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Category : Insurance
New consumer Medicare website now online – www.medicare.gov
A new version of Medicare’s consumer website was released today, located at www.medicare.gov. The new site is part of a series of steps the Centers for Medicare & Medicaid Services (CMS) is taking to facilitate use of the website by seniors and those who care for them.
Among features included in the improved website are Medicare benefits summaries, coverage options, rights and protections, and answers to many of Medicare’s FAQ’s.
Take a look at the new Medicare website here. I actually kind of like it.
Remind patients: The end of the year is near (and deductibles will be renewing)
Believe it or not, it’s that time of year again.
As we quickly approach the end of October, today marks just 70 days until calendar year medical benefits will reset for many of your patients. Renewed deductibles, expiration of existing insurance plans, and the zeroing of health savings accounts will — in very short order — mean more money out-of-pocket for your patients. As you’re aware, this has a tendency to accompany the delay of non-urgent care, resulting in decreased volumes and revenues for healthcare practices shortly after the first of the year.
This cyclical nature of medical benefits should come as no surprise, as it is something we see year in and year out. The fact that there is something that can be done about it now is something that many practices neglect to realize however, leaving opportunity out on the doorstep even in light of this predictable, annual occurrence.
So, what do you do about it? The answer is simple – remind your patients. This is a busy time of year, and while patients also realize that their medical benefits will be resetting in just a few short months, day-to-day life often trumps important details like this that can result in the savings of hundreds, if not thousands of dollars in out-of-pocket healthcare expenses.
A simple form letter sent out by mail merge, a mass email distribution, individual phone calls, or in-office reminders can all be acceptable ways to remind your patients that if they anticipate the need for medical, physical therapy, or dental services in the next few months – now is the time to act.
A gentle reminder to your patients may go a long way toward saving them money, ensuring their health, and making them appreciate that you’re looking out for them in more ways than one. If you’d like some ideas on how to communicate this important message to your patients, along with examples of sample letters, don’t hesitate to contact us for more information.
Medical association fights back against RAC’s
The Texas Medical Association is fighting back against RAC’s through a lawsuit that claims false assertions during a medicare recovery audit. You can bet that people on both sides of the RAC issue will be paying attention to this one.
“This is about protecting our patients’ private health information and fair treatment for physicians,” says Richard J. DePersio, MD, president of the 7,800-member TMA. “Our members complained to us about the HRI ’strong-arm’ letters. We had to act because we cannot tolerate business practices that ignore state law and contracts, threaten patient privacy, and make false accusations of physician fraud. The threats and intimidation tactics used by HRI were a catalyst for our actions.”
via Tennessee Medical Association Sues Recovery Contractor
Specialization in health care means more cost to the system
It’s the unfortunate reality that while increased specialization of labor in health care can result in better care, it most certainly results in more expensive care. This is going to be an issue until we find a way to pay more for “brain time” or “cognitive medicine.”
From, the NY Times: Let Doctors Bid for Medicare Business
Researchers have observed that having one additional specialist (per 100,000 people) in a region leads to about $13 more in health care spending per Medicare patient. New York City, for instance, has 186 specialists for every 100,000 residents, which is twice as many as Albany’s 93. Accordingly, Medicare spends $12,114 a year treating each patient in New York City, but only $5,950 in Albany.
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Tannus Quatre PT, MBA is a private practice consultant and principal with Vantage Clinical Solutions, Inc., a nationwide healthcare consulting and management firm located in Bend, OR and Denver, CO. Tannus specializes in the areas of healthcare marketing, strategy, and finance, and can be reached through the Vantage Clinical Solutions website.
MGMA’s Project SwipeIT: Standardization of health insurance cards
The Medical Group Management Association (MGMA) is taking on waste…IT style.
It’s a great initiative, and I recommend that we consider getting on board. The goal is to prevent up to 2.2 billion in waste that occurs each year through the use of non-standardized insurance cards. By using machine-readable cards, patients, private practice clinics, and insurers can all save. Click below to learn more about this great initiative.
MGMA’s Project SwipeIT for standardized health insurance cards
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Tannus Quatre PT, MBA is a private practice consultant and principal with Vantage Clinical Solutions, Inc., a nationwide healthcare consulting and management firm located in Bend, OR and Denver, CO. Tannus specializes in the areas of healthcare marketing, strategy, and finance, and can be reached through the Vantage Clinical Solutions website.
