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ACO’s and the Tech Needed to Be Ready

Posted on April 22, 2014 I Written By

The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.
Barry Haitoff
For those not familiar with ACOs (Accountable Care Organizations), I want to provide some insight into ACOs and how a medical practice can better prepare themselves for the coming shift in reimbursement, which is epitomized by the ACO. This is a challenging subject since the ACO is a somewhat nebulous idea that’s rapidly changing, but hopefully I can provide you some strategies that will help you be prepared for the coming changes.

You may remember when we talked in a previous post about the Value Based Payment Modifier and its impact on healthcare reimbursement. As we talked about in that post, healthcare reimbursement is changing and CMS is looking to only pay those providers who are providing quality care. As part of this movement, an ACO is an organization that works on behalf of a community of patients to ensure quality care.

The metrics of how they’ll measure what they reimburse and what they consider quality care are likely to rapidly change over the next few years while CMS figures out how to measure this. However, one key to being ready for this shift is that you’ll need to be part of an organization or group of providers that will take accountability for a patient population.

In some areas of the country, the hospitals are leading these organizations, but in other areas groups of physicians are coming together to form an ACO of just physicians. Either way can work. The key is that the members of these groups are going to each share in the reimbursement the group receives for improving the quality of healthcare patients in the community receive.

Also worth noting is that membership in an ACO isn’t necessarily a prerequisite for value based reimbursement. Whether you choose to be a member of an ACO or not, you’re going to be impacted by value based reimbursement and will need to be ready for the change. Not being ready could lead to lower reimbursement for the services you provide.

While it’s great that organizations of doctors are coming together to meet the need for ACOs, much more is going to be needed to do well in an ACO reimbursement world. The reality is that an ACO can’t exist without technology. Don’t even think about trying to meet the ACO requirements without the use of technology. ACOs will base their reimbursement on trackable data that can be aggregated across a community of providers that are likely on hundreds of different systems. Try doing that on paper. It just won’t happen.

In fact, many people probably think that their EHR software will be enough to meet the needs of the ACO as well. I believe this to be a myth. Without a doubt, the EHR will play a major role in the gathering and distribution of the EHR data. However, unless you’re a homogeneous ACO with providers that are all on the same single instance of an EHR, you’re going to need a whole suite of services that connect, aggregate, and interpret the EHR data for the community of patients. Add on top of that the communication needs of an ACO and the care manager style tracking that will need to occur and it’s unlike your EHR is going to be up to the task of an ACO. They’ll be too busy dealing with meaningful use and EHR certification.

Let me highlight three places where an ACO will need technology:

Communication
One of the key needs in an ACO is quality communication. This communication will happen provider to provider, provider to care manager, provider to patient, and care manager to patient and vice versa. You can expect that this communication will be a mix of secure text messaging and secure emails. In some cases it will be facilitated by a patient portal, but most of the secure messaging platforms for healthcare are much slicker and more effective than a patient portal that so far patients have rarely used.

Are you using a next generation secure messaging system to communicate with other providers, your staff, and the patient? You’ll likely need to use one in an ACO.

Provider Data Aggregation
Much like paper charts won’t be enough in an ACO world, faxed documents won’t be enough either. Providers in an ACO will need to have patient data from across the entire community of ACO providers. At a minimum providers in an ACO will need to have their EHRs connected with Direct, but most will need to have some sort of outside HIE that helps transfer, aggregate and track all the data that’s available for a patient in the ACO.

The ACO and doctor will really benefit from all the patient data being available at the click of the button. Without it, I’m not sure that ACOs will be able to meet the required quality measures.

Patient Data Aggregation
While all of the providers will need to be sharing their patient data, I think most ACOs will benefit from aggregating patient data as well. At first the ACO won’t be aggregating all of the patient generated data that’s available. Instead, they’ll find a slice of their patient community where they can have the most impact. Then, they’ll work with those patients to improve the care they receive. This is going to require ACOs to receive and track patient generated data. Without it, the ACO won’t have any idea how it’s doing. With so many patients on mobile devices or with access to the internet, what an amazing opportunity we have to really engage with patients.

Those are just a few of the ways technology is going to be needed for the coming changes in healthcare reimbursement and the shift towards value based care in things we call ACOs. Far too many providers are sitting on the sidelines while they let ACOs settle into place. What a missed opportunity. The fact that the ACOs are rapidly changing means that if you participate and make your voice heard, you can help to shape the direction of them going forward. We definitely need more doctors involved in these conversations.

