Category Archives: Medical Billing

MACRA is not the Macarena But It Is A Dance You Can Learn

The Medicare Access and CHIP Reauthorization Act of 2015, also known as MACRA, is on the minds of physicians and practice managers from coast to coast. As with any new ruling from CMS, the challenge is to fully understand the changes to the law and what it means for your practice. Change is never easy, but this change has to be met head-on, or the clinic’s bottom line may suffer.

To help address your questions about MACRA, GE Healthcare is hosting a webinar called “MIPS, MACRA and YOU in 2018” on Monday, November 27th from 9:00 a.m. to 10:00 a.m. Pacific Time. The webinar will feature Mark Segal and Donna Maddox from GE Healthcare, and David Swartout from Mountain View Medical in Forest Grove and Hillsboro, Oregon.

While MACRA presents a host of new challenges for clinics, Donna Daniel of IBW Watson Health argues that managing and analyzing patient data is the core function that clinics must learn to master.

Provider performance will be measured against national peer performance to establish goals, incentives, and payment structure. Organizations that perform well against the quality benchmarks while controlling costs will be financially rewarded. Those who miss the mark may see their Medicare reimbursements shrink. This puts a great deal of pressure on providers to immerse themselves in performance metrics.

We all know that practicing medicine has plenty of its own pressures. Know that you can lean on HealthCo and GE Healthcare to help you manage MACRA/MIPS.

Understanding Merit-based Incentive Payment System (MIPS)

MIPS replaced the Physician Quality Reporting System, Value-Based Modifier, and Meaningful Use of electronic health records programs. It also added a fourth component, Improvement Activities, which is intended to give physicians credit for their efforts to reduce disparities in care, engage patients in shared decision-making, and other activities designed to improve care.

Instead of three separate programs, MIPS is designed to be one cohesive program with a single score for each physician or group. The score will be derived from four components: quality, costs, improvement activities, and advancing care information.

Sandy Marks, Assistant Director of Federal Affairs at the American Medical Association, notes that MIPS presents a variety of special challenges for small and rural practices.

When Congress enacted MACRA, it recognized the unique challenges facing physicians in small and rural practices. For example, the law required CMS to set a low-volume threshold so that physicians who do not treat enough Medicare patients to have a chance at getting a positive return from participating in MIPS would be exempt from it. MACRA also called for creating virtual groups so that physicians in small and rural practices can combine their resources to jointly report on MIPS measures.

Get A Firm Grip On 2017 MIPS Reporting

Under MIPS, each clinician will be measured against four categories: quality, cost, improvement activities and advancing care information. Quality is the most important category right now, as it accounts for 60% of the clinician’s overall score. Each clinician under the MIPS program receives a final score (from 1 to 100) and that number determines the amount of payment the clinician is eligible to receive in 2019.

If you’d like to learn more about these four reporting categories, CMS has excellent “explainer” videos on the topic available.

Our dedicated team of Centricity Practice Solution specialists is also available to walk you through any specific MACRA- or MIPS-related questions.

Accurate ICD-10 Coding Is Critical To The Clinic’s Bottom Line

GE Healthcare’s Centricity Practice Solution, like all business-essential software, helps remove complexity from tasks that would otherwise be unmanageable. For one, the clinic’s EHR software must assist physicians and medical coders in the clinic with the correct choice of ICD-10 codes. With more than 68,000 options in the International Classification of Diseases database today—up from just 13,000 in the ICD-9 standard—the likelihood of human error is too high to proceed without automated assistance.

To provide just one example, “degenerative myopia with retinal detachment” has five ICD-10 codes assigned to it, not one. This granular level of detail helps describe the precise diagnosis. The good news here is we have Clearinghouse tools available in Centricity to help you manage the complexity of ICD-10 coding and maximize revenue.

Improving clinic workflows is another critical aspect in getting ICD-10 right the first time. Data is only as good as the inputs received, which squarely places the responsibility on the clinic’s physicians to make the accurate call at the point of care. You never want the clinic’s coder(s) to guess which code is correct after the fact and input the wrong code or series of codes. That will quickly make for an unnecessary billing logjam. The chain of communications from physician to coder to payer needs to be flawless, or payments will be denied or lost in the system.

