Points of Interest 04/28/2014

Points of Interest

April 28, 2014

 

Why doctors need to care about price transparency ?

 

As healthcare costs become a bigger and bigger chuck of our Gross Domestic Product (GDP), price transparency is a subject that insurance companies and patients are talking about. The idea of knowing how much something costs, be it canned black beans in the grocery store or replacing the leaking faucet in your kitchen, seems obvious but it will be an uphill battle to enact change within the healthcare system.

 Transparency is here, and it’s hunting season on doctors

 The data released by Medicare includes the doctor’s name, address and specialty. For each physician, there is a list of CPTs performed for more than 10 patients during CY 2012, and for each CPT there is the number of unique patients billed for the procedure, the number of times the procedure was performed (or billed to Medicare), the average charge per CPT and the average payment for the same. There are over 800,000 names on the list (not just physicians), so chances are good that unless you are a pediatrician or a concierge doc, your name is on it. Of course, this is just the preliminary raw list, but given enough time and innovative efforts, many, many sub-lists will be evolving. Even before the list was released to the public, several publications with advanced media access, managed to quickly produce high-spender lists, so stay tuned to your favorite news outlet for more to come.

 

The Medicare spending we should be concerned about

Here are the payment figures that really caught my eye:

·         $12 billion spent on outpatient visits in 2012, with average reimbursement of $57 per visit. This is out of a total Medicare spending of $600 billion for the year.

·         $77 billion overall paid to doctors and health care providers. (Unclear to me whether this is just Part B, or also includes payments to doctors during hospitalizations.)

·         $13.5 billion spent on “commercial entities like clinical laboratories and ambulance services.”

Look at that. Outpatient visits are 2% of Medicare spending. And at $57/visit, is it any wonder that primary care for seniors is often woefully inadequate?

We spend more on laboratory services and ambulances than we do on outpatient visits.

How generations of doctors will handle health care change

With American health care in the midst of rapid transformation, both doctors and patients will be forced to adapt to changes stemming from the Affordable Care Act, also known as “Obamacare.”

Of course, everyone responds to change differently. But is it possible to predict how doctors will adapt to health care reform based on the year they were born? The answer may surprise some patients and even force them to think differently about who provides their care in the future.

How different are the generations, really?

A lot of data exists on the characteristics that define and differentiate generations. While none of that data can paint a totally accurate picture of any one doctor, the research does allow us to cover the canvass in broad strokes:

Baby boomers (born 1946-1964) .

Millennials (born 1984-present) .

How generations of doctors will handle change

Not all generational generalities are foolproof: Some baby boomer physicians are as high-tech as the savviest millennials and plenty of Generation X doctors put in long hours.

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Points of Interest - April 22, 2014

Points of Interest

April 22, 2014

  

Warding off fraud suits after CMS physician payment revelations

 

The release of Medicare’s payments to doctors could impact medical practices and health systems in a lot of ways, including being fodder for fraud accusations – a problem that’s worth getting ahead of from the get-go.

Medicare Advantage final rule benefits insurers and providers

 

Insurers offering Medicare Advantage plans got a bit of a reprieve this week when the Centers for Medicare & Medicaid Services gave them a rate increase instead of the expected cut. CMS’ 2015 rate announcement also addressed concerns over provider terminations and beneficiary cost sharing.

 The new risk model that began in the 2014 plan year and is being phased in at the 33 percent proportion will eventually increase, CMS wrote in its final rule. Likewise, the withdrawn proposal to exclude home risk assessments (the second time it has been proposed and retracted) may return.

 

New entrants into the healthcare market threaten traditional businesses 

New entrants in the healthcare market could snatch billions of dollars of revenue from traditional healthcare companies if the traditional companies do not move faster to provide services in the setting consumers want. 

Medicare RACs at a crossroads 

With the new contracts CMS leaders are promising to “refine and improve” the Medicare Recovery Audit program. Among the changes are a 30-day auditor-provider discussion period before claims can be sent to MACs for adjustment and revised additional documentation request limits based on a providers denial rate, with lower limits for those with fewer claims denials.