Medical Management Corporation of America, a leading provider of medical billing services, is a proud sponsor of EMR and HIPAA.

ICD-10 – Is Everyone Ready? – ICD-10 Tuesdays

Posted on March 25, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.
Barry Haitoff
One of the biggest challenges to revenue a practice will face in 2014 is the move to ICD-10 on October 1, 2014. One of the biggest challenges with ICD-10 is that it impacts the entire healthcare ecosystem. This means that revenue flow could be impacted if any one part of the healthcare billing continuum isn’t ready.

The first key step every organization can take to prepare for the switch to ICD-10 is to do an audit of which systems, people, and processes will be impacted by the change. Second, you should evaluate the ICD-10 readiness of each system, people and process. Finally, you should make a plan for how you’ll ensure that each piece of the puzzle is ready for ICD-10.

Here’s a quick look at some of the places you’ll want to look when doing an audit of your ICD-10 readiness:
EHR Software
This is an obvious one. We all know that the EHR vendor needs to be ready for ICD-10. However, as John posted previously, Is Your EHR Ready for ICD-10, Not Just Say They’re Ready? it’s really easy for an EHR vendor to say they’ll be ready for ICD-10. At the core of being ready for ICD-10 is just being able to use a new code. Every EHR vendor will be able to enter the new code. Instead of asking if they are ready for ICD-10, you should ask your EHR vendor what interface they’ve created for you to be able to find the ICD-10 codes. You’ll want to get in and test this new interface for finding codes well before the ICD-10 deadline so they can make any changes to the software.

Providers
Every doctor I know understands they they’re going to have to be ready for ICD-10. They’ve heard about the expanded set of codes and how finding the right code is likely going to take extra time. What many doctors haven’t realized yet is that with increased coding specificity, the doctor’s documentation is going to have to change as well. Coding 101 is that the coding has to match the documentation. This will require every doctor to change the way they document their visit even if it’s only a small change.

Billing Software
This is another obvious one and many of the lessons mentioned above about EHR software apply to billing software. However, you’ll definitely want to make sure that your billing software is ready for ICD-10. Can you imagine the impact to your organization if they’re not ready? You might not think this is possible, but I’ve heard some billing software already announce that they’re not planning to revise their software for ICD-10.

Billers and Coders
This is the group that seems most prepared for ICD-10. Most people realize that the coders or billers in their organization need to be ready for ICD-10. Unfortunately for many organizations, that’s where they think all the ICD-10 preparation needs to happen. As this list shows, they are so wrong. However, if you haven’t invested in getting your billers and coders ready for ICD-10, then you better start doing so now. In some cases you may have an older coder that chooses to retire instead of learning ICD-10. Make sure you learn if this is the case now instead of October 1st.

Billing Company
It’s really hard to imagine a billing company not being ready for ICD-10. It’s a basic fundamental of them being a business. If they can’t do ICD-10 they’ll be out of business. However, it makes sense for you to check with them to see what they’ve done to prepare for ICD-10. You’re their customer and it never hurts to hold them accountable. If they don’t thank you up front, they’ll thank you on October 1st when they’re ready for the change.

Labs and Radiology
You’d think that these wouldn’t be that big of an issue since we’re just talking about a new code that gets sent to the lab or radiology. However, if they’re not expecting ICD-10 codes, your patients could run into issues. Plus, many of you have interfaces which send this information automatically. You’ll want to make sure that these interfaces can handle the new codes as well.

Payors
This is probably the most important one and also one of the most challenging. It is the most important, because if they’re not ready for ICD-10 that could mean that you stop getting paid. In many organizations, a hit to their cash flow could have serious ramifications. My guess is that some of you don’t think that this could ever really happen. I assure you that it could happen. Certainly they’ll eventually fix whatever issues they have and they’ll get rolling with ICD-10. Although, will it take them a week, a month, a couple months, to fix whatever issues they may be experiencing? Can you handle not getting paid for a week, month, or multiple months? The challenge is that there’s no simple way for you to know if the payors are indeed ready for ICD-10. The best advice I can offer is a famous statement, “The squeaky wheel gets greased.” Don’t be afraid to make some noise to make sure they’re ready.

Hospitals and HIE
Many vendors are starting to build interfaces with their hospital or an outside HIE (Health Information Exchange). If you have one of these interfaces, you’ll want to make sure that it can support the new ICD-10 codes. Don’t forget to check and test both sides of the interface for their ICD-10 readiness.

