P3CARE’S MEDICAL BILLING SERVICES FOR EMERGENCY PHYSICIANS

P3Care’s medical billing services are precise when it comes to physician-specialists and accurate when we talk about accounts receivable management. Hence, strength on both the fronts make us one of the most recognized medical billing company in Ontario, California.

CMS recognizes P3 Healthcare Solutions as a MIPS Qualified Registry for the 3rd time in 2019. To see the list of qualified registries for 2019, check out the following link – https://b0wms2ojuok4bi2s1zhfjksf-wpengine.netdna-ssl.com/wp-content/uploads/2019-Qualified-Registry-Posting_Final_v1.0.xlsx. When you tap the “P” tab in this excel sheet, P3 Healthcare Solutions appears at the top.

Outsourcing medical billing is a tough decision to make but an important one. There are several factors which influence the decision-making process such as putting your finances at risk, in the hands of a company which is physically unreachable.

A medical billing service expedites the process of filing a claim with the insurance company for timely reimbursements. When you receive the payment in your bank, it completes the revenue cycle for that claim. Revenue cycle management is a highly professional way of providing organized transactional insights. Moreover, the first-time claim acceptance rate matters a lot, and P3Care does perform reasonably well when it comes to first-time acceptance of claims.

What is an ASC? P3Care Stands by Your Side in Critical Times

ASC stands for Ambulatory Surgery Center. P3Care’s philosophy and the visionary statement speaks of the deep relationship it has with the healthcare professionals dealing with emergencies. Emergencies can be traumatic and stressful.

P3Care sympathizes with doctors who are part of the emergency setup. Furthermore, it wants the doctors to feel the support round the clock. Doctors volunteering to treat those in bad shape deserve all the praise and appreciation. Going the distance for healthcare professionals who save lives by treating patients at the right time is one of P3Care’s core principles. We do everything we can to lend a helping hand to providers and Eligible Professionals.

The ASC billing goes on a different pattern as compared to the normal billing. P3Care realizes the demands of insurance companies, therefore, preparing correct claims according to those demands is one of our specialties.

Anti-Traumatic Medical Billing Services

P3 Healthcare Solutions takes pride in handling the billing for surgical practices and ASCs. The trauma or emergency doctors require an anti-traumatic billing solution. That means they are looking for reliable and trustworthy medical billing services. The accuracy of those claims leads the way to their acceptance resulting in smooth cash flow for our clients.  If you sign up for P3Care medical billing services, you will be updated, as part of our workflow, with timely reports, evaluations, and reimbursements. Call us for a quote at 1-844-557-3227.

P3Care delivers for the ASCs and Surgeons

At the ASC, both critical and diagnostic procedures are performed. There may be instant surgeries at hand and lives can be at risk. Whatever the situation may be, your billing partner needs to be proactively involved. There is no chance for errors in ASCs, and similarly, P3Care creates error-free claims to get those reimbursements quickly.

You should meet certain requirements for better ASC billing outcomes. P3Care files the bills using CMS-1500 forms.

Nonetheless, for ASC’s better performance, the patients and the providers must agree to a few terms and conditions. Once those conditions are met, insurance companies reimburse the full amount. There can be deductions on account of missing CPT or medical codes. P3Care makes sure everything is in place.

ASC Procedures

Ambulatory Surgery Centers can have all the specialized workings under one roof. They can be an independent entity or part of a larger hospital.

The procedures or operations performed in an ASC can include:

  • Colonoscopy
  • Surgical Dressings
  • To get a cast.

Final Verdict

P3Care takes the lead in medical billing services for Ambulatory Surgery Centers or surgical claim approvals. Our medical billing & coding staff caters to the department of pain management, orthopedics, gastrointestinal, ENT, urology, and general surgery.

P3CARE MEDICAL BILLING SERVICE FACILITATES REIMBURSEMENTS FOR PROVIDERS

Welcome to P3 Healthcare Solutions. Medical billing services are getting sophisticated and tech-oriented with new rules and guidelines. The electronic health records are fast replacing the old way of manually maintaining medical records. It is becoming difficult for medical practitioners to be able to get a grip on procedural necessities leading to obstacles in the collection.

Previously, PHI documents were hand-written and exchanged through the traditional mail, but since the advent of the internet, things have become effective. However, complexities are a big part of the new age computerization with hard-to-understand software functionalities and apps. They are designed to make the medical billing process easier which often prove to be a roadblock for the providers.

