customer service perspective. Practices that understand the importance of effectively managing thes...

MU Payments: Not Too Late for Medicaid

February 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Looking for $63,750 in bonus payments? That’s the sum total of the checks you’ll receive over a six-year period if you are eligible to participate in the Medicaid Electronic Health Record (EHR) Program. The days of receiving payment boosts for “meaningful use” through Medicare are long...

New Coding Opportunity

February 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Chronic Care Management (CCM) services offer the opportunity to receive payment for the non-face-to-face services provided to patients by clinical staff. There are certain requirements for billing CCM, one of which is the establishment of a care plan that provides the foundation of the care provided by staff,...

The Afternoon Sweep

February 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Morning huddles offer an exceptional method for preparing for the day; however, it’s not uncommon for the results to fall short of one’s expectations. Even if your reminder calls went out previously, it’s likely that you’ve had a couple of cancellations that morning. Filling empty slot...

Meaningful Use: 2016 Reporting & Potential Relief from Penalties

January 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Although 2016 has come to a close, the time is now to report for the Electronic Health Record (EHR) Incentive Program. As confirmed in November, the reporting period is any 90 consecutive days during 2016. The criteria were drastically reduced from prior years, so it may be an opportune time to report even if...

Patient Access & Charging for Medical Records

January 2017  |  Loretta Duncan, FACMPE

Providing patients with copies of their medical record is not a new concept for medical practices. However, processes in place for doing so may need some significant updates based on guidance issued by the U. S. Department of Health and Human Services (HHS) in 2016. In this guidance, which is based on 45...

Film-Based Imaging Reimbursement Cut (January 2017)

January 2017  |  Elizabeth Woodcock, MBA, FACMPE, CPC

If you rely on film-based imaging in your practice, Medicare reimbursement will change when you bill for an x-ray. Film-based imaging services billed globally, or when billing the technical component only, must be submitted with a modifier FX. The new modifier, required as of January 1, 2017, triggers a reduc...

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