Thirteen research projects totaling approximately $21.7 million over 5 years will explore nondrug approaches to managing pain and related health conditions such as post-traumatic stress disorder (PTSD), drug abuse, and sleep issues. The effort seeks to enhance options for the management of pain and associated problems in U.S. military personnel, veterans, and their families.

Thirteen new studies will address pain with non-drug approaches.

The National Institutes of Health’s National Center for Complementary and Alternative Medicine (NCCAM) and National Institute on Drug Abuse (NIDA) and the U.S. Department of Veterans Affairs (VA) Health Services Research and Development Division provided funding for this initiative. The research projects are located at academic institutions and VA medical centers across the United States.

“Pain is the most common reason Americans turn to complementary and integrative health practices,” said Josephine P. Briggs, M.D., Director of NCCAM. “The need for nondrug treatment options is a significant and urgent public health imperative. We believe this research will provide much-needed information that will help our military and their family members, and ultimately anyone suffering from chronic pain and related conditions.”

A 2011 Institute of Medicine (IOM) report states that nearly 100 million American adults suffer from chronic pain at a cost of $635 billion per year and notes a need for a cultural transformation to change this problem. Chronic pain disproportionately affects those who have served or are serving in the military. A June 2014 report in JAMA Internal Medicine showed an alarmingly high rate of chronic pain—44 percent—among members of the U.S. military after combat deployment, compared to 26 percent in the general public.

“Unless the ‘cultural transformation’ called for by the IOM begins in earnest, our nation faces additional crises in the future. Many service members and veterans with pain also have comorbid conditions such as posttraumatic stress syndrome or traumatic brain injury,” a commentary in the journal said. “Many of them are at risk for a lifetime progression of increasing disability unless the quality, variety, and accessibility of evidenced-based ‘self-management’ skills are improved. Without more effective and less costly approaches to pain management, the estimated costs of care and disability to the country will approach $5 trillion.”

One co-author of the commentary is Eric B. Schoomaker, M.D., Ph.D., a retired U.S. Army lieutenant general who is a scholar-in-residence and Distinguished Professor of Military and Emergency Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Maryland, and is a member of NCCAM’s Advisory Council. The other is Wayne B. Jonas, M.D., a retired U.S. Army lieutenant colonel who is president of the Samueli Institute, a nonprofit organization in Alexandria, Virginia, with a mission that includes applying academic rigor to research on healing, well-being, and resilience; and translating evidence into action for the U.S. military and large-scale health systems.

Pain is not the only issue. According to the JAMA Internal Medicine report, 15 percent of U.S. military post-deployment use opioids, compared to 4 percent of the general public. Drugs such as opioids that are available to manage chronic pain are not consistently effective, have disabling side effects, may exacerbate pain conditions in some patients, and are often misused. According to NIDA, an estimated 52 million people (20 percent of those aged 12 and older) have used prescription drugs for nonmedical reasons at least once in their lifetimes.

“Prescription opioids are important tools for managing pain, but their greater availability and increased prescribing may contribute to their growing misuse,” said Nora D. Volkow, M.D., Director of NIDA. “This body of research will add to the growing arsenal of pain management options to give relief while minimizing the potential for abuse, especially for those bravely serving our nation in the armed forces.”

Read about the researchers and descriptions of the thirteen projects.

This work is supported by the following grants: DA038971, AT008347, AT008399, AT008427, AT008336, AT008448, AT008404, AT008422, AT008423, AT008387, AT008349, HX001704, AT008398.

For b-roll, other visuals, and to arrange interviews, contact the NCCAM Press Office at 301-496-7790 ornccampress@mail.nih.gov.

VA Research has been contributing to improvements in the lives of veterans and all Americans since 1925. The program, part of the nationwide VA health care system, is unique because of its focus on health issues that affect U.S. veterans. To learn more about VA Research, visit http://www.research.va.gov .

NCCAM’s mission is to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care. For additional information, call NCCAM’s Clearinghouse toll free at 1-888-644-6226, or visit the NCCAM website at http://nccam.nih.gov/.

NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to inform policy and improve practice. Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page at http://www.drugabuse.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Flaws in the medical billing process can cripple your RCM and burn a hole in your pocket. Know the top five don’ts of billing to avoid bottlenecks in the revenue collection.