Core Objective of P3Care Medical Billing Service Company

P3Care Healthcare Solutions offers many services, and medical billing is one of them. The goal, however, is to support the healthcare industry by leveraging advanced technical and computerized solutions for both the physicians and specialty-specific clinical experts all across the US.

P3Care always works hard on delivering for the providers to help add to their revenue. The high claims acceptance percentage in one go is relieving for both the providers and the payers which further endorses their confidence. Getting the job done before it gets complicated is accomplished through experience, dedication, skills and staying on our toes.

Deft Handling of Medical Billing Issues

P3Care consultants undergo extensive training, and the availability of skilled personnel at hand gives an edge to medical operations and procedures in favor of the providers. The staff here keeps a close eye on any changes in rules or guidelines that can have implications for the US healthcare industry. For instance, ICD-10 update has led many billers to face denials on account of incorrect coding, but with P3Care, consistency and constant learning helps overcome claim rejections.

Give us a call today – 909-245-8350 to know P3 Healthcare Solutions could help reduce claim denials and the services that we offer to our customers.

Billing Rates for Consultants

The rates of outsourced medical consultants are always lower than in-house billers and coders. With P3Care, it is even more competitive because we are willing to solve any situation right there and then, in a highly cost-effective manner. A medical billing service fee of P3Care is very reasonable and budget-friendly.

Characteristics

Let’s have a look at the two primary attributes of a medical billing company –

  • The top-most quality of a medical billing service is to offer full support on reporting a claim according to the latest medical coding guidelines(for instance – ICD-10). Companies failing to keep tabs on current rules eventually fail in getting the claims approved. With P3Care, everything is synched – any rule updates are well-received, understood and implemented by our medical billing & coding staff.
  • Sending incorrect medical bills result in 80% denials. A company knowing its reputation is at stake will keep qualified coding staff with experience or certifications to back their skills. The insurance companies are meticulous and critically view medical claims. Even a slight error results in outright denial. Such claims need to be correctly filed again, but it may take months to receive that claim. If your Accounts Receivables are piling up, you need to revisit your medical billing strategy.
  • P3Care believes in double checking the claims on every step, making sure the billing codes are correct, allowing them to sail through the complexities of revenue cycle management. It isn’t easy but if you choose P3Care, we will take care of the issues in the revenue cycle management and you can focus on treating the patients.
  • With the necessary addition of EHRs into the medical system under QPP, the practices or providers have to implement and ensure the reporting is based on them. These are patients’ health records in digital form. Your in-house practice management system that should be efficient enough to handle EHRs. But if you are having trouble, P3Care would lend a helping hand. We are technically aware and technologically sound to deliver and file medical claims via EHR.

Conformity with HIPAA

P3 Healthcare Solutions are HIPAA compliant. HIPAA (Health Insurance Portability and Accountability Act) regulations ensure the protection of patient’s private health data. Patient’s health information is always kept confidential and only shared with the relevant medical personnel.

The medical billing services by P3Care complies with HIPAA. HIPAA security rule is applied to companies dealing with Protected Health Information (PHI) – PHI is any information about a patient’s health condition; it can be healthcare payment details or other sensitive information utilized by covered entities (healthcare providers, clearinghouses, etc.), to identify a patient.

RCM

Revenue Cycle Management with P3Care includes –

  1. Writing claims and submitting to insurance companies after screening them for errors
  2. To keep in touch with the insurance companies for any pending claims.
  3. Customer service promptly responds to patients’ billing queries
  4. Take care of Clearinghouse handling and collection of payments
  5. Reviewing the denials amending those mistakes and refiling the claims
  6. Going for repeals to minimize accounts receivables

Charge Codes

Medical billing services fee schedule for P3Care repeats on a monthly basis. As you know medical billing & coding is not an easy task, but Revenue Codes or Charge Codes for medical billing make the whole process understandable. They explain the treatment and the exact amount due at the payer’s end.

List of CDM charge codes helps identify the services rendered by the providers. They are a summary of patient care activities along with the respective charges sent out to payers and patients.

Medical Billing Costs

Medical billing cost is not much of a bother because we are working tirelessly for positive outcomes. Our charges are fair and realistic!

Furthermore, medical billing services cost is brought down by speeding up the revenue cycle management and not postponing claims. You will witness the number of account receivable decreasing.

Medical biller rates vary from specialty to specialty. Some specialties require more effort and resources to get their claims through.

ICD-10 Capable Coders

P3Care coders have made sure all the current claims are by the latest coding guidelines. Hence, our claims acceptability ratio is higher than most.

