Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

Why Physician Practices Need a MIPS Expert on Staff

Posted on April 16, 2018 I Written By

The following is a guest blog post by Marina Verdara, Sr. Training Specialist for CMS Incentive Programs, Kareo.

Healthcare providers go to school to learn how to care for patients, and that’s what they do best. However, billing processes, performance-based payment adjustments, and payment incentives are typically not included in this education. Being responsible for today’s regulatory complexities and workload may not have been what providers envisioned for their career. And it’s taking a toll. Nearly half of physician practices spend more than $40,000 per full-time physician per year on complying with Medicare payment and incentive programs, according to an MGMA survey. These costs factor in loss of physician productivity and staff training needs, along with IT expenses.

Independent practices must find a way to streamline the CMS incentive program reporting process. One important way to do this is by designating a “MIPS expert” among your staff. This could be your lead clinician or another manager who has oversight of patient encounter documentation.  While 2017 reporting is done, now is the time to specify the MIPS expert so they can ensure compliance throughout all of 2018.  Don’t wait until 2018 is done to specify your MIPS expert.

MIPS Recap

In 2015, The Department of Health and Human Services (HHS) announced new goals for value-based payments in Medicare that changed your practice’s payment structure. The Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) introduced a system where providers receive payment based on the value and quality of services provided, not the volume. These changes repealed the Sustainable Growth Rate Formula, streamlined multiple quality reporting programs into MIPS, and provided incentive payments for participation in Advanced Alternative Payment Models (APMs).

HHS made these changes as the first steps to creating a Medicare for healthier people. Their goals are to create a Medicare system that will be here for generations to come while also providing open, flexible, and user-centered health information.

Navigating The System

This sounds like a great plan, right? But, how do you keep up with the frequent MIPS changes and alerts while maintaining a successful private practice?

You need a MIPS expert.

You wouldn’t leave your busy practice in the hands of a mechanic, and you shouldn’t leave your billing and incentive payments in the hands of someone who doesn’t understand MACRA and MIPS. You need an internal staff member who is your MIPS champion. This is the person who can partner with your EHR vendor to ensure that the eligible providers in your practice earn the highest incentive available, as well as avoid any negative penalties. In my role of training practices on implementing a streamlined CMS reporting system, I can tell you that practices with a designated MIPS expert are much more successful and efficient in their MIPS reporting process—and these are the practices that are earning the highest possible score.

Invest in the education and training of your internal MIPS expert so you can be confident that your practice is among the highest earners.

3 Reasons You Need a MIPS Expert at Your Practice

1. A MIPS expert will help maximize your payments. MIPS is all about streamlining your practice to become more efficient in how you diagnose and improve patient outcomes. When you do this well and report your data, you increase your chances of earning a positive payment adjustment.  

Participating in MIPS earns you a payment adjustment according to evidence-based and practice-specific quality data. The better the quality of your data, the better your chances of earning a positive payment adjustment.  

Your MIPS expert will understand the details of the MIPS program. They should be familiar with the activities and measures that are most meaningful to your practice. Your MIPS expert can help your eligible clinicians select measures that best apply to the specialty to prove their performance and maximize their payments.

2. A MIPS expert will be your education partner. This staff member should stay educated and informed of the latest regulatory details. Here at Kareo, we notify eligible clinicians and the designated MIPS expert of ongoing education opportunities. These are offered on a set schedule and as needed with new changes to MACRA and MIPS.

3. A MIPS expert will mobilize your practice staff and clinicians. To successfully meet MIPS requirements, the entire practice needs to be engaged. The MIPS expert can partner up with your EHR vendor to ensure that eligible clinicians in your practice understand the MIPS requirements and know how to navigate through the system. In this process, your practice can identify areas where any given workflow should be modified to earn the highest possible score and receive maximum payment for the great care they deliver.

Resources for Your MIPS Expert

As we mentioned above, MIPS experts at independent practices must stay up to date on all MIPS alerts and resources available to you through the Quality Payment Program. They should take time to educate themselves, understand changes, and read all alerts provided by Medicare or by their EHR vendors.

