AMBA 2019 National Conference Summary
Written by Stephanie Cremeans of EZClaim
Acupuncture and chiropractic medicine have faced stigma for some time in the medical field, often considered alternative treatments. As the opioid epidemic continues to grow patients are looking for alternatives and the US is starting to recognize the therapeutic value of both chiropractic and acupuncture treatments. Thanks to the internet, patients can educate themselves on alternatives and as more patients want the treatment, they also approach their self-funded employer plans for coverage of such treatment. As a result, we are seeing more and more insurance plans that will cover the cost of these services.
Requirements for providers vary greatly by the state for licensure as well as the scope of practice but both acupuncturists and chiropractors can generally bill for Evaluation and Management (E&M) services, and both need to have a very clear understanding of patients’ benefits. Many insurance plans will combine the number of allowed visits for acupuncture and chiropractic services, and some even include physical therapy visits as well. Unfortunately, both specialties also lack in medical billing training, leaving providers to figure it out as they go.
For providers considering accepting insurance, it is important to familiarize yourself with the guidelines for the specific payers and plans that you would like to contract with as well as the diagnosis and procedure codes that are billable. If you are just getting started, consider working with a consultant to ensure that you are properly enrolled with payers and help you understand the specifics of acupuncture and chiropractic billing for your state.
One recommended consulting firm is RCM Insight.
If you want to go about billing on your own, which we do not usually recommend unless you have the experience, then speak to AMBA so that you can learn the basics. They are a very good organization to get you started.
The EZClaim platform offers its customers a low-cost option that has all the functionality needed to get their claims paid.
The State Of Physical Therapy
The State of Physical Therapy: Reimbursement Edition. Guest Author: Abbe Klein of Breakthrough Marketing
Costs are going up for private practice owners. Meanwhile, reimbursement rates relative to inflation are going down. Sound familiar? Looking for solutions? Some of the most respected names in the physical therapy industry are taking part in a live panelist webcast to discuss their top strategies for increasing your practice’s profitability, maintaining staff morale and getting paid for the value you provide – in light of these issues facing the private practice physical therapy industry. Our guests have more than sixty years of combined experience in helping owners take control of their revenue. They have some unique methods that may surprise you and can help if you are experiencing issues in today’s market.
A few of this year’s panelists include:
- Bob Kowalick – CEO & Founder | Certified Reimbursement Solution
- Chad Madden – Private Practice Marketing Expert | Breakthrough
- Mary Daulong – President & CEO | BCMS Comp. Inc
- With more to be announced
Here is a sample of the topics to be discussed:
- How To Influence Your Payer Mix
- How To Go Direct To The Consumer
- How To Control How Fast You Get Paid
This is a free online webinar for private practice owners. Click the link below to learn more about each panelist and we hope you will join in for a ton of valuable information from the speakers. If you are experiencing shrinking reimbursements then we highly recommend you tune-in.
Learn more and register today!
In addition to this very informative webcast, Breakthrough Marketing is hosting its largest event of the year, the Direct Access Summit, January 16 – 18 2020, in Dallas, Texas. The purpose of this event is to educate physical therapists on how to be better business owners and will feature presentations on operations, financial, personnel and mindset management, and more. This is a great opportunity to meet an incredible community of practice owners and talk about the challenges you face as well as share wins and ideas.
In addition to EZClaim, there will be a number of other companies featuring operational software, therapy tools, recruiting services, continuing education course and more. Visit Breakthrough for additional information and to register. Don’t forget to use the coupon code: ezclaim to get $200 off your ticket price!
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Claim Status Inquiry – EZClaim and Trizetto Provider Solutions
Tired of manually checking the status of your claims? Learn how using Claim Status Inquiry allows you to instantly access the up-to-date status of your claims, sent directly and in real-time from hundreds of payers – ending the need to manually check the status of your claims.
EZClaim and TriZetto Provider Solutions can help you identify and fix rejected claims and reduce data entry and phone calls to payers to check on claim status. Stay on top of the claims you submit every day and save your staff hours of work every week!
• Access up-to-date status of your claims from hundreds of payers
• Take action to fix and resubmit your rejected claims
• Learn from your most common rejections to reduce the chance of reoccurrence
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2019 MIPS Reporting
2019 MIPS Reporting – Guest Author: Sarah Reiter of Health eFilings
The Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law on April 16, 2015, and is driving the transition in healthcare from a volume to a value-based care model. CMS programs such as MIPS require providers to transition to a value-based care model or else face significant financial risks and even reputational harm. The stakes have been raised every year and it is even more complex than it has been in the past, further increasing the stress, burden and financial risk to providers. For a provider, it is critical to understand the impact that the reporting methodology has on one’s MIPS score and to choose the best methodology and reporting partner.
Within this new framework of the MIPS program, all healthcare practices regardless of size or specialty must evolve their approach to reporting to assure their financial viability. However, most do not understand or have awareness of, the different reporting methods available to them. Many providers erroneously still think that a registry is the only reporting option available to them or that they are required to use a registry. Or, they think that their EHR covers their reporting obligation. This misperception and general lack of awareness of the other reporting methodology is detrimental to the financial interests of any practice. And, furthermore, for the 2019 Reporting Period, it is likely the first time that traditional, legacy reporting systems (registry or EHR) may be unable to fulfill enough of the reporting criteria to avoid the minimum score penalty.
The other reporting methodology, known as Certified EHR Technology or CEHRT, has emerged as the superior reporting methodology. Reporting through a CEHRT dramatically improves the efficiency and effectiveness of the MIPS reporting process especially when done using ONC certified software. Also, a CEHRT utilizes eCQMs (electronic Clinical Quality Measures), which are a better way to optimize the points that can be earned. When the process utilizes ONC certified software and is, therefore, an end-to-end electronic solution, CMS awards significant bonus points toward the provider’s MIPS score.
Health eFilings, a CEHRT, is the best choice for a reporting partner. Our cloud-based ONC-certified software fully automates the process and does all the work with no IT resources, administrative support, and workflow changes. Health eFilings’ service is an end-to-end electronic solution that will save significant time, be a turn-key submission process and maximize the financial upside for providers.
And, finally, an important and timely addendum: While the 2019 reporting period is quickly coming to a close, Health eFilings can support you with reporting for 2019 so that you will avoid the automatic 7% penalty for not complying. But, time is of the essence, reach out NOW to connect with Health eFilings.
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The Importance of Administrative Safeguards
Hundreds of Patient Records Found in Trash
The Importance of Administrative Safeguards. Guest Author: Jim Johnson President of Live Compliance
A gastroenterology office in New York is under investigation after hundreds of patient records were left in boxes on a curb outside of the office and in the trash. These records contained Protected Health Information (PHI) such as first and last names, dates of birth, social security numbers, and even pictures of the patients.
They recently moved to a new office down the hall and some of the old records were waiting to be picked up by the shredding company from the former office, and they believe the cleaning company may have disposed of them.
Ensuring that proper administrative and physical safeguards are in place is absolutely necessary and to avoid HIPAA violations, and in doing so, Media Disposal Policies are essential to be understood by all workforce members, especially because breaches and improper disclosures of this kind seem to be occurring more frequently. For example, a medical records maintenance company was fined $100,000 for leaving patient records in an unlocked vehicle!
Patients must trust who they share their personal, private, and protected health information with, and breaches such as this, are obviously devastating for the patient and their doctor’s reputation. How can physicians ensure that they are meeting the HIPAA requirements and have proper safeguards in place to avoid this sort of breach?
First, an accurate and thorough Security Risk Assessment and Analysis must be conducted to expose and target any potential administrative, physical, and technical vulnerabilities. Doing so would have highlighted a major flaw in the practice’s administrative safeguards and the importance of Media Disposal policies and procedures and the practice’s need to implement.
It is also important to note, that all compliance solutions and Business Associates, must also, in turn, be compliant. Ensuring that your Patient Scheduling (check out our last post about if Google Calendar is compliant!) and other software solutions are HIPAA Compliant can eliminate the risk associated with maintaining paper patient records.
Next, ensure all employees complete HIPAA Workforce training. All employees of the practice, including the physicians, must take HIPAA training to ensure employees have a clear understanding of the HIPAA Privacy rule and actionable policies and procedures.
Finally, if visitors, such as janitorial services have access to the facility, it is crucial that Facility and Visitor Access Logs are kept, as well as a clear understanding of who has access to keys and alarm codes.
Healthcare organizations and their vendors have a responsibility to be HIPAA Compliant, and that starts by performing, updating or reviewing an accurate and thorough Security Risk Assessment covering your Technical, Administrative and Physical Safeguards. This will help uncover vulnerabilities and help you understand what information is being transmitted, shared and how.
TAKEAWAYS AND THINGS TO CONSIDER:
- Complete a Security Risk Assessment and establish a Corrective Action Plan that is accurate and thorough.
- Remediate any potential risks or vulnerabilities. A Security Risk Assessment will target vulnerabilities related to what is potentially exposing Protected Health Information.
- Develop Actionable policies and procedures that clearly outline the disclosures of PHI. Policies and Procedures can be edited and shared directly with staff from your Live Compliance staff portal.
- Ensure all employees complete and have a clear understanding of the HIPAA Privacy Rule and policies and procedures. Completely built into your portal, Live Compliance training is custom, online, and role-based. Training is delivered and monitored within your Live Compliance portal, anytime and from anywhere. Easily send and monitor HIPAA training in one click.
Don’t be the cause of your provider’s reputational damage and fines! Take advantage of the limited time offer for a FREE Organization Assessment to ensure you are meeting the requirements mandated for you and your organization. We hope you enjoyed this article about The Importance of Administrative Safeguards. Click here to read more interested and informative articles from EZClaim.