Monthly Archives: April 2014

Collecting From Patients

According to industry studies, providers who don’t adopt payment best practices only collect 50-60% of their co-payments. With patient responsibility increasing, it is critical to have the tools and processes in place to collect payments up front. Recent estimates state that 30% of all provider revenue is coming out of the patient’s pocket and industry experts concur that ineligible patient insurance coverage is the leading cause of claim rejections and denials by payers. According to a study from McKinsey Quarterly, 52% of patients are willing to pay a portion of what they owe up front. Knowing expected out-of-pocket costs beforehand empowers the patient to make more informed decisions about their own care and protects them from being surprised by a large bill months down the road.

Step in determining a patient’s responsibility:

  1. Verify their eligibility status. By checking eligibility before the appointment, you can inform the patient of the co-pay beforehand and collect it prior to rendering services.
  2. Calculate the patient’s responsibility and share it with the patient. This will help improve the revenue cycle, reduce bad debt, and help improve patient satisfaction.
  3. Offer flexible payment options including credit, debit, ACH, and payment plans. According to a study from McKinsey Quarterly, when asked why they didn’t pay a medical bill, 37% of patients with outstanding balances said it was due to a lack of financing options. Setting up a financing plan right away makes the billing process a lot less expensive for providers.

FACT: The longer a debt exists, the less likely the organization will ever see the revenue.

“Doc Fix” SGR Patch

Senate Approves SGR Patch

By a vote of 64 to 35, the Senate passed a so-called “doc fix” bill approved by the House, the 17th time Congress has acted since 2003, to temporarily delay cuts to doctor reimbursements under Medicare. In 1997, Congress created the Sustainable Growth Rate (SGR), a system that pegged the amount of money budgeted for Medicare payments to projected growth of the economy. However, within a few years, health-care costs far outpaced economic growth, creating a multibillion-dollar shortfall in funding for Medicare payments.

“Doc Fix”: Prevents the 24% cut in reimbursement to doctors who treat Medicare patients on April 1, 2014 and replaces it with a 0.5% (through December 31, 2014) and a 0% update from January 1 until April 1, 2015.

Between now and then, Congress will have to enact a permanent fix or enact another patch to prevent a huge drop in Medicare Physician payments next April 1. In addition to preventing the SGR related reduction, Congress approved language extending various other Medicare provisions slated to expire.

Summary/Highlights of SGR Patch Legislation

Protecting Access to Medicare Act of 2014

  • Extends Medicare work Geographic Practice Cost Index      (GPCI) floor for 1 year
  • Extends Medicare therapy cap exception process for 1      year
  • Extends Medicare ambulance add-on payments for 1 year
  • Extends Medicare adjustment for Low-Volume hospitals      for 1 year
  • Extends Medicare-dependent Hospital (MDH) program for 1      year
  • Extends Medicare Advantage Special Needs Plan for 1      year
  • Extends Medicare Reasonable Cost Contracts for 1 year
  • Extends funding for National Quality Forum (NQF)      through the first 6 months of fiscal year 2015
  • Extends funding outreach and assistance for certain      low-income programs for 1 year
  • Extends Two-Midnight Rule Auditing program for      Hospitals for 6 months
  • Technical Changes to Long-Term Care Hospitals
  • Extends Qualifying Individual (QI) Program for 1 year
  • Extends Transitional Medical Assistance (TMA) for 1      year
  • Extends Medicaid and CHIP Express Lane Option for 1      year
  • Extends the Special Diabetes Program through fiscal      year 2015
  • Extends Abstinence Education through fiscal year 2015
  • Extends the Personal Responsibility Education Program      (PREP) through fiscal year 2015
  • Extends Family-to-Family Health Information Centers      through fiscal year 2015
  • Extends the Health Workforce Demo for Low-Income      Individuals for 1 year
  • Extend funding for the Maternal, Infant, & Early      Child Home Visiting for 6 months
  • Extends funding for the development of pediatric      quality measures
  • Delays for 2 years the enactment of the Medicaid Third      Party Liability Settlements
  • Delays the transition to ICD-10 under the Medicare      program for 1 year.
  • Repeals the ACA’s limitation on deductibles for small      group health plans
  • Requires a GAO report on Children’s Hospital GME      Program implementation

Demonstration Programs to Improve Community Mental Health Services:
Demonstration grants to implement Assisted Outpatient Treatment Grant Program for individuals with mental illness

Skilled Nursing Facility (SNF) Value-Based Purchasing Program (VBP):
Establishes a Skilled Nursing Facility Value-Based Purchasing program based off of individual SNF performance on a hospital readmission measure.