Your MIPS expert should be able to find an education partner using one or both of these paths:   

  1. Your Regional Extension Center: Contact them to ask questions and get connected with a MIPS education partner.
  2. Your Electronic Health Record company: As an example, Kareo has MIPS training specialists who can partner with your MIPS expert to help maximize payments, stay up to date on the latest changes, and provide support. We have training sessions and ideas for implementation of new workflow processes.  

Don’t be intimidated by the complexity of MIPS. Take time to designate a MIPS expert on your staff and get them connected to their education partner today.

About Marina Verdara
Marina is a Sr. Training Specialist guiding Kareo customers to higher levels of success with their CMS Incentive Program reporting, including MIPS and Meaningful Use. Marina has over seven years of experience working directly with several hundred small practice clinicians on a variety of projects specializing on CMS Incentive programs such as Meaningful Use, PQRS, and MACRA. Kareo is a proud sponsor of Healthcare Scene.

Moving from “Reporting on” to “Leading” Healthcare – A Conversation with Dr. Halee Fischer-Wright, President & CEO of MGMA

Posted on October 11, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

In Chapter 3 of Dr. Halee Fischer-Wright’s new book Back to Balance, she writes: “People are increasingly being treated as if they are the same. Science and data are being used to decrease variability in an attempt to get doctors to treat patients in predictable ways.” This statement is Fischer-Wright’s way of saying that the current focus on standardization of healthcare processes in the quest to reduce costs and increase quality may not be the brass ring we should be striving for. She believes that a balance is needed between healthcare standardization and the fact that each patient is a unique individual.

As president of the Medical Group Management Association (MGMA), a role Fischer-Wright has held since 2015, she is uniquely positioned to see first-hand the impact standardization (from both legislative and technological forces) has had on the medical profession. With over 40,000 members, MGMA represents many of America’s physician practices – a group particularly hard hit over the past few years by the technology compliance requirements of Meaningful Use and changes to reimbursements.

For many physician practices Meaningful Use has turned out to be more of a compliance program rather than an incentive program. To meet the program’s requirements, physicians have had to alter their workflows and documentation approaches. Complying with the program and satisfying the reporting requirements became the focus, which Fischer-Wright believes is a terrible unintended consequence.

“We have been so focused on standardizing the way doctors work that we have taken our eyes off the real goal,” said Fischer-Wright in and interview with HealthcareScene. “As physicians our focus needs to be on patient outcomes not whether we documented the encounter in a certain way. In our drive to mass standardization, we are in danger of ingraining the false belief that populations of patients behave in the same way and can be treated through a single standardized treatment regimen. That’s simply not the case. Patients are unique.”

Achieving a balance in healthcare will not be easy – a sentiment that permeates Back to Balance, but Fischer-Wright is certain that healthcare technology will play a key role: “We need HealthIT companies to stop focusing just on what can be done and start working on enabling what needs to be done. Physicians want to leverage technology to deliver better care to patient at a lower cost, but not at the expense of the patient/physician relationship. Let’s stop building tools that force doctors to stare at the computer screen instead of making eye contact with their patients.”

To that end, Fischer-Wright issued a friendly challenge to the vendors in the MGMA17 exhibit hall: “Create products and services that physicians actually enjoy using. Help reduce barriers between physician, patients and between healthcare organizations. Empower care don’t detract from it.”

She went on to say that MGMA itself will be stepping up to help champion the cause of better HealthIT for patients AND physicians. In fact, Fischer-Wright was excited to talk about the new direction for MGMA as an organization. For most of its history, MGMA has reported on the healthcare industry from a physician practice perspective. Over the past year with the help of a supportive Board of Directors and active members, the MGMA leadership team has begun to shift the organization to a more prominent leadership role.

“We are going to take a much more active role in healthcare. We are going to focus on fixing healthcare from the ground up –  from providers & patients upwards. In the next few years MGMA will be much bigger, much strong and even more relevant to physician practices. We are forging partnerships with other key players in healthcare, federal/state/local governments and other associations/societies.“

Members should expect more conferences, more educational opportunities and more publications on a more frequent basis from MGMA going forward. Fischer-Wright also hinted at several new technology-related offerings but opted not to provide details. Looking at the latest news from MGMA on their revamped data-gathering/analytics, however, it would not be surprising if their new offerings were data related. MGMA is one of the few organizations that regularly collects information on and provides context on the state of physician practices in the US.

