All posts by Francisco Guevara

06Jun/17

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?

EHR

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

PHI

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

 

12Apr/17

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!

27Mar/17

Revenue Performance – The future remains cloudy

The Repeal and Replace of ObamaCare did not happen … not sure about you, but I have not seen many news headlines inspiring excitement to make you jump up and down. It feels more like the dark cloud never went away and continues to loom over the Healthcare industry. .

This is the time to make decisions and move your private practice forward especially if you accept Medicare. More likely, CMS will begin to circulate the letters they promised indicating which providers are exempt from MACRA and which are not, but be aware: what your records show may not necessarily be what Medicare has. So be on the look out for this letter.

Remember, if your yearly charges to Medicare exceed $30K and you see more than 100 Medicare patients a year you must comply with MACRA to avoid the 4% penalties or get up to 4% increase on your reimbursements from Medicare. Percentages increase every year

Let’s say you barely missed the exemption so your first instinct tells you it is OK to ignore it because the amount of money is not that much. While this may be true, a penalty in MACRA also means poor performance which will be published and made available to the public. Remember, your patients and potential new patients search for doctors online all the time!!!!

Ouch!!!! …. yes, your reputation is also at stake, so wouldn’t you do all you could to avoid a poor performance ranking that could deter new patients or worse, lose the loyal ones?

The possibility of softening MACRA remains. Dr Tom Price, head of HHS has been a strong proponent for softening MACRA. If he is able to do so then more power to all private practices, but what if he is not?

This is a crucial pivot point for every private practice still playing on the sidelines, undecided about MACRA, to take action to protect their revenue and reputation; after all “it’s all about revenue”

Need help getting started? … contact us to schedule a FREE consultation

Francisco Guevara | 713-301-4521 | francisco@etekmed.com

 

17Mar/17

Revenue Performance Beyond the Regulatory Turmoil

Setting the stage

Let’s first look at two key responses from Dr Price when asked about MACRA during the confirmation process:

Question: Do you also agree that the successful implementation of the bipartisan Medicare Access and CHIP Re-authorization Act (MACRA) will require the continued development of value-based payment models?

Answer: The Medicare Access and CHIP Re-authorization Act of 2015 (MACRA) is built on the principle of encouraging providers to develop Alternative Payment Models (APMs) that can ultimately be adopted by CMS and commercial payers.

Question: Will you commit to supporting the continued development of value-based payment models in Medicare and increasing the percentage of provider payments made through those models?

Answer: We share the goal of improving Medicare by empowering providers to be creative and develop payment models that best suit the unique needs of their patients to ultimately improve patient care.

These responses lead us to believe that he is supportive of MACRA, mentions “commercial payers” and seems to be consistent on his “patient-centric” focus for this reform.

What we’ve learned in the last two weeks 

Now, to the crux of the matter, here is Dr Price’s response during Meet the Press interview on 3/12/17.

Question: Define success, in terms of number of people covered and the cost when it comes to percentage of income

Answer: It is difficult to put numbers to it, however success is more people covered who are not covered right now, at an average cost that is less and I believe we can do it with the plan we laid out. Remember is not just the bill that is in congress right now, (second prong) it’s a look at the regulatory apparatus that has been placed over the past 8 years by the previous administration that has made it more difficult for folks to practice medicine, more difficult for folks to care for patients, driving up cost …. And then (third prong) it’s an array of options from a legislative stand point that reforms the insurance coverage system so you can purchase across state line … again driving down cost making it so you have an accessible, affordable quality and choices plan

Watch this short video of Dr Price’s response

The plot thickens even more, now that the White House submitted the budget cuts proposal for HHS and other agencies that have been key in recent years in the transformation of value-based reimbursements.

Beyond the regulatory turmoil

You have to wonder how is MACRA and value-based medicine going to fit in the new “patient centric” approach as Dr Price and team look at the “regulatory apparatus” ?

Will MACRA go away totally? What if they only remove certain portions of MACRA?

Decisions, decision, decisions …. Is your practice ready? Do you roll the dice and hope for the best or start a plan that will help your practice beyond this turmoil?

Give us your feedback!

By Francisco Guevara, CEO and founder of Etekmed

23Jan/17

Revenue Performance MACRA-MIPS & APM … build your plan – Step2

The previous blog “It’s all about Revenue” pointed out the importance of having a solid Revenue Cycle by performing an assessment to ensure a successful MACRA implementation plan.

Here are the areas to assess: Accurate Coding, Clinical Documentation Support, Audit Protection, Strong Appeal Practices, Contract Reimbursement Scrutiny and Patient Collections Performance

Step 2 is the breakdown of MACRA, who is eligible, your options for 2017, the MIPS components and performance allocations for the composite scores.

