All posts by Francisco


There is a new payer in town – Part 2


Patient Financial Engagement

On the previous post “There is a new payer in town” we listed 6 reasons why the patient responsibility portion of the revenue stream is now a large percentage of the overall revenue and therefore must be prioritized and managed like any other major payer.

Now let’s look at this fascinating transformation and why it is important that every private practice, rehab facility, hospital, etc. take charge to avoid being left behind.

One of the biggest reasons collecting from patients is so difficult is because not many patients understand insurance coverage during and after the visit, and a well informed patient is more likely to pay promptly.

Set these goals to capture more revenue from your patients at a faster pace:

  • Create a digital billing experience for patients
  • Increase financial interaction between patient and provider thru automation
  • Transition from standard paper statements to efficient electronic statements
  • Reduce costs and shorten patient billing cycle

Tips and Techniques to accomplish goals above: 

  • Take an end-to-end education process of the patient financial responsibility
  • Use new and secured technology to engage the patient during benefits verification and collection of copay prior to the visit
  • Engage the patient with automation about remaining balances thru multi-channel communications
  • Patient views bills digitally from anywhere with live support to help them understand their financial responsibility and answer any questions

Stay tuned for more posts on improving your patient responsibility revenue stream.

For more on Digital Health solutions, contact us today


There is a “new payer” in town


There’s a new kid in town” … remember the hit song by the Eagles?

  Eagles / New kid in town (Live 1977) – YouTube

I recently asked some of my physician clients: What is your largest revenue stream?

Without hesitation, they quickly named one or two of their commercial insurance payers. Until recently, commercial payers have accounted for the largest revenue streams in private practices; however, this is not the case today.

There’s a new kid in town – “a new payer” as a direct result of today’s unstable healthcare landscape; it is impacting your revenue and must be addressed with a sense of urgency.

One of the lines in the song says, “There’s a new kid in town, I don’t want to hear it.” Well, let’s just leave that line in the song, because based on the survey conducted by HIMSS Analytics earlier this year and the reasons below, you do want to hear it. There’s a “new payer” in town!

Furthermore, the fast pace at which the industry is embracing emerging technologies and solutions to tackle this “new payer” is gaining momentum and is breathtaking.

The new payer in town is the patient who makes up your patient revenue stream; managing this revenue has never seen the “white glove treatment” commercial payers get, until now.

6 Reasons the patient has become the new payer

  • Today, the patient responsibility bucket equals or surpasses the commercial payers bucket.
  • Providers say that roughly 33% of all payments are successfully collected from patients, compared to 76-100% of reimbursements collected from commercial payers.
  • High-deductibles mean patients are paying more for their healthcare than ever before, increasing the overall patient responsibility.
  • Lack or delay of payment from patients continues to escalate and write offs continue to increase.
  • Confusion from multiple paper statements and difficulty getting the bill explained.
  • The growing patient responsibility means growing revenue cycle risk.

Now that the cat is out of the bag, is your practice experiencing this new payer in town?

The sense of urgency to prioritize your patient responsibility processes and align them with the rest of the commercial payers is critical.

Stay tuned for upcoming posts on how these trends and technologies are improving the performance of the patient revenue stream to levels closer to that of the commercial payers.

For more on Digital Health solutions, contact us today


Time to review for a fresh start

End of year is the perfect time to review, re-assess and bring in the New Year with a fresh start and a touch of Holiday cheer!

We’ve spent years helping client physicians just like you by providing solutions and services to solve challenges that impact revenue performance so you can focus on patient care.

As 2017 comes to an end, it is a good thing to look in the rear-view mirror and see how things went.

Did revenues hit the mark? How did MIPS (if you accept Medicare) impact your workflow and operational costs? Is managing the providers’ credential data still a manual nightmare and resource intensive?

If any of the above showed up in your rear-view mirror, then consider the following:

Revenue: if you did not hit the marks or experienced declines in reimbursements or increases on rejects, then it is time to do a Gap Analysis to find root causes for “revenue leaks” impacting your cash-flow.

MIPS: Like a tsunami, MIPS has caught many by surprise. As we peel away the many layers of the steps taken so far and the ones on the horizon to submit the final data, it seems as if the requirements get more involved and time consuming. The year 2018 will bring higher expectations, longer reporting periods and more. It’s time to consider a MIPS software tool and here are just a few key functions it must have.

  • Cloud based
  • EHR agnostic
  • Integrated with any certified EHR
  • Has a mobile app feature
  • Provides calculation simulator to maximize performance
  • Capable of submitting your data
  • and more ….

