How can Podiatrists Shift the Preventive Care from Fee-for-service to Value-based Care?

How can Podiatrists Shift the Preventive Care from Fee-for-service to Value-based Care?

In the rapidly changing healthcare landscape, payers are asking Podiatrists to shift from volume-based care fee for service to a value-based reimbursement structure fee for value with a population health approach. This evolution toward value-based reimbursement benefits the patient, the healthcare provider and the payer. Value-based reimbursement encourages healthcare providers to deliver the best care at the lowest cost. In turn, patients receive a higher quality of care at a better value.

Podiatrists are aware of the efforts underway to transition the United States healthcare fee-for-service payment system away from one based on volume to one that is determined by “value” and links costs to improved patient outcomes. The problem with the current system is that patients who stay in service the longest and have the most procedures and therapeutic interventions generate the greatest revenue regardless of whether outcomes are favorable.

For podiatrists who treat Medicare patients, value-based reimbursement is about to get real. The Centers for Medicare & Medicaid Services is gearing up for next year’s launch of its Merit-Based Incentive Payment System (MIPS), which will factor value, and not solely services performed, into the Medicare reimbursement a provider receives.

If that program is a success, other insurers will likely follow suit with pay-for-performance plans of their own.

Understand That Customer Service Is Essential

The patient experience is more than just clinical care. Podiatrist practices will need to change their approach to patient intake by having staff members take on more of a customer service role. This is especially important for recurring patients. Sit down with each patient and help them understand the financial details of their health care, from pre-admission through the entire care process. Increased interaction, patient education, and patient assistance through this hands-on approach dramatically improves the patient experience, and in turn, increases revenue for your practice

The good news is that these challenges are not that overwhelming, and podiatrist professionals have long managed as the market evolves and organizations find the right mix. Here, we’ve identified important key considerations to consider as they prepare for the ambiguous future ahead.

Making Data More Actionable & Meaningful

Today’s health care organizations are accumulating an overwhelming amount of data, including patient-reported information, social determinants of health, clinical and claims data. With all this information, it can be difficult for organizations to sort out what they do and don’t need – but data is only valuable if it results in informative and actionable results.

Bringing all of this data together to form a substantial record that has 360 degree view of each individual can be keys to an organization’s success. This view enables organizations to understand the opportunities for care interventions to ensure quality measures are being met and can provide a deeper level of analytics into areas such as utilization.

Standardizing the Care

In this complex ever-evolving health care industry, standardized care is a beacon among health plans, risk contracts and shared savings programs. In a time where health systems and providers are balancing new regulations, health plan variations and individual people and population demands, adhering to a standardized level of care removes some of the complexities, while ensuring quality and safety are paramount. Processes and metrics to define standardized care help to ensure patients receive consistent, quality care, every time.

Managing Care & Engagement

Engaging with patients goes beyond helping them manage their conditions. Active participation and shared decision-making is vital, and it’s most effective when an individual’s goals are identified in conjunction with the appropriate tools to make it easy and convenient for them to achieve their desired outcomes. For podiatrists, engaging patients depends on the insights generated from actionable, measurable data.

Final Thoughts

Additionally, front-end revenue cycle processes are now more important than ever, meaning that collecting the correct patient data before service is critical to ensuring clean claims. In order to improve revenue, providers should emphasize eligibility authorization, collection of copayments, and collection of patient deductibles.

Value-based reimbursement helps in preparing for an evolving patient population with:

  • Increased access to care, which can lead to more patients and less network leakage
  • A more engaged patient population that is responsible for its own care. Patients in turn want more insight into their care and value for their dollar
  • Increasing market share when patients have more choice in where they receive care

As healthcare delivery moves toward value-based reimbursement, the business model and the care model become increasingly intertwined. Changes made to care processes can have a significant impact on financial performance. Organizations need tools that help them identify their revenue cycle management, cost drivers and provide insight regarding how cost, quality, and care decisions impact the network as a whole.

Posted in Medical Billing, Medical Billing Company, Medical Billing Services, Medicare Medicaid, Podiatry Billing, Practice Administration, Practice Management, Revenue Cycle Management (RCM) | Leave a comment

Why Radiology Facilities Need to Update Their Technology for Reducing Partial Payment?

Why Radiology Facilities Need to Update Their Technology for Reducing Partial Payment?

U.S.A healthcare providers are to adopt digital radiography (DR), the Medicare system will begin reducing payments for exams performed on analog x-ray systems starting in 2017. The year after that, sites using computed radiography (CR) equipment will also see payment reductions.

The New Norms

Medicare payments will be reduced by 20% for providers submitting claims for analog x-ray studies starting in 2017 under a provision in the Consolidated Appropriations Act of 2016, which was enacted into law in December 2015. Starting in 2018, payments for imaging studies performed on CR equipment would be reduced by 7% for the next five years, and 10% after that.

While the law’s provisions on analog x-ray are expected to have a minor impact due to the small number of traditional systems still in operation in the U.S., the reductions in CR payments could have a much broader effect: More than 8,000 CR units are still in service in the U.S. All of these systems must be replaced or imaging facilities will experience payment reductions.

New Radiology Facilities

Radiology procedures are defined as global services and fall in the 7xxxx series of the CPT book. For example, the radiology code 71020 (two view chest, frontal and lateral) is considered a global CPT code, as it consists of the professional component and the technical component combined. The relative value units have been calculated to include the expense for the whole package. When charging for only a portion of a service, a modifier must be appended to the code on the CMS-1500 form to indicate a reduction in reimbursement is owed to the service provider.