It will be exciting to watch MGMA evolve in the years ahead.

A Girl, a Fitbit, and an Already Failed New Year’s Resolution

Posted on February 9, 2017 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 blog post by Cristina Dafonte, Marketing Associate of Stericycle Communication Solutions as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter:@StericycleComms
cristina-dafonte
Have you ever heard the story of the person who makes a New Year’s Resolution to exercise more and eat healthy, buys themselves a cool new gadget to stay motivated, a fresh new pair of sneakers, and then has already failed by February? This person is me – in February of 2017, I have fallen victim to every New Year’s Resolution stereotype in existence.

Last week, after eating half of a “family sized” bag of Cool Ranch Doritos and thinking about how frustrated I was that I couldn’t eat healthy for a whole two months, someone gave me a bit of great advice. They told me to write down what I had learned since January.

Lesson 1:

I love Cool Ranch Doritos and I have no self-control over my hand-to-mouth motion when I am around them.

Lesson 2:

Eating half of a family sized bag of Cool Ranch Doritos is guaranteed to make you feel extremely sick.

Lesson 3:

My “stay motivated” gadget is way cooler than I thought.

I bought myself a FitBit Charge 2 so that I could not only monitor the number of steps I took, but also monitor my heart rate while exercising. I had no idea why this was important, but my triathlete boyfriend had a heart rate monitor, so I wanted one too.

After about 1 week with my new FitBit, I was hooked. I was monitoring my heart rate all day, everyday. I wanted to know where my peak heart rate was and how far it was from my resting heart rate. I used the customized “relax” feature on my FitBit, which took me through guided breathing exercises to lower my heart rate. The FitBit also calculates how many hours you sleep and how many calories you burn while running, all based on my heart rate! I was amazed on how much I learned about my body just by watching my heart rate, which led me and my #HIT mind to thinking about how this data could or should be shared with my primary care doctor.

In a recent study by Stanford Medicine, researchers proved how wearables could tell when a person was getting sick. They discuss how healthcare providers can use wearables and the data they collect to help individualize medicine – by establishing a unique “baseline,” providers will easily be able to tell when something is wrong.

The future of healthcare, and personalized medicine, and the interconnectedness of it all is exciting. I know that given the option, I would gladly share my FitBit data with my primary care physician. I trust that something I wear every single day that monitors my activity, sleep, and heart rate knows me better than the doctor I visit once a year. I look forward to the day where this is a reality, and all of this incredible data that wearables are collecting can be used to help advance medicine and enrich patient data.

Learn more about some of the ways Stericycle Communication Solutions is closing the gap between patients and their providers here.

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality call center & telephone answering servicespatient access services and automated communication technology. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services.  Connect with Stericycle Communication Solutions on social media: @StericycleComms

Are Providers Using Effective Patient Communication Methods?

Posted on December 1, 2016 I Written By

The following is a guest blog post by Cristina Dafonte, Marketing Associate of Stericycle Communication Solutions as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter:@StericycleComms
cristina-dafonte
This year at MGMA 2016, the Stericycle Communication Solutions team had the opportunity to survey over 800 providers about their patient communication strategy. Getting to collect our own data, rather than relying on facts and figures from scholarly articles, was truly invaluable. But what was even more exciting was sitting down and analyzing the results.

Many of the statistics weren’t surprising – nearly 100% of providers are sending appointment reminders, 60% of providers are using technology to send these reminders, and 2/3 of providers surveyed love the idea of online self-scheduling. These statistics all made sense to me… it’s almost 2017, of course providers would prefer to use technology when it comes to their patient communications.

But as I dug more into the numbers, I saw a startling trend:

  • Only 1 out of 3 providers who “love” online self-scheduling offer it to their patients
  • While almost all providers are sending appointment reminders, 1/3 are still manually calling their patients
  • Over 60% of providers are only sending appointment reminders via ONE modality

I started to think about other parts of my life where I booked appointments or used technology to interact with a vendor– did these healthcare numbers match their non-healthcare counterparts?

