Population Health During COVID: Moving Together in the Right Direction

We’ve all been hearing the term population health alongside news of the pandemic so what exactly is population health, and how does it differ from public health? 

First, a bit of history. The awareness of the term “population health” increased with the rise of the “Triple Aim” of healthcare, coined by the Institute for Healthcare Improvement in 2007. The Triple Aim is defined as, “Improving the patient experience of care (including quality and satisfaction); improving the health of populations and reducing the per capita cost of health care.”

Although the Triple Aim sharpened the focus on ‘health of populations,’ frequently referred to as population health, it didn’t give an exact definition of which population, which has become problematic. Over time, it has morphed into the terms population health management or population medicine. Although many envision a geographic location as the foundation of a population, that isn’t necessarily the case. Clinical settings often use the term to describe patient groups, such as cancer patients. Although there is a discussion in the highest levels of health policy about semantics, when the term population health is used, it may be a good idea to clarify if it is a geographical or patient subgroup reference.

Public health is different than population health

According to the Centers for Disease Control and Prevention (CDC), “public health works to protect and improve the health of communities through policy recommendations, health education and outreach, and research for disease detection and injury prevention.” Therefore, the main difference between population and public health is that public health relies on official policies to drive change. In contrast, population health elicits change through all stakeholders, including providers, patients, payers, academics, and the communities themselves.

Population health makes suggestions for allocation of resources

The CDC’s 6|18 Initiative is a prime example of a population health program. Through its Medicare and Medicaid branches, it’s reaching out to partners to work together and improve beneficiaries’ health while lowering costs. It focuses on six areas of health improvement:

  • Reduce tobacco use
  • Control high blood pressure
  • Improve antibiotic use
  • Control asthma
  • Prevent unintended pregnancy
  • Prevent Type2 Diabetes

Each area of focus contains recommendations to improve patient outcomes and reduce costs. For example, to control high blood pressure, the CDC urges stakeholders to improve medication compliance with strategies such as ensuring low copayments, easy-to-read packaging, care coordination between providers, and encouraging self-monitoring with home blood pressure monitors.

Population health during COVID

There is no doubt that the pandemic will significantly affect population health initiatives. The Institute for Healthcare Improvement suggests that organizations focus on a framework of four concepts during COVID:

  1. Physical and/or Mental Health – Identify those in the population at increased risk during COVID and ensure access to appropriate care.
  2. Social and or Spiritual Well-Being – Consistently screen for social and spiritual well-being and utilize partnerships in community-based organizations to help meet patient needs.
  3. Community Health and Well-Being – Share data and work with other organizations to address caregiving strengths and weaknesses.
  4. Community of Solutions – look outside traditional roles when seeking solutions; for example, consider a community-based business to manufacture PPE rather than a conventional supplier.

When viewed through a population health lens, we can see there have been many COVID-related population health strategies already put into place. Increased access to telehealth, programs to support front-line healthcare workers, car parades for graduations, and using alternative sites for testing are examples of population health in action.

What you can contribute to population health

As a healthcare provider, participation in a population health initiative can be good business. It’s an opportunity to strengthen professional relationships as well as introduce your practice to the community. Contact your local health authority, hospital system, or community outreach center to learn more about population health initiatives in your area.

Staying on top of the latest regulations and initiatives can be challenging– using the right partner for electronic health records, practice management and billing software makes it easy. Contact us today at (412) 424-2260 or visit vowhs.com to learn how we can help optimize MIPS, streamline claims and maximize revenue.

Will Your EHR Comply with the New Information Blocking Regulations?

The new Final Rule has implications for providers as well as patients

Interoperability could be considered the ultimate goal of healthcare technology. Clinically, it would achieve universally accessible patient records, leading to better health outcomes. Administratively, healthcare’s push away from volume to value payment models depends heavily on its potential administrative and clinical cost savings. A provision in the 21st Century Cures Act Final Rule, which will begin November 2, 2020, aims to bring down a potential barrier to interoperability that occurs at all levels, from the provider’s office to multi-million dollar EHR companies – data and information blocking. What is data and information blocking? It’s withholding patient health information, either intentionally or unintentionally, by making its access difficult.

The Department of Health and Human Services (HHS) sounded the alarm about information blocking in the Report on Health Information Blocking published in 2015. The report stated, “While many stakeholders are committed to achieving (interoperability), current economic and market conditions create business incentives for some persons and entities to exercise control over electronic health information in ways that unreasonably limit its availability and use.”

