Physician reimbursement is in for a bumpy ride. Accountable care organizations (ACOs) are on the rise, fundamentally changing the structural and financial models of care delivery.  Next up are value-based modifiers that differentiate reimbursement to physicians based on quality and cost. For some practices these modifiers will affect reimbursement in 2015 – based on clinical services provided now in 2013! 

In this free webinar sponsored by Navicure, learn how to align your practice for value-based reimbursement and begin the transition from fee-for-service medicine to alternate reimbursement forms.

Join us on Tuesday, June 11^th at 1:00 pm EDT/10:00 am PDT: Critical Update on Physician Payment Reform: ACOs and Value-Based Modifiers. Register now.

During this hour, Deborah Walker Keegan, PhD, FACMPE, will discuss:

• The current state of ACOs and the leverage employed to ensure value-based care
• Payment reform models currently being tested and models likely to emerge as industry standards
• Key recommendations from the Physician Payment Reform Commission and their impact on the medical practice
• Methods and processes for value-based modifiers and what you can do to prepare for the future now

Register for the live event today.

Participants can earn 1.0 Continuing Education Unit (CEU) from the AAPC by attending the live webinar.*

*This program meets AAPC guidelines for 1.0 CEU. On-Demand product requires successful completion of post test for continuing education units. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

Physician practices know there is a lot to understand about the various healthcare reform policies. With so many changes—from reform to ICD-10 to value-based care models—it can often be overwhelming to work through all of the updates. You’re not alone if you’ve found the details to be a little complicated and hard to work through. To help you and your practice understand some of the major changes from recent reform, we’ve answered some of your top questions.

Does mandatory repayment refer exclusively to CMS and not to private insurance? 

The proposed mandatory repayment rule only refers to Medicare/Medicaid payments and does not cover overpayments by private payers. Contracts between your practice and each payer should cover similar rules that align with individual payer policies to safeguard your practice.

Does Meaningful Use (MU) include University Student Health Centers?

Potentially—eligible professionals, hospitals and critical access hospitals can receive MU incentives, even if they are part of a University. If you work at one of these organizations, the best next step, in our opinion, is to review the eligibility requirements for Medicare and Medicaid MU incentives and then determine which individual practitioners in your organization are eligible for the program.

In regards to MU, if a physician left our practice in November 2012 and their National Provider Identification (NPI) was terminated with our facility, where will the incentive payments go?

The payments will go to the individual physician who has completed the certification and proper forms, so payment status will depend on the information the physician provided. If he or she has received the payment, you may have a difficult time getting the money back unless the physician’s employment agreement explicitly provided that the practice was entitled to the funds.

Can specialty practices create an ACO? Why might physician offices join other practices?

Specialty practices can create an ACO; however, they should consider that in order to be an ACO, they must have 5,000 primary care Medicare patients. Therefore, they need to make sure they have an adequate number of primary care physicians to serve this population. It could be helpful for individual specialty practices to join together to help with the high cost of running a practice and to help ensure each patient can be cared for within the ACO.

To learn more, download this free webinar, Top 5 Practical Healthcare Reform Realities for Physician Practices in 2013. Do you have additional questions about healthcare reform or other industry-wide changes? Let us know in the comments section below.

It’s a straightforward question with tremendous impact on the revenue cycle: Should we offer payment plans to our patients? In one word, the answer is yes—but with a caveat.  Not every type of patient balance should qualify. Practices must place some parameters around when a payment plan is appropriate.

Patient co-pays, for example, should be collected in full at the time of service if at all possible. It just doesn’t make fiscal sense to chase $20 over several months. On the other hand, it might be perfectly feasible to extend a short payment plan to a patient who can’t pay the $100 deductible upfront.

The key is to develop specific policies and criteria.

At one practice where I worked, any balance under $300 had to be paid within three months of the date of service. Larger balances had to be paid within six months. Furthermore, any payment plan agreed upon was put into writing for the patient to sign. This helped to increase not only the patient’s commitment to pay, but could be used as leverage if the bill was sent to collections.

