CMS Trying To Attract More Doctors And Patients To ACO

Recent reports suggest that the CMS is trying to improve provider and patient participation in Accountable Care Organizations (ACOs). They are planning to improve participation by automating the process to pair patients with the doctors who are participating in the ACO models. This means that in the coming weeks, Medicare beneficiaries will be able to go to a website that has their enrollment details and list their primary care doctor. “ACOs have told us they prefer to know with more certainty at the beginning of the performance year what beneficiaries the CMS will…Read more …

How To Talk To Your Clients About Outsourcing

I get the same question all the time from existing and prospective clients "Do I tell me clients that I am outsourcing their work to India or not?".   Typically, medical billing companies have contractual provisions whereby the medical providers authorize the billing services to be performed by employees, agents, contractors, and subcontractors of the billing company, which includes the authority to perform certain billing services offshore.  These contractual provisions are now standard given the industry shift toward offshore services, and the desire of medical billing companies to have the offshore option open.…Read more …

The Expansion Of Bundled Payment Programs Has Been Delayed By The CMS

In the latest move, the Centers for Medicare and Medicaid Services has delayed several bundled payment initiatives. This includes the implementation of cardiac bundled payment initiatives and the expansion of Comprehensive Care for Joint Replacement Model. In addition to that, this new policy from CMS will also extend Cardiac Rehabilitation Incentive Payment Model’s effective date from July 1 to October 1. Reports from several sources also claim that the interim rule from CMS has also delayed the effective date of a final rule for the second time. The effective date for the final…Read more …

Three Things I Learned About Doing Business in India

I first traveled to India over ten years ago.  At the time I owned a medical billing company and wanted to research the medical billing BPO's in Chennai.  It was a time before social media.  Any company could have a website and make it appear as if they had a large company when in reality they may just be working in a hut in a remote village with limited internet connection.  I had to go to India and check out these companies for myself. I asked my friend Mike, also a medical billing…Read more …

Trump’s 2018 Budget Proposes Highest Priority For Medicaid And Medicare Programs

President Donald Trump’s upcoming fiscal budget for 2018 is expected to direct more funds to curtail many of Medicare and Medicaid frauds, wastages, and abuses. It indicates major changes to Medicare, Medicaid, and the Children’s Health Insurance Program. This new proposal in the upcoming budget is made with the intention of focusing the agency resources on the highest priority activities vital for the efficient running of the programs. The proposed fiscal 2018 budget covers the discretionary funding and has requested a sum of $69 for the HHS. This, however, is lower to about…Read more …

Doctors Remain Clueless About MACRA Compliance Requirements

It is reported that doctors are potentially facing loss of millions of dollars in Medicare reimbursement. This is due to the lack of MACRA-related guidance from the CMS, says a letter from the Medical Group Management Association (MGMA) to the CMS. In a final rule that was announced last year, CMS said that they would exempt those physician practices, which have less than thirty thousand dollars in Medicare charges or less than hundred unique Medicare patients every year, from complying with the MIPS plan that is outlined under the MACRA. CMS was supposed…Read more …

How To Deal With Employee Resistance To Outsourcing

Employees and most human beings fear the unknown.  When an employer announces that they are outsourcing any kind of work employees get nervous and worry that their job is in jeopardy.  I have studied this process extensively and have facilitated the movement of many medical billing tasks offshore successfully.  I have listed some of the tactics that I have used to achieve a successful  transition. You are supplying them with an assistant.  One of the most common reasons for outsourcing work, is having more work than the current staff can handle.  To alleviate the…Read more …

CMS Launches A New National Campaign For Promoting Coordinated Care Program

Health care providers in the country are leaving millions of dollars in federal funding, which will certainly help them to provide better health care to the sickest beneficiaries of Medicare. The CMS recently announced that they are planning to launch a national campaign for encouraging the physicians to take advantage of these funds. A recent report revealed that CMS has been offering an average payment of $42 per patient a month to physicians for coordinating chronic care services and consulting with specialists. Several experts in the field believe that this program will significantly…Read more …

American Health Care Act To Repeal And Replace ACA

The Republicans have finally revealed their much-awaited legislation for replacing the Affordable Care Act. The health bill, named American Health Care Act, aims in phasing out key aspects of the law over a course of several years as the stalemate between the moderates and the conservatives in the party continues. The American Health Care Act has numerous proposals that include a refundable and age-based tax credit to aid people in opting insurance. This would also eliminate the requirement to have coverage and the taxes used for funding the law in 2010. Furthermore, several…Read more …

HHS Unable To Clear Medicare Appeals Backlog By Deadline

HHS recently said that they do not have the resources and funds to clear the pending Medicare billing appeals by the deadline of 2021, which is imposed by the court. HHS said in a report to a U.S. District Court in Columbia that they were not able to reduce the Medicare billing appeals backlog and that they have even more pending appeals than anticipated. Last year, the court ordered HHS to fully clear all the pending Medicare appeals from various hospitals by Jan 01, 2021. This order was to resolve a long-standing dispute…Read more …