Blog

Mistake #1:
Not Using Imaging

Imaging guidance and localization for facet injections is included in the code descriptors and is required. Fluoroscopy and CT guidance are not separately billable. If ultrasound guidance is used, use category three codes.

Mistake #2:
Reporting bilateral injection rather than an add on code for unilateral multi-level procedures

When you report these codes, remember to append the 50 modifiers when the physician injects both the right and left side at the SAME spinal level.

Mistake #3:
Billing multiple units of 64492 or 64495.

These codes are only billable once per day, regardless if more than three levels were performed.

Mistake #4:

Coding 64494 for L2-L3 since that is the second facet joint in the lumbar region or second block for the patient.

64493 is the first code to report, 64494 and 64495 are merely add on codes for additional levels performed. 64491, 64492 must be billed in conjunction with 64490. 64494, 64495 must be billed in conjunction with 64493.

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*Disclaimer: Information provided in this presentation was accurate at the time of release in October 2016. Due to constant coding changes, it is recommended to verify the information at time of use.

Have you started on MIPS & MACRA?
Avoid getting a negative 4% payment adjustment from Medicare and START NOW!

What is the Quality Payment Program?
The Quality Payment Program implements provisions of the Medicare Access and CHIP Reauthorizations Act of 2015 (MACRA) and improves Medicare payment to focus care quality for patients. This combines and replaces three separate Medicare related programs with a single system where Medicare providers can be paid more for higher quality of care. Most of the measures are clinician-oriented, ensuring that physicians are being rewarded for what matters more to them and their patients.

Who participates in the program?
You are part of the MIPS track of the Quality Payment Program if you:
* Bill Medicare Part B more than $30,000 as an individual clinician
* Provide care for more than 100 Medicare Part B patients during the determination period and are a Physician, PA, NP, Clinical Nurse Specialist or Certified Registered Nurse Anesthetist.

Who DOES NOT participate in the program?
You do NOT participate in MIPS if you are in your first year as a Medicare provider, below the low-volume threshold listed above, or are above the threshold for significantly participating in an Advanced APM.

When does it start?
You can choose to start anytime between January 1,2017 and October 2, 2017.
How Will the Quality Payment Program Affect Payments?
* If you decide to participate in an Advanced APM, you may earn an incentive payment through Medicare Part B.
* If you decide to participate in MIPS, you will earn a performance-based payment adjustment- up, down or nothing- based on the data you submit.

The first payment adjustments based on performance in 2017 go into effect on January 1, 2019
In 2017, you can assess your readiness and decide how and when you will participate in MIPS.

Your options are:

* Submit the minimum amount of 2017 data required to Medicare and avoid a negative payment adjustment
* Submit a minimum of 90 days of 2017 data to Medicare to earn a neutral to positive payment adjustment
* Submit up to a full year of data to earn a positive payment adjustment.

IF YOU DON’T SUBMIT ANY 2017 DATA, YOU WILL RECEIVE A NEGATIVE 4% PAYMENT ADJUSTMENT

Do you qualify for a hardship exemption? Visit the Quality Payment Program Website at https://qpp.cms.gov/about/hardship-exception to find out more.

Tips to take the pain out of appealing denied medical claims
Denials can be overwhelming, here are some tips to help know if you need to appeal and the process to get it done effectively.

Tip #1: Understand the denial
Verify the information initially provided on the claim, and ask yourself…

• Does the documentation justify the CPT and ICD codes billed?
• Were the modifiers appropriate or missing?
• Are the TOS (type of service) and POS (place of service) codes correct?
• Was this bundled with another procedure, either in the post op period or the same day?
• Did you verify that you are following LCDs, NDC or medical policy guidelines for the payer?

Truly understanding your denial will guide you to your next step!

Tip #2: Gather Supporting Documentation
What to include:
• Notes for procedure as well as other supporting documentation (past treatment notes showing what has been tried and failed)
• Referral or authorization from payer
• Original claim number assigned by payer
• Proof of timely filing, if necessary

What is NOT needed:
• New claim form
• Copy of insurance card
• Documentation that has already been submitted for review
• Copy of denial

LEVELS OF APPEAL SUMMARY
Level 1: 120 days after date of initial date of determination
Level 2: within 180 days of the date of the Redetermination decision.
Level 3: within 60 days of the reconsideration decision
Level 4: within 60 days of the ALJ’s decision
Level 5: within 60 days of the DAB decision

TIPS FOR WRITING STRONG APPEAL LETTERS
1. Be direct and intentional with your first sentence.
2. Clear description of issue and expected outcome
3. Give supporting information about coding, coverage expectations pertinent to that payer.
4. Quote coverage policy and give policy # in letter.
5. If you are appealing an “unlisted” procedure (ex 64999), give comparable procedure and the rate you expect it to be paid.
6. Don’t overdo it. Be clear but not too “wordy”.
7. Include some medical backing for why you think this should be paid-for example “The patient had 90% relief with diagnostic MBB”.