Still, even written payment plans can’t guarantee 100% reimbursement. One effective option for patients who struggle with their payment plans is a quick-pay discount. Because these discounts are extended in exchange for immediate payment in full, they offer a solution that ensures partial collection while also relieving a patient’s financial anxiety. My former practice typically offered a 25% discount; managers could approve up to 40% and administrators up to 49%.

As with any financial policy, patient payment plans pose both advantages and disadvantages. There will always be those patients, for example, who want to spread a minimal balance over an unreasonable length of time. In the end, though, the advantages outweigh the disadvantages. Physician practices exist to care for patients; that commitment should apply to their financial health as well as their clinical well-being.

Thanks to everyone who attended our webinar, ICD-10: It’s Time to Dive In, on May 8. During the webinar AAPC ICD-10 expert, Shelly Cronin, CPC, CPMA, CPPM, CPC-I, CANPC, CGIC, CGSC, discussed:

• An overview of ICD-10, including the ways ICD-10 is very different from today’s ICD-9
• ICD-10 benefits and tips on how to build awareness, educate and obtain buy-in from stakeholders
• How ICD-10 impacts both clinical and office staffs, systems and processes
• Various documentation challenges, coding examples and more

To learn more, click here to download a recording of this webinar. After you’ve listened, let us know if you have any questions or comments.

*This program meets AAPC guidelines for 1.0 CEU. On-Demand product requires successful completion of post test for continuing education units.

Do your patients understand, at a glance, the billing statements you send them? The answer to that question is critical to your practice’s financial health, since nearly a quarter of your revenue likely comes directly from patients. Here are some revealing statistics:

• Patient collections account for 23.2 percent of total patient services revenue, according to recent MGMA-ACMPE research.
• The number of high-deductible health plans and health savings accounts (HSAs) has more than doubled in just the past four years, according to America’s Health Insurance Plans’ (AHIP) Center for Policy and Research.

Taken together, these facts mean that patient payments will only continue to grow in importance for physician practices. The problem, of course, is that patients who don’t understand their bills very often don’t pay them—at least, not in a timely manner.

The good news: A few changes to your billing statements can go a long way toward making it easier for patients to quickly comprehend and pay their balances. Here are just a few of many suggestions from MGMA-ACMPE:

• Describe the services rendered in layman’s terms to help patients recall the reasons for their visits. While CPT and ICD-9 codes mean a lot to practice staff, they rarely mean much to a patient.
• List clearly and distinctly:
  1. Total charges
  2. Amount already paid by insurance
  3. Amount already paid by the patient
  4. Amount the patient still owes
• Tell patients the next step. Very often, that will be as simple as, “Pay patient balance owed.”

Maximizing revenue cycle effectiveness often requires long, involved financial processes. Designing an easier-to-read patient billing statement, on the other hand, is a simple way to help spur cash flow.

The Navicure Complete revenue cycle management solution provides you with access to alerts, advanced reporting, and analytics as well as unlimited secondary paper claims and more.

In this overview, learn how Navicure Complete can help improve your practice’s revenue cycle management.

Download your Navicure Complete overview today!

The Navicure Symphony package provides you solutions to enhance the management of your electronic remittance advice (ERA), and rejected and denied claims.

In this overview, learn how Navicure Symphony can help manage claims and remittance in harmony with how you work.

Download your Navicure Symphony overview today!

Navicure Symphony Video Overview

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The Navicure Simplicity package helps simplify your workflow and reduce the cost of managing your revenue cycle.

In this overview, learn how Navicure Simplicity can help make claims, eligibility, and remittance easier.

Download your Navicure Simplicity overview today!

Spot trends. Answer questions. Communicate results.

In this overview, learn how Navicure Analysis Channel will provide you with a variety of key reports to analyze how your practice is performing.

Download your Navicure Analysis Channel overview today!

Navicure Analysis Channel Video Overview

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Increase your practice’s efficiency and effectiveness – from denial to appeal to payment with Navicure Receivables Manager, the evolution of the Navicure ERA Filing Cabinet.

In this overview, learn how Navicure Receivables Manager provides you with one central repository for insurance denials, appeals and payments and how Navicure standardizes your electronic remittance advice (ERA), turning your data into actionable information.

Download your Navicure Receivables Manager overview today!