All of that comes after enormous provider frustration with recovery auditors, and amid an appeals backlog so long it’s out of compliance with federal law. 

 

PCMHs a boon to providers and payers

 

The latest patient-centered medical home study suggests that cost and utilization reductions are noticeable for only the highest-risk patients – a boon for payers. But there are pluses for providers too, including better patient and clinician satisfaction, more roles for specialty care and a roadmap for accountable care.

 

Accountable Care Organizations (ACOs)

 

General Information

ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program. 

ACO Programs at CMS

Medicare offers several ACO programs, including:

·         Medicare Shared Savings Program (cms.gov) - For fee-for-service beneficiaries

·         Advance Payment ACO Model - For certain eligible providers already in or interested in the Medicare Shared Savings Program

·         Pioneer ACO Model - Health care organizations and providers already experienced in coordinating care for patients across care settings

A series of three Accelerated Development Learning Sessions were held in select cities across the country. Additional information on each Session can be accessed below:

·         ACO: Accelerated Development Learning Sessions - For existing or emerging Accountable Care Organizations (ACOs) to develop a broad and deep understanding of how to establish and implement core functions to improve care delivery and population health while reducing growth in costs.

 

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Points of Interest 04/15/2014

Points of Interest

April 15, 2014

 P4P – What’s Next ?

 Pay-for-performance programs are likely to expand across US health care in the near future, especially with implementation of the Affordable Care Act. But experience to date with pay-for-performance initiatives has raised a number of questions that require more research and experimentation.

 Transitioning to ICD-10

 Given the political fallout from the data system problems encountered with implementation of the health insurance exchanges, the Obama administration will likely be extremely sensitive to any potential problems with claims processing due to the ICD-10 conversion. Extensive testing, both of the system's connectivity and of coding accuracy, is needed to ascertain readiness for the conversion. In February 2014 CMS administrator Marilyn Tavenner had announced that there would be no further delays and implementation would proceed on October 1, 2014. However, since Congress responded to physicians' concerns and again delayed implementation, the administration and providers must deal with the implications of the delay and revise plans for training and testing. While the delay will be costly for organizations that have already made substantial investments in preparing for the change, it may also provide more time to make sure the transition occurs more smoothly.

Mental Health Parity

The push to make mental health treatment equal to treatment for other health issues has a long history in Congress, in state legislatures, and with the Federal Employees Health Benefits (FEHB) program. In 1996 Congress passed the Mental Health Parity Act (MHPA, championed by Senators Paul Wellstone (D-MN) and Pete Domenici (R-NM). This law applied to large employer-sponsored group health plans (those with more than fifty employees) and prohibited them from imposing higher annual or lifetime dollar limits on mental health benefits than those applicable to medical or surgical benefits. The law applied to both fully insured group health plans (those that purchased insurance from an insurance company or issuer) and self-insured group health plans (those that retained the financial risk for health care claims). The law contained a cost exemption that allowed group health plans to receive a waiver, exempting them from some of the law's key requirements, if the plans demonstrated that costs increased at least 1 percent as a result of compliance. It is important to note that the MHPA did not mandate coverage for mental health treatment, rather, it only applied to group health plans that offered mental health benefits.

Medicare Advantage (MA) Rolls On

Monday afternoon, the Centers for Medicare and Medicaid Services (CMS) released the final rates and other reimbursement policies for Medicare Advantage (MA) plans, referred to as the Final Call Letter. Once again, the Administration took pains to ameliorate planned cuts to MA, demonstrating the program’s increasing popularity with seniors and, by extension, its robust political strength.

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Points of Interest 04/11/2014

Points of Interest

April 11, 2014

What was the real Medicare waste? Not sharing data sooner

Federal officials said they hope Wednesday's "unprecedented" disclosure of data about $77 billion in Medicare reimbursements to 880,000 physicians and other providers in 2012 will lead to reporters and researchers uncovering fraud, waste and unwarranted variations in treatment that could lead to significant cost savings in the future.

Those officials also said it was "impossible" to quantify how much taxpayer money could have been saved in the past if such Medicare data hadn't been kept secret for 35 years, and instead had been available for independent analysis.