Other ICD-10 Readiness Advice
When assessing the readiness of the various entities listed above (and you will likely have others), it’s important that you ask the right questions to make sure you get the right answers. Much like when you’re evaluating between EHR vendors, you want to avoid asking Yes/No questions. For example, if you ask your EHR vendor, “Are you ready for ICD-10?” then you will quickly get a response of Yes. If instead you ask, “What have you done to get ready for ICD-10?” you will get a much more informative answer that helps you understand their true ICD-10 readiness.

Also, when doing your assessment of their readiness, don’t forget to also verify that they can handle ICD-9 for those situations where an organization still hasn’t moved to ICD-10. Yes, it’s crazy that some government organizations aren’t moving to ICD-10. However, it’s the stark reality, so make sure that when needed to you can still support ICD-9 as well.

In all of this, there’s a challenging balance between doing your training too early or too late. If you train your doctors on ICD-10 too early, then they’re likely to forget it by the time October 1st rolls around. However, if you wait until the ICD-10 deadline approaches, the resources for ICD-10 won’t be available. Can you imagine what it will be like to try and hire an ICD-10 coder or ICD-10 trainer in September?

Medical Management Corporation of America, a leading provider of medical billing services, is a proud sponsor of EMR and HIPAA.

PQRS Incentives, Penalties and the Coming Value Based Payment Modifier

Posted on February 20, 2014 I Written By

The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.
Barry Haitoff
Much of the focus of healthcare has been on meaningful use and the EHR incentive money. Considering we just reached $19 billion of payouts, it’s definitely a topic worthy of attention. However, a topic which hasn’t gotten nearly as much attention, but is nearly or possibly more important than meaningful use is PQRS and the Value Based Payment Modifier.

Before I dig into some of the details and timelines for PQRS and the Value Based Payment Modifier, it’s really important to note that both of these programs are really just a preview of what’s happening with Medicare reimbursement. These programs are the core of the shift towards paying physicians differentially based on the quality and cost of the care they provide and away from the traditional fee for service model. We’ve seen similar value based payment arrangements with the advent of ACOs, CINs and other clinical networks establishing innovative payment models with payers. Understanding where these programs are going will give you a preview of what’s happening with healthcare reimbursement.

PQRS
When it comes to PQRS, much like meaningful use, there is both a PQRS incentive and PQRS penalty (carrot and stick if you prefer). 2014 is the final year to receive the PQRS incentive money (0.5% of Medicare Part B claims) and participants must submit 12 months of 2013 CQM data by February 28, 2014 if reporting by claims data, March 21, 2014 if reporting by GPRO web interface, and March 31, 2014 if reporting by registry data. (Note: The 2013 MU reporting deadline was moved to March 31, 2014, but the PQRS deadlines have not changed.). However, more important is that providers who don’t report PQRS 2013 data will be penalized 1.5% in 2015. Those who don’t participate in PQRS in 2014 will be penalized 2% in 2016.

Value Based Payment Modifier
While most people have heard about PQRS and are hopefully participating to avoid the penalties, many people haven’t heard about the Value Based Payment Modifier that is built on the PQRS foundation. While you could look at the Value Based Payment Modifier final rule, this Value-Based Payment Modifier summary is a much better overview of the program.

Essentially, the Affordable Care Act (ACA) required that CMS implement a value based payment modifier that would apply to Medicare fee for service payments. This program will start with physicians in groups of 100 or more eligible professionals under the same TIN beginning January 1, 2015, and apply to all physicians and groups by January 1, 2017. CMS also recently announced that this applies to both par and non-par Medicare providers with 100 or more eligible professionals.

Here’s a look at how this new Value Modifier will work for groups of physicians with 100 or more eligible professionals and will likely be a preview of what’s to come for all Medicare physicians:
CMS Value Modifier

While the program starts with relatively small 1% adjustments, this quote from CMS also provides a clear indication of where they want to take this program:

We also anticipate that we would propose to increase the amount of payment at risk for the Value Modifier as we gain additional experience with the methodologies used to assess the quality of care, and the cost of care, furnished by physicians and groups of physicians.

What should you do to be prepared for this new Value Based Payment Modifier?
1. Participate in the PQRS program since it’s the foundation of what’s to come.
2. Keep an eye on changes to the PQRS and Value Based Modifier programs. They are changing regularly and it’s worth knowing what’s changing with these programs.
3. Work with your professional organization to provide feedback on these programs. No doubt they’re keeping an eye on them and providing feedback as part of the government rule making process. Make sure your voice is heard.