The report alleges that some stakeholders may engage in activities that impede the exchange of health information because it is in their financial interest to do so. For example, charging “fees for data exchange, portability or interfaces,” or creating platforms that “lock-in” users and effectively block electronic communications, leading to additional services and subsequent cost.

There is some debate about whether there are intentional barriers for data exchange or only “incompetence in the industry.” Nevertheless, the Final Rule mandates that providers and vendors cannot obstruct the exchange of information (data blocking) with:

  • Practices that restrict authorized access … between certified health information technologies
  • Implementing health IT in nonstandard ways … (that could) increase the complexity or burden of accessing, exchanging, or using electronic health information (EHI)
  • Restrict the access, exchange, or use of EHI with respect to exporting complete information sets or in transitioning between health IT systems
  • …Impede innovations and advancements in health information access, exchange, and use

What the Final Rule means for providers

Healthcare organizations and providers need to be aware that intentionally manipulating data exchanges that lead to waste or abuse are prohibited (for example, tests needing to be repeated because the data was inaccessible).

Another provision to be aware of is the requirement that developers create application programming interfaces (APIs) that allow “health information from such technology to be accessed, exchanged and used without special effort through the use of APIs or successor technology.” In terms of real-world use, this will drill down to three things for healthcare providers:

  1. Patients must have access to records that require no “special effort” to obtain; this means information cannot be siloed in different electronic locations. It also opens the door to third-party application developers – patient access to records through a smartphone may soon be available.
  2. All documents should be scanned into the patient record.
  3. Transferring information from one vendor system to another may soon become more straightforward, potentially creating smoother (and cheaper) billing operations.

What providers should look for in EHR partners

Although it’s vendors’ responsibility to ensure their technology aligns with the 21st Century Cures Act mandates, providers may want to confirm their software platforms are compliant. Features to look for include:

  • Compatibility with HL7 Fast Healthcare Interoperability Resources (FHIR) Release 4
  • Optimized patient portal features that allow sharing and downloading of records
  • The ability for patients to share or link their information to third parties, such as smartphone applications

Enforcement of the Rule

Although the official start date is November 2, the OIG will use its discretion to enforce the new regulations (especially considering the COVID-19 pandemic.) Now is the time to check with your EHR partner to confirm your technology will comply with the Act’s requirements, so both your practice and patients can benefit from the new interoperability rules.

Staying on top of the latest regulations can be challenging– using the right partner for electronic health records and medical billing software makes it easy. Contact us today at (412) 424-2260 or visit vowhs.com to learn how we can help optimize MIPS, streamline claims, and maximize revenue.

Should You Apply for a MIPS COVID-19 Exception?

In June, CMS announced that clinicians participating in the Quality Payment Program Merit-based Incentive Payment System (MIPS) for 2020 whose practice is being adversely affected by COVID-19 can apply to re-weight their performance categories through an exception.

The two exceptions available in PY 2020 are:

  • The Extreme and Uncontrollable Circumstances Exception
  • The MIPS Promoting Interoperability Performance Category Hardship Exception

The application period for both exceptions closes on December 31, 2020.

The Extreme and Uncontrollable Circumstances Exception

This exception is designed to help organizations cope with uncontrollable circumstances (such as natural disasters) and public health emergencies (such as COVID-19). To receive the exception, an organization must demonstrate circumstances that inhibit the ability to collect the necessary information for a MIPS performance category and meet at least one of the two conditions below:

• The inability to submit the performance information for a period of time
• The process of submission would affect regular operations, which in turn would impact performance on MIPS measures

The exception application process

This year, CMS began requiring an HCQIS Access Roles and Profile (HARP) account for exception submission. After signing into QPP, the exception application is located on the left navigation bar after login. (A QPP Access User Guide to register for a HARP account is located at https://qpp.cms.gov/mips/exception-applications. )

You can check on the application status by signing into QPP and be notified of the application outcome by email. Approved organizations will see an eligibility profile on QPP, but it may not appear in the QPP Participation Status Tool until data submissions beginning in 2021.

Organizations that receive approval will not have to report the requested performance categories and the remaining categories will be re-weighted. Clinicians that submit information for two or more categories will receive a final score based on the data.

