The Centers for Medicare and Medicaid Services (CMS) announced several weeks ago that they were extending the “Probe and Educate” review of hospital payments under Medicare as part of the implementation of CMS-1599-F, better known as the “Two Midnight Rule.” This means that the regional Medicare Administrative Contractors (or MACs) will continue to audit claims made by hospitals for payment, but RACs (Recovery Audit Contractors) will “generally” not yet begin post-payment reviews, or audits that seek to draw money back from hospitals for payment of improper admissions or documentation. This “Probe and Educate” period, originally slated to end March 31st is intended to educate hospitals about necessary billing practices and ease the transition to the new rule before retrospective audits begin.
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As physician advocates, telehealth – connecting patients and providers remotely through video, audio, and monitoring technologies – is one of the most exciting frontiers in care delivery. The industry is facing a constant torrent of change and reform, but is also newly armed with tools that allow medicine to be practiced on the patients’ and providers’ own terms.
The opportunity to provide a more convenient and accessible healthcare system, as well a one that is more coordinated and efficient is at the core of all this telehealth excitement. A newly formed lobbying organization is putting some serious political muscle behind the idea, and their first step is to re-brand telehealth all together. Say hello to “connected care!”
Some of the benefits of connected care are: (more…)
If your practice is using desktop or laptop computers with Windows XP installed on them, you could be in for a rude awakening this spring. Microsoft has announced that after April 8, 2014 they will no longer support or release security patches for Windows XP.
What does “no longer support” actually mean?
As I said in my recent post “10 Predictions for Medical Practices for 2014″, this is the Year of the Mandate. To avoid payment penalties from Medicare, practices must implement electronic medical records (EMR), must have a patient portal, and must participate in the Physician Quality Reporting System (PQRS), which will feed into the new Value-Based Payment Modifier (VBPM) system.
What is really looming large, though, for any practice that accepts payments from insurance companies is the transition to ICD-10 in October. Although conservative estimates place the cost of this change at $80K per physician (lost productivity, lost revenue, and the cost of training and implementation) it is the widespread fear that the transition will take months to work out the bugs between physicians, vendors and payers that has everyone sweating. No practice has the ability to survive reduced or no insurance payments for three months, and three months of operating cash is what many practice consultants (including me) are recommending to physician practices to stockpile or have available as a line of credit.
We are beyond thrilled and proud that our friends David, Lori and Ravi at Medlio have launched their virtual insurance card app for iOS in the App Store and in the Google Play Store for Android! We were early proponents of Medlio due to their vision of using patient responsibility information to empower both practices and patients to understand their financial stake in their care.
Disclosure: Manage My Practice is working with Medlio in an advisory role.
Medlio provides a solution to a tangible and growing problem for physician practices, and we’ve been recommending people learn more since we first heard the idea. More than that they are creating a single platform for patients, providers, and payers to communicate.
Learn more in their press release below, download the app, and have one less card to worry about.
Congrats to the team at Medlio!
Medlio Unveils Virtual Health Insurance Card App
Ushering in the new age of healthcare consumerism
DURHAM, NC. Jan. 14, 2014 – Medlio is proud to announce the launch of its secure
digital health insurance card that can be displayed on a smart phone, similar to the
e-boarding passes now available for airline flights.
Medlio provides healthcare consumers with immediate access to current insurance
information. Everyone can set up an account today and capture an image of their
insurance card. Most users will also be able to access real time benefits including
progress towards their deductibles and expected copays or coinsurances for
various services. Many insurance companies’ benefits are already accessible, and
Medlio is working feverishly to add even more who have signed up through the
But Medlio is not just building an insurance card app. The company aims to connect
patients directly with their doctors and insurance companies all on one simple
communications platform. In addition to insurance benefits data, Medlio also currently
allows people to easily find doctors and facilities from the app’s provider search
functionality. Soon app users will also be able to schedule an appointment, check in,
share insurance information and medical forms, get a cost estimate and pay for their
visit all with just a few taps on their smart phone.
David Brooks, Medlio co-founder and CEO developed the idea for Medlio after starting
and managing a primary care practice for several years. He realized the lack of cost
transparency and antiquated billing processes were a critical problem for healthcare
consumers as the rise in High Deductible Health Plans (HDHPs) shift more and more of
the healthcare costs onto them.
