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Medical billing services, Medical billing company, MIPS in healthcare, Healthcare Solutions California, HIPAA medical billing company, Meaningful use of EHRs

5 Front Desk Basics to Improve Your Medical Practice

Like in any business, front desk staff plays a vital role in healthcare affairs. The business of knowing the right person for the right job matters in healthcare more than it matters anywhere else. Because whether it is a hospital or a private practice, patients need all the attention they can get. Moreover, if it is missing out from a crucial place such as the front desk, they can expect the worst outcomes later on.

P3 Healthcare Solutions, Ontario, CA analyzes this aspect of healthcare while it deals with the IT side. Since first impressions are usually the last ones, we have to make the most of them. Otherwise, we can’t promise patients to become a long-term asset of the practice.

Greet Patients As You Mean It

Every human, related or unrelated, deserves care. When a patient decides to check-in, they deserve to be treated in the best manner by the front desk staff. Greet them with a smile because what happens at the front desk sets the tone for the rest of their visit. Making lasting first impressions and treating them like someone you care about is the key to running your medical practice. Believe me, it makes a huge difference. Higher patient satisfaction level depends on the positivity that starts right after a patient checks-in and registers their presence by the front desk.

Speak Politely on the Phone

To get by your day rather smoothly, treat everyone on the phone in a polite way. It is similar to having a patient in real in your office and talking to them. A friendly attitude, calmness in manner, and providing appropriate information are the three factors to an ideal patient-practice relationship. Because they are not well in the first place, and when someone is not well, emotions take over rather quickly. Anything that’s said and done in that situation lasts forever.

As a medical billing service, we start proceedings with clients both old and new with positivity, and replying carefully to their queries. There’s a QA team present behind the calls to check them for quality, and ensuring seamless delivery of service.

A Clean Environment Influences the Most

A clean and well-maintained waiting area has wider implications than one can imagine. A sick patient can get better just by spending some time in it. As a doctor, you speak of cleanliness now and then. How can you expect your patients to sit in a dirty room? It won’t do your practice any good.

Wipe chairs and tables with a disinfectant before they arrive and make sure the place smells good. Put the trash in the bin where it belongs. A seemingly neat and tidy place can look all messed up if the magazines are not returned to the shelves. What matters is that the visitors enjoy their stay while they wait for the physician.

Smooth Patient Workflow Needs to be In Place

From the time a patient checks-in to the time they go out of the doctor’s office, the workflow needs to be in place. I am talking about timely notifications of the arrival of the patient to the doctor. A seemingly simple visit to the doctor’s office can become a complex problem when the front desk staff fails to function.

Furthermore, the front desk has to notify patients of any delays in their check-ups. And if there are any system failures, before the IT staff can deal with it, it has to come to the notice of both the patients and their doctors. When the front desk delivers to the best of their abilities, a smooth patient flow happens as a result.

Full HIPAA Compliance for Patient Records

As a HIPAA medical billing company, P3 considers the safety of patient records as its number one priority. Because breaches of any sort can result in fines and even jail time in some cases. The same is the case with a doctor’s office.

Verification of patient information is the first thing that happens when a patient checks-in. The front desk has to stay updated on the demographic and other relevant data like the date of birth, address, and phone number.

MIPS in healthcare is an incentive program that rewards clinicians with incentives year after year with performance categories such as promoting interoperability in action. The category was previously meaningful use of EHRs ensuring quality use of Certified Electronic Health Record Technology (CEHRT). Hence, electronic health records are crucial as the US healthcare industry moves into the next phase of value-based care.

To read more about medical billing services, go here – 5 advantages of electronic medical billing services for providers

How Can MIPS Consulting Services Help Increase Your CPS?

MIPS has been an amazing initiative in the healthcare industry. This quality payment program instantly got attention from clinicians in terms of providing value-based services to patients. Therefore, the physicians’ participation rate has been outstanding since the very first year. This trend has also put pressure on the MIPS consulting services to use improved methods to better report clinical data.

Another reason for high participation is the fortification from the penalty that is imposed on non-participation or poor performance. This has to do a lot in changing physicians’ thinking to strive for being the top-scorer, especially, when there is so much to gain as incentives and bonuses.

Reporting MIPS quality measures with data completeness constraint requires accuracy and dedication from MIPS consulting services. The thing to consider is that healthcare organizations already have data and then consult MIPS qualified registries to report data.

Then, how can MIPS consulting services improve performance based on the present data? This question demands thorough analysis and this article gives insight into four MIPS score-increasing tactics.

  • Document Data for a Large Set of Quality Measures & Look for High Performers

This is the simplest way to ensure that the data you have is best for reporting MIPS quality measures. When healthcare organizations consult MIPS consulting services, most of them already know about the best-suited quality measures. However, there are some that at the start of the MIPS reporting period, run hundreds of tests to determine the most scoring MIPS quality measures.

The advantage of running this strategy besides the obvious one is to check if you can get extra points from the available data while submitting it to CMS. Moreover, the search for high-priority measures becomes easy for MIPS consulting services via this method.

Some professionally qualified registries or even healthcare organizations tend to chase a larger set of performance measures throughout the year. This way, they get the flexibility to report for the best performing measures at the end of the year.

  • Switch to Electronic Methods for Reporting

The end-to-end electronic reporting method is the best way to earn bonus points, and thus requires data submission through Certified Electronic Health Record Technology (CEHRT) to CMS. It automates the data submission process with efficient data extraction and measures calculation.