Medical billing has direct connection with your RCM. Minor mistakes can delay the process of getting the desired reimbursements from insurance companies. So, to have a smooth revenue cycle and track-able flow of money, avoid the following ten billing mistakes.

1. No Document No Billing

When you have nothing to prove your claims, refrain from billing the same and I am not indicating malpractice here! Consider this, you have a genuine suffering patient but he doesn’t have his symptoms documented by the physician and thus, in the records too. Now, you have incurred losses alright but how do you convince the payer?

2. Club the Particulars of the Bill

A visit to the doctor involves all these things together: diagnosis, tests for ruling out conditions or pinpoint diseases, the treatment, prescription of medicines, other services to assist the treatment. So, it is important to club all of these together when billing.

3. Do Code When There’s a Code

There is a reason why a certain code exists in the CPT to describe the patient’s condition. Having proper knowledge of which code to assign plays an important role in not getting a denial. Hence, the billing staff should assign the precise code instead of a non-specified one.

4. Be Lenient with Modifiers

A modifier is an alpha numeric code which should be assigned when multiple services are performed on the patient under special or unusual circumstances. Do not forget to add E&M (Evaluation and Management) coding when clubbed with any kind of surgery.

5. Submit Non-Standardized Forms

Bills should be submitted in the proper format and that very much includes the prescribed forms, e.g. the CMS-1500. This is as far as the hardcopy submissions are concerned. As for the electronic records are concerned HIPAA rules should be diligently followed to avoid audits.

Health and Human Services Secretary Sylvia M. Burwell today released a new report showing that in 2013 alone, consumers benefitted from $1 billion in savings from lower than originally requested health insurance rates. This includes $290 million in savings for individuals and families, and $703 million in savings for small employers. Combined with refunds consumers received because of the 80/20 rule, consumers saved more than $2.8 billion in 2012 and 2013. Secretary Burwell also announced roughly $25 million in rate review grant awards to 21 states.
The Affordable Care Act is bringing greater scrutiny and accountability to health insurance premium increases, resulting in big savings for consumers. Because of the law’s “rate review” provision and state efforts, consumers are continuing to benefit from lower than requested premium increases.
“Before the Affordable Care Act, consumers regularly faced significant annual premium increases,” said Secretary Burwell. “In 2013 alone, we see that rate review programs saved consumers approximately $1 billion while providing them with the information they need to get the care they deserve.”
Before the Affordable Care Act, annual premium increases were often in the double digits. Insurance companies were able to raise premiums without explaining their actions to regulators or the public or justifying the reasons for their high rates to consumers. Now, the law requires insurance companies in every state to publicly justify any rate increase of 10 percent or more. Consistent with previous years since the rate review provision went into effect, today’s report shows that the implemented rate increases were smaller than what was originally requested across both the individual and small group markets.
The Affordable Care Act provides states with Health Insurance Rate Review Grants to enhance their rate review programs and bring greater transparency to the process. Today’s awards will continue to support state efforts to enhance their review of health insurance rate increases, educate consumers, help hold insurance companies accountable, and to scrutinize medical pricing data. States getting these awards include: Arizona, Arkansas, California, Delaware, Hawaii, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, Oregon, Rhode Island, Utah, Vermont, Washington, and Wisconsin. These grants are also supporting data centers that, among other activities, expand the availability of medical pricing information available to consumers, businesses, and entrepreneurs.
Rate review is one of many initiatives in the health care law aimed at saving money for consumers and it works in conjunction with the 80/20 rule. The 80/20 rule, also known as the Medical Loss Ratio (MLR) rule, requires insurers to spend at least 80 percent of premium dollars on patient care and quality improvement activities. If insurers spend an excessive amount on profits and red tape, they owe a refund back to consumers. The combined amount of refunds and lower than originally requested rates resulted in more than $2.8 billion in savings for consumers in 2012 and 2013.
The rate review report released today is available at:http://aspe.hhs.gov/health/reports/2014/RateReview/rpt_RateReview.pdf
Information on the states receiving rate review grant awards today is available at:http://www.cms.gov/CCIIO/Resources/Rate-Review-Grants/index.html
General information about rate review is available at: http://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Review-of-Insurance-Rates.html
source: http://www.hhs.gov/news/press/2014pres/09/20140919a.html

I started an incredible journey last year. One that I never thought I would have to take. In May of 2012 I found a lump at the base of my neck which was eventually found to be thyroid cancer. Thank God I am now cancer free, but having gone through the medical system as a patient I came away with some insight into the lives of patients that billers usually don’t see or deal with.
Having been in the medical field for more than 20 years, you know I had scores of colleagues, coworkers, friends, and acquaintances who wanted to give me expert advice. I had people tell me their take on the situation or detail their story to me in detail by agonizing detail. Why is it that when something happens to you, everybody in the world seems to know all there is to know about what you should do or shouldn’t do and feel compelled to tell you every “worst-case scenario” they have ever heard about?