There are circumstances when automatic re-weighting can occur. If a provider (groups are ineligible) is located in a CMS-declared extreme and uncontrollable event zone, they will qualify for a weight adjustment and receive a neutral payment. As of June, no qualifying events were announced by CMS. To be informed when a qualifying event occurs, sign up for QPP updates.

Clinicians can earn credit for COVID-19 clinical trial participation

Physicians that participate in a range of clinical trial types and report findings to a clinical data repository or registry may be eligible to attest their participation and receive MIPS credit. According to a letter sent by CMS to physicians in April, “MIPS eligible clinicians who report this improvement activity will earn 20 points or half of the total 40 points needed to receive a maximum score in the MIPS Improvement Activities performance category.”

Proposed boost to the Complex Patient Bonus due to COVID

CMS is revising this QPP incentive in light of the additional complexity of treating patients with COVID. Clinicians and organizations may be able to earn up to 10 bonus points for 2020 (the prior maximum was five).

Expanded use of telehealth toward measures

Forty-two quality measures can be assessed using telehealth as an encounter tool, even if the entire measure cannot be completed virtually—as long as the whole measure is performed it can be included (for example, the patient receives a blood test after a telehealth encounter).

Examples of measures eligible for a telehealth encounter include:

  • Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
  • Cervical Cancer Screening
  • Breast Cancer Screening
  • Preventive Care and Screening: Influenza Immunization

Other eligible measures include:

  • Dementia: Cognitive Assessment
  • Depression Remission at Twelve Months
  • Adult Major Depressive Disorder (MDD): Suicide Risk Assessment
  • Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk Assessment

Trying to keep up with MIPS categories, measures and reporting can be overwhelming – using the right partner for practice management software and billing makes it easy. Contact Virtual OfficeWare Healthcare Solutions today at (412) 424-2260 or visit vowhs.com to learn how we can help optimize MIPS, streamline claims, and maximize revenue.

The Impact of Fee Schedules

The Impact of Fee Schedules

Fee schedules play a critical role in reimbursement for every physician’s practice. Many physicians, however, don’t know what, exactly, a fee schedule is, and how their own is kept up-to-date.

Oftentimes, when we speak with physician practices and ask about their fee schedules, the physician acknowledges that they have a fee schedule, but that they have no idea who created it, maintains it, or even where it originated.

So, let’s start at the beginning…

A fee schedule is a complete listing of all the fees used by an insurance carrier to pay physicians and other providers of healthcare services/products. This comprehensive listing provides a maximum reimbursement that each carrier will pay to physicians for their services.

Often, many commercial/managed care carriers will base their fee schedules off of the CMS’ Physician Fee Schedule, and so CMS is frequently referenced as the leading authority for the average reimbursement for medical services. Each insurance carrier that a physician/physician group is credentialed and participating with will have their own fee schedule that is a part of their contract with physicians for reimbursement.

Fee schedules are also used internally by physician practices for both cash billing and carrier billing for services provided. These fee schedules are created and maintained by the physician and their billing staff and are used to ensure that the physician is collecting the maximum amount of revenue allowed by the carrier for each date of service.

Why is all of this important to physicians?

Let us provide an example…

Say you see a new patient and your internal fee schedule (what you bill the insurance company) is set at $75 for a new patient office visit CPT. The insurance carrier receives and processes the claim, and reimburses you the entire $75. That’s great, right? Not always.

Total reimbursement by an insurance carrier for a billed amount often signals that the billed amount may be too low and that the provider may be losing out on the maximum allowable reimbursement for that CPT; this is an indicator that the practice needs to review their billing fee schedule and perhaps increase the charged amount on certain CPT codes.

Conversely, imagine that the same patient has returned for another visit. You’ve updated your fee schedule and are confident that you will now collect the maximum you are owed for the service. Your billed amount is now set at $150 for this service. The insurance company receives and processes this new claim; however, this time only reimburses you for $25 of the billed amount. What happened? Is your fee schedule now set too high or did the insurance company reimburse too low?

Unless you have a copy of your fee schedule with that carrier or understand what the average reimbursement for that CPT is, it will be difficult for your biller to know why the claim was reimbursed at such a low rate.

These two scenarios are good representations of what we frequently encounter when we consult with various physician practices and organizations. It is not uncommon to uncover significant lost revenue, either because the claim was billed at too low an amount, or because the biller did not have the time, information and resources (system set up) necessary to make sure each claim was being paid correctly.