Dear Doctor: Here is half your money, take it or leave it
I recall as a student when – somewhere near the last day of school – an instructor would share the funniest things that they’d seen come across their desk throughout the year. It was usually some 5-word blooper from a student or a simple, yet funny misstatement of history that found it’s way into a writing assignment; something that managed to set itself apart from the rest, truly catching the attention of the instructor through a countless sea of papers, essays, tests, and homework assignments. Only the real gems would make it to that last day of school.
We’ll, I wish I could say that I’ve got a “gem” for you, or perhaps even a blooper. If not that, then at least something that is a bit rare and unusual. Unfortunately, the only qualification that my statement has is that is has caught our attention, and it should catch yours as well. It’s not funny, rare, or even a blooper.
One of our functions is as a provider of medical billing services, and we consider this to be a “sign of the times” in health care and in our economy, and the statement is simply this (taken from an actual letter from patient to doctor):
Dear Doctor:
I am your patient and I have a bill for $400. I will send you half within the month if you will agree to write off the balance. Please sign below acknowledging this agreement.
Sincerely,
Your Patient
Approved:_________________________
Medical Practice Authorized Representative
Our recommendation is simply this: If you believe in your services, your prices, and your policies, then don’t fall hostage to anyone, not even a patient. If you feel that arrangements such as this are in the best interest of your practice, and your financial policy supports this behavior, then it certainly might be right for you. But understand the risks of too quickly going after the quick buck in lieu of collecting the sum of what is rightfully yours as a provider of health care services.
There are no easy answers, but it is in your interest to know that these letters are coming and you should at least know how you will respond.
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Tannus Quatre PT, MBA is a private practice consultant and principal with Vantage Clinical Solutions, Inc., a nationwide healthcare consulting and management firm located in Bend, OR and Denver, CO. Tannus specializes in the areas of healthcare marketing, strategy, and finance, and can be reached through the Vantage Clinical Solutions website.
Mandating medical loss ratios: Good or bad?
A recent article in HealthLeaders (April 2009) addressed the issue of regulating the commercial health insurance industry by setting provisions for medical loss ratios. Medical loss ratio is the fraction of revenue from a health insurance plan’s premiums that goes to pay for medical services. In California and other states, legislation has surfaced to force insurers to spend a given level of revenue on direct medical care. For example, last year in California a bill was introduced which would have required an 85% medical loss ratio for health plans, forcing insurers to spend at least that level of revenue on medical care. This bill was vetoed by Gov. Schwarzenegger. However, would this have improved the value received by patients from their health insurance plans?
Physicians and providers typically believe setting minimal limitations on medical loss ratio will squeeze resources out of the administration costs of insurance – costs associated with disease management, care coordination, information technology and customer service - channeling resources into paying for direct medical care; the medical care the patients and employers who purchase the plans intend to receive.
The insurance industry argues that medical loss ratio does not accurately reflect whether quality care is paid for on behalf of the enrollees or not. They are argue that this type of regulation will drive up premiums, as medical loss ratios vary from plan to plan, and will limit the plans which they are able to offer.
As the health insurance industry continues to consolidate and the general public continues to express dissatisfaction with their commercial health insurance carriers, what are the accurate measures that can be used to ensure value in the commercial health plans we purchase?
Bridget Morehouse PT, MBA is a consultant with Steffes and Associates, a rehabilitation consulting firm based in Wisconsin.
Fee schedules, RVU’s, and payer negotiation tips: The numbers are in.
If you provide healthcare services, getting paid isn’t quite as easy as falling off a log.
In fact, as you already know – getting paid for services rendered is quite complicated. Out of this complex system of fee schedules, RVU’s, payer negotiation, and co-pays, the specialty of billing/coding has been borne, and with it, the cost of care has gone up, up, up. Far worse though, the complexity of the reimbursement system has left many in private practice without the resources necessary to overcome payment hurdles, causing many excellent practitioners to return to employed positions or to leave the profession altogether.
Fleeing the fiduciary responsibility that coincides with being a practice owner allows those frustrated or confused by the reimbursement system to no doubt breathe a momentary sigh of relief, but this sigh is undoubtedly accompanied by some measure of regret for having lost the ability to implement a vision for healthcare as they see it best.
Well, this is why we exist, and why I’m blogging about this topic right now. A little bit of knowledge can go a long way when it comes to managing the reimbursement of a private practice, and for those that are interested, this article from Physician’s Practice is a gem. It boils down fee schedules and RVU’s by the numbers, providing recent benchmark figures as well as some very practical payer negotiation tips.
