Medical Practice Fee Schedule Annual Review

In the wake of healthcare reform and delayed or reduced reimbursements, many medical practices may feel like pressure surrounding fee schedules. One way they can ease into this new reality is by examining fee schedules on an annual basis and adjusting accordingly for maximum benefit. Determine Top CPT Codes and Costs The first step of [...]

2019-09-03T16:00:12-05:00December 8th, 2018|HEALTHCARE|

Winning a Gold Medal for Alternative Payment Model Participation

Participating in the Olympic Games can create career-defining moments for elite athletes. Similarly, healthcare providers that participate in alternative (or “value-based”) payment models can yield desirable benefits for themselves and their patients. These models are intended to incentivize a greater continuity and coordination of care between providers, leading to better patient outcomes at lower costs. [...]

2021-09-20T15:26:42-05:00July 14th, 2016|HEALTHCARE, POST ACUTE CARE|

How Do You Approach Alternative Payment Models?

In January 2015, the Centers for Medicare & Medicaid Services (CMS) released an initiative to quickly move the Medicare payment system away from traditional fee-for-service reimbursements and toward those linked to value and quality – including alternative (or value-based) payment models. Most, if not all, healthcare providers are at least partially affected by these models. [...]

2020-07-14T16:02:44-05:00July 14th, 2016|HEALTHCARE, POST ACUTE CARE|

Measuring Non-Physician Providers with Benchmarking Metrics

Medical practices seek effective ways to prepare for the arrival of new patients receiving healthcare coverage through the Affordable Care Act’s (ACA’s) new Health Insurance Marketplaces and expanded Medicaid programs. Non-physician providers (NPPs), including nurse practitioners, nurse midwives, physician assistants, and physical therapists can provide much-needed support in this new healthcare era. However, for NPPs [...]

2018-11-12T15:52:21-06:00January 23rd, 2015|HEALTHCARE|

Time is Money: Tracking the Work Relative Value Unit to Increase Physician Productivity

The adage “time is money” is particularly relevant when establishing a system to track physician productivity. Unfortunately, most practices use an outdated method that measures units, charges, and collections. These metrics do not accurately measure physician productivity because they are sensitive to modifiers, charge increases, payer mix, and changing reimbursement amounts. As a result, physician productivity [...]

2018-11-12T15:55:06-06:00June 11th, 2013|HEALTHCARE|

Economic Credentialing in the Form of Accountable Care Organizations (ACOs)

When health maintenance organizations (HMOs) evolved into managed care organizations (MCOs) approximately two decades ago, there was a strong push for provider panels to accept only physicians who could practice cost-efficient medicine. These parameters meant choosing doctors who used minimal resources without compromising quality. This process, called “economic credentialing,” provoked vigorous debate and lawsuits. The disputes [...]

2018-11-12T15:55:07-06:00June 7th, 2013|HEALTHCARE|

Growing Medical Practice Patient Collections

Successful gardeners know that growing flavorful vegetables requires high attention to detail. Attention to detail is also necessary for a healthcare facility to maximize its collection rates. Planting the Seeds for Payment at Time of Medical Practice Service Planting the seeds for payment at the time of service (TOS) requires proper staff training on: understanding [...]

2018-11-12T15:55:35-06:00December 17th, 2012|HEALTHCARE|

Is the Medical Practice Grass Greener Out of Network?

Many physicians see few advantages to remaining on an insurance company’s provider panel. Physicians are transitioning to out-of-network provider status primarily because of billing and payment difficulties. However, is the grass greener out of network? Medical Practice Risks to Being Out of Network Because out-of-network providers avoid contractual adjustments and in-network claims processing, they may [...]

2018-11-12T15:56:06-06:00April 11th, 2012|HEALTHCARE|

Manage Patient Accounts Receivable and Maintain Cash Flow

As healthcare reimbursements decrease and patients incur greater responsibility for healthcare costs, medical practices must properly manage patient accounts receivable to maintain their cash flows. Many employers are moving away from traditional health insurance plans as employer insurance costs continue to rise. High-deductible health plans (HDHP) offer lower premiums to employers in exchange for higher [...]

2019-03-14T10:12:57-05:00July 17th, 2011|HEALTHCARE|