CMS to Cancel Group Practice Provision of MPPR-PC

The following announcement was released from the RBMA today regarding the CMS announcement regarding MPPR and further reimbursement reductions on services rendered by the same physician or group practice. The ACR and RBMA worked fervently, opposing this new policy, due to the impact these further cuts would place on American radiology professionals.

The Centers for Medicare & Medicaid Services (CMS) announced Friday that due to “operational limitations”, CMS’ contractors will not apply the Multiple Procedure Payment Reduction (MPPR) of 25 percent to the professional component (MPPR-PC) of subsequent CT, MRI, or ultrasound services to group practices in 2012.  The 25 percent reduction, effective January 1, 2012, remains in effect for subsequent CT, MRI, and ultrasound services when furnished to the same patient, by the same physician, during the same session on the same day.  The expansion of the MPPR-PC to group practices was opposed vigorously by the American College of Radiology (ACR).  RBMA also opposed the policy and supported the ACR’s efforts in recent meetings with CMS.

In last month’s final rule for the 2012 Medicare physicians’ fee schedule, CMS announced its plans to expand its Multiple Procedure Payment Reduction (MPPR) policy to the professional component (PC) of CT, MRI, and ultrasound services when furnished to the same patient, by the same physician or group practice (emphasis added), in the same session on the same day.  The procedure with the highest PC and technical component (TC) payments would be paid in full, but the PC payment of the subsequent procedure will be reduced by 25 percent.

CMS’ proposed rule for the 2012 Medicare physicians’ fee schedule included a 50 percent MPPR-PC but failed to mention it applying to physicians within the same practice. 

By publishing the group practice provision only in the final rule, ACR argued that the agency violated public rulemaking and that the group practice provision was counter to current subspecialty radiology patient care.  Bob Still, RBMA’s President-Elect, added that the provision would be difficult to implement for contractors and practices alike.

After this announcement on Friday, CMS released the following statement:

“The Medicare Physician Fee Schedule claims for services rendered on or before December 31, 2011, are unaffected by the 2012 claims hold and will be processed and paid under normal procedures and time frames.  The Administration is disappointed that Congress has failed to pass a solution to eliminate the sustainable growth rate (SGR) formula-driven cuts, and has put payments for health care for Medicare beneficiaries at risk.  We continue to urge Congress to take action to ensure these cuts do not take effect.”

SGR Bill Passed House of Representatives Now On to Senate

Well we have dodged the first bullet, but there is still a whole war to be won concerning H.R. 3630, known as theMiddle Class Tax relief and Job Creation Act that was passed on December 13th by the U.S. House of Representatives.  The Act prevents a further 27% cut to Medicare physician reimbursement and provides physicians with a 1% increase in Medicare payments for 2012 and 2013. So far, there have been no additional medical imaging cuts, so kiss your babies but keep your fingers crossed folks, because we still have to make it through to the Senate.

There is still the concern that this act does not contain information from the Diagnostic Imaging Services Access Protection Act (H.R. 3269), which protects against the implementation of a 25% payment reduction on professional fees for multiple MRI, CT and ultrasound procedures.  Fortunately, there are 127 supporters of H.R. 3269 in the House of Representatives and the ACR has announced that they will continue on their plight to add the language from H.R. 3269 as the SGR legislation heads to the Senate.

This SGR adjustment means good things but since it still does not address the proposed rule from CMS that would severely cut the Medicare reimbursement rate for radiologists who interpret multiple images, we have to hope that pressure from all concerned, including the ACR, pushes the Bill through. Although this is certainly a step in the right direction, this could just be a “quick fix” and the proposed cuts to radiologists would be the 8^th cut in the past six years to Medicare funding for Diagnostic Imaging.  The seven cuts that have occurred over these past six years have totaled more than $5 Billion and with imaging growth at less than 2% annually, additional cuts would end up limiting American’s access to quality diagnostic imaging due to the facilities that would suffer and end up closing their doors if the cuts went through. Republican representative James Renacci did introduce a legislation that would allow for a six-month grace period for new diagnostic imaging centers, so that those certain suppliers of Medicare imaging services could bypass the MIPPA accreditation requirement to receive reimbursements during that period of time.  The grace period begins when a new physician or facility submits images to the accreditation process and ends either with the approval or denial of their request, or after 6 months have commenced.  The center will be able to receive reimbursements during this time, however if they are unable to get accredited by the end of the period, any reimbursements they received would need to be paid back.

It can be assumed that due to the Senate’s Democratic leadership, they will attempt to create their own version of the legislation that will include a one to two year “doc fix,” which equates to questionable Senate action timing.  TheRBMA estimates that a package will be put together by the end of the week and voting will take place Monday or Tuesday, dependent upon the ability to create a package that gains some Republican Senate support.  This brings a whole new meaning to the term, a house divided sports fans, and we could end up waiting on a decision until well into 2012.

Tags: health care reform, diagnostic imaging, affordable health care, DSO, reimbursements, ACR, RBMA,Medicare, imaging cuts, SGR

Culture of Quality Care and Service: The Impact on Patient Experience

The health care community has seen a number of significant changes in the past year, which has opened the doors for many discussions, and one of the most talked about topics is the high cost of health care. Whether you are a patient or a physician, the cost of health care has most likely impacted you.  For patients, they have started to require pricing transparency, so that they know what they are truly paying for, which places a heavier weight on the overall patient experience.  Practices are essentially going back to the drawing board to reevaluate how to instill a culture of exceptional service, reassessing their “brand” and overcoming the plateau-effect.