So this is what I learned about how to deal with patients from being one myself:
1. Be careful what you say and how you say it.
I wanted people to be honest with me, but I also wanted more positivity that I was getting.

I didn’t want to hear things like, “Oh well if you’re going to have cancer, thyroid cancer is the kind you want.” So, “Um, no, I don’t want any cancer, thank you very much,” is what I wanted to say back to these hopefully well-meaning folks.
2. Don’t make light of what they are going through.

Another common thing I heard was, “Oh, it’s just thyroid cancer.” Anytime you say “it’s JUST” this or that, you are belittling the seriousness of the issue being discussed. Yes I understand that thyroid cancer is not as life threatening or treatment intensive as some other cancers, but it is still cancer and still an ordeal with which you much come to terms.

You might be able to handle a certain diagnosis better than someone else. That fact does not lessen the impact of what they are experiencing.
3. Don’t assume you know what they are feeling.

If I had a nickel for every time someone told me they knew exactly how I felt, I would be a millionaire. Everyone comes into a situation from a different vantage point and with different baggage. Each of us possesses a unique set of emotional triggers and a particular breaking point. Many things go into what feel during a medical crisis… … the external aspects of our lives at that given time, our personality, our previous experiences with similar episodes, our outlook on life, and our faith or lack thereof. Even if you have had the exact same diagnosis as the patient you are dealing with, you did not come from the exact same background nor have you lived the exact same life as that patient, so you do not know exactly how they feel. And feelings are fickle, how you feel today can be completely different than how you feel tomorrow. One thing I experienced during my sickness was that my emotions were wide ranging. Some days I felt strong and blessed while on other days I felt weak and overlooked.
4. Realize that you are not the only biller calling them.
When you have an extended illness or a condition requiring numerous tests, procedures, surgeries, and visits, the bills quickly add up. All billers know that deductibles and out-of-pocket limits have skyrocketed. A few years ago, the average out-of-pocket limit for most insurance plans was $3,000. This year, the average out-of-pocket limit is $9,000. The majority of patients must make monthly payments and that amounts to $750 per month out of their salary. Combine that with lost time from work and there is a very real danger of the patient’s savings being depleted or worse.
As billers, we are in a position to offer tremendous help to patients as they try to navigate through the pitfalls of dealing with their insurance company and their medical condition at the same time. Our insensitivity to them can make or break our office’s relationship with that patient and eventually other patients as well.

By: Marsha Sosebee

– Source: http://www.physicianspractice.com/medical-billing-collections/improving-patient-relations-your-medical-practice-2014#sthash.rPSj8PWU.dpuf

Last week’s discussion of the ethical and contractual considerations when patient copayments are routinely forgiven left on unanswered question: “What efforts to collect coinsurance payments are required of you, in keeping with you obligations to the patient and the insurance plan.” In a recent case filed in Houston federal court, North Cypress Medical Center v. Cigna, 4:09-cv2556, an insurance plan refused to pay between $20 million and $30 million in out-of-network hospital charges because the medical center did not seriously attempt to collect coinsurance payments from patients.
The controversy centered on language in the insurance contract to the effect that Cigna would not be obligated to pay any amount for which the patient was not obligated to pay. At the time of admissions, the medical center informed patients that the patient would remain responsible for any amounts which were not covered by insurance. In other words, the patient actually incurred the debt and was obligated to pay it. However, Cigna sent out 62 survey letters to patients and 27 reported that if they were billed at all, the amount of the bill was closer to the “in-network” rates. Cigna argued that it does not matter that some patients sign forms stating they are responsible for the bill, if in reality, the patient was never under any serious threat of collection activities. The court sided with Cigna and the case is being appealed.
The court did not state what collection efforts would have changed the outcome, but seemed to be persuaded by two factors:
1. The medical center ignored the “in-network/out of network” cost-savings structure of the health plan. Cigna wrote the plan in a way to discourage out-of-network utilization. The medical center appears to have frustrated this plan provision. If the medical center did attempt to collect, Cigna successfully argued it attempted to collect too little.
2. The specific evidence persuaded the courts that patients were never in any imminent danger, in the real world, of being required to pay the bill.
So what must you do, in the real world so to speak, in addition to creating a bill and sending it to patients? Until a more solidly developed body of case law exists, the best course of action is to simply ask each insurance company to tell you what is expected of you. This places the insurance company in a somewhat delicate position. If the insurance company is too harsh, demanding, for example, that you turn each patient over to collection agencies or worse, file a lawsuit, this might have negative consequences for the insurance company. People might not wish to do business with such a company.
Hopefully, the insurance company has already though of an answer and will be happy to tell you what it is.