CMS looks at this new value based modifier as a budget neutral program. That means that there are going to be winners and losers. By understanding how these programs work, you can better assess if you want to work to avoid the payment adjustments or if you’re ok taking them on.

Like it or not, PQRS is the start of the movement towards quality based reimbursement and likely a small preview of coming attractions. Of course, if the SGR Fix gets funded by congress, then PQRS, Meaningful Use and the Value Based Modifier will be sunset at the end of 2017 and rolled into a new Merit-Based Incentive Payment System (MIPS) that will start in 2018. More on MIPS in the future, but I think we can safely say that MIPS will be an amalgamation of all these incentive programs.

Medical Management Corporation of America, a leading provider of medical billing services, is a proud sponsor of EMR and HIPAA.

Interview with Barry Haitoff, CEO of Medical Management Corporation of America

Posted on January 20, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is an interview with Barry Haitoff, CEO of Medical Management Corporation of America.
Barry Haitoff

Tell us about Medical Management Corporation of America (MMCOA).
MMCOA helps physicians and physician groups increase collections, assure compliance, manage overhead and navigate the maze of EMR/EHR, Meaninful Use, PQRS and other Government incentive programs and regulations. With a focus on revenue cycle management, MMCOA helps our clients stay ahead of the curve with things like the transition to ICD-10.

What are the keys to running a good medical billing company?
Like any successful business, I believe the 2 most important assets are people and systems. We hire, retain and cultivate quality individuals and empower them with state of the art systems and technology. We never settle for status quo and continue to look for better ways of doing things. My style of leadership is one of servitude. It is my goal to provide all staff members a great work environment, financial incentives and proper tools to perform their functions.

What’s your take on the economics of outsourcing medical billing? Where’s the ROI for an office that’s considering going with an outside medical billing company like yours?
I tell physicians, “do what you do best and outsource the rest”. Your tax work is handled by a professional accountant, your legal work is handled by a professional attorney, who is handling your billing? Outsourcing your billing can sometimes be more expensive than keeping it in-house, however, the return should far outweigh the added cost.

Most practices do not have adequate resources in their billing department to do the right job. A great deal of money winds up being left on the table. There is a reason that the tallest buildings in most metropolitan cities are owned by insurance companies. A quality billing company will increase your collections at a rate that will far exceed the fee.

In addition, because the typical fee structure is based on a percentage of collections, not only does the billing company have “skin in the game” to do a good job, the billing overhead of the practice is better managed. If one or more physicians are out of the office on vacation resulting in lower charges, that eventually results in lower collections. With billing in-house the practice still pays salaries, benefits, software licenses etc. All the fixed costs remain in place regardless of collections that month. With outsourced billing company, the practice’s cost for billing is directly in proportion to the amount collected that month.

What are some of the biggest changes to medical billing that have happened over the past couple years?
EMR/EHR, PQRS, ePrescribing, HIPAA, Meaningful Use, Accountable Care Organizations, Value/Quality based reimbursement, Bundling, Health Insurance Exchanges, added governmental regulations, OIG compliance and soon…..ICD-10, ICD-10, ICD-10. ICD-10 will prove to be the biggest challenge to date. We’re ready!

How is medical billing going to be impacted by things like ACOs (Accountable Care Organizations) and value based reimbursement?
Someone will still need to make sure that services rendered are reimbursed properly. More challenging, someone will need to distribute funds appropriately to the myriad of providers involved. There will be a greater need for revenue cycle management as payments are bundled.

Is healthcare ready for ICD-10? What are you doing to make sure you’re ready?
Our research to date says no. Providers and staff are not yet trained. Insurance carriers and software vendors have not yet successfully tested.

We have established an ICD-10 committee headed by our Director of Healthcare Informatics. We have begun informing and educating our clients and staff, researching tools, attending training sessions, initiating dialogue with our software vendors and staying up to date.

In what ways has the Accountable Care Act (Obamacare) and the health insurance exchanges impacted your clients?
I’d say that it’s caused a whirlwind of confusion. Providers must take the time to determine which HIX plan networks they’re in, so as not to provide care outside of a contracted relationship with the HIX plans, which predominantly lack out-of-network coverage. We expect our clients to become busier. We expect the additional covered lives to find their way into our clients’ offices. We have helped our clients figure out if they are participants in the Exchanges in their area.