The common modifiers in radiology billing are 26; TC, 76, 77, 50; LT, RT, and 59 below are the brief explanation regarding each modifier:

  • 26 -professional component

When a radiologist is only interpreting films or imaging/tracing and is not providing the machinery, this modifier should be added to the code on the claim form. Typically, this occurs when a radiologist is reviewing for a hospital, an ambulatory surgery center (ASC), or a doctor’s office that owns the equipment and provides the staff but requires the radiologist to interpret the images and write reports.

  • TC – technical component

 This modifier covers the expense of the staff, machinery, equipment, and nonprofessional interpretation elements required to provide a radiological film or image/tracing. Oftentimes, a hospital, ASC, or office will use this modifier when submitting a claim for a radiological service performed.

Modifiers 76 and 77 are similar in that they relate to the same radiological service performed on the same date of service; however, the provider of service determines which modifier is selected for the additional service performed.

  • 76 – repeat procedure same physician

 When a procedure or service must be performed again on the same date of service by the same physician, it requires this modifier should be included with the CPT code on the CMS-1500 form.

  • 77- repeat procedure different physician

This modifier should be included with the CPT code for the same scenario involving modifier 76 but when a different physician performs the repeat procedure. (Note: Medicare considers all physicians in the same group practice with the same specialty to be the same physician.)

  • 50 – bilateral procedure

 This modifier relates to circumstances in which both sides of the body are imaged or a procedure is performed on both sides of the body. Do not use this modifier if the code is written as a bilateral procedure or service, as it is expected to be performed on both sides. Also, “both sides” does not mean front and back (AP/PA and lateral); it refers to right and left sides.

  • LT/RT – left side/right side

 Depending on the side of the body that is imaged, one of these modifiers is be appended to the code to reflect only one side was imaged.

The Conclusion

It is important to note that radiologists should not decrease the fees they submit to payers, as payers will do those themselves when a modifier is submitted. However, fees should be increased when modifiers are submitted, with two units added when reporting on one line item because the payer will not automatically increase its reimbursement if the rates aren’t already increased.

It is imperative that general radiology does not get left behind as the rest of the world moves with advanced technology. It can be easy to overlook the impact and importance of general radiology on patient volumes and consequently, the bottom line, as reimbursements are much lower for these types of exams and especially due to the high cost associated with upgrading technology.

However, the clinical benefits and soft dollar considerations can help offset some of the financial burden. Even though the high price of going digital presents a challenge in today’s healthcare economy, it will not be long until we are looking at analog technology as a thing of the past.

Posted in Medical Billing, Medical Billing Company, Medical Billing Services, Medicare Medicaid, Practice Management, Radiology Billing, Revenue Cycle Management (RCM) | Leave a comment

Value-based Care and Independent ASC Facilities: What You Should Know?

Value-based Care and Independent ASC Facilities

With the tremendous changes in the health care industry, it is going evolving with new rules and regulations to match up the people’s expectations and demands. It is one of the biggest transition phases wherein the independent practices are transforming their independent practices to value base care.

Ambulatory surgery centers (ASCs) are health care facilities that offer patients the convenience of having surgeries and procedures performed safely outside the hospital setting. Since their inception more than four decades ago, ASCs have demonstrated an exceptional ability to improve quality and customer service while simultaneously reducing costs. At a time when most developments in health care services and technology typically come with a higher price tag, ASCs stand out as an exception to the rule.

A transformative model

As our nation struggles with how to improve a troubled and costly health care system, the experience of ASCs is a great example of a successful transformation to value based care.

ASCs perfectly support this ambition in several ways. For one, the physician-led structure on which ASCs are built follows systematic value-based care platforms, whereby a physician’s investment and engagement in the center invites collective assurances for quality and safety.

Further, these centers are able to provide a better overall experience because there are fewer complications muddling the process, such as unscheduled emergency procedures that bump already-scheduled patients and dedicated surgical teams. These more efficient processes also improve productivity and cost management: surgeons can perform up to two more procedures every day, and more predictable schedules reduce staff overtime costs.

Implementing Value Based Care Model

Because the fee-for-service medicine model is going away, and reimbursement based on value is the new system, hospitals must provide community access points for convenient and cost-effective care. In addition to the construction of more ambulatory centers, hospitals must also invest in the latest information technology.

In order to maximize on the ASC reimbursements:

Providers and outpatient surgery centers need to focus on improving in terms of operational and financial perspectives.

The idea here is to ensure that the organization achieves set scores to avoid penalties and lower reimbursement rates.

Outpatient surgery centers need to consider participation in value-based payment models, such as bundled pricing, pay-for-performance, and shared savings.

Attention needs to be paid to the commercial payers, as they make up a significant percentage of ASC’s payer mix.

Because of the shared-risk arrangements between surgery centers and payers, meaningful conversations need to take place between the two regarding contracts.

As the market continues to change bringing growth to the ASC sector, several medical billing and coding companies have shown keen interest and commitment in helping ambulatory surgery centers which are designed to identify and dive into your most pressing operational issues via an expansive suite of intuitive analytics, reports and dashboards.

As long as outpatient surgery clinics employ effective strategies to manage revenue cycle; acquire ideal payer contracts; and meet the rising challenges in the industry ASC facilities will thrive nicely in a value-based payment mode

Posted in Accounts Receivables, Ambulatory Surgical Centers, Claims Denials, Medical Billing, Medical Coding, Practice Administration, Practice Management, Revenue Cycle Management (RCM) | Leave a comment