Beware of Discounting Vendors

A proposal by the low-cost medical billing vendors may sound intimidating, but not everyone understands the complex, mind-boggling and draining world of medical billing. However, their lack of experience and skills can hurt your business interest. Whichever company you choose to sign up with, make sure you get the list of tasks that you want to be taken care of.

Simplifying the Process

P3 medical billing consultant services include –

  • Verifying the patients with the insurance companies
  • Checking if the provider is listed on payer’s panel
  • Keeping the patient records up-to-date
  • Processing all claims within a specific time frame
  • Keeping a check on each claim until it is approved and collected
  • Email and phone correspondence with the payers and patients
  • Handling the collection process and managing copayments
  • Sending weekly or monthly reports to providers for analytical purposes.
  • Executing each step according to the rules set by CMS

We are committed to the US healthcare industry to deliver what’s rightfully yours. Moreover, aiming to be one of the top medical billing companies isn’t easy and doesn’t happen overnight. It takes all the energy and skills to deploy favorable results to our customers.

Agreement

Outsourcing medical billing only relieves the burden on you and your practice. However, a written medical billing services agreement explaining the contractual details between the provider and the biller is required.

Farsighted Approach

There are hundreds of online medical billing companies out there but choosing a reliable and trustworthy partner to handle your finances is a tough decision. P3Care falls on the list of medical billing companies in the USA with credibility and farsightedness to see denial in advance. It takes appropriate steps to make the claims error-free.

We are offering specialty-specific billing services to the specialists along with primary-care physician billing services. The specialties include almost all of them including chiropractic and radiology billing services.

For questions out of this knowledge base, or on instructions on how to get started call a MIPS specialist today at 1-844-557-3227 (1-844-55-P3CARE) or email at info@www.p3care.com.

MIPS 2018 UPDATES FOR CLINICIANS AND HEALTHCARE PROVIDERS

The MIPS 2018 will help the healthcare providers realign themselves to ensure compliance, enabling them to keep taking advantage of the incentive payments.

CMS gave an update on 2nd November 2017, sharing MIPS 2018 updates applicable to the QPP (Quality Payment Program).

A Background to the MIPS 2018 Updates

We all know that there is a shift in the US healthcare industry towards quality healthcare. These new updates reflect the refinement of the policies for QPP while taking into consideration the US healthcare industry’s transformation concerning infrastructure, technology, clinical practices, and physician support practices.

MIPS 2018 Updates & QPP Strategic Payment Program Objectives

CMS aims to accomplish 7 strategic QPP objectives with the introduction of MIPS 2018 Updates.

  1. To assist in the overall improvement of beneficiary outcomes. It also means engaging patients by deploying relevant MIPS and Advanced APM policies.
  2. The improvement in the clinician experience through the introduction of a transparent and flexible program. This approach will help provide clinicians with easy to use program tools.
  3. Increase adoption and availability of the robust Advanced APMs.
  4. Maximize participation and understanding of the program by deploying customized communication which focuses on support, education, and outreach. The underlying theme is to ensure the program fulfills the needs of diverse types of practices, patients, physicians, and small healthcare providers.
  5. To promote the increased sharing of data and information relating to the program’s performance. Thus, the underlying concept is ensuring timely yet accurate availability of actionable feedback to clinicians and other relevant stakeholders.
  6. Help deliver IT systems with improved capabilities relating to reporting, data submission, and an overall improvement in its front and backend, delivering greater efficiency and value.
  7. Lastly, one of the core strategic QQP objectives is to improve program implementation and foster ongoing development that keeps the requirements of the US healthcare industry into context. Furthermore, it also helps small and rural healthcare providers successfully take part in the program.

What are the MIPS 2018 Updates?

Let’s look at the highlights of MIPS 2018 updates.

  • Performance Period
  • The performance period is changed from 90 days to the 12-month calendar year.
  • The cost will be applicable based on the 12-month calendar year.
  • A minimum of 90 days period will be under review for Advancing Care Information.
  • A minimum of 90 days period will be under consideration for evaluating Improvement Activities.

Performance Threshold or Payment Adjustment

  • Minimum Performance Threshold will consider 15 instead of 3 points.

Road to accomplishing 15 points for performance threshold

Here is how you can attempt to accomplish the 15 points. You can fulfill any one of these criteria to reach the goal of 15 points.