By: Martin Merritt

– Source: http://www.physicianspractice.com/medical-billing-collections/serious-attempts-capture-patient-copays-your-medical-practice#sthash.3SaH1PvF.dpuf

We’ve all done it; some of us have even been caught doing it. Driving faster than the posted speed limit that is. I remember my first ticket, I was going 48 MPH in a 35 MPH zone. It was a steep downhill slope, but it doesn’t really matter, I was speeding. That is my only ticket, as I learned something that day. I was taught a lesson, and I took that lesson to heart.
Every day is full of lessons to be learned, if only we would pay attention to them. Lessons present themselves in various forms throughout the day. We make conscious and unconscious decisions every second, resulting in some type of action. Are you going to run that yellow light just as it is turning red? What if that jogger on the corner stepped off of the curb one second sooner than she should have and you ran that light? There are so many opportunities presenting to you to see these lessons. Here are some thoughts about identifying these in your medical practice:
If you had a patient that came in for her appointment, and during the 30-minute visit had a bad experience and left angry, wouldn’t you want to know why? Don’t shrug your shoulder and say, “Wow what a cranky person!” Perhaps there was an interaction with a staff member that did not go so well, or she did not want to pay for the visit because she did not understand that her deductible started over for the year. Maybe she was just having an off day. It’s worth it to find out if there was anything wrong with the service provided by your staff, or if more patient education is in order. Those are easy fixes, and should not be brushed off or ignored.
Did you receive a denial from an insurance company? Don’t ignore it, or just accept that is “part of the healthcare industry life.” Find out why. Make a list of the denial types, and then modify your process to stop those denials from happening. It’s a lot easier than you think, and will immediately increase your inflow and decrease your accounts receivable within a few weeks.
Do you have a really good staff member that just seems to be getting more and more frustrated at their job? Rather than just accept that they want to quit and lose vital personnel, find out why. Perhaps there are some areas that need updating within your practice. Maybe this person has tried to bring these areas to a supervisor’s (or your) attention, and still nothing has been done and nothing has changed. Change is inevitable, and a necessary part of professional growth. Enlist this person to help identify the true issues and have them help solve those issues. Your staff member will feel empowered and less stressed about their needs being ignored.
Many people avoid confrontation at all possible costs, and then wonder why there are problems in their business. If you are not comfortable being the person to tackle those issues head-on, hire someone who can. It’s so important to find out why something is happening. It makes it a lot easier to resolve the issue in a much more appropriate manner. Once you realize the problem, you must apply a reactionary discipline to that realization. This can be as simple as a policy update, or how patients are entered into your software system.
When you go into work today, observe the areas that might need some much needed attention and see what you can learn today.

By: P.J. Cloud-Moulds

– Source: http://www.physicianspractice.com/medical-billing-collections/turning-lessons-learned-action-your-medical-practice#sthash.1KDDqtHd.dpuf