Feel free to contact us for more details on our MyMIPSScore tool

or email us at [email protected]

Credentialing:  If the credentialing process of collecting, sharing and maintaining provider’s data is still manual, you need to seriously consider a software based tool and here are just a few key functions to look for.

  • Drastically reduce the process time for credentialing and onboarding
  • Makes your credentialing process more efficient
  • Automated alerts when credentials are about to expire
  • API capable for integration and form generation
  • and more …

Feel free to contact us for more details on our Signature tool

or email us at [email protected]


The MIPS 2017 race is on the last stretch, are you ready? 

This month marks the culmination of a hard run marathon for many practices when it comes to MIPS 2017, and the beginning of a long-term multi-year commitment to MIPS and Value-Based Care beginning in 2018. You can see why on my previous post 5 takeaways for your 2018 MIPS Reporting  Just as an athlete prepares to run a marathon to the finish line, so does a practice to implement a successful MIPS program that will take it to the finish line and beyond.

The performance of the runners during the last stretch is what determines the winner and the difference almost always points back to “preparation”. How well the practice prepared for MIPS before the race started on October 2nd will determine the performance level and ultimately the quality of the MIPS program will carry them to the finish line on December 31st.

Unlike a marathon, MIPS does not end on Dec. 31st, so it is critical to take a serious pulse check NOW. Is your practice ready to tackle the last stretch as you take a hard look at the quality of your preparation or your MIPS program? Practices and groups struggling today is a sure sign of poor and mediocre preparation or MIPS program, while those cruising along is a sign of good and adequate preparation and a sound MIPS program.

2018 is right around the corner so by now every practice should be preparing for the new MIPS 2018 period while simultaneously finishing 2017 MIPS.

The key word is “simultaneously”. I recently posted 5 takeaways for your 2018 MIPS Reporting  to give you some ammunition to start getting ready for 2018. Of course, there are many other aspects to consider, but those 5 takeaways will get you started.

MIPS is not about avoiding penalties is about embracing quality, better outcomes and  Value-Based Care. 


5 takeaways for your 2018 MIPS reporting

Quality Patient Care is in the forefront of every medical practitioner … but is reporting Quality Measures even on their radar?

The transition to Value-Based Care includes the reporting of Quality Measures, Improvements Activities, patient engagement and more via MIPS or APM for Medicare and other Payment Models for private insurances.

Practice Advisor is your resource to stay on top of this transformation and make informed and strategic decisions about your Quality Patient Care.

5 takeaways for your 2018 MIPS reporting  

  • COST category effective in 2018 – Major change!

The COST category will be 10% of the final MIPS score. CMS will use the Medicare Spending per Beneficiary (MSPB) and total cost per capita to score the COST category.

The total composite score breakdown: Cost 10%; Quality 50%, ACI 25% and IA 15%.

The reporting period for Quality and Costs is from Jan 1st – Dec 31 while the Advancing Care Information and Improvement Activities remain at a continues 90-day period.

 Key action item: engage providers and staff in learning the 2018 Rule and develop and implement a strategy.

The reporting period for 2018 starts in just a few weeks!!!

  • More demanding performance scores, thresholds and higher penalties!  

Penalty increases to 5%; Threshold exception up to 90K or 200 patients; Data completeness up to 60%; bare minimum score to avoid the 5% penalty went up to 15 points.  

Key action item: Set performance score targets and monitor throughout the reporting period.

  • Relief for practices affected by disasters & bonus for small practices!

Evaluated on a case-by-case basis via hardship application for providers in areas declared an emergency or major disaster by the Federal Emergency Management Agency.

Complex patient bonus: CMS will award five bonus points in the MIPS program for treatment of complex patients.

Small practice bonus: CMS will award five bonus points on their MIPS final scores to small practices having 15 or fewer eligible clinicians. The bonus is awarded as long as the eligible physician (or group) submits data for at least one performance category.

Key action item: Contact us if you were affected by Irma, Harvey, Maria or other natural disaster.

  • Leverage Virtual Groups to maximize your participation!

For solo practitioners and groups of 10 or fewer eligible clinicians. These professionals can partner with at least one other group to report MIPS quality metrics, regardless of location or specialty. Can help track and share best and most cost-effective methods of clinical care to benefit all members of the virtual group.

 Key action item: Contact us now because Virtual Groups are being formed right now. Deadline to join a Virtual Group is Nov 30 !!!

  • Easier Alternative Payment Models participation and All-Payer Payment Models!

CMS fosters APM participation in 2018 by extending nominal risk of 2017. Participation in APM is expected to double and the preparation for the All-Payer Payment Model begins.   