A number of EHR companies have started doing medical billing. How do you differentiate the services you offer versus an EHR vendor?
Most of the EHR vendors that have just started doing medical billing, just started doing medical billing. MMCOA has been in business for 18 years, growing primarily by word of mouth. Some of the EHR vendors are publicly held companies whose most important stake holder is their shareholders. Our most important stakeholder is our clients. We have had clients leave us for those solutions and have since come back. We will continue to provide quality service on a consistent basis and will never sacrifice integrity for growth.

What are the biggest revenue cycle management issues you see in organizations?
Not enough staff. Outdated or inadequate technology. Lack of leadership. Lack of ongoing training. Lack of incentive.

Where do you see revenue cycle management going in the future?
My crystal ball is broken right now. Seriously though, there is a lot of consolidation in our industry and the smaller billing companies will likely go out of business or be acquired. Physicians and physician groups will continue to need assistance with their reimbursements. Unless all healthcare providers wind up employed by an ACO, Hospital System or other Healthcare entity with adequate revenue cycle management expertise, there will be a need for continued navigation of the maze we know as healthcare revenue cycle management.

Medical Management Corporation of America, a leading provider of medical billing services, is a proud sponsor of EMR and HIPAA.

Where Are We At With Meaningful Use?

Posted on December 11, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.
Barry Haitoff
It seems like meaningful use is in a constant state of flux with moving deadlines and multiple stages that apply to each organization differently. With meaningful use stage 2 just around the corner for many providers it is worth taking a quick look at where we are on the journey to meaningful use.

Meaningful Use Timelines
The most important thing many organizations need to remember is the various timelines for each meaningful use stage. This can be pretty complex because it changes based on when you first attest to meaningful use. Plus, last Friday CMS announced an extension to meaningful use stage 2 and a delay of meaningful use stage 3 for one year.

Before this recent change, CMS put out the following chart which clearly illustrates how much EHR incentive money a provider will get for showing meaningful use of a certified EHR. Plus, it shows which meaningful use stages you will have to comply with based on the year you started attesting to meaningful use. After the aforementioned announcement, the only change to this chart would be that both meaningful use stage 3’s would become meaningful use stage 2.

Meaningful Use Medicare Incentive Timelines and Stages

The above chart is just for EHR incentive money under Medicare. The chart for Medicaid is much simpler and hasn’t changed much since the EHR incentives were first announced.

Meaningful Use Medicaid Incentive Timelines and Stages

EHR Penalties
While the incentive money for EHR is important for many, it seems like doctors are motivated as much or more by the Medicare adjustments that will be enforced if they aren’t meaningful users of a certified EHR system. Here’s the timeline for the EHR payment adjustments:

Meaningful Use Penalty Schedule

There are a number of hardship exemptions that a provider can claim to avoid the penalties. If you plan to pursue one of these hardship exemptions, you have to apply for one by July 1, 2014. CMS has put out a nice tipsheet covering payment adjustments and hardship exemptions. As you can see, the exemptions are pretty narrow. Although, maybe they’ll create more exemptions over time like they did with the eRX penalties.

Other Notable Meaningful Use Updates
Regardless of what stage of meaningful use you are at or any prior years reporting, all eligible professionals will only have to attest to 90 days of meaningful use in 2014. This change was made to give organizations plenty of time to upgrade to the 2014 certified EHR technology. However, many EHR vendors have taken this extra time into account and are still not 2014 certified because they know eligible providers only have to attest to 90 days in 2014. Anyone attesting to meaningful use regardless of meaningful use stage will have to be on a 2014 certified EHR. The 2011 EHR certification will be expired and not accepted.

It is also worth noting that those who have not begun participation in the Medicare EHR incentive program will need to attest to meaningful use in 2014 if they want to be eligible for any EHR incentive money.

Meaningful Use Audits
If you’ve already attested to meaningful use stage 1, then you better make sure your documentation is in order. Meaningful Use audits have already begun and a number of organizations are getting caught without the proper documentation. This is worth also noting for those planning to attest to meaningful use for the first time. Make sure that you keep all your meaningful use attestation documentation in case you’re ever audited.

The most common audit issue organizations have is with core measure 15 which requires an organization to conduct a security risk analysis. Many organizations checked off this box without actually doing a security risk analysis. That’s a very risky proposition. This is one meaningful use requirement where you can’t rely on your EHR vendor to do it for you. This is not a hard task and many organizations will be happy to come and do one for you. Just make sure you’ve actually done it before you attest.

Medical Management Corporation of America, a leading provider of medical billing services, is a proud sponsor of EMR and HIPAA.