As I work to close out the books from 2013, I am struck at how much “bad debt” I am forced to write off. A lot of this debt is $5 and$10 deductibles and co-insurances from in-hospital patients our primary-care pediatrician will never see again having cared for the newborn only for a few days after his birth. Some comes from families that have been dismissed from our practice for non-payment. The dollar amounts are too low to justify sending multiple statements and, even for the larger amounts, the legal risk of reporting to the credit bureau via a collection agency is too high, so I write them off. And it bothers me.
It bothers me for many reasons. First, all those small dollar amounts add up to big numbers and ‘ my performance bonus goes out the window. Second, why shouldn’t these people have to pay their bills when I pay all my bills? Lastly, and here is what I want to talk about in this post, the insurance company’s intent to have the patient have some “skin in the game” is all for naught.
I understand why insurance companies are pushing more and more of the cost of healthcare onto the patients. Although not without controversy, I agree with the “skin in the game” concept that when patients recognize how much one provider cost versus another, the patients may make more fiscally conservative decisions (then again, they may not). Still, knowledge is power and all that after-school special junk and I get it. In real life, though, a significant number of patients are never feeling that pain of payment because we, the providers, have limited power to collect. The patient is getting away without having to pay their portion; a cost that was intended to encourage the patient to not over utilize or to pick lower-cost providers.
A surprisingly high number of our patients “forgot their wallet at home” or state “my ex-husband will send a check” leaving us with a significant amount of accounts receivable. Now I know some of you out there will say, “We don’t see anyone without a copay. We send them to the ATM across the parking lot or make them reschedule.” I, personally, am way too risk adverse to enforce such a policy. What if that patient has a seizure or other medical emergency between the time you turned them away and the time of their rescheduled appointment? Providing timely medical care is not the same thing as selling someone a loaf of bread and the liability associated with each reflects that. We see patients at the time of their scheduled appointment and then chase them for the copay or deductible after. If we didn’t, we risk a patient’s health and open ourselves to a lawsuit that we’d lose.
Chasing after, however, is mostly a losing game. I was recently at an industry event where the speaker pointed out a rise in the number of providers being sued (and losing) because they erroneously sent a patient to a collection agency that reported to the credit bureaus; the error was the insurance company’s error, not that it mattered. That was enough for me to stop reporting to collection agencies. While I will eventually dismiss families for failure to pay (for more on how to dismiss patients the right way, I highly recommend this blog post by attorney Martin Merritt), I stop short of reporting to the credit bureaus. It’s too much risk over mostly small-dollar amounts. Of course here again the patient gets away without paying and the insurance company’s intended behavior doesn’t happen.
Here’s my solution: Insurance companies should collect co-insurance and deductibles and not leave it to hospitals and doctors’ offices.
Hear me out:. If the insurance companies collected the patient-owed portion, there would be a number of benefits. First, collections are better administered by insurance companies. As I’ve already explained, providers are bad at it, which defeats the primary purpose (i.e., patient picks cheaper provider). The insurance companies have the administrative staff plus the power (i.e., cancelling a policy) if patients do not pay.
There would be a secondary benefit in that one way to cut healthcare costs is to increase the accuracy of diagnosis. Providers can best diagnose a patient when there is a good doctor-patient relationship and nothing hurts that relationship more than making your doctor the insurance company’s collection agent. After all, patients already have grave animosity toward the insurance companies. Adding on collections can’t worsen that relationship, but it can lift a huge cloud off of a patient’s feelings toward his doctor. It is bad enough doctors lecture us on exercise, smoking, and drinking. Being handed a huge bill (as determined by our insurance company, not our provider) just adds fuel to the fire and makes the patient less likely to be honest with the provider or take her advice to heart.
The more I think about it, the more astounded I am that no insurance company has implemented this yet. At the very least, I’d think the insurance provider would want the providers to report non-payment, but I’ve never been asked to do so. Patients should have “skin in the game” and know that their medical choices have consequences, both individual as well as communal. That said, until the insurance companies collect these fees themselves, I don’t see the impact as being significant enough.

By: Leann DiDomenico McAllister

– Source: http://www.physicianspractice.com/medical-billing-collections/why-insurance-companies-should-collect-patient-payments#sthash.UmR2qtwE.dpuf

Medical home incentives
In addition to incentives for meeting performance targets, many payers are offering value-based incentives that relate to improved care coordination and case management.
Practices that have gained recognition as Patient-Centered Medical Homes (PCMHs), or that have met medical home recognition criteria set forth by payers, are most likely to be offered this type of incentive. Typically, medical homes must demonstrate improved care access, care coordination, and care quality to gain recognition.
The incentives offered to medical homes vary by payer, says Mary Witt, senior vice president of The Camden Group, a healthcare management and consulting services company based in El Segundo, Calif. They include funding for infrastructure development or care coordination, such as funding to hire a care coordinator in a practice; a percentage increase to a practice’s fee schedule; a per member, per month stipend for care coordination activities; or even shared savings opportunities, for instance, when a medical home manages to decrease emergency department utilization or hospital readmissions.
Still, while medical-home-related incentives are gaining traction, not all practices that become medical homes experience them, cautions Lutz. “At the end of the day, the physician may actually see [fewer] patients and do better economically as a result of participating and sponsoring these kinds of initiatives, but they have to do it in collaboration with a payer that’s going to be an active participant,” he says. “Depending on where you go in the country, some of these things are very well implemented … and in other parts of the country they’re just barely getting off the ground.”
To hear one physician discuss how her practice transitioned to a medical home, visit bit.ly/PCMH-transition.
Shared savings models
While not all payers are offering incentives to medical homes, transitioning to that model of care has other perks. Cook says it’s a great way for practices to gain experience delivering value-based care, and it’s also a great jumping off point for successful ACO participation.
In ACOs, groups of providers, including physicians, practices, hospitals, and/or larger healthcare systems, partner to improve the quality of care and reduce the cost of care provided to a particular patient population. If successful, the participants share in the cost savings with their payer partner. If not, in some arrangements, participants share in the losses.
Over the past two years, hundreds of ACOs have cropped up across the country. One is Coastal Carolina Quality Care, which has participated in Medicare’s advanced payment model ACO program since 2012.
“We felt that it would help us better focus and prepare for the future,” says Stephen Nuckolls, chief executive officer of Coastal Carolina Health Care, P.A., the multi-specialty medical group that formed the ACO. “We feel this type of aligned incentives is the way that medicine is moving and we wanted to go ahead and get some experience with that,”
Due to its ACO participation, Coastal, which is located in New Bern, N.C., has stepped up its focus on population health management, care coordination, cost control, and quality metrics, says Nuckolls. Those efforts may be paying off. Though CMS has not yet released Coastal’s first-year ACO performance report, Nuckolls says that the health system’s internal metrics are showing positive signs. “We are showing our emergency room utilization down year over year in excess of 30 percent,” he says. “We’re seeing hospital admissions down a little over 10 percent.

By: Aubrey Westgate

– Source: http://www.physicianspractice.com/medical-billing-collections/getting-paid-value-defining-new-reimbursement-models/page/0/2#sthash.eSREQ1EQ.dpuf

As someone who represents physician practices and writes many of the financial policies presented to patients, it’s always an interesting experience for me to go to my own physician’s office (who I do not represent) and be on the receiving end of similar financial policies.
Last month I went to my doctor’s office and checked in at the front desk. I was asked for my insurance card and my credit card. When I asked why I had to provide a credit card, staff said there was a new policy and that I would now be billed immediately if my insurance did not pay, but “not to worry,” as I would receive a call first to let me know!
Being somewhat familiar with how these policies typically work, I asked for a copy to review. Generally, this practice’s approach is as follows:
1. It expects payment at time of service.
2. It requires a credit card to be kept on file, but it makes no charges without notifying the patient. Specifically, the practice can leave a message and no actual communication is required with the patient as to the status of the insurance claim.
3. According to the practice, because state law (in this case) requires insurance carriers to pay claims within 30 days, if my carrier does not comply with state law, it’s the patient’s responsibility to contact the carrier if the practice is not paid within 30 days. Otherwise, the practice charges the patient’s credit card.
Aside from the short period provided for the insurance company to pay (even 30 more days would probably not be enough in many states, no matter what the law says), the expectation that patients contact their insurance as a first step is simply unreasonable. In this particular practice, which is large and maintains a sophisticated billing staff, placing this immediate responsibility on the patient (in my opinion) is premature.
This practice’s policy is that it will submit to insurance and, as such, it needs to have an appropriate policy to allow time for payment. Otherwise, it should require its patients to submit claims on their own without pretense of handling the paperwork on the patient’s behalf.
Even if the above process is acceptable to some, I think the practice must consider the manner in which it presents the process to patients, both in the wording of any statement and the terminology used by the front-desk staff. This is especially important as a patient’s evaluation of his physician/practice is often tied to front-desk experiences and even incentive compensation arrangements.
Consider the following in developing your practice’s policies:
1. The front-desk personnel should explain that there is a new policy and why it has been put in place before simply demanding a credit card.
2. Office staff should actually be able to explain the policy and answer patient questions. They should not become defensive if a patient requests clarification. This comes with proper staff training and role playing. In this case, the office staff was hostile when I asked them to explain the policy and their responses were incorrect (i.e. did not match the policy itself).
3. Is your policy reasonable? Is your practice’s expectation, regardless of what state law provides, realistic? Given delays caused by healthcare reform, this policy is almost guaranteed to allow the practice to charge the credits cards of all patients. Having the patient call is not going to change the carrier’s timeline or cause the carrier to lose the patient as a beneficiary. However, charging a patient’s credit card after 30 days with no effort on the part of the practice to reach out to the carrier will challenge the patient’s feelings about remaining with this medical practice.
I am completely sympathetic to struggles practices face in collecting accounts receivable. However, in my view, being unnecessarily aggressive can be off-putting to patients. There is a cost to doing business and it’s a burden to be shared between patient and practice, not off-loaded to patients who are unlikely to understand the process.
While the importance of collecting in an efficient manner is undeniable, a policy that balances respect for the patient and a realistic timeline for payment is ideal.