"I'm sure that there are savings that would have been achievable," said Chris Holt, director of health-care policy for the American Action Forum. "I'm sure that there were savings that weren't realized, but I'm not sure how much that has been."

But Cristina Boccuti, who analyzes Medicare policy for the Kaiser Family Foundation, said that having data about how much the government was paying individual doctors in past decades could have led to big cost savings, particularly if such data were publicly available in the 2000s, and if Medicare authorities had adjusted their policies in response.

 ObamaCare

Obamacare's most controversial feature—the requirement that nearly all Americans have health coverage this year or pay a fine—may not have been a big motivator for the more than 7 million people who signed up for new insurance plans, several analysts said a week after the close of open enrollment.

Obama nominates OMB Director Sylvia Mathews Burwell to lead HHS

President Barack Obama today officially nominated Sylvia Mathews Burwell, currently director of the Office of Management and Budget, as his next HHS secretary, saying in a Rose Garden announcement that he “could choose no manager as expert, as competent.”

High drug prices skewing payouts to some physicians

A close inspection of Medicare's physician payment data reveals that many of the highest-paying codes for eye doctors relate to the use of a drug for macular degeneration that costs $2,000 a dose.

 ICD-10

Despite the delayed ICD-10 compliance deadline, health care organizations must continue to plan for the inevitable change in coding standards.

Many organizations are looking to AccuChecker to help eliminate issues associated with staffing, retention and training.

The AccuChecker team will help you with the Transition to ICD-10. We will help your organization achieve efficient, consistent and compliant coding.

• Mitigate financial impact with lowered A/R days or DFNB (Discharged Not Fully Billed)
• Ensure compliance standards are met and maintained
• Improve coding effectiveness and efficiencies by teaming with highly trained experts

For more details call AccuChecker at 305-227-2383

 

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Points of Interest - 04/10/2014(a)

Points of Interest

04/10/2014 (a)

Ahead of the ICD-10 Transition

With 2015 just around the corner, practices should begin making their ICD-10 transition strategy  a top priority. Because while the new coding set is expected to produce higher reimbursements down the line, its sheer complexity can be unbelievably disruptive for practices. AccuChecker is the tool for this transition. For details call 305-227-2383  or 1-877-938-9311 .

 

2014 MU incentive program off to a relatively slow start

As of the end of February, there were 458,137 total participants – up from 448,750 in January – from all versions of the EHR incentive program, according to Elizabeth Myers, head of policy and outreach at the Office of eHealth Standards and Services, Centers for Medicare & Medicaid Services at the Tuesday HIT Policy Committee meeting.

Since February, 9387 eligible providers have joined the meaningful use incentive program. That total includes 5,716 Medicare providers, 3,662 Medicaid providers and 9 hospitals

Announcement from the State of Georgia

The State Board of Workers’ Compensation will adopt ICD-10-CM/PCS for diagnosis and procedure coding to coincide with the Centers for Medicare and Medicaid Services’ (CMS) implementation date. Because of this transition, there have been a number of significant changes to the fee schedule. Therefore, this year’s Georgia Workers’ Compensation Medical Fee Schedule’s effective date will be May 1, 2014. Please disregard the effective date of April 1, 2014 printed on the binder cover of the fee schedule.

Patient-Centered Medical Home

The patient-centered medical home is a way of organizing primary care that emphasizes care coordination and communication to transform primary care into "what patients want it to be." Medical homes can lead to higher quality and lower costs, and can improve patients’ and providers’ experience of care.

 Drop in substance abuse treatment, especially in Medicare

The proportion of people diagnosed as chemically dependent who proceed to recommended, timely treatment has declined dramatically over several years. The drop has been largest in Medicare plans, suggesting that America’s fast-growing senior population is more likely not to get needed treatment for addiction..