I highly recommend you take a peek at the article as it could be just what you need to get “in the know” about your reimbursement cycle.
The state of physician reimbursement is pretty depressing. That’s hardly a surprise, we know — but our exclusive research is shedding new light on just how bad it is out there. For starters, commercial insurers’ payment rates, which have been declining for years, are now almost as bad as government pay — on average nationally, a mere 10 percent or less over Medicare for E&M codes. Our annual Physician Fee Schedule Survey reveals that average reimbursement for a 99213 — a midlevel established office visit — is just $71.67, a tad better than Medicare’s $59.80 national rate.
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Unfortunately, some practices aren’t sure what they themselves are getting from some payers, much less what a given insurer is paying generally. “It baffles me frankly, but those payers will get you to sign a contract, but they won’t give you the data about what they are reimbursing,” Reiser points out. He suggests approaching the problem with a spirit of fun and doing a bit of “reverse engineering.”
Ask payers for allowables for your top 10 codes — or study your EOBs to see what they pay. Take their rate for each code and divide it by the RVUs Medicare gives the code in its fee schedule. The result essentially gives you the payer’s conversion factor — the number it multiplies RVUs by to come up with a payment. “If you do it for all the codes you have, you’ll see the conversion factor they are applying is pretty close across all codes,” promises Reiser. There will be some variation, but a median will become clear. Apply that conversion factor across every code and you’ll have a full fee schedule by payer.
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Tannus Quatre PT, MBA is a practice consultant and principal with Vantage Clinical Solutions, Inc., a national healthcare consulting and management firm based in Oregon and Colorado. Tannus can be reached through the Vantage Clinical Solutions website by clicking here.
Female patients not immune from economy’s impact on healthcare services
We’re blogging about this quite often here at The Healthcare Entrepreneur, but in case you haven’t noticed, the souring economy is having an impact on the healthcare provided through private medical, physical therapy, and dental practices. People are delaying care, paying more slowly, and losing insurance coverage – all of which have a direct impact on the ability for private practices to run strong.
It seems that women are no exception.
In this article from WebMD Health, a new study released by the National Women’s Health Resource Center (NWHRC) is said to indicate that the rising costs of healthcare combined with the economic downturn is having a major impact on women’s decisions regarding their care.
- 28% of women said they put off going to the doctor during an illness for financial reasons.
- 19% said they had skipped recommended medical procedures, such as Pap smears or mammograms, because of cost.
- 18% said they had taken less than the recommended dosage of a prescription drug in order to make it last longer and 18% failed to fill some prescriptions.
- Only 4% said they had put off taking their children to the doctor because of the cost.
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Click here or call (888) 827-5613 for information on a free program dedicated to helping private practices throughout the U.S. strategically adjust to the slowing economy. Free program runs through March 31st, 2009 and is open to practice owners and administrators of any healthcare discipline.
Tannus Quatre PT, MBA is a practice consultant and principal with Vantage Clinical Solutions, Inc., a national healthcare consulting and management firm located on the west coast. Tannus can be reached through the Vantage Clinical Solutions website by clicking here.
Moody’s revises healthcare outlook from “stable” to “negative”
Maybe we only think we are recession proof. With the seemingly never ending spiral of credit, housing and banking crises ravaging through the global economy, investors are starting to take notice that healthcare doesn’t exist in a silo.
Medical practices, hospitals, and physical therapy clinics get paid by someone, and if that someone is in financial trouble, you can bet the problems don’t stop at the practices’ front doors. The someone just so happens to be “everyone,” or so it seems in our economy today.
This article from the ChicagoTribune.com discusses Moody’s downgrade of the healthcare industry’s 12- to 18- month outlook.
The New York-based financial ratings firm has issued reports in the past two weeks on various sectors, from hospitals and medical devices to insurance companies, revising the health-care industry’s 12- to 18-month outlook to “negative” from “stable.”
Moody’s sees fewer patients seeking medical care, particularly elective surgeries, while more people could lose their health-care coverage altogether. Such trends will lead people to delay getting medical care or avoiding treatment.
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Click here or call (888) 827-5613 for information on a free program dedicated to helping private practices throughout the U.S. strategically adjust to the slowing economy. Free program runs through March 31st, 2009 and is open to practice owners and administrators of any healthcare discipline.
Tannus Quatre PT, MBA is a practice consultant and principal with Vantage Clinical Solutions, Inc., a national healthcare consulting and management firm located on the west coast. Tannus can be reached through the Vantage Clinical Solutions website by clicking here.
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