The first step in re-instilling a culture of care in your practice is to reevaluate the core of your practice’s belief system.  What is the most important factor of your services? Is it that you have the most up-to-date technology; your impressive turn-around time or maybe it’s your low prices?  Once you have a focus, a campaign can be built around your mission.  Your entire staff should adopt the culture of service in order to succeed and everyone should have a hand in improving the patient experience, so that they recognize your facility for that focus that sets you apart from the competition.

                 

The practice’s new mission will encompass the facility’s “brand.”  No you’re not selling cars or vacuum cleaners, but even when people do, they are selling their brand, which encompasses not only the product, but also the feeling consumers get from that product.  If what you and all of your competition are selling is health care, you have to sell a better “feeling.”  This will require a number of things, including:

-       Getting to know your patients to understand what they want

-       Leaders with service-focused visions and values

-       Consistent delivery of the message

-       Effective ways to measure success of your initiative

-       Useful development, training and coaching to achieve success

-       Constant improvement and growth

These steps will assist your practice to encompass the concept of culture you are attempting to represent, and will lead to successfully overcoming the plateau effect your practice might be experiencing in this time of health care crisis.  Often times practices think the solution is to throw money at a worthless ad campaign or try some innovative marketing technique, however sometimes it just takes going back to the basics.  

Are You In Control of Your Practice's Medical Billing Collections?

The weight of the challenges currently on the shoulders of our nation’s health care professionals has grown increasingly debilitating in the past year and it appears that 2012 will be the same old song.  Physicians are starting to recognize their lack of recoveries and collections due to shrinking reimbursements, and a solution is needed. The feeling that your revenue is spinning out of control, is not only daunting, but also nerve-racking. So how do we combat this? It is time to re-evaluate the billing process and look for new medical billing solutions. To help mend this issue, we have created a checklist for you to use in determining where your process can be altered to improve practice revenue and so that your practice can achieve overall success.

Our goal when working with new clients is to help them overcome any hesitations they might have with outsourcing their billing by keeping them in control of the process.  It seems that the concerns are usually similar from practice to practice.  Physicians want to improve process time and increase revenue, but they also want to maintain control over their payments, personnel and data.  

By giving our clients complete access to our live database to produce reports, we keep the lines of communication open and operating in real time.  Physicians can see patient accounts and track them on their own, without the behind the scenes hassle. Also, many external billing companies have an inefficient collection process, which includes the company scraping a fee off the top of each service. We don’t work like that.

Another concern is that a billing acquisition will end up serving as an Exodus for the personnel that have been with a practice for so long.  Many offices fear that their dedicated staff will be removed and replaced with newbies, which is not true with us.  We always vow to retain key individuals at practices, because we don’t believe in fixing something that isn’t broken. 

The final concern is that the practice will no longer be in control of its own data.  People in “the biz” call this unfortunate side-effect of a poorly operating billing department, “black hole syndrome.’ This is when no one can really be sure what exactly is happening within their own company because they are no longer able to monitor success, progress and inefficiencies.  We eliminate that lack of knowledge and replace it with participation so that the staff is a part of the change.

Tags: medical billing, medical billing collections, ICD-10 codes, DSO, SCRUBS, EHR, PCT codes, revenue cycle management, improve practice revenue, practice revenue

The Self-Pay Solution: Benefitting Providers & Patients

Whether you are recently unemployed, a college graduate, or a hard-working professional with a family to provide for, the prices for health care services are enough to make your heart stop.  Americans are trained to think that without insurance, they simply can’t afford good health care.  The Complete Idiot’s Guide to Medical Care for the Uninsured even states, “Americans without insurance don’t get the health care that those with insurance do.” Well we’re here to ask who the idiots are now, because readers, that is just simply not true anymore.

The quagmire of cost variations and the questions they bring, have built up in the minds of patients and providers alike as a result of the utter disrepair our health care system has found itself in, and now it needs a solution. That solution is self-pay, or cash-pay, whatever you want to call it.  In the past, physicians have shied away from promoting self-pay pricing within their facilities due to a myriad of reasons that usually relate back to low collections. However, with insurance companies cutting reimbursement, those physicians have found themselves trapped in quite the Catch-22. 

                 

Hospital systems have suffered the most when it comes to cash-pay collections, which is one of the many reasons the list prices for services like MRIs are so high there. They are having to cover-up for the patients that never pay-up.

What patients often don’t realize, is that their medical decisions are 100% up to them and they should price shopfor their services in the same way that they shop for cars.  Thanks to a new trend of pricing transparency, patients are seeing the light. The Pueblo, Colorado newspaper, The Pueblo Chieftain, wrote an article about the wide-ranging prices for MRIs in their area, showing the disparities between the hospital system and the independent diagnostic imaging facilities.  “Cash-paying patients in Colorado can shell out as much as $3,460 for a basic shoulder MRI, but a little shopping around can cut that cost to $450.” If you could save over $3,000 on an MRI, and still receive the same level of service and care, why wouldn’t you?

So, patients are obviously at a pricing advantage when you look at it this way, but we like win-win situations, so we found a solution that benefits both patients and providers.  That solution is Save On Medical.  For physicians, Save On Medical ensures that chasing after collections is a thing of the past, by collecting the previously agreed upon service cost ahead of time. Patients have the ability to price shop for services in their area in one place, without having to call around to 20 different facilities and question whether or not they are paying for quality care because the Docometer grades each option.  Studies show that on average, families end up paying upwards of $4,000 a year out-of-pocket for medical services, or they could just go to Save On Medical first.