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Insights to guide your practice. 

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The Value-Based Payment Modifier Program and It's Impact on Your Practice

by Jeff Jones, CPHP on May 4, 2016

The Value-based Modifier (VBM) provides for differential payments to a physician or group of physicians under the Medicare Physician Fee Schedule and is based upon the quality of care furnished compared to cost during a performance period. The Value Modifier program will provide comparative performance information to physicians as part of Medicare’s effort to improve the quality and efficiency of medical care. Here is how the Value Modifier program relates to PQRS and MIPS to further the movement from fee-for-service to value-based reimbursement.

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Topics: PQRS, Value-Based Reimbursement, Incentive Programs

Selecting the Right PQRS Measures: Individual vs. Measures Groups

by Jeff Jones, CPHP on May 2, 2016

Taking time to select the right PQRS measures can make a huge difference in an Eligible Providers (EP) performance in PQRS. How? Because choosing PQRS measures that align with your specialty usually makes it easier to report for the PQRS. Therefore the measure selection process should begin with a review of the entire measure list to determine which measures are important to the EP and the practice.

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Topics: PQRS, Incentive Programs

5 Ways to Increase Physician Referrals to Your Practice

by Kaitlyn Houseman on April 28, 2016

Independently owned clinics - particularly specialty clinics - may find the process of getting physician referrals to be daunting. There are multiple reasons for this. For one thing, the number of specialist categories has grown in the past decade, so there are more types of specialists for patients to be sent to. At the same time, there are more multispecialty groups that refer to specialists within the group, while many smaller clinics are being purchased by hospitals where internal referrals dominate.

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Topics: Revenue Cycle Management, Medical Business, Practice Management

What Is the Patient Experience?

by Kaitlyn Houseman on April 26, 2016

The concept of "patient experience" seems straightforward however, there are widely varying views among people in the healthcare industry as to what the "patient experience" really means. Nearly three-quarters of respondents (74%) to the  2013 HealthLeaders Media Patient Experience Leadership Survey expect to focus on patient experience training and education over the next three years. The patient experience is clearly a priority but what is it?

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Topics: Practice Management, Patient Engagement

How to Prepare for Thousands of New ICD-10 Codes

by Kaitlyn Houseman on April 19, 2016

The shift from ICD-9 to ICD-10 brought some big challenges to healthcare. To help relieve some of these transition difficulties, the CDC and CMS instituted a freeze on updates to the codes prior to the October 1, 2015 implementation date, according to the American Hospital Association. But now, CMS has lifted the freeze and announced they will be adding a host of new diagnostic and hospital inpatient procedure codes (5,000+ new codes) to ICD-10 for fiscal year 2017.

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Topics: Revenue Cycle Management, ICD-10

How to Avoid Revenue Loss During Your EHR Transition

by Keith Lage on April 18, 2016

An upgrade or change of vendor for an electronic health records (EHR) system is a major IT initiative, and disruption is to be expected. The problem is that a hiccup in one business process can propagate causing disruption to your entire practice, or in this case, your practice's revenue cycle management.

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Topics: EHR, EHR Training

Everything You Need to Know About PQRS Reporting Methods

by Jeff Jones, CPHP on April 15, 2016

As we shift the focus from volume and profitability to patient outcomes, physicians are having to dig a litter deeper into reporting. Healthcare is shifting towards value-based reimbursement models and the Physician Quality Reporting System (PQRS) is a step in that direction. Unfortunately, at first glance, PQRS and CQM programs can be intimidating to say the least. Not only can PQRS be intimidating, but a large number of physicians believe that PQRS is time-consuming. PQRS participation rates reflect the number of providers that aren't making PQRS a priority. 

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Topics: PQRS, Incentive Programs

Understanding PQRS: What It Is and What You Need to Know Now

by Jeff Jones, CPHP on April 12, 2016

You could say Meaningful Use stole the spotlight from PQRS over the past couple of years. This could be why so many providers still have questions about the Physician Quality Reporting System. With the Merit Based Incentive Payment System (MIPS) just around the corner, PQRS isn't quite in the spotlight but it does play an important role in physician reimbursement. Now is the time to begin understanding PQRS (if you don't already) and how it will contribute to MIPS.

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Topics: PQRS, Incentive Programs

CMS Launches Comprehensive Primary Care Plus: Value-Based Model for Primary Care Practices, Multiple Insurers

by Kaitlyn Houseman on April 11, 2016

The Centers for Medicare and Medicaid Services on Monday launched a new risk-based primary care initiative that it hopes will accelerate the movement towards value-based reimbursement for medical practices. The five-year, Comprehensive Primary Care Plus, or CPC+, starts in January 2017 and will include up to 5,000 practices and 20,000 physicians in an estimated 20 regions.

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Topics: Value-Based Reimbursement, Incentive Programs

Communicating About Co-Pays to Patients

by Kaitlyn Houseman on April 11, 2016

Increasing plan deductibles might be a sound solution to slowing health care cost growth, but these high deductible health plans pose a new array of challenges to healthcare revenue cycle management. The number of people covered by an employer-sponsored high-deductible health plan (HDHP) is growing while almost 90% of enrollees in Affordable Care Act (ACA) in Affordable Care Act (ACA) Marketplaces have a HDHP. Communicating financial responsibilities to your patients is no longer optional, it's essential.

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Topics: Revenue Cycle Management, Practice Management

Common EHR Myths Debunked

by Adrienne Schrimpf on April 7, 2016

EHRs have come a long way in the past couple of years. We've seen vendors exit the market while others have gained market share and in the cloud has become a common theme. Of course we're all counting down to the day when interoperability is solved and we can easily communicate patient information regardless of organizational, geographic, or vendor boundaries. In the mean time, I want to put an end to some common EHR myths I encounter during the sales process.

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Topics: EHR

Healthcare Metrics You Need to Track in an Age of Value-Based Payment

by Kaitlyn Houseman on April 5, 2016

The incorporation of value-based payment into healthcare revenue cycle management is one of the defining narratives of this era of healthcare in the United States. The Department of Health and Human Services hopes to shift its payment system to nearly one-third value-based this year, with 50% of its payments to be value-based by the year 2018. Furthermore, it expects nearly all fee-for-service health plans to include some degree of value-based components by then.

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Topics: Revenue Cycle Management, Value-Based Reimbursement

Should You Be Participating In PQRS?

by Jeff Jones, CPHP on March 29, 2016

For the first few years of PQRS, practices were eligible for incentive payments for PQRS reporting. In 2015, however, EPs that did not report on specific quality measures are facing downward adjustments to Medicare payments in 2017. Here's how you know whether you should be participating in PQRS (if you aren't already).

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Topics: PQRS, Incentive Programs

Recognizing the Signs of Physician Burnout

by Kaitlyn Houseman on March 28, 2016

Burnout is an occupational hazard for high achievers, so it's no surprise that it is becoming more common and severe among physicians, who tend to be very high-achieving individuals. Physicians who face burnout are often the ones who are most passionate about what they do, making burnout more difficult to detect and prevent.

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Topics: Medical Business, Practice Management

5 Mistakes to Avoid When Hiring a Medical Billing Service

by Adrienne Schrimpf on March 24, 2016

Your healthcare practice holds a great deal of responsibility in providing quality care to your patients. Making the strategic decision to outsource your billing is supposed to make your practice run more effectively, not generate more stress and administrative oversight.

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Topics: Revenue Cycle Management

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