“The idea is to minimize billing time, reimbursement time, get a clean claim and get money get faster and improve cash flow,” Denver Wade Harless, who works for the Sacred Heart Health System, told Healthcare Finance News. Harless believes “a lot of clinical legwork needs to be done to get more specific information from physicians.” Our take is, workflow improvements are always highly beneficial, but workflow realignments, in combination with added functionality in the EHR, produce the biggest wins for the clinic.

Four Keys To ICD-10 Coding Success

1) An awareness of the issue and a commitment to solve it
2) Physician training to help identify the right codes at the point of care
3) Customization and optimization of Centricity
4) Select clinic workflow improvements (determined on a case by case basis)

There’s no question that the challenges in value-based care, including keeping up on the latest developments in ICD-10, puts an extra onus on practice administrators and physicians. The complete solution includes hiring talented coders, internal training, process improvement, and software upgrades.

Our implementation team at HealthCo is available to discuss your ICD-10 questions on a call that I am happy to set up fro you. Send me a note at rachaelr@healthcosystems.com.

Better Data Leads To Improved Care And Higher Profits

Meeting the various reporting and measurement standards imposed by CMS is no cakewalk. On one hand, clinicians must be adept at change management. On the other, they must be technically proficient and knowledge rich.

There can be no doubt that successfully practicing medicine today requires clinicians to overcome several significant challenges. It’s our job to reduce at least one challenge—and we do, by clearing the path to payment under value-based care.

Shiv Gopalkrishnan, GE Healthcare’s General Manager of Enterprise Financial Management Solutions, addresses one problem head-on when he asks, “How can we deliver solutions faster through the cloud?”

In busy clinics, resources are limited, which puts an extra onus on technology to do more of the heavy lifting. As Centricity migrates to the cloud in 2018 and beyond, physicians and practice managers will begin to benefit from the “no touch, low touch solutions” that help drive automation, which leads to optimized workflows and a notable reduction in workloads around the clinic.

Gopalkrishnan says, “Whether it is clinical outcomes, financial outcomes, or operational outcomes, we know with value-based care, these are all going to be tied together. You’re going to get paid because you demonstrate clear clinical outcomes and quality of clinical outcomes.” He adds, “It’s very important that we deliver a solution suite that helps clinics achieve these net financials.”

In order to deliver the results our partners in clinics count on, GE Healthcare and HealthCo bring a true understanding into provider workflows and reporting requirements. Thanks to our years of experience working in clinics and with clinics, we also understand the pressures involved (in making big changes) and how to relieve them.

Let’s recap. The “Triple Aim” of value-based care can be summarized like so:

    1) Reduce the cost of healthcare
    2) Enhance the patient experience
    3) Improve population health

At HealthCo, we are on board with all of the above. We also come to work each day ready to deliver on these core promises:

    4) Enhance care quality
    5) Improve provider efficiency
    6) Strengthen financial performance

We know the move from fee-for-service to value-based care is a big change, and the entire transition cannot normally be made all at once. It takes time, a solid plan, and reconfiguration of systems to properly record the numerous measures of quality that help determine the overall health of your patient population.

Remember, you need to demonstrate improvement to get paid today.

According to RevCycle Intelligence:

Value-based reimbursements are calculated by using numerous measures of quality in determining the overall health of populations. Unlike the traditional model, value-based care is driven by data because providers must report to payers on specific metrics and demonstrate improvement. Providers may have to track and report on hospital readmissions, adverse events, population health, patient engagement, and more.

We are happy to help you refine your tracking procedures and update your workflows to meet the need of value-based care. Measuring the full set of outcomes that matter most to patients is indispensable to better meeting patients’ needs. It is also one of the most powerful vehicles for lowering health care costs. Let’s work on it together. Better care at a lower cost is a promise for the future that is within reach today.

Measure Methodically To Make A Major Difference

Clinics are working overtime to meet the demands of value-based care.

In today’s healthcare environment, it pays to have a firm grasp on your clinic’s key performance indicators. That’s why we made this new visual aid to help elevate the importance of tracking to your clinic’s bottom line.