Medicare Lab Fee Schedule Reform:
Adopts market-based private sector payment rates for lab services.

Medicare End Stage Renal Disease (ESRD) Prospective Payment System Revisions:
Prohibits the inclusion of the payment for the oral-only drugs that beneficiaries take related to their ESRD in the Medicare per-dialysis treatment bundled payment rate through 2024.  It spreads out the payment reduction required by the American Taxpayer Relief Act of 2012 to adjust for the reduced use of intravenous or injectable drugs that are paid through the bundle.

Quality Incentives for Diagnostic Imaging & Evidence-Based Care:
Establishes CT equipment radiation dose standards for purposes of payment under the Medicare program in order to protect the health and welfare of beneficiaries.  Sets into place appropriate use criteria for imaging services paid to medical.

Transitional Fund for SGR Reform:
Uses the $2.3 billion set aside for SGR in the Bipartisan Budget Act of 2013.

Ensuring Accurate Values for Physician Fee Schedule Services:
Allows the Secretary of Health and Human Services to use information received from medical providers and other sources to adjust code pricing to address mis-valued codes used under the Medicare Physician Fee Schedule.

Medicaid Disproportionate Share Hospital (DSH) Relief and Rebase:
Delays reductions in payments to Disproportionate Share Hospitals by 1 year and then makes additional reductions through 2024.

Medicare Sequester Realignment:
Realigns the Medicare sequester in 2024 without increasing the overall effect of the sequester on Medicare providers

10 Reasons to Eat Romaine Lettuce

Green leaf, red leaf, butter head and iceberg are just a few common types of lettuce available at most markets. However, in terms of nutrient density, none are healthier than Romaine.

1. Low Calorie Content
Lettuce has only 17 calories for every 100 grams. This is why it can be consumed in massive quantities without dramatically increasing daily calorie consumption.
2. Helps Weight Loss
Romaine lettuce contains fiber and cellulose. Besides filling you up, fiber improves your digestion. Improving your digestion is actually essential for long term weight control.
3. Heart Healthy
Romaine Lettuce’s vitamin C and beta-carotene work together to prevent the oxidation of cholesterol. This prevents the buildup of plaque.
4. Omega-3 Fatty acids Romaine lettuce has a two to one ratio of omega-3 to omega-6. That’s a great ratio. The fat content in lettuce is not significant UNLESS you eat a lot–but we actually suggest you do!
5. Complete Protein
Romaine lettuce’s calories are 20 percent protein. Like all whole foods, much of this protein is complete, but the amount can be increased by combining with balancing proteins.
6. Helps with Insomnia
The white fluid that you see when you break or cut lettuce leaves is called lactucarium. This has relaxing and sleep inducing properties similar to opium but without the strong side effects.
7. Romaine Lettuce is Alkaline Forming
The minerals in romaine lettuce help remove toxins and keep your acid/alkaline balance in order. Once you are balanced on this level there are a host of benefits including greater energy, clearer thinking, deep restful sleep, and youthful skin.
8. Low Glycemic Index
Romaine Lettuce has an average glycemic index of 15, but because it has so few calories, its glycemic load is considered zero. Foods with low glycemic indexes are great for anyone watching their blood sugars for medical reasons, or for weight management.
9. Whole Life Food
Romaine Lettuce is almost always eaten raw, providing us with many micronutrients not found in cooked or processed food. Eating raw food also adds vital energies not recognized by nutritional science.
10. Lettuce Taste Great
Even though lettuce is very low in calories, many varieties still have a sweet taste. To maximize benefits from your food you should really WANT to eat it with your whole body–not just your mind saying it is good for you



Another ICD-10 delay

President makes ICD-10 delay official, but CMS remains mum.

According to EHRintelligence, “the delay seemed to take CMS entirely by surprise.  CMS Administrator Marilyn Tavenner strongly enforced the deadline of October 1, 2014 during the HIMSS14 conference in February, and CMS continued to release materials warning of the imminent deadline up until the very morning of March 27, right before the vote.  Perhaps the agency just needs a little more time to walk back its materials, revamp its timelines, and formulate a plan to address what the extended window will mean for the industry.”