It is critical that physicians and their managers recognize this crucial piece of the billing cycle, and work to make certain that it is kept up to date within their practice management system.

If you have questions or need extra help with your fee schedule and/or other areas impacting your revenue cycle, we can provide assistance.

Patient Statements: Your Secret Weapon to Improve Patient Payments

Every year, patients are paying more out of pocket for their healthcare – and given recent headlines, the situation may become worse. As a result of COVID-19 costs, one organization estimates that premiums for private plans will increase between 4 – 40% next year. In addition to monthly premiums, deductibles are on a steady rise as well. The percentage of workers with a deductible of $2,000 or more has increased from 18% to 28% over the past five years.

As a result of the shift in reimbursement from insurance payers to patients via high deductibles, patient revenue is a top source of income for many providers, following closely behind Medicare and commercial plans such as BCBS. Even before the pandemic, patient collections were a significant concern for providers, as indicated by a survey where 58% said collecting from patients was their top revenue cycle concern.1

Are organizations underestimating the impact of patient statements, and by association, patient payment options on their bottom line? Some statistics to consider:

  • 70% of consumers reported being confused by their medical bills
  • 80% said an easy-to-read statement was important for their medical bill experience
  • 65% would consider switching providers for better healthcare payments experience
  • 80% said that payment channel choices were very or somewhat important to their medical bill payment experience

Despite worries about collecting from patients, 41% of providers haven’t updated their patient statements in five years or more.1

The cost of patient statements

In addition to patient preferences driving a re-think of how you bill, statement material and labor expenses can impact your bottom line. The material costs are well over a dollar to mail a statement, and of course the labor of coordinating their generation and mailing needs to be factored in as well.  According to an MGMA Stat poll, over 46% of respondents mail three statements before a patient account is sent to collections.

Given patient perceptions, and the high cost of sending statements, taking a second look at your patient billing and payment systems may be in order.

Boost revenue with easy patient statements and payments

When updating your patient billing and payment systems, there are three critical components to bear in mind: statements, payments and past-due reminders. VOWHS can provide your practice with these features, as well as electronic statements receive payments faster.

Customized statements provide opportunities

Customized statements, especially electronic statements (e-statements), are an excellent way to decrease costs, a resourceful way to communicate with patients and useful tool to reduce billing question calls into the office. Practices that take advantage of customized messaging can communicate things such as:

  • If you think your claim is denied in error, please contact your insurance carrier to confirm coverage before calling us.
  • Question about your bill? Go to our website (insert your web address) for answers to frequently asked questions.
  • Want to speak to a billing representative? Call (insert your billing phone number). Press (X) for a callback if you don’t want to wait on hold.

Customized e-statements are also an opportunity to tell your patients what they owe in a straightforward way. Columns can be tailored into easy-to-understand language. For example, rather than calling an amount due “coinsurance,” customized statements can call it “your portion.” Rather than using the word “adjustment” at the top of a column, you can choose to call it an “insurance discount.” Small changes in wording can create a tremendous positive impact on patients. For example, a heart specialist practice was able to collect nearly $3,000 more a week with customized statements.2

The convenience of online bill pay encourages payment

It is well documented that patients are in a consumer mindset. Many see a statement as just another bill to pay and think, “If I can pay my utility bill online, why not my medical bill?” Younger patients may not even possess a checkbook! Online bill pay offers the convenience of 24/7 availability. It also makes it easy for caretakers to pay bills for their loved ones on a credit card rather than directly from a bank account. Up to 75% of patients will pay their bills online given the opportunity.2

Automated past due reminders

Most patients have every intention of paying their medical bill. However, sometimes other bills take priority, or they are distracted by life events. Rather than sending out another costly statement, automated phone calls and texts can be a quick and effective reminder that their bill is past due. If you offer online bill pay, some patients near a computer will pay as soon as they receive the alert. One practice in St. Louis used a combination of online bill pay and automated reminders to shave almost a week off their accounts receivable (A/R).2

Is it time to investigate how updating your patient billing and payment systems can improve revenue? Using the right partner for practice management software and billing makes it easy. Contact us today at (412) 424-2265 or visit our RCM page. 

1 Four ways group practices can create a better patient experience. MGMA. https://www.mgma.com/resources/revenue-cycle/four-ways-group-practices-can-create-a-better-pati.