#1: Start- decide you are going to do it, and follow through! Don’t avoid it just because it can seem intimidating. If you don’t have the resources in house to accomplish it, outsource it.
#2: Do your homework. Start by reviewing the numbers and your payer mix. Calculate revenue per visit and CPT comparisons.
#3: Decide which companies to start with. Determine what your breaking even point is (average monthly expenses divided by average number of patients per month) then what companies fall below this point are the ones to start with.
#4: Read your contracts thoroughly.
#5: Arrange a meeting.
#6: Know your alternatives to the negotiated agreed upon rates and what leverage you have. (i.e. If you see a large volume of patients of a certain company). Depending if you have leverage or not, you can decide how aggressive to be with the company.
#7: Prepare. Write letters to the insurance company stating your case and why you feel your rates should be better.
#8: Present your case.

If you have a contracts in place and need to re-negotiate – keep these tips in mind:
Before you begin, know that this is a project that will take approximately 6 months and 100+ man hours to complete.
Try to focus on overall rate increase, not selected codes- ideally a percentage of Medicare.
Avoid increases based on RVU rates
Know your area and what your competitors are receiving.
Don’t forget important codes like labs or flouro or drugs.
Avoid forever renewing contracts. 2-3 years is ideal.
Make sure they send you a signed version of the new contract.
Consider the impact that dropping a contract could have on key referring physicians.
Check your EOBs to make sure they have converted to the new fee schedule once the contract is in place.
Don’t be tricked by CPT specific adjustments. (I.e. A 15% increase on E/M codes but a 5% cut in procedures could be worse than your current contract).
Start with a smaller insurance (in your payor mix).
Develop relationships with all your insurance reps.
Fees are not the only thing to negotiate (also can work on authorization process, period allowed for denials, period for submitting claim).

Questions to ask as you get started with credentialing:

· In-Network vs. Out of Network? Consider the pros and cons.
· Is the insurance company part of an IPA?
· Are you credentialing as a group or individually?
· Is the panel open or closed?
· Is the provider already contracted under another entity? Can you add your entity to their existing contract?
· If you are credentialing a midlevel, what insurances will contract with midlevel?

**Keep in mind, every area, insurance company, and situation varies**

Information from CE Medical Group

Your front desk is the first and last impression a patient has on your practice. Your receptionist can make a huge difference in patient retention and new patient referrals.
The following tips will help to manage your front desk to be as effective and efficient as possible.

Educate your staff

Make sure your staff are trained and educated to do their job correctly. Train them to know what information to collect and why it is important. Obtaining the correct information and ensuring accuracy initially will increase the entire business efficiency and prevent issues later. Incorrect entry of any demographic or insurance information will delay payment, many employees do not understand the “domino effect” of a small error. Provide support- even after training, make sure your team knows they have support when needed and be willing to step in and help when they need it.

Prioritize customer service

It may seem like common sense, but it is important to make sure your staff understands what your expectations for customer service are. Everyone has a little different idea of what “good” customer service is.
• Greet patients warmly and sincerely
• Listen to patients
• Use names- staff introduce themselves and call the patient by name
• Always show respect to everyone, patients and coworkers
• Set policies on what time frame calls are to be returned and if calls should be going to voicemail or always answered by live person, set clear expectations

Build positive office culture

A happy office is an efficient office. If you set the culture of the working environment to be one that promotes team work, excellence and respect, this will reflect in the work. Hiring people that fit the culture, will make it so your employees always put the patient first and are focused on providing the best customer experience possible. Providing praise and appreciation for all your employees do is not just about being a nice boss, it is about getting employees to give their best, which most will do when they feel appreciated.