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Chris Lay of Cascade Orthopedics says, “Centricity provides the necessary reporting for our billing and collections team to really analyze the data. Our surgeon-owner has an M.B.A., and he expects quality data to be delivered in a timely manner, which we’re able to deliver with HealthCo.”

We love to hear positive testimony like Chris’s because it validates our focus on helping clinics track key metrics and sift through quality data.

Order your own Clinic KPIs poster today. The poster arrives with a set of instructions for best use, and we are happy to discuss KPIs in greater detail on the phone or in person.

Accelerate 2016 Recap: Three On-Point Presentations for Practice Managers

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Practice managers from clinics around the Portland metro gathered last week at Marylhurst University for Accelerate 2016—our first in a series of half-day workshops designed to help HealthCo customers and prospects raise their overall business savvy and remain strong independent clinics.

Following my opening remarks, Andrea Cunningham, HealthCo’s Director of Professional Services, walked participants through a presentation about maximizing EMR software return on investment. Andrea reminded us that a functional EMR requires good data inputs, even more so today with the emergence of Value-Based Payment Models. “Quality tiering means you are being compared to your peers in clinics across the country,’ Andrea explained. “Better data helps you to challenge the payers.”

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The next presenter, Jean Roque, founder and President of TruppHR in Portland, spoke about staffing in the context of organizational change. It was a particularly rich topic, given how much change clinics are being forced to manage today, and how critical hiring and training are to the clinic’s financial results. Jean said when interviewing you want to ask if a candidate is “results capable.” Then, once the new hire has been trained, ask, “What does success look like?” Once you know what success looks like, Jean recommends documenting the findings for the benefit of the whole team.

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Jean discussed how organizational change can be exhausting, and how we all move through distinct phases during these changes. She cited William Bridges’ transition model, and also mentioned the positive benefits that can come from “elevating constraints” (a manufacturing concept that also applies to clinics and other organizations).

The third presentation of the morning was about theft of medical records. Data security expert, Sean Hoar, Partner at the prominent law firm, Davis Wright Tremaine, said, “Human error is the weak link in information security.” Sean added, “Medical data is particularly valuable to criminals—clinics more so than most businesses, need to raise awareness and increase security.” Sean suggested rewarding team members who practice good data security measures, and that he’s seen these kind of small rewards work well at his own firm.

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All told, we heard three distinct but interrelated presentations from experts in their field. It was good to see so many customers in attendance, and even better to know we offered compelling material for them to take back to the clinic.

David Swartout, Owner and Director of Operations at Mountain View Medical Center said, “I enjoyed the mix of topics, and I definitely have some key takeaways that I can use right away in our practice.”

Here are the slide decks for your review.

I’m also happy to answer any questions you might have about any of the topics.

Accelerate 2016 Is A Free Half-Day Workshop for Practice Managers on June 9th

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Please join us Thursday, June 9th at Marylhurst University in Lake Oswego. This event is free to attend, and the morning session will be packed full of insights from industry experts and professionals like yourself on the front lines of the A/R battle.

“Today, clinics often find the simple act of getting paid for services to be a complex and difficult thing to achieve,” says Dustin Wienecke, President of HealthCo. “Clinics endure longer accounts receivable cycles and spend more than any other industry on billing and collections for services already rendered,” he adds.

Three Keynote Speakers In one Morning Session

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  • Andrea Cunningham, HealthCo’s Director of Professional Services, will kick off the speaker series at Accelerate 2016 with a session entitled “Getting ROI from Your EMR.”
  • Jean Roque, the Founder & President of Trupp HR, will focus on how to effectively work with existing staff to change their daily tasks, as well as provide her insight into designing and running effective training programs.
  • Sean Hoar, Partner at Davis Wright Tremaine LLP, will present information on security incident response. He will walk through topics that explore breach investigation, notification requirements and how to protect your clinic.

Marylhurst University is conveniently located near downtown Lake Oswego with easy access and free parking. Plus, come early and enjoy free coffee and breakfast snacks starting at 7:30 a.m.

If you haven’t done so, please register for Accelerate 2016 today. See you on campus in June!
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