2 POS Professional Office Services, Inc. (2020).

Moving Forward: Managing the Repercussions of COVID-19

As the country reopens from the COVID-19 shutdown, healthcare organizations are gradually emerging from the most extensive mass disruption to healthcare delivery ever known. In March, the CDC recommended postponing all elective surgeries during a nationwide lockdown. Additionally, practitioners of all specialties saw volumes drop, leading to an unprecedented plunge in revenue that resulted in 1.4 million healthcare jobs lost in April alone.

COVID-19 caused shortages of PPE, which meant that some providers were not fully equipped to protect themselves from the virus and contracted the disease. Climbing infection rates and death tolls made daily headlines. The worst may not be over; recent reports warn Americans to brace themselves for a second wave.

Where do healthcare practices go from here? There are many factors to consider, ranging from ensuring the health and safety of patients and staff, to reviewing finances to keep the practice open, to getting ready to be hit by the virus again. Here are some practical suggestions to get you started moving in the right direction.

Ensuring the health and safety of patients and staff – adjusting workflows

Although patient volume should steadily grow in the coming weeks, many patients are still reluctant to visit their healthcare provider. Healthcare organizations are aware that some members of staff may have concerns about returning to work. One answer to assure health and safety is to adjust workflows mindful of three categories: utilizing technology, maintaining social distancing, and enacting cleaning and visit protocols.


Many providers are using telehealth to treat patients without seeing them in person, saving PPE and eliminating possible exposure in the office. Pre-visit COVID-screening phone calls are another useful tool to warn providers of potential cases. Some offices have chosen to ask patients suspected of having COVID remain in their cars during specimen retrieval, so the patient never enters the office. Phone or video visits can also be used by support staff for histories of present illness and health histories, so they don’t need to be done in-person, saving time (and limiting exposure) while the patient is in the office.

Social distancing

The use of ‘pod’ treatment areas is a hospital concept that can be applied to outpatient settings. Some offices are designating staff to COVID and non-COVID workstations. The idea is to keep staff and supplies completely separate, thereby lowering the risk of cross-contamination. Limiting staff and patient entrances and exits is another strategy to maintain social distancing (and screen for COVID before entering the building). Both patient and staff areas should have seating at least six feet apart and consider using partitions in places where it makes sense, such as the front desk.

Cleaning and visit protocols

Communicating to your patients about visit protocols, including enhanced cleaning and disinfection, may help patients feel more comfortable during their appointments. A bonus is that it is likely to help your staff feel more comfortable as well. Visit the CDC website for printable notices about stopping the spread of COVID-19 and educational materials to display in your office. Some offices have enacted ‘split shifts’ to accommodate new cleaning measures; for example, half a shift is dedicated to regular duties, while the second half is used for cleaning.

Review finances to prepare for future fluctuations

Unfortunately, many offices will begin operating with a diminished workforce due to lay-offs. As volume starts to increase, the need for staff will rise as well. Building financial forecasts will help organizations gauge their readiness to move toward building a ‘normal’ practice. Some financial considerations include:

  • Ensuring funding/capital is available for future needs (consider how to minimize the economic impact of a second wave or where you can go for money if needed)
  • Review the unforgivable part of the SBA 7(a) PPP loan, note reporting requirements and payment deadlines
  • Consider offering payment plans to patients that have become unemployed or uninsured; if you already provide payment plans, review payment options and limits to see if you think they are still appropriate
  • Review EOBs to look for trends indicating changes in payer mix and anticipate how changes may affect revenue moving forward
  • Consider outsourcing billing to protect your revenue flow; third-party organizations have layers of employees and systems resilient to staffing fluctuations

Also, think about revising your budget based on anticipated volume, historical collection ratios, and payback of deferments and loans. Moving forward will be much easier when you know where you stand.

Get ready for a second wave of COVID-19

Health officials warn that there will likely be a second wave of infections in late Fall of this year. Now is the time to prepare for possible PPE and drug disruptions, as well as renewed stay-at-home orders.

  • Avoid future PPE and drug shortages by analyzing consumption and supply since March
  • Build a stockpile of PPE that can carry you through the initial stages of a second wave
  • Find alternate suppliers of infection control PPE
  • Build a list of alternatives to commonly prescribed drugs at your practice
  • If you are not already using online visits, investigate platforms and consider adding them as a standard service; it will help minimize future patient care disruptions

Many lessons have already been learned since the outbreak of COVID-19, and there are undoubtedly more to come. Practices that continually assess their health and safety protocols, financial stability and preparedness for another emergency put themselves in the best position to weather upcoming challenges.