This year, 66 percent of companies with 1,000 employees or more offered at least
one HDHP. That number is expected to jump to 80 percent by next year. According
to Towers Watson, by this time next year, one out of every four big employers will
only offer HDHPs. “Yesterday’s patients are swiftly becoming tomorrow’s consumers
as more of the cost and responsibility of their care falls upon them,” said Brooks. “It’s
become critical to simplify and clarify the healthcare check in and payment process.
This is a problem both patients and providers desperately need solved now.”
“The new medical consumers are taking an active rather than a passive role in their
personal healthcare. They expect a better experience,” explained Tiffany Marum, MD,
one of Medlio’s first provider customers. “If their expectations are not met, consumers
will seek care elsewhere and share their negative experience with others. We expect
this app to help us engage our patients in a dialogue about their care.”
We’ve received resounding feedback from the healthcare providers who want to
better focus on and respond to the needs of their increasingly empowered and mobile
healthcare consumers,” Brooks said. “We have a number of providers who’ve signed up
and we are working as quickly as possible to get them all onto the system.”
To use the service, patients download the Medlio app from the Apple App Store™ or
Google Play® or visit the Medlio website (medl.io). Registration is a quick three-step
process. Patients just enter their name, insurance plan, and their primary provider.
Medlio then shows real-time health plan benefits information, along with the ability to
share insurance details and medical forms data with their providers.
Medlio, founded in 2013, builds tools and technology that empower consumers to get
involved as never before in the management of their own care. Medlio graduated from
the inaugural DreamIt Health accelerator program sponsored by Penn Medicine and
Independence Blue Cross. The company’s first tool, a virtual health insurance card, puts
the traditional static insurance card—currently the only intersection between patients,
providers, and payers—on a single, secure, real-time communications platform. It is a
simple, yet sophisticated solution bringing patients from the periphery to the center of
healthcare by fostering new attitudes and awareness around healthcare consumption.
As a recent announcement by GlaxoSmithKline highlighted – the pharma giant will stop paying doctors to promote its products – the relationship between physicians and pharma reps is a complex and sometimes twisted one. At my first job in healthcare as a receptionist in the 1980s, I remember being puzzled when I was told one of the physicians was being “detailed”. Detailed? What the heck was that?
Detailing the Physician
Physicians have been extending credit to patients almost since the beginning of time. Any time a patient receives healthcare services, has a financial responsibility and does not pay their portion at time of service, they are in essence receiving credit from the physician. Typically, medical practices have extended credit to patients without interest added, and usually on a schedule that patients can handle. Physicians have created payment plans for patients, or allowed them to carry a balance as long as the patient made a payment every month.
Exchanges and employer-sponsored plans carry higher deductibles in 2014.
Flublok, a influenza vaccine manufactured without live influenza virus or chicken eggs, was approved by the Food and Drug Administration (FDA) in early 2013 for adults ages 18 to 49. Flublok is not only free of egg protein, it has no other ingredients not essential to the vaccine itself including antibiotics, latex, formaldehyde and the mercury preservative thimerosal.
Protein Sciences, the Meriden, Connecticut company that manufactures Flublok, anticipates selling 5 million doses in 2014 and expects to receive additional FDA approval for use in adults ages 50 and older. As reported on HartfordBusiness.com, “…the vaccine’s target market includes the more than 600,000 Americans who are allergic to eggs. They also want to target the “Whole Foods” crowd, or people who prefer organic products that don’t contain chemicals or antibiotics.”
Today the Centers for Medicare and Medicaid Services, announced payment for Flublok for dates of service beginning January 1, 2014, although claims will not be processed until April 1, 2014.
The local Medicare contractors will add influenza virus vaccine CPT code 90673 to existing influenza virus vaccine edits and will determine payment rates. Note that the cost of this vaccine is higher than that of other influenza vaccines.
You may have heard the news last week that CMS will be collapsing the five levels of service for outpatient visit into a single flat rate.
What you may not have realized, though, is that this news relates only to HOSPITAL outpatient visits, and not to the professional (physician fee) component, but only to the facility (hospital) component. Let’s unpack this announcement and understand exactly what it means.
First, some clarifying terminology:
For anyone who tried to register after we were full, or couldn’t attend, there will be a Webinar Replay here: http://bit.ly/1cnb8dn as well as replays on the webinars from previous months and an Action Pack of resources – all free!
Please join us Tuesday, November 12, 2013 for our free monthly HIPAA Webinar. The topics we will be discussing this month are based on the following questions you’ve asked: