Blog
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...
The Benefits of Clinically Integrated Networks for Physicians
There is a trend in the local and national health care markets towards value-based contracting. This requires a focus on improving a practice’s quality score and reducing the cost of care. Clinically integrated networks (CINs) are integrated systems of physicians,...
Capitalize on Claims Data to Benefit Your Practice
Despite the past year of uncertainty surrounding healthcare policy, one objective has remained consistent. As payment models shift from fee-for-service to value based care, physicians are more accountable than ever for providing high quality services, while lowering...