  • To submit 6 Quality Measures which meet data completeness criteria.
  • To meet the base score for Advancing Care Information. To accomplish it, you will have to submit 5 base measures and also submit a medium-weighted Improvement Activity.
  • To meet the base score for Advancing Care Information. Also, submit 1 Quality Measure which meets data completeness requirements.
  • Lastly, you can also reach the 15-points performance threshold goal by reporting all Improvement Activities.
  • For achieving exceptional performance, the providers must reach the threshold of 70 points.
  • The law requires the payment adjustment for the 2020 payment year to range between -5% to +5X% (where +5% means = 5% X scaling factor). Scaling factor is achieved to ensure accomplishment of budget neutrality.
  • Under the revised MIPS 2018 updates, the adjustment factor applies to items and services under Medicare Part B (It includes Part B drugs too).

Quality

  • The 2018 Quality Measures Specifications will become applicable.
  • Weight to the final score is 50% instead of 60%.
  • For Data Completeness, CMS wants providers and clinicians to meet a minimum threshold of 60% instead of 50%. Therefore, measures not meeting this data completeness criterion will only get 1 instead of 3 points. However, small healthcare practices will still get 3 points.
  • The scoring has a 3-point floor for measures against the benchmark. There are 3 points for measures which either do not have a benchmark or they do not meet the case minimum requirement. Measures which fail to meet data completeness requirements will only get 1 point and not 3 points, except small practices getting 3 points. There is no change introduced for the bonuses. One of the MIPS 2018 updates is that CMS proposes the introduction of a cap of 6 points for a particular set of 6 topped out measures.
  • The improvement scoring will be given by measuring the rate of improvement. The increase in improvement will mean more points, particularly for the providers that have a lower performance during the transition year. The improvement will be measured in the Quality Performance Category Level, with ten percentage points available for Quality Performance Category.
  • One of the MIPS 2018 updates is about the topped out measures scored with maximum 7-points and not the standard 10-points.

6 topped out measures for 2018

  • #21. To either select the Prophylactic Antibiotic-First or Second Generation Cephalosporin.
  • #23. Venous Thromboembolism Prophylaxis, when they are indicated in all the patients.
  • #52. The COPD (Chronic Obstructive Pulmonary Disease), Inhaled Bronchodilator Therapy.
  • #224. The overutilization of the Imaging Studies in Melanoma.
  • #262. Confirmation via image, of successful excision of Image Localized Breast Lesion.
  • #359. To optimize patient exposure by utilizing Standardized Nomenclature for CT (Computerized Tomography), imaging description.

Improvement Activities

  • The providers must be aware of the specifications of the 2018 Improvement Activities.
  • The weight to the final score will be 15%.
  • There isn’t any change in the number of activities which MIPS eligible clinicians need to report for reaching 40 points. CMS wants to propose more activities to select from and also wants changes to existing activities for Inventory. The clinicians practicing in rural areas and small practices would only be needed to report no more than 1 high-weighted or 2 medium weighted activities for reaching the highest score.
  • For the TIN to get credit for group participation, only one MIPS eligible clinician would have to perform the Improvement Activity.

Advancing Care Information

  • The providers and clinicians must be aware of the specifications for the 2018 Advancing Care Information Measures.
  • The weight to the final score is 25%.
  • To allow the MIPS eligible clinicians to use either the 2014 or 2015 Edition of CEHRT in 2018. And also to grant them a bonus if they only use 2015 Edition of CEHRT.
  • To add exclusions for the Health Exchange Measures and E-Prescribing.
  • To add more Improvement Activities which would show the use of CEHRT to the list eligible for a bonus of Advancing Scare Information.
  • One can earn 10% in performance score if they report about any of the criteria to clinical data registry or single public health agency.
  • An additional 5% is allocated for submitting to one additional clinical data registry or public health agency (not reported underperformance score).
  • To add decertification exception for those eligible clinicians who’s EHR has been decertified, retro effectively for 2017 performance periods.
  • The deadline for exception application submission for the year 2017 and for future years, is set at December 31st for measuring whole year’s performance.
  • Small practices which have 15 or fewer clinicians, the addition of a new category for hardship exceptions to re-weight the category of Advancing Care Information to 0. To reallocate the 25% of the category weight of Advancing Care Information to the category of Quality Performance.
  • CMS will reweight the category of Advancing Care Information to 0 and reallocate its 25% performance category weight to the category of Quality Performance for these reasons.
  • Automatic Re-weighting
  • Certified registered nurse anesthetists, clinical nurse specialist, physician assistants, and nurse practitioners.
  • The non-patient facing clinicians including pathologists and radiologists.
  • The hospital-based MIPS eligible clinicians.
  • The ASC (Ambulatory Surgical Center) – based MIPS eligible clinicians and the certified registered nurse anesthetists.
  • To reweight through an approved application.
  • There are significant hardship exceptions, and CMS will not be applying a five years limit for these exceptions.
  • A new hardship exception to the clinicians practicing in small practices has 15 or fewer clinicians.
  • There is a new decertification exception added for the eligible clinicians whose EHR has been decertified and becomes effective retroactively for the performance period of 2017.