What is MACRA

The transition from “fee-based pay” to “value-based pay” with two tracks to choose:

  1. MIPS = Merit-based Incentive Payment System
  2. APM = Advanced Alternative Payment Models

 You must participate in the program if …

  • you are not in the first year of Medicare part B participation
  • your Medicare billing charges are more than $30,000 per year and you provide care to more than 100 Medicare patients per year
  • your practice does not participate in an Advanced Alternative Payment Model

For MIPS you must be a Physician, Physician assistant, Nurse practitioner, Clinical nurse specialist, Certified registered nurse anesthetist.

If your practice does not fall in this category, or does not accept Medicare, or is cash only … continue reading for new opportunities for your practice

The charts below explain the breakdown, however contact us if you have any questions

Most private practices will follow the MIPS track. 2017 and 2018 will set the benchmark of your performance for payment increases of penalties. 2017 for 2019, 2018 for 2020 and so on.

Track 2017 2018 2019 2020 2021 2022
MIPS Benchmark for 2019 Benchmark for 2020  4%  5%  7%  9%
APN 5% Incentives – No MIPS required

The chart below shows your options on how to participate, however you must choose an option which will help pave the way into 2018 for a full year participation

You can pick your own pace but remember: “if you don’t have a plan, plan to fail”

Type of  Participation Adjustment (-) (+)
None No action from the provider (-) 4% Penalty
Some Data Submit some 2017 data None
Partial Report a 90-day period in 2017 Small (+) 
Full Report a full year starting 1/1/17 Modest (+)
APM Join an Advanced APM in 2017. (+) 5 %

MIPS is broken down into 4 components (See chart below) Quality, Advancing Care Information, Clinical Practice Improvement Activities and Resource Use. Each component has a score value and a percent of the total composite score.

MIPS Components 2017 Score Allocation 2018 Score Allocation
Quality (Replaces QPRS) 60% 50%
ACI (Replaces MU) 25% 25%
CPIA (Brand New) 15% 15%
Resource Use (Starts in 2018) 0% 10%
SRA (Security Risk Assessment) Required Required

TIPS for your plan

  • Quality Measures
    • Identify quality metrics that your practice has a proven success record with and can easily incorporate into your workflow to alleviate reporting burdens and maximize revenue opportunities under MACRA.
    • List of Quality Measures
  • ACI – Advancing Care Information
    • Take an “all hands on deck” approach, revise policies and procedures and monitor regularly. If done right, you’ll transform your practice to a more engaging and inviting practice for your patients.
    • List of ACI Measures
  • CPIA – Clinical Practice Improvements Activities
    • Look at your practice, your strengths and the community you serve and select services that will maximize your options to improve outcome while increasing revenues, Set goals and milestones.
    • List of Improvement Activities
    • Non-Medicare or cash only practices should look into CPIA!
  • Resource Use/Cost – Replaces Value-based modifier – Starts in 2018
    • For 2017, do a Revenue Cycle Assessment
  • SRA – Security Risk Analysis – Required for each reporting year

Click here to learn more about the Quality Payment Program

Stay tuned for Step 3 >>> Set Your Practice Apart – beyond MACRA

14Dec/16

Revenue Performance Beyond MACRA Step1

In a couple of weeks, the new year begins and so does MACRA, but how is all this possible? Whether your practice takes Medicare or operates on a cash basis only, you must have a plan for 2017. MACRA brings about a big industry transformation all practices should learn about.

The real scoop: it’s all about revenue and outcome, patient engagement, innovation and new opportunities to incorporate new technologies into your practice, while increasing your revenue!!!

Step 1 – It’s all about Revenue

When implementing something new and the size of MACRA to your organization, we recommend to take a step back and look at areas that need improvement. This type of housekeeping serves to help pave the way for the new MACRA related activities.

Here are some areas to consider:

Optimization, efficiency and monitoring

  • Look for higher profitability of your current services and identify revenue options based on your organization and the community you serve.
  • Focus process improvements, services and innovation to engage the patient, maximize appointment scheduling and having a stellar and painless “patient payment process”!

Optimize your Revenue Cycle and reduce risk

  • Review the provider’s workflow to ensure pristine documentation. Perform random chart audits … All reduce risk and maximize reimbursements.
  • Use expert billers to perform regular reviews of coding to reduce/eliminate rejects, denials and audits
  • Optimize coding, Practice Management software and EHR for MACRA
  • Maximize collections with eligibility verification and authorizations
  • Review fee schedules

Efficiency and economics

  • Know your base cost
  • Streamline operations and increase throughput
  • Reassess staff productivity levels to accommodate new revenue generating activities for MACRA
  • Implement automation and innovation to reduce cost per service and implement best practices

Implement KPIs to monitor and manage your performance

  • Monitor monthly insurance and patient revenue
  • Appointments per month
  • Days in AR
  • Claims turnaround time – Service to Billed
  • Cancellations and no-shows

Reminder: all of the above applies to any practice, not just those who must comply with MACRA

Step 2 – MACRA-MIPS & APM … the breakdown to continue building your plan!
Stay tuned …