Using the right partner for practice management software and billing can help you continue operations during uncertain times. Contact us today for a no-obligation discussion at 412.424.2265 or email info@vrsmed.com.

COVID-19 Telehealth Info. to Know

Advertisements for telehealth are everywhere – insurance companies, hospitals and healthcare organizations of all sizes are encouraging patients to use virtual visits in the age of COVID-19. However, in many sectors of healthcare, the adoption of telehealth services has been slow.

To encourage both patient and provider utilization to help people comply with stay-at-home orders (as well as to protect healthcare workers from possible infection exposure) the Office for Civil Rights (OCR) and the U.S. Department of Health and Human Services (HHS) have eased regulations for telehealth during the COVID-19 emergency. There are three main points to know:

  1. Everyday video/audio communications are permitted (you don’t need to use a specialized platform – although there are distinct advantages for doing so)
  2. HIPAA regulations have been relaxed
  3. There are new, expanded options for billable telehealth visits

A closer look at COVID-19 telehealth

It’s okay to use Skype, Apple Facetime, Google Hangouts or similar technology – but proceed with caution

According to the OCR and HHS announcement concerning the new regulations, as long as the visit can be one-on-one, everyday applications like Skype are permitted. Platforms such as Twitter, Facebook Live and chat rooms are not allowed because they are not ‘private.’ Providers do not need a Business Associate Agreement from the technology platform to use video conferencing during the emergency.

As a short-term solution, using regular commercial platforms will help patient flow. However, from a business perspective it may not be a viable solution for long. Billing for virtual visits that are in no way linked to your organization’s practice management or EHR system will require additional administrative time that will inflate labor costs, as well as raise material costs-to-collect. Organizations that use an integrated solution, such as ezTelemedicine, an athenaPractice™ (formerly Centricity™ Practice Solution) integrated solution, will not only avoid the headaches of manual claim input and after-visit payment collection, but will also have the security and convenience of their normal medical management software. Providers that choose to use ezTelemedicine can be up-and-running in as little as seven days.

Make reasonable efforts to protect patient privacy during visits

HIPAA regulations have not been completely dismissed. As long as providers are making an effort to protect patient privacy as much as possible, the OCR and HHS will not penalize for HIPAA breaches (such as a hack into a visit). What types of efforts are considered reasonable for healthcare organizations? Some examples include:

  • Using permitted technology
  • Conducting visits in as much privacy as possible
  • Continuing to abide by the minimal disclosure rule
  • If working from home, using a secure network and protecting patient information from household members

There are more ways to use telehealth during COVID-19

CMS published an expanded list of telehealth services to give both inpatient and outpatient providers more options to see patients. CMS is encouraging providers to use telehealth to minimize in-office patient visits as much as possible – which means the appointments don’t necessarily need to involve COVID-19 cases and suspected cases.

For example, group psychotherapy can be held via teleconference technology (CPT® 90853). Physical and occupational therapists can perform evaluation visits, physical performance tests and self-care management training. Inpatient providers can utilize telehealth for emergency department visits and observation. In-home visits by providers are also covered and can now be done via telemedicine, if appropriate. Visits eligible for telehealth before the pandemic remain on the list (new and established patient E/Ms, behavioral health visits, etc.) Billers will still need to use Modifier 95 to indicate a telehealth visit.

Keep an eye out for changing rules and regulations

The expanded telehealth codes have been valid for use on claims since March 1. As of now, there are no end dates for the new (but temporary) codes. Although most major insurance companies will likely accept telehealth billing, it is always wise to check before sending out claims.

As the response to the pandemic evolves, compliant billing and coding will change as well. Stay on the lookout for updates from CMS and payers to avoid problems with payment in the future.

Do you have questions about integrating telemedicine into your practice? Contact us today at (412) 424-2265 or visit our RCM site.

COVID-19 Update from athenahealth CEO

“We want you to know that we are thinking of you on the front lines of managing Coronavirus Disease 2019 (COVID-19). While you are navigating this rapidly evolving situation, we are taking every step to ensure that athenahealth is prepared to support you through it.