Cost

  • There will be a weight of 10% added to the final score.
  • CMS will include the total per capita cost measures and MSPB (Medicare Spending per Beneficiary) for calculating the Cost performance category score for the MIPS performance period of 2018. These two measures will be carried over from the Value Modifier Program. These two programs are also currently used for providing feedback for MIPS transition year.
  • CMS will be calculating the cost measure performance. The clinicians do not need to take any action.
  • The new changes offer Virtual Groups with participation option for Year 2, providing clinicians with another way to participate in MIPS. The Virtual Groups can contain Solo Practitioners and Groups containing 10 or fewer eligible clinicians. They are eligible to participate in MIPS, coming together virtually with at least one such other Solo Practitioner or Group for participating in MIPS. In general, clinicians’ being part of a Virtual Group would have to report as a Virtual Group for four different performance categories. They will also need to meet the same performance category requirements and measures as that of the non-virtual MIPS groups.
  • Virtual Groups need to conduct their elections at the beginning of the performance period. It cannot be changed once the performance period starts.
  • Groups and Solo Practitioners wanting to participate in a Virtual Group have to go through the election process.
  • The period given for election is from October 11thto December 31st, 2017, for them to be considered for 2018 MIPS performance period.
  • To increase the low volume threshold by excluding individual clinicians or groups eligible for MIPS having < $90,000 in Part B allowed charges. It is also applicable to those individual clinicians or groups with < 200 Part B beneficiaries falling within the low volume threshold determination period occurring during a performance period or a prior period.
  • CMS is not changing the way it defines non-patient facing clinicians. Individuals <100 patient facing encounters, and for groups, it stands at > 75% NPI’s billing under the group’s TIN falling within a performance period and labeled as non-patient facing.
  • Under the Complex Patients Bonus, there is an adjustment applied to up to 5 bonus points by adding average HCC (Hierarchical Conditions Category) risk score to the final score. The score addition would be anywhere from 1 to 5 points given to the clinicians depending on the patient’s medical complexities.
  • The Small Practice Bonus will adjust the final score of an eligible clinician or group working in a small practice as defined in the regulation, applicable to 15 or fewer clinicians. It would add 5 points to the final score provided eligible clinician or group submits the data for at least one performance category within the applicable performance period.
  • There are payment adjustments by CMS for Extreme and Uncontrollable Circumstances, approximately given to 572,000 eligible clinicians. They would have to participate in MIPS for the 2018 MIPS performance period. Under the newly proposed rule, the payment adjustment for 2020 payment year may range from =5% to +5X%. (X is the adjustment factor which allows MIPS program for staying budget neutral.)
  • If the CEHRT for a MIPS clinician is unavailable due to uncontrollable circumstances like a natural disaster, public health emergency, or hurricane, etc. the clinician can submit a hardship exception application for getting reconsidered for reweighing of Advancing Care Information performance category. The application is due with a cut-off date of December 31st, 2017.
  • There is a final rule with comment period extending this reweighting policy for the performance categories of Improvement Activities, Cost, and Quality which starts with the 2018 MIPS Performance period. The deadline for this hardship exception application is December 31st, 2018.

As far as 2018’s submissions are concerned, the deadline was April 2, 2019. Moving on, if you were eligible back then, you are eligible in 2019 as well.

MIPS consulting services job is to satisfy your end of the deal with the authorities for compliance and data completeness. That is what we do for our clients!

Moreover, those of you who weren’t eligible then may be eligible now. Give us a call or simply fill up the form on the homepage to notify us. P3 Healthcare Solutions connects clinicians to high scores which means rewards and a better reputation.

QPP 2019 is prevailing and it is important to submit measures against Quality, Meaningful Use (MU) or Promoting Interoperability (PI), Improvement Activities, and Cost performance categories. With the promise of less reporting burden by CMS, we can expect the program to become clinician-friendly as time goes by. Please follow us on LinkedIn here – https://www.linkedin.com/company/p3-healthcare-solutions

What is next?

What changes to expect in MACRA-MIPS 2019?

For questions out of this knowledge base, or on instructions on how to get started call a MIPS specialist today at 1-844-557-3227 (1-844-55-P3CARE) or email at info@www.p3care.com .