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Alta
Partners News & Tips. Information to Improve your Practice |
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By Popular Demand: Alta Practice Manager Boot Camp
BACK BY
POPULAR DEMAND: Move over Military, this is Alta
Partners Boot
Camp!
Started as a new service to our clients, Alta Partners introduced Practice Manager Boot Camp in the summer of 2007 as a new line of training geared not to the every day Misys user, but to their supervisor, the Practice Manager. This training is a two part course that offers managers instructions on how to run, read, interpret, and analyze financial and billing reports. Whether you are a new practice manager or a seasoned veteran, these courses will help hone your analytical skills to better manage your physician practice using our Misys practice management system. Session 1 will review of all of the reports that are currently provided to Practice Managers over the course of a year, and include detailed descriptions about how each of the reports can be used to assess your practice’s billing performance on a daily basis Session 2 will be an advanced lecture which will cover other reports the Practice Manager can run from the office to further analyze their business (Supplemental Client Reports) As we did in the summer, we are offering both morning and afternoon sessions. Because of the material to be covered, invitations are extended to the Practice Manager and/or Office Supervisor of our client practices only. Boot Camp 1 Monday – March
10, 2008 (9am-11am) Boot Camp 2 Tuesday – March
25, 2008 (1pm-3pm) Attendance of Session #1 is required in order to attend Session #2. ENLIST today to improve your bottom line tomorrow! If you are unable to attend either of these sessions, stayed tuned to future editions of the Alta Newsletter for information on when we will be offering these classes again. To register please contact Jeff Kovacs at 440-808-3644 or email at jpk@altapartnersllc.com.
Understanding Physician Reimbursement Under Medicare The Resource-Based Relative Value Scale (RBRVS) is the prevailing model used today to describe, quantify, and reimburse physician services. Since the Health Care Financing Administration (HCFA) introduced the RBRVS-based fee schedule in 1992, use of this system among commercial payors has spread rapidly. Today, Medicare, Medicaid, and many private insurance companies use the RBRVS to determine payment for physician services, and many practices and institutions use relative value units (RVU’s) to track physician productivity and evaluate job performance. But do you know how the two work? The RBRVS assigns numerical values to health care services—office visits, hospital care, procedures, etc— to quantify the relative work and cost of these services. These units allow comparison of apples to oranges (i.e., surgery to primary care visits) and can determine the allowable payment for any service in any specialty. The main element of the fee schedule is a relative value scale, which is comprised of three components:
Though these three main components remain constant across the country, which makes the RVU system great for comparing productivity among physicians, several adjustments are necessary to go from units to payments. First, a Geographical Price Index (GPCI) for each of the components must be factored in. This adjustment takes into account the cost of living differences across the country. In addition, since the Balanced Budget Act required that changes to the RVU payment schedule be budget neutral, a conversion factor and a payment modifier amount must be taken into consideration each year. Once all of these factors are known, a simple formula can be used to determine the Medicare Allowable Amount for a particular CPT code:
Although some physician specialties have seen positive changes in the WRVU, PERVU and PLIRVU over the years, the budget neutrality factors have tempered these changes. For example, from 2006 to 2007, commonly used Primary Care Physician evaluation and management CPT Codes received a considerable overall increase in WRVU value, 29%. However, the overall payment increases that these physicians experienced were not commensurate, increasing only 9%. (See the following graph)
A closer comparison of how the Medicare Allowable Amount for CPT Code 99213 was calculated each year shows us the impact on reimbursement over the past three years:
As we can see from the illustration above, the WRVU component increased by 37%, but the RVU-GCPI, PE-GCPI and PLI-GCPI all decreased in value, for an overall positive Medicare Allowable variance of only 13%. It should be noted that although this example for Primary Care Physicians still amounted to a positive payment variance, other specialties, such as General Surgery, actually experienced a decrease in reimbursement. Overall, physician reimbursement has been relatively flat since 2005. Physicians have received well below inflation payment updates in 2004 and 2005, zero percent updates in 2006 and 2007, and a minuscule .5% increase for the first six months of 2008. Unless Congress acts, physicians will experience a 10.5% reimbursement decrease for the last six months of 2008. Greater reimbursement decreases are projected well into the future.
Congress, Administration and various Advocacy groups are at odds on balancing physician reimbursements due to concerns that too many cuts will result in physicians dropping from participation in Medicare at a time when Medicare beneficiaries is at an all time high. As this debate goes on, be sure to contact your local congress representative and ask them to replace these looming Medicare physician payment cuts with positive updates the truly reflect practice cost increases to ensure the Medicare beneficiaries in the United States continued access to quality healthcare.