We are actively monitoring the spread of COVID-19 and are in daily contact with the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and other federal agencies. Like you, we are preparing for the impact that COVID-19 could have on our employees, our communities, and our customers. We are doing all we can to help keep our employees and their communities safe and healthy. In terms of our day-to-day support of your business, a majority of our operations are automated, and we are cross-training employees and developing contingency plans to mitigate the potential impact on our services.

In addition to preparing our teams, we are also enhancing our products. We are working to align existing product structures with CDC best practice recommendations.

Please continue to monitor the CDC website for up to date information and know that we are here for you. If your organization is in a crisis and needs immediate assistance, please contact your Customer Success Manager directly.”

-From Bob Segert, Chairman & Chief Executive Officer and Bret Connor, Senior Vice President,Chief Customer Officer.

Are you working harder, not smarter?

Examining your gross and net collections ratios will tell you.

Have you been in this scenario?

You’ve gone through your financial reports, again and again, trying to figure out why your practice is making less money. The problem is everything looks the same. There is no increase in denials, chargebacks or write-offs. Your patient visits have remained steady. Where do you go to find answers?

According to Alyse Danley, Revenue Account Manager at Virtual Revenue Solutions, a sister company and partne of Virtual OfficeWare Healthcare Solutions, there are two ratios you should check: your gross collections ratio (GCR) and your net collections ratio (NCR). “Understanding these numbers can help you gauge your performance and forecast future earnings,” said Danley. “When you look at these numbers in conjunction with your fee schedule, you can understand adjustments you may need to make to put your practice back on track.”

Understanding your gross collections ratio (GCR)

Total payments/charges

One question this ratio answers is how close you are to your payers’ rates. Monitor your top codes to confirm that you are in line with your practice’s established fee schedule ratio (typically around 150% of Medicare allowable amount or above). If your top code fee ratios are smaller than your set ratio, it may be time to renegotiate your rates with payers. Outdated reimbursement rates are often a problem with older practices because operational costs have gone up, but payment rates are stuck in the year the payment contract was signed.

If your GCR is inching-up every month, then it’s time to review your fee schedule and consider raising your rates. There’s a possibility that your fees may be lower than some of your payers’ allowable amounts. Low fees happen more frequently than many realize. Yearly reviews of your fee schedule against payer reimbursement will help avoid this issue.

According to Danley, your GCR is best used for internal measurement. It’s good to be aware of your number every month, but looking at a rolling six-month analysis allows for variances due to seasonality (such as deductibles at the beginning of the year, holiday slow-downs or times of the year when you get particularly busy).

Understanding your net collections ratio (NCR)

Payments – adjustments/ charges

Your NCR measures how well your practice is collecting the money it is owed. Ideally, NCR ratios should be at 95% or above – meaning you have collected 95% or more of possible revenue. This ratio is dependent on many factors, both operational and payer-related, including your mix of carriers, the types of procedures you perform and how quickly A/R is resolved.

If your NCR needs to be improved, or you are seeing large month-to-month fluctuations, there are several questions you should be asking. The answers will help you pinpoint weaknesses and set goals for improvement. They include:

  • Are you carrying A/R past 60 days?
  • Is there an issue with receiving payments?
  • Are payments posted promptly?
  • Do you have a consistent mix of appointments (new patients, sick visits, follow-ups, etc.)
  • Are you performing more or less of your top procedures?
  • Has reimbursement for your top procedures changed?
  • Is there a problem with sending out secondary claims or patient statements?
  • Are there payers having unusual delays in payments?

A change in payer mix may account for variations in your NCR as well, so Danley recommends performing a payer mix review on at least a yearly basis. Isolate your top payers and pull reports showing charges, payments and adjustments for the last twelve months. It may be that payers that reimburse less are a more substantial part of your patient population than a year before. She also recommends periodic reviews of longer data periods (three to five years) to identify macro trends that are hitting your bottom line.

Another useful aspect of knowing your NCR is that it is an excellent metric to use to compare your practice to others. Resources to find comparable data include the MGMA, HFMA and other medical associations. In many instances, you will pay for the reports, but the value of having realistic benchmarks to work toward and simply knowing how your practice is performing against others can make the cost worthwhile.

Do you have questions about your GCR or NCR ratios, or concerns about your practice’s overall performance? Contact us today at (412) 424-2265 or visit our RCM page. 

ICD-10 Codes for the Holidays.