Under the new Health Insurance Portability and Accountability Act (HIPAA) version 5010 standards, the electronic remittance advice (ERA) transaction has been enhanced to include such information as a patient’s coverage expiration date and the claim received date. In addition, ERAs for Medicare claims will include national and local coverage determinations so physicians can easily identify which items and services Medicare will cover. These changes will eliminate much of the time-consuming research physicians previously had to perform.

Click here to learn more about the benefits of using ERA from an AMA webinar. 

Accepting electronic remittance advice (ERA) and automating your claims process can:

• Speed up payment
• Save time spent on manual processes such as opening mail, filing and phone calls to health insurers
• Eliminate lost EOBs and expedite filing to secondary payers
• Free time for revenue-enhancing functions such as ensuring correct payment

Cost of paper EOBs: $2.96 x 6200 = $18,600
Cost of electronic remittance advice: $1.48 x 6200 = $9,176

Annual savings from claims automation per physician: $9,424*
*Based on an annual average of 6,200 claims submitted for a single physician. Source: Milliman, Inc., Electronic Transaction Savings Opportunities for Physician Practices. Technology and Operations Solutions. Revised: January 2006

 

Join SFMS/CMA for our complimentary coding webinar with Arthur Lurvey, MD of Palmetto GBA.

Coding for Medical Necessity

Wednesday, August 1

12:15 pm to 1:15 pm

Medicare and private payers all recognize medical necessity as a deciding factor for claims payment and it is important that all practices know the rules. This webinar will discuss applying the rules to your patient encounters, medical decision making and medical necessity, the importance of diagnosis coding, coverage determination policies, using an electronic health record, how to respond to requests for records, and how to appeal if you disagree with decisions from outside reviewers.

To register for this webinar, please visit www.cmanet.org/events. Non-SFMS members are invited to join this webinar for $99.

Health system reform may be driving some of the decline, but some say medical homes and accountable care organizations offer new opportunities for small groups. How Private Practice May be Encouraged to Stay in Business, from the Physicians Foundation Report Findings.

Physicians and health analysts testified to lawmakers that growing evidence shows doctors are shutting down their small private practices to join larger health organizations due to administrative, payment, and medical liability pressures — and that health system reform may be playing a part.

The specter of declining payment, especially with the sustainable growth rate formula threatening cuts to Medicare payments each year, as well as increased reporting requirements and doubts over future earning potential, “are driving private practice physicians to seek employed positions,” said Louis McIntyre, MD, who testified on behalf of the American Assn. of Orthopaedic Surgeons.

Doctors also are facing increases in overhead costs and a decline in office visits as health plans and Medicare place a tighter hold on managing clinical decisions, according to a separate report from the non-profit Physicians Foundation.

Pressures of this type are what prompted Dr. McIntyre and his partners to forgo their private orthopedic practice in Westchester County, NY, to join a hospital in 2011.

The need for huge outlays for technology improvements is another stressor for small practices, Dr. McIntyre said. His practice invested in a $500,000 electronic medical record system in the hopes that the new technology would reduce costs and improve quality. It initially saved the practice money, but the need to hire more information technology personnel and install upgrades eventually negated these savings. Quality data collection and reporting rules for federal EMR incentives also presented a significant burden for the practice, he said.

Still, ACOs need to be driven by physicians because their offices are “where the care is given,” said Joseph Yasso Jr., DO, medical director of Heritage Physicians Group, a small physician practice owned by the Hospital Corporation of America.

“There’s no reason why solo practices can’t be a part of these delivery models” provided they can work with other entities within the ACO, Dr. Yasso said following the hearing, where he testified on behalf of the American Osteopathic Assciation. In his testimony, he said both ACOs and medical homes encourage care coordination and allow physicians to share resources.

Physicians on the panel suggested additional steps Congress could take to ease the burden on small or solo practices and encourage them to stay in private practice.

One key step is to eliminate Medicare’s SGR formula, said Jerry Kennett, MD, who testified on behalf of the American College of Cardiology. A stable platform for payment that reflects the appropriate services provided should be established so that physicians don’t have to keep guessing on a monthly or yearly basis what their payments are going to be, he said.

Dr. McIntyre said private practices should be allowed “to band together to negotiate rates without onerous overhead structures” so they could compete with larger entities. Also, medical liability reform “would go a long way to decreasing costs of not just private practices but medicine in general,” he said.

At its House of Delegates Annual Meeting in June, the American Medical Association approved new policy to channel AMA resources to protect and support solo and small group practices, and their ability to provide quality care.

Source: American Medical News, July 30, 2012.

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How private practices might be encouraged to stay in business

Physicians are seeing their independence deteriorate as they face increasing costs and declining office visits while health plans and Medicare tighten management of clinical decisions, according to the Physicians Foundation. A report from the group makes several recommendations for policymakers to help sustain private practices.

• Boost Medicare fees by 30% for both management of clinical problems and diagnostic decisions. Make the increase applicable to primary care physicians as well as such diagnostic decision-makers as radiologists, cardiologists and pathologists.

• Develop patient-centered medical homes and other new practice models to improve physician productivity and diversify the services offered by practices.

• Reduce hospital payments for outpatient imaging and surgical services relative to the fees offered for the same services in lower-cost, private settings.

• Eliminate the Medicare site-of-service differential that allows hospitals to charge more for physician services offered in a facility setting than for those offered in a private practice office.

Source: “The Future of Medical Practice: Creating Options for Practicing Physicians to Control Their Professional Destiny,” The Physicians Foundation, July 17, 2012.

Centers for Medicare and Medicaid Services (CMS) is hosting a national call about a proposal to apply a value-based modifier to physicians’ Medicare payment rates. Register on the CMS Upcoming National Provider Calls web page for this call on August 1, 2012, at 11:30 am PST. Advance registration is strongly encouraged to secure a space.  

Officials will discuss the proposed implementation of a provision in the Affordable Care Act that will apply a value-based modifier to physicians’ Medicare payment rates. The program is being phased in over three years, beginning in 2015, and will result in payment increases for some physicians and reductions for others. You can learn more about CMS’s proposed implementation of the value-based modifier on pages 559-622 of the proposed 2013 physician fee schedule.

A Q&A session will follow the presentation, and all registrants will receive a link to the slide presentation on the day of the call.

Click here to register for the call.

Three SFMS members were honored at the 2012 Health Care Heroes Breakfast on July 25.

Organized by the San Francisco Business Times, this annual event recognizes individuals and organizations from the local health care community and their dedication and commitment to the enhancement of the value and quality of health care.

Toni Brayer, MD, past SFMS president and chief medical officer of Sutter Health West Bay Region, was recognized for leading medical missions to disaster areas. She worked long hours in challenging conditions to deliver care to people in crisis in Haiti and New Orleans.

Vivian Reyes, MD, an emergency medicine physician, was honored for developing the Emergency Response Team at Kaiser Permanente. The team specializes in helping keep hospitals ready for natural disaster or emergency that could affect the entire region.

Gina Gregory-Burns, MD, an internal medicine physician, was acknowledged for helping Kaiser Permanente San Francisco achieve health equity by spearheading programs and strategies for delivering culturally competent care in diverse communities.

SFMS would like to congratulate our members, whose tireless commitments to health care are invaluable to a thriving medical community!