Value-Based Care is not a destination it’s a journey MIPS

Value-based Care is not a destination, it’s a journey and it’s picking up momentum with Medicare’s 2017 MIPS/APM Reporting now in full motion!

The gazillion dollar question … Who is embracing this transition?

  • Providers who received the letter from CMS indicating they must report MIPS for 2017 and are currently collecting MIPS data have embraced the Value-based Care journey.
  • Physicians who signed up with ACOs and their participation in 2017 qualified them for the APM track of MACRA have embraced the Value-based Care journey.
  • On the flip side, providers who have not embraced the journey have chosen to simply take the penalties along with the ZERO performance score. They may simply be unaware that MIPS/APM is all part of the Value-based Care journey every physician must embrace.

Significant considerations

If you are an approved Medicare provider and must report MIPS, you must take an action now! Your patients, referring providers and affiliated facilities will appreciate you have embraced the Value-based Care journey.

  • The window to avoid penalties and a ZERO performance score is closing in!
    • Penalties increase every year. 2017 is 4%, 2018 is 5% and so on and a ZERO performance score is damaging and visible to all; your patients, referring physicians, affiliated hospital etc. … must act NOW!
  • Opportunities to improve outcomes and increase revenues!
    • The Value-based World requires a certified EHR; however, the fundamental driving reason for implementing an EHR should never be regulation-centric but rather patient-centric. Thinking “Outcome”, the EHR is a tool that assists physicians in mining vast amounts of data to make informed medical decisions, not for a single patient, but for the thousands of patients and across the thousands of combinations of diagnoses and diseases a single provider cares for on a yearly basis.
    • Maximizing the EHR gives patients secure on-line access to their medical information encouraging the patient to be more engaged with the provider’s care.
    • Capitalize on reimbursement bonuses and add new revenue streams with clinical improvement activities.
  • 2017 is the transition year and 2018 raises the bar!
    • Yes, 2018 is the real thing and all physicians must be ramping up now. The final ruling for 2018 is due in November so this is the time to start putting together your plan.
    • There is no TEST option in 2018 and some categories may require a full year of data collection.
    • There is a laundry list of action items, such as obtaining a new EIDM account, registration for attestation, participation in virtual-groups and much, much more.
  • Protect your public reputation … a huge game changer!
    • Patient referrals will incorporate a new level of scrutiny with the on-line publication of MIPS performance for all Medicare approved providers. This is why a ZERO performance score is so damaging!!!
    • The Physician Compare Website will be available to patients, providers, hospitals, affiliates and healthcare facilities searching for Medicare providers. Scheduled for 2018.
    • Users can also view primary and secondary specialties, practice locations, phone numbers, board certifications, education, residency, Medicare assignment status, group affiliations, ACO affiliations, hospital affiliations and much more. Most information comes from PECOS.

Driving Revenue Performance – MIPS start your engines – Revenue Killers – PHI

MIPS start your engines

MIPS is a critical component of Value-Based Care which increases your revenue. Starting MIPS too late WILL impact your practice negatively!!!

The traffic light colors indicate the levels of risk that could impact your revenue and your reputation. Obviously starting now increases your chance to successfully implement MIPS.   


Revenue Killers

One of the most common “no so good business practice” is poor cash controls.

Pay close attention to your month end reports to ensure charges and collected amounts are balanced. Keep a closed eye on those cancellations and no-shows and be sure to have them re-scheduled. Don’t allow the person who opens the mail post payments or write refund checks and by all means only physician owners should sign checks.  

Protecting patient data is protecting your practice

OUCH!  Provider hit with $31,000 HIPAA settlement over lack of business associate’s agreement 


Has eClinicalWorks Put Your Practice and Patients at Risk?

As you know, eClinicalWorks (eCW), was fined $155 million to settle a False Claims Act lawsuit for misrepresenting the capabilities of its software and for paying kickbacks to certain customers to promote its product, according to the US Department of Justice (DOJ).

Additionally, eCW’s software also did not accurately record user actions in an audit log, and in certain situations did not reliably record diagnostic imaging orders and did not perform drug interaction checks. In addition, eCW’s software failed to satisfy data portability requirements intended to permit healthcare providers to transfer patient data from eCW’s software to the software of other vendors.

There you have it, “did not perform drug interaction checks” means your practice inadvertently put your patients at risk!!!!!.   

These are some serious allegations affecting all practices using eCW; however, there is a light at the end of the tunnel.  The DOJ mandated eCW to assist, at no cost to its clients, with the transition to another software, for those who choose to remove themselves from all “by associations” in an effort to protect their practices and their patients.