The Centers for Medicare & Medicaid Services (CMS) now provides coverage for a full range of preventive services and screenings that can help seniors and other Medicare beneficiaries stay healthy, detect disease early, and manage conditions to reduce complications. Approximately three years ago, CMS determined there was adequate evidence to conclude that smoking and tobacco-use cessation counseling, based on the current U.S. Public Health Service Guideline, is reasonable and necessary for certain individuals and should be covered by Medicare. Effective for services performed on or after March 22, 2005, Medicare has provided coverage of two levels of counseling for smoking cessation (intermediate and intensive). Medicare now provides coverage of smoking and tobacco-use counseling for beneficiaries who meet one of the following criteria: 1. Use tobacco and have a disease or an adverse health effect that has been found by the U.S. Surgeon General to be linked to tobacco use 2. Are taking a therapeutic agent whose metabolism or dosing is affected by tobacco use as based on Food and Drug Administration-approved information. Still not widely known by physicians, Medicare will cover two cessation attempts per year. Each attempt may include a maximum of four counseling sessions. The total annual benefit covers up to eight smoking and tobacco-use cessation counseling sessions in a 12-month period. The beneficiary may receive another eight counseling sessions during a second or subsequent year after 11 full months have passed since the first Medicare-covered cessation counseling session was performed. Intermediate and intensive smoking cessation counseling services will be covered for outpatient and hospitalized beneficiaries who are smokers and meet all coverage requirements as long as those services are furnished by qualified physicians and other Medicare-recognized practitioners. Until recently, these counseling sessions were billed using temporary codes created in March 2005, G0375 and G0376. These codes are now deleted. The codes that will replace these codes are 99406 (smoke/tobacco counseling, 3-10 minutes, reimbursed at $12.13) and 99407 (smoke/tobacco counseling, >10 minutes, reimbursed at $23.12). For these services, if the counseling occurs during a separately identifiable Evaluation/Management visit, it should be billed with a 25 modifier. For more information about coverage, coding, billing, and reimbursement of Medicare-covered preventive services and screenings, visit: http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp
Free Educational Sessions Available Founded by healthcare veterans and a team of committed employees, Alta Partners offers a unique, firsthand understanding of the business side of healthcare that stems from our extensive experience in physician billing and practice management. Working in partnership with our clients, Alta Partners dedicated, knowledgeable personnel navigate the increasingly complex billing environment to help streamline billing processes. In addition, our practice management expertise allows us to understand how billing and practice operations interact in order to realize full billing effectiveness. Alta Partners would like to share our knowledge with you. As a new service in 2008, we have developed an educational series that we are offering physician staffs and practice managers. The series includes the following:
If you are interested in learning more about one of these subjects, or scheduling an educational session, please contact Michael Moran @ 440-808-3649 or mjm@altapartnersllc.com.
During these two hour sessions, Alta’s staff BWC experts will walk participants through the BWC claims process, to include but not limited to the following:
Classes will be offered on the following days: February 22, 9AM – 11AM Class space is limited and will be offered on a first come first serve basis. Sign up early and begin working towards becoming an EXPERT in the first steps of the BWC claims administration process! To register please contact Jennifer
Negulescu @ 440-808-3712 or email
jnn@altapartnersllc.com.
Searching for an existing patient account? Creating a new patient account? The data base in the MISYS system is a shared data base for all our clients. A new patient in one office could be an existing patient in another office. Performing a proper account search for each patient will save each office both time and money. Additionally, it is much easier to locate an existing patient account and just attach your office information to the account than it is to create a new account. There are several ways to perform a proper patient search. Keep in mind that when searching for a patient account or creating a new patient account you must use the correct name on the insurance card, not nicknames or abbreviated names. (i.e. Joseph not Joe, Deborah not Debbie) Pediatric offices need to be especially careful when searching for newborn accounts. Newborn accounts are sometimes created with the last name of the mother and the first name as “baby boy” or “baby girl”, because the child may not have been named prior to the OB office submitting the bill for their services. An additional problem that is encountered with parents and children occurs when a parent who has a child in the system, subsequently becomes a patient. Instead of creating a new account for the parent, the Responsible (R) accounts and / or Subscriber (S) accounts should be changed to a Patient (P) account. When searching for an account many fields can be used; first and last name, social security number or date of birth. The most common field is the first and last name. When you enter the last name, we recommend that you only put in three letters of the last name with an asterisk (Smi*) and two letters of the first name with an asterisk (Ja*). From this, you should get a comprehensive list with all patients who have this combination of letters in their names (Smi*Ja*). To select the correct patient from this list, scroll down through the patient names for the correct date of birth. The date of birth can also be added to the first and last name search if the last name is a real common name. It is important to remember that some of the Responsible accounts and Subscriber accounts do not have the date of birth or social security number listed on the account, so be careful to pick the right patient in such instances. Although proper account maintenance will save each office both time and money, probably the biggest benefit from this process is that experienced by the patient. By only having one account in the system, each patient will only receive one statement, with all recent activity, no matter what the office, on that statement. With one statement, there is less patient confusion and the patient tends to pay their outstanding account balances in a more expedient fashion. Accidents will happen and there will be times when duplicate accounts will be made and found after the fact. If a duplicate account is made, continue to complete the merged log sheet that we have supplied each office (Date of submission, group number, completed by, patient name, patient date of birth, and account number with current information and duplicate account numbers). Once complete, please fax the log to Alta Partners @ (440) 808-3676.
We recommend that the merge log be
completed on a weekly basis, even if there is only one account that
needs to be merged. That way all of us will have access to an up to
date database on a regular basis, causing less work for us all. For
questions or comments about merged accounts or for a copy of the merge
log, please contact Brenda Izold @ 440-808-3711.
Alta Partners Quarterly Newsletter Benchmark: This chart shows the average charges for common office / outpatient visit codes 99211 through 99215 and compares them to the Medicare Allowable amount for Ohio for 2005 and 2006. The average charge is based on how many times the code was billed and the total charges submitted to Center for Medicare and Medicaid Services (CMS). As you can see, the average provider charged between 142% and 170% of the Medicare Allowable amount for these CPT codes during these years. Is your fee schedule set as such? If not, you may be leaving important dollars on the table.
Alta Partners Calendar of Events As a new feature to our quarterly news letter, Alta Partners has begun publishing a calendar that will keep you up to date with our educational sessions and remind you of important dates for your business. Remember to keep an eye out for this feature in each newsletter!
Feb/March
April
Email your ideas to Michael Moran @ mjm@altapartnersllc.com.
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