Establish or revamp office policies and protocols
The current way to do things may not be the best way. Don’t let old habits dictate the way the office runs. Work with your team to determine if there is a faster, more efficient way to run the front desk. After reviewing current policies and determining if there is a better way, get everyone on the same page.
Policies/protocols to review:
• Check in/out processes, collecting demographic data (make sure this is done at every visit to eliminate delayed payments)
• Patient copay and balance collection policy
• Patient scheduling policies
• Employee breaks and lunches- overworked and stressed out staff promotes chaos
• Phone etiquette policies

Learn More About Our Consulting Services at www.cemedicalgroup.com

Information provided by CE Medical Group: The Pain Medicine Business Experts

Marketing your practice is essential to stay competitive. Below are some tips on how and where to market to get the most out of your money and help you get found!

Social Media Promotion

Stats: 40% of consumers say that information found on social media affects the way they deal with their health, 90% of 18-24-year old people say they would trust medical information shared by others on their social media networks. Advantages of Social Medical Marketing:

Lower marketing costs
Finely tuned targeted marketing
Helps generate better SEO rankings
Higher conversion rates
Improved loyalty
Custom Website

Build a custom website that attracts more patients. Your website should be professional, informative and most importantly, be mobile friendly. Mobile internet access is the new norm. Smartphone and tablets account for 60% of all digital media time spent. Consumers want to be able to even schedule appointments from their mobile device.

Newsletters & Infographics

While it is essential to be online, you need to have a well-balanced approach and still have other marketing tools for your practice.

Patient Education Seminars
Posters and Brochures
Newspaper ads
Marketing to existing patients
Search Engine Optimization and Marketing

77% (8 in 10) of online health seekers say they began their search at a search engine. 52% of US adult smartphone owners say they have used their phone to look for medical or health information online. SEO can help increase the page’s visibility in a search engine’s free, organic search results.

Animated Videos & Testimonials

Using a video online can increase conversion by up to 80%. Using animated videos can help develop a connection with the audience and will get them more engaged with your message. A marketing video is a very powerful resource for your SEO strategy because it helps gain presence in Google. It is proven that explainer videos boost a website’s average visit time from 8 seconds to 2 minutes on average.

Learn more about our consulting services at www.cemedicalgroup.com.

Information provided by CE Medical Group

Educational Series: Tips to Help You Succeed

How to Handle A DEA Investigation: The DEA Is in Your Lobby, Now What?

By: Nathan Crane, Attorney with Snow, Christensen & Martineau in SLC, Utah

Four years ago, a pain management physician contacted me and told me that two agents from the Drug Enforcement Administration (“DEA”) showed up unannounced at his clinic. The agents told the physician he was under investigation for over-prescribing and that things would go better for him if he voluntarily surrendered his DEA registration. The agents told the doctor he can always apply for a new registration at any time. The DEA agents pulled out a form and he signed it. The physician then called me and proudly told me that he had voluntarily surrendered his DEA registration heading off the investigation. Unfortunately, I had to burst his bubble. This physician did everything you should not do. Within a couple of weeks, the physician was facing criminal charges and after four years of trying, has not been able to get his DEA Registration reinstated.

The hard lesson, DEA agents (including all law enforcement officers) do not have to tell you the truth.

Each of you has a property interest in your DEA registration. This means the DEA cannot take your registration from you without due process—right to have notice of the DEA’s intended action and right to a full hearing before a neutral judge. If the judge finds against you, that determination is appealable to a higher court.

DEA agents ask physicians to voluntarily surrender their registrations because by doing so the physician waives their right to due process (notice and a hearing).

If DEA agents ask you to voluntarily surrender your registration tell them no or that you want some time to think about it. They cannot force you to surrender your registration and they cannot penalize you for not surrendering your license. There may be times when it is appropriate to surrender a DEA registration, but do so only after careful consideration and consultation with an attorney.

Nathan Crane is a shareholder at Snow, Christensen & Martineau in their Salt Lake City, Utah office. He represents doctors across the country in licensing matters before the DEA, State licensing boards, and in criminal prosecutions.

To learn more about our consulting services visit www.cemedicalgroup.com

Information presented by CE Medical Group: The Pain Management Business Experts

TOP 5 MOTIVATORS FOR EMPLOYEES:

Challenging work

Recognition

Employee involvement

Respect for boss

Compensation

RETENTION STARTS WITH THE RIGHT HIRE

The 7 C’s of Hiring by Alan Hall, Forbes Contributor

Competent: Has the necessary skills, experience and education to be successful

Capable: Employee has the potential for growth and ability to take on more responsibility

Compatible: Willingness to be harmonious with their boss and co-workers

Commitment: Consