Is it time to bring on an associate or partner? There are many reasons you might consider it. For example, your practice might have become so busy that you have little time with your patients. Perhaps your practice volume has grown so much that you need help managing it, or maybe retirement is around the corner and you’re thinking about eventually selling.
Like many industries, the manufacturing industry has fallen to the provisions of the Affordable Care Act (“ACA”) and the updated Department of Labor overtime regulations. Many companies are struggling to maintain their overhead, comply with regulations, and pay for the ever-increasing health care costs, all the while attracting and retaining skilled workers. If you have felt the heat, you are not alone. According to the 2016 Manufacturers’ Outlook Survey, a lot of companies are dealing with these same concerns.
Managed care, Medicare and Medicaid reimbursements, and the Affordable Care Act (ACA) all present challenges for a medical practice. On the other hand, many problems that arise are self-inflicted. Is your medical practice not performing as well as expected? Are revenues dropping? Are you having problems covering costs? Take a hard look at your practice and diagnose the problem. To help put you on the road to recovery:
Coding after the end of the ICD-10 grace period
After the transition from ICD-9 to ICD-10 went into effect in October 2015, the Centers for Medicare and Medicaid Services ("CMS") allowed medical practices a one-year “grace period” in which to get up to speed with the new reimbursement codes. During the past year, physicians have had a safety net when they’ve made mistakes. But effective October 1, the grace period is over.
The 3.8 percent net investment income tax (“NIIT”) under the Affordable Care Act (“ACA”) has been in effect since 2013 and remained in effect for tax year 2015 and beyond. The taxpayer is liable for NIIT on the lesser of their net investment income (“NII”), or the amount by which their modified adjusted gross income (“MAGI”) exceeds the threshold based on filing status.
The wave of health care reform has led to a closer focus on the need for clear, consistent, and transparent communication of patient financial information. Thus, the Healthcare Financial Management Association ("HFMA") has developed “Patient Financial Communications Best Practices” for improving and standardizing how health care organizations should communicate with patients about their financial responsibilities. The guidance covers several areas of critical importance for community hospitals.
It’s hard to miss news reports discussing the shift in the basis for provider reimbursements from “volume” to “value.” Public (Medicare and Medicaid) and private payers are promoting value-based payment methodologies for physicians and hospitals — including “meaningful use,” “pay-for-performance,” “Accountable Care Organizations,” and “patient-centered medical homes.” So, what does value mean in your practice?
Physician practices face not only clinical and financial risks, but also business ones. Fortunately, insurance can mitigate many of these risks. But practice leaders may not be familiar with the different types of coverage available. Here are eight business policies that every physician practice should consider:
The financial side of the practice appears to be running smoothly. Claims are submitted and paid. Expenses are being paid on time, too. But no one really knows whether the revenue cycle management system is functioning at its peak potential. In such cases, a checkup of the practice’s system may be called for.
Claim denials can be a major source of frustration for physicians and their practice managers, and can have a real impact on cash flow and the financial performance of a practice. If office procedures are good in gathering correct information and submitting clean claims, you can still expect to see at least 5% of denials for claims. So, how can you conquer the issue?