 HEDIS

HEDIS includes performance measures related to dozens of important health care issues. Selected measures include, but are not limited to:

§  Advising smokers to quit

§  Antidepressant medication management

§  Breast cancer screening

§  Cervical cancer screening

§  Children and adolescent access to primary care physician

§  Children and adolescent immunization status

§  Comprehensive diabetes care

§  Controlling high blood pressure

§  Prenatal and postpartum care

Overuse use of antibiotics still a problem

In findings that echo and corroborate recent CDC warnings about overuse of antibiotics leading to antibiotic resistance, we see no progress on overuse of antibiotics—a serious public health threat.

More Medicaid enrollees like their care

Medicaid enrollment is growing and will continue to growth with the implementation of the Affordable Care Act. Fortunately, patients are increasingly happy with their doctors – both primary care and specialists – in their Medicaid plans

  

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Points of Interest 04/08/2014



Points of Interest

08/APRIL/2014

CMS to increase Medicare Advantage (MA) pay rate by 0.4%

 After an aggressive lobbying push from the insurance industry, the CMS announced Monday that it would increase the overall rate it pays Medicare Advantage plans by 0.4% in 2015, despite a proposed policy issued in February that signaled a 1.9% rate cut.

 Preventative vs. Diagnostic Services in the Affordable Care Act

 Under the Affordable Care Act, insurance plans now cover preventative care without patient cost sharing, i.e., without co-pays, co-insurance, or deductibles.  However, services that are not classified as preventative care are still subject to cost sharing. It is important for physicians and their staff to be able to differentiate between the two in order to avoid blindsiding patients and avoid experiencing a revenue loss.

 What Physicians Need to Know About Fraud and Abuse Prevention Updates

 On March 18, the Department of Health and Human Services, Office of the Inspector General's (OIG) "Compendium of Priority Recommendations" was released. The report addressed the top 25 unimplemented recommendations, which would serve to protect the integrity of HHS programs. For physicians, two areas are of particular note: fraud and abuse prevention and recovery audit contractors (RACs).

Five Things to Know About Medicare Advantage Plans

Of all the evolutions seen in senior healthcare over the past four decades, few have proved to be more significant than the changes in regulations in the 1970s that provided Medicare beneficiaries the freedom to opt out of traditional Medicare and instead receive healthcare benefits through private health plans. Today more than 14 million American seniors and individuals with disabilities — about 28 percent of the total Medicare population — are enrolled in Medicare Advantage (MA) plans.

 Five important things to know about Medicare Advantage:

·         Care coordination work

·         MA plans are driven to improve quality

·         MA plans are attractive to younger seniors

·         Enrollment happens all year round

·         We're all in this together

 

AccuChecker

AccuChecker OnLine BASIC

 

The AccuChecker OnLine BASIC is the ideal tool for the practice that demands limited coding but that can take advantage of AccuChecker OnLine comprehensive state-of-the art ICD-10-CM system and FREE-HOTLINE support. The AccuChecker OnLine BASIC cost less than 50 cents a day.

 

The AccuChecker OnLine BASIC is an Internet service with:

 

• Procedures  – CPT, Category II and HCPCS codes
• Diagnoses codes (ICD-9-CM and ICD-10-CM)
• Converter of ICD9 to ICD10

Accuchecker OnLine CLASSIC

 

AccuChecker OnLine Classic has been the only AccuChecker OnLine version since 2000 hundreds users from across the nation use the CLASSIC and renew their subscriptions every year, we are most grateful for their support and loyalty.

 

The AccuChecker OnLine CLASSIC is designed for medical practices that require coding techniques and pricing services. Fast, accurate, easy-to-use Coding and Pricing Techniques for less than $1.00 a day

 

The AccuChecker OnLine CLASSIC is a comprehensive database with:

 

• Procedures  – CPT, Category II and HCPCS codes
• Diagnoses codes (ICD-9-CM and ICD-10-CM)
• Converter of ICD9 to ICD10
• Medicare fee schedules including OPPS rates in radiology
• Coding techniques like:
• Corrective Coding Initiative (CCI),
•  Medical Necessity – procedures matching diagnoses,
• Medicare’s LCD and NCD,
• Surgical modifiers outlining coding guidelines
• Global period for surgical services – 0, 10 or 180 days
• Diagnostic procedures with modifiers - 26, TC and global.

 

For more details call 305-227-2383 or 1-877-938-9311.

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