In response to the demand for improving the capture of chronic illness diagnoses for reimbursements, the Center for Medicare and Medicaid Services (CMS) mandated the development of the Hierarchical Categorical Condition (HCC) code system and implemented it in the year 2004. The incorporation of the HCC codes has helped drive CMS payments to Medicare Advantage (MA) members.
With healthcare reform and system changes underway, accurate medical documentation and coding is critical to the financial health of your practice and to the health of your patients. In 2004 Medicare implemented an HCC (Hierarchical Condition Categories) model to adjust capitation payments to private health care plans for the health expenditure risk of their enrollees.
Representing a departure from the volume based, fee-for-service model, MACRA replaces the SGR (sustainable growth rate) formula to control Medicare costs. Linking Medicare reimbursements to quality metrics with providers being rewarded for quality and value based care; MACRA repeals the set payment rates based on economic growth, which was the hallmark of SGR.
Your credentialing process needs to start well in advance if you are planning to start your own practice or bring in new doctors to your existing practice. It is important to understand how credentialing can make a significant difference to the pace of your cash flows and how smooth your practice runs. Ignoring the credentialing process will result in delayed cash flows,
Revenue cycle management throws up tons of data for tracking. However, not everything requires regular tracking and measuring. While it is important to look at all the data derived from the system periodically, it is very important to track and measure some key metrics regularly. Measuring the key metrics against the industry standard is a good way to determine where your processes require improvement.
A worldwide trend in healthcare reforms and new organizational arrangements, integrated care (also known as comprehensive care, transmural care, co-ordinated care or seamless care) focuses on more integrated and co-ordinated forms of care provision. According to the WHO, “Integrated care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis,
Physicians educate and train themselves to practice medicine and impart health care to the populace. However, a large part of their daily lives is spent tending to administrative tasks – something that they would rather not be doing given half a chance. With the constantly evolving medical regulatory and payment space, it is very difficult for physicians to escape from the requirements of administrative tasks.
Identifying keywords from about 35,000 Google+ reviews of physicians that were most commonly associated with the rating levels given, a marketing and public relations firm for specialty medical practices, conducted a study of patient complaints regarding physician offices. Published in the Journal of Medical Practice Management, the study reveals that the majority of patient complaints are about customer service at the physician’s office.
Healthcare practices typically outsource their billing for two reasons – lack of resources and/or lack of time. While outsourcing your billing has many advantages, there are certain factors that need to be checked before hiring a billing company. Remember that most outsourcing contracts generally last for two to three years and it would be detrimental to your practice if you choose a billing company that exhibits most of the following:
- The billing company has no existing clients with the same specialty as yours.
Replacing the much-maligned sustainable growth rate formula and in an effort to increase quality while bringing down costs, the Congress last year passed the Medicare Access and CHIP Reauthorization Act (MACRA). While MACRA rules are still being finalized, it will essentially transform the way Medicare reimburses healthcare providers for services. The main purpose of this overhaul to the payment system is to improve the quality of healthcare that is provided to patients.