Poll results: eClinicalWorks customers should take their data and run, readers say

What is the risk to your practice and your patients? … you and thousands of eCW users are asking the same question and soon you must make a decision, because your patients are watching.

Not an easy decision to make, so as you contemplate switching, keep our solution in mind and feel free to reach out to me if you want to discuss your options. AdvancedMD EHR and PM Software 

Happy to help!

Francisco “Pacho” Guevara
713-574-9578 | Office
713-301-4521 | Mobile


Driving Revenue Performance – Transition to Value-Based World

The transition to the Value-Based World is happening as we speak. Medicare is taking the lead with its Quality Payment Program  for MIPS and APM and all indications from the new HHS administration show full support to move forward. We just don’t know how they’re going to change the course , but one thing we know for sure, … it is going to be patient-centric and not government-centric or administrative-centric.

Private practices must embrace making the transition to the Value-Based World because their reimbursements will be based on their performance, value and quality of their services.

If you accept Medicare and have not yet received a letter from CMS indicating weather you must report MIPS in 2017 or not. Simply click on this link and enter your NPI.

Am I included in MIPS?


Having an EHR is part of the transition to the Value-Based world, so you must have an EHR in place or you would need to look for one.

BEWARE, BEWARE, BEWARE, not all EHR software is going to be around for ever. The market is expected to see mergers and acquisitions and just last week eClinical Works was fined by the DOJ for falsifying information during their certification and part of their punishment is to provide free data conversion for clients who want to jump ship!

Not a good week for eCW and if your practice use eCW you owe it to your patients to read these articles and make a decision.

eClinicalWorks fate in question

DOJ demands eCW to transfer data to rival ehrs

What should eCW customers do?

Latest and on the ECW fiasco


On of the largest Hospitals in the US violated PHI policies and got a hefty fine. Again you owe it to your patients to read what caused it, how you can prepare your practice to avoid this. the Value-Based World expects every practice to ensure each patient’s PHI is secured for the safety and security of the patient.

Texas health system settles potential HIPAA disclosure violations



Driving Revenue Performance – Value-Based Payments & MACRA Made Easy

The transition to Value-Based Payments is a reality and MACRA is not going anywhere!  

MACRA is a separate legislation from ACA and was passed with bipartisan support. This means too many GOP votes behind it to repeal. The question is “can it be improved or be modified?” Of course, the answer is yes and more so now that the GOP Doctors Caucus is monitoring how the MACRA implementation is coming along. As a Medicare participant, your voice matters when it comes to regulations and MACRA can be fine-tuned so the patient and your private practice are the main beneficiaries and not the government. If MACRA is too complicated, small practices will stop accepting Medicare and lose those patients and revenue.

The GOP Doctors Caucus must continue to watch the roll out of MACRA, listen to small private practices, and work with Dr. Price and the Trump administration on improving it.

How you implement MACRA can impact your revenue and your practice’s reputation

If you choose to do nothing in 2017, you must have a plan for 2018 and a reasonable explanation for when patients search the internet and end up at CMS’ Physician Compare website. By the same token, a half-baked MACRA implementation that yields poor performance scores will do as much damage, not to mention the loss of revenue in penalties. To learn more about your Quality performance score and your public online reputation visit the “Physician Compare” website and click on the “Improving Healthcare Quality” button.

MACRA is new to all of us and it is complex; however, knowing the key steps to get started is critical. CMS puts out many training webinars on MACRA, but who has the time? … The purpose of these blogs is to disseminate all that information into simple and to the point postings to help you make decisions for the benefit of your patients and your practice.

Once considered the “death knell” for small practices, this is no longer the case. Implementing MACRA is relatively easy. In a recent “deep dive” webinar on MIPS, CMS showed how much they have relaxed the requirements of one of the most challenging components, making it very easy to achieve compliance with MACRA in 2017. Maybe the Meaningful Use roll out fiasco a few years back has put CMS under the scope and they don’t want a repeat.

Sample MACRA Implementation guidelines

This sample guidelines will help you develop your plan for best performance scores and protection of your on-line reputation, however it is not a full set but it’ll get you started:

  • Understand the MACRA requirements for your practice and specialty.
  • Know which track to select (MIPS or APM)
  • Ensure your EHR truly meets MACRA requirements
  • Determine your Clinical, Operational, Financial, Technology and Security objectives
  • Identify training and support required by all staff
  • Establish the reporting period, set a Go-live date and a timeline.
  • Establish Milestones and performance score checkpoints (This is key to meet the 2017 reporting)
  • Develop plan for 2018

Value-Based Payments and MACRA open the door to new revenue streams … Stay tuned!