Blog
Doctors in the Media: Abiding by HIPAA
In today’s digital age, it’s important to stay apprised of the rules and regulations surrounding providers and patients. A recent case in Connecticut serves as a good reminder of the rules set forth in the Health Insurance and Portability Act (HIPAA), which prohibits...
Building Direct-to-Employer Programs
The cost of healthcare has become a burden on employers. As a result, employers are looking for ways to: Increase the quality and efficiency of medical services Eliminate the healthcare middlemen or payers These two goals have led employers to establish direct...
Data Exchange Standards: Fast Healthcare Interoperability Resources (FHIR) & Blockchain
The Centers for Medicare and Medicaid Services (CMS) now supports improved health care interoperability efforts through applications that enable a data exchange between two disparate computer systems. One type of application programming interface (API) or data...
Health System-Owned Physician Practices Operating at a Loss
Some recent U.S. Department of Justice (DOJ) enforcement cases and settlements suggest that owning physician practices that are losing money may be a significant regulatory concern. The DOJ has suggested in the last few years that practice...
Getting Paid for Transitional Care Management (TCM)
Medicare adopted transitional care management (TCM) payment codes in 2013 to encourage clinicians to provide TCM services after beneficiaries were discharged to the community from medical facilities. As a result, Medicare spending on TCM services increased over 200...
Medicare Payment Advisory Commission (MEDPAC) Reimbursement of Evaluation & Management Codes
MEDPAC recently issued a report to Congress. It reviewed the reimbursement levels for office-based E/M codes versus procedural codes. The commission recommended a significant increase in the reimbursement of E/M codes. The increase ranged from 5% to 30% as a pay...
The Provider’s Role in Risk Adjustment Coding
Physicians must code diagnoses properly to succeed under Medicare & other value-based contracts Each year, CMS sets cost benchmarks for every Medicare member, based on the patients’ diagnoses during the prior year. But what if the physician hasn’t reported their...
Developing a High-Performing Ambulatory Care Network
Success in a value-based services environment requires physicians to: (1) continue improving the quality of their services, and (2) provide those services in an efficient manner to reduce the cost of care. In addition, physicians and ambulatory networks must strive to...
Medicare Advantage Star Rating and the Provider: Rewarding, Complex and Competitive
CMS created the Star Ratings system in 2008 to help seniors compare quality and performance among Medicare Advantage (MA) Part C plans and Part D prescription drug plans (PDPs). Insurance companies also benefit, as a plan’s star rating influences patients and directly...
Shared Services Model – An Option for Small Physician Practices to Transition to Value-Based Care
Shared service providers help small physician practices transition to a value-based care environment. These organizations [i.e. Clinically Integrated Networks (CINs), Independent Practice Associations (IPAs), payers and/or private health care firms] also allow...