By: Ericka L. Adler

- Source: http://www.physicianspractice.com/medical-billing-collections/patient-payment-collection-policy-mistakes-avoid#sthash.yGxejJCV.dpuf

As payment for physicians’ services continues its steady decline, practices across the country are exploring new ways to thrive. For pediatrician Jesse Hackell’s five-physician practice, part of the solution was joining a large multi-specialty pediatric group.
“We found that payments were not keeping pace with inflation and hadn’t been for many, many years, and that was becoming an untenable situation,” says Hackell, whose practice is located in Pomona, N.Y. “What joining a large group enabled us to do was finally level the playing field a little bit in negotiating with the insurance companies. It gave us some strength by virtue of our numbers.”
But while partnering up might provide some practices with negotiating leverage, it may only be a temporary solution to a more permanent problem. The results of Physicians Practice’s 2013 Fee Schedule Survey indicate that the downward reimbursement trend continues. Between 2012 and 2013, average commercial payer reimbursement for all new and established office visits fell nearly 9 percent. That’s on top of a 10 percent decline that occurred between 2011 and 2012. (More in-depth survey data is available in the accompanying survey results and online at PhysiciansPractice.com.)
Editor’s note: The results of our annual Fee Schedule Survey are in. See where your practice stacks up when it comes to payment for top codes.
Eventually, even negotiating higher rates with payers won’t get practices very far.
But it’s not all bad news. As fee-for-service declines, more payers are exploring value-based reimbursement models, in which practices receive higher pay if they provide high-quality, low-cost care. And while many physicians are hesitant to embrace such models — only 16 percent of our fee schedule survey respondents said the shift in payment methodology would be good for their practices — experts say a proactive approach is the best course. “The world’s changing and the market’s changing, and I think that all too often physicians like it the way it was, and it’s not going to be like that,” says John Lutz, managing director at Huron Healthcare, a healthcare consulting firm based in Chicago. “I think that the sooner people start looking forward instead of looking in the rearview mirror, we’ll be better off.”
But finding the best path forward is not easy, and the broad array of emerging value-based payment models and incentives makes it even more difficult. Here’s a closer look at some of the most prevalent value-based models and incentives, and what the experts say your practice can do to get involved.
Pay-for-performance incentives
Getting paid for value does not mean your practice needs to jump headfirst into a full-fledged value-based payment model, such as an accountable care organization (ACO) or a bundled payment arrangement. Many payers are offering smaller-scale value-based incentives, such as pay-for-performance incentives, to practices that reach quality and/or cost targets.
Though pay-for-performance incentives are nothing new, the bonus targets set forth by payers are becoming “much more sophisticated” as the shift toward value gains momentum, says Randy Cook, president and CEO of consulting firm AmpliPHY Physician Services.
For example, in the past, a practice may have received a bonus if it prescribed generic medication to a certain percentage of its patients. Now, a practice may receive a bonus if a certain percentage of its diabetic patients have their A1C levels under control. “That’s what’s called an outcome measure,” says Cook, who is based in Columbia, Tenn. “[You] have to accomplish a whole lot of other things in order to create that outcome.”

By: Aubrey Westgate

– Source: http://www.physicianspractice.com/medical-billing-collections/getting-paid-value-defining-new-reimbursement-models#sthash.mllD9Yhe.dpuf