First I looked to my hair salon. When I go to their website, I have the ability to book an appointment with my current hair dresser directly on their home screen. I get an email reminder the day that I book the appointment with a calendar attachment. The day before the appointment, I get a text reminding me what time my appointment is and whom it is with. Four months after the appointment, I get an email reminding me that it’s time to come in for my next appointment… with a link to book an appointment online. Surprisingly, this didn’t match what I was seeing in my survey data analysis. When I looked at scheduling an appointment to get my car serviced, I saw the same trend – booking was conveniently online, the communications were all automated, and I received more than one reminder.

So why does there seem to be such a difference when it comes to healthcare communication? Our survey shows that providers like the idea of technology, so, I wonder, why are most providers only going halfway? What is it that is holding them back from fully investing in automated patient communications? According to TIME, the average person looks at his or her phone 46 times per day. As we near 2017, shouldn’t we reach and capture patients where they are engaged and spend most of their time – on their mobile devices and computers?

For more MGMA survey results and a sneak peak into how Stericycle Communication Solutions can help you adopt an automated patient communication strategy, download the infographic here.

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality call center & telephone answering servicespatient access services and automated communication technology. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services.  Connect with Stericycle Communication Solutions on social media:  @StericycleComms

Is Innovation Missing at MGMA 2016?

Posted on November 2, 2016 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.

This week I’ve been at the MGMA Annual Conference in San Francisco. It’s been a very interesting event with a ton of people that really want to improve healthcare. I’m always impressed by these practice administrators passion for their work and their desire to do what’s right for patients.

While I love their passion, I can’t help but feel that there’s a clear lack of innovation at MGMA. More specifically the practice executives and not the MGMA organizations itself. Instead of trying to figure out and participate in new business models that will take their practice to the next level, most healthcare practices seem focused on optimizing their existing practice.

Sure, many of them are focused on various government regulations like MACRA. In fact, I’d suggest that most of them are too focused on government regulations. No doubt that’s part of why healthcare executives at MGMA aren’t focused on innovation. They’re too busy dealing with government regulation to be able to have time to sit down and think how they could take patient care to the next level or create new business models.

The two places I do think we see some interest in innovation is the shift to value based reimbursement and the change to direct primary care. The problem with value based care is that people don’t really know what that’s going to be. Most are in wait and see mode to see where it’s all going to go. Direct primary care is quite interesting to many, but that largely only applies to primary care and many feel it’s limited in which primary care practices can and should participate (I know that many people firmly disagree with this idea).

I guess that means that MGMA stands in somewhat stark contrast to many of the other healthcare conferences out there. Maybe that’s not such a bad thing. We need to optimize our current processes as well. I just think that many of these medical practice executives would benefit from more effort talking about where healthcare is heading in the future.

It’s great that patients can now schedule an appointment on a physician website. However, are practices ready for appointments to be auto scheduled based on personal device data or through a simple request through Amazon’s echo? I know that’s ahead of the curve, but it’s not that far off either.

Insightful Tweets from Farzad Mostashari’s Session at #MGMA15

Posted on October 13, 2015 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.

Today, Farzad Mostashari took the stage at the MGMA Annual Conference. As a man that I respect and someone that has deep connections and insights into what’s happening in Washington and how that plays out in actual practice (thanks to his ACO company), I was interested in the insights he’d share.

Here’s a quick Twitter roundup of some of the insights he shared:

Major Theme from MGMA 2015: Collaboration

Posted on October 12, 2015 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.

MGMA’s annual conference has just started, but I’m already starting to see what I think is a major theme at the event: Collaboration. To say it a different way, I think the theme is:

We Can’t Solve These Problems Alone!!

That’s a message that we need to resonate across all of healthcare. Atul Gawande’s keynote this morning did a great job highlighting this need along with the MGMA Presidents comments yesterday. He talked about how much more efficient an organization can be if everyone is rowing together. Although, I think his comment that struck me most was when he said that just scheduling the time for various people to get together and talk about how they can work together is the first step.

Far too often we get overly prescriptive on what we need healthcare organizations to do. When you do that it’s really easy for an organization to rationalize why their organization’s needs are different and why the prescriptive advice doesn’t work for their organizations. I guess that’s what made Atul’s advice to powerful. It’s really about getting the disparate parties together to talk about ways they can collaborate. They’ll figure it out. They know what will and won’t work, but they’ve just never really sat down to work on the challenges together.