This method helps MIPS consulting agencies to earn additional points per measure or even increase 10% of the total MIPS score.

  • MIPS Consulting Services Should Report Free Text DataMIPS Consulting and quality measures

Qualified services should invest additional efforts in collecting free-text data. It surely involves the extra time and a bit of investment but can result in improving the MIPS scorecard.

Going through patients’ reviews and medical codes can help taking out important points. A dedicated team is required to abstract data for this purpose. Otherwise, outsourcing companies can also do this favor for MIPS consulting services.

  • Review the MIPS Score for Individual & Group Performance

Getting incentives and eligibility for the bonus pool gear up physicians’ performance and it is only possible when MIPS data is optimized. Before data submission, reporting services should check performance rates both as individuals and even as a group.

It is possible that clinicians get more points while submitting data as a group for treating a similar set of patients. It also helps to add low-performing physicians in the group that may be excluded from the MIPS race as individual healthcare providers.

Thus, physicians can earn a high score when MIPS consulting services uses a few simple tricks. Indeed, these tricks require efforts and but continuous monitoring of score throughout the year, provide opportunities to increase revenue cycle.

As a MIPS consulting service, would you try these tactics or have any other ideas for high MIPS score, share with us at https://www.linkedin.com/company/p3-healthcare-solutions

4 Statistical Reports To Access Revenue Cycle Management

Medical billing services in the US play a major role in the revenue cycle management process. They use the latest health IT tools and techniques to counter day-to-day challenges. According to the Kaufman Hall study of CFOs from more than 350 hospitals in 2018, the priority of the physicians was to reduce the cost of care delivery. Because the healthcare system is becoming more and more price-competitive.

MIPS being part of value-based healthcare has everything in favor of the physicians monetarily and patients in terms of their health. Quality is the number one requirement of this program, and it is judged by weighing doctors in four performance categories. Optimizing the RCM is one way to control the prices of care delivery, and that’s where P3 focuses the most.

Today, physicians or others related to them don’t have to manage patient records on paper, but there is dedicated software for them. As a billing company, we operate on Certified Electronic Health Records Technology (CEHRT) to maintain a steady cash flow for clinicians. In an EHR, data is automated, and we don’t have to worry about digging up a file from underneath a pile of papers.

Given below are some types of reports that will inform you about the progress of the revenue cycle management method.

1. High-Level KPI Report

This report helps in learning about the Current Procedural Terminology (CPT) in medical coding. It confirms that medical coders use the most common and profitable codes in a medical claim.

This report estimates the following parameters:
• Total encounters
• Total collected payments
• Accounts receivables
• Number of procedures

The difficulties in these KPIs help in knowing the areas that need improvement. For example;

If in a month, cost consumption increases, profit for that month should also increase in the same ratio. You experience a reduction in the accounts receivables (ARs).

Generally, medical billing software conducts everyday tasks of medical billing and coding in an efficient manner. The software has an inbuilt template for CPT, and if there isn’t, you must create one to promote future accurate claim creation.

2. Per-Encounter Reimbursement Report

Another KPI is to compare the reimbursement rates with that of your competitors. The formula to calculate the rate is simple – It is per-encounter reimbursement which is the total payment divided by the total number of encounters in a specific time.
When we know the average reimbursement rate per patient, it improves the consistency of the revenue cycle management process.

3. Report To Keep a Track of Accounts Receivables (ARs)

Revenue cycle management becomes more efficient when we keep a track of accounts receivables for the physicians. Ordinarily, medical billing and coding agencies neglect accounts receivables which exceed 120 days.

However, professional medical billers know the periods for particular claims – 30 days, 60 days and so on to keep an eye on the amount due by the insurance companies. If payments cross the 120-days mark, medical billers find out the exact reason for the delay and join heads to figure out a solution.

When the AR is less than 10%, it represents an ideal situation. If it is more than 25%, drastic changes in the revenue cycle management or a medical billing audit may be the ultimate remedy.

4. Report for Checking the Ratio of Net Collection

By the net collection rate, we know the exact performance of the revenue cycle management system. It highlights whether we are collect payments as per the number of resources we utilize or otherwise. Medical billing practices aim for 95% of revenue collection to progress in the healthcare industry. If the ratio is lesser, there is room for improvement in the RCM.

Charge value is an important parameter and it is the contractual adjustment of the total billed amount. By knowing this value, billers can calculate the total collected amount and give an estimate of the profit.

Conclusion

We can’t measure the performance of a physician’s practice unless the billing system works on specific lines of improvement. Ineffective billing directly affects revenue at the end of the day. Therefore, it is crucial to have your best personnel on revenue cycle management to keep it in a profitable mode.

P3 works to increase the revenue of physicians in an organized yet efficient way. Because they know the vitality of such an effort. It gives them a chance at increased revenue along with satisfied patients. The statistical reports mentioned in this article breathe life into the process of revenue generation from start to finish.

For a free RCM consultation, call 1-844-557-3227 without hesitation.

As a clinician, why do you think it is important to have an effective RCM process in place?

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 that 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?

MIPS 2018 Updates and quality measures

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 that 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). The scaling factor is achieved to ensure the 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 that 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 a maximum of 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. 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 that 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 the 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 scores 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 on December 31st for measuring the 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 specialists, 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 the 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 options 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 the 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 the 2020 payment year may range from =5% to +5X%. (X is the adjustment factor that allows MIPS program for staying budget neutral.)
  • If the CEHRT for an 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.