The only other thing I’d add to this advice is to make sure that there are some common goals. A great example of this is seen in how hospitals have come together around hospital readmissions. That common goal has produced results. Atul suggested that a common goal might be focusing on improving care to the 5% of patients who drive 50% of the healthcare costs. He also suggested considering goals like improving patient wait times that will improve the experience for all patients as opposed to just a few patients.

Having everyone involved in a healthcare organization meeting together often to talk about how they can solve common goals is a magical formula.

#MGMA15 Tweetup and Hosting This Week’s #KareoChat

Posted on October 7, 2015 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 busy fall conference season is upon us and the fun begins. Honestly, I love traveling to all of these events (other than that part about leaving my family). I seriously feel lucky to take part in so many amazing healthcare IT and EHR related events. I know that some people see them as work, but they are all learning and fun for me. I guess I’m weird like that.

MGMA 2015
Next up on my calendar is MGMA this weekend. MGMA 2015 is in Nashville which is exciting for me since I’ve never been to Nashville. I hear that Nashville is chock full of great healthcare IT companies. My schedule is already jam packed with meetings. I’m also excited to see what practice managers are going to say about the current state of healthcare. I’ll be evaluating them for EHR PTSD (Although maybe it will all be ICD-10 PTSD).

If you’re going to be at #MGMA15 or live in Nashville, the good people at Stericycle have put together a tweetup on Monday, October 12th from 5:00 PM – 6:00 PM at the Fuse Sports Club inside the Gaylord Opryland Resort and Covention Center. You can find all the details for the tweetup and RSVP here. Everyone’s welcome to attend the tweetup whether they’re attending MGMA 2015 or not. I hope to see many of you there.

Hosting the #KareoChat
Kareo Chat Hosting by John Lynn
I’ll be once again hosting this week’s #KareoChat where we’ll be discussing Ways to Grow and Market Your Practice. The chat happens every Thursday at 9 AM PT (Noon ET). I hope you’ll be able to join us tomorrow. Here’s the 6 questions we’ll be discussing:

  1. What are the most effective ways to market your practice today?
  2. Which new opportunities are you watching that you believe will eventually help grow your practice?
  3. What tools or technologies do you use to help grow and market your practice?
  4. How do you engage your existing patients in your marketing efforts?
  5. What sources do you look to to stay up to date on the latest marketing practices?
  6. In what ways can small practices compete against large health system competitors when marketing their practices?

This topic is becoming more and more important to small practices who are trying to figure out how to survive. I hope you’ll all join me on the Twitter chat and share your insights into the topic.

Full Disclosure: Kareo is an advertiser on Healthcare Scene.

3 Macro Health Payment Trends to Watch

Posted on June 5, 2014 I Written By

The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.
Barry Haitoff
It’s not a stretch to say that the healthcare payment system has hit some tumultuous waters. Medical billing hasn’t been easy for a long time, but with things like the Affordable Care Act, Value Based Reimbursement, and the shifting world of data driven healthcare there is a lot you need to watch out for when it comes to getting paid. What does seem clear is that medical billing is not going to get any easier.

Let’s take a look at three broad health payment trends worth keeping your eye on:

Increased Patient Pay
One of the major trends in the health insurance industry is the move towards high deductible plans. Some of this change is coming from employers changing their plans and the ACA insurance exchanges are driving this trend as well. I see this shift continuing as healthcare and employers work to make the patient more accountable for their healthcare.

There are two main things you need to do to prepare for these high deductible plans. First, make sure you have a solid method in place to know how much the patient owes before or immediately after the visit. There is no better way to reduce patient collections than to collect the payment while the patient is in the office. Many are ready and willing to pay, but some practices don’t have the systems that allow them to know how much to charge the patient before they leave. Second, look at your processes for collecting patient payments once they’ve left the building. Do you have a good strategy in place to make sure the patient knows how much they owe? Do you have a variety of simple ways for the patient to make the payment? The use of an online payment portal for patients is the most obvious way to make submitting payment to physicians simple for patients. If you solve these two problems you’ll go a long way to improving your patient collections.

Higher deductible plans are here to stay and so an investment in systems that address the patient responsibility portion of the visit are incredibly important.

Data Driven Reimbursement
With the increased adoption of EHR software, you can be sure that insurance plans are going to want more and more data to justify your reimbursement. This is not a new trend for insurance companies. They’ve been requiring more and more documentation to justify payments forever. However, we’re at the point where what they’ll require will be so complex that you better have your documentation ducks in a row.

Certainly this means that if you don’t have an EHR or other technology infrastructure you will likely have issues. This will become particularly poignant as payers start to pay based on population health and value as opposed to the current fee for service model. I literally can’t see how insurance companies could switch to value based payments in a non healthcare IT world. The data in these systems is going to drive future reimbursement.

Newly Insured
Offices around the country are starting to see a set of newly insured patients thanks to the Affordable Care Act (ACA or Obamacare if you prefer). Are your office staff prepared for these new patients? While millions of uninsured patients are getting insurance and visiting your clinic, offices are also seeing many of their existing patients switching from a previous insurance to an ACA plan. Does your staff have the time required to update records? Not to mention, are you accounting for the extra time spent doing eligibility checks for these new insurance plans?

A MGMA survey of mostly independent physician practices recently found that 62 percent of practices are struggling to identify patients whose insurance came from the ACA exchange and to verify their eligibility or obtain plan details. Most practices also say that patients who got their insurance via an ACA exchange are more likely to have high deductibles and don’t understand that fact. Half of the practices say they can’t provide services to ACA exchange patients because their practice is out of network.

Can you see the potential problems to your practice? What will this new patient population act like when it comes to paying you for your services? Certainly a shift by existing patients to new high deductible plans will cause issues like increased patient responsibility that we talked about above. However, the newly insured population is being shifted from the ER to your offices. If you consider the history of ER payments by patients, there’s reason to be concerned about how well this new patient population will do at paying their portion of the bill.

Plus, we’ve seen many practices that are finding it really difficult to determine their participation status with the payer. It seems that payers have cherry picked providers for their new narrow exchange networks and haven’t informed providers of whether they’re in or out. Once you finally do determine you par status, be sure your staff can recognize the new insurance cards so they can flag them or potentially turn them away if the provider isn’t par.

These are just a few of the major healthcare payment trends I see happening in the industry. I’d love to hear in the comments what trends you see happening in your offices. What other things should we be aware of in this constantly shifting healthcare payment world?

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

Mobile Health Missing at MGMA13

Posted on October 8, 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.

I just finished my participation at the MGMA Annual Conference in San Diego. It’s a really great event for healthcare and this year it was buzzing with practice managers that play such a crucial role to the business of healthcare.

At the conference there was certainly an extreme interest in IT as represented by the vendor floor which was dominated by health IT vendors and of course EHR vendors. There’s little doubt that the IT revolution is hitting every healthcare organization. However, as I think through all the vendors I saw and the discussions I had, mobile health wasn’t really on the radar.

Sure, every EHR vendor had their approach to mobile. I also had some discussions where we tangentially talked about some quantified self mobile devices. The conference itself had a nice mobile app which I heard was a big improvement over previous years. MGMA even mentioned that mobile was an important part of their path forward. However, I didn’t see a big presence from mobile health companies that I’d find at mHealth Summit or CES (Consumer Electronics Show).

In some ways I think this illustrates the divide that is found between the mobile health movement and healthcare organizations. Certainly many mobile health companies are thinking too far ahead, but I believe it’s also true that many healthcare organizations are way behind on what’s possible with mobile health. I think there’s going to be some unfortunate consequences if healthcare organizations choose to continue to lag behind. If I’m a doctor or a healthcare organization, I want to be part of the mobile health conversation and not just beholden to it after the fact. I’m afraid we’re heading for the later.

It’s possible there was more mobile health presence at MGMA and I just missed it. I did like that MGMA is trying to embrace social media more fully including the Cerner sponsored Tweet Street. Plus, the #MGMA13 hashtag seemed more lively than in past years.

We’ll see how this continues to evolve, but I’d love to see more healthcare organizations embrace mobile health technologies. As it currently stands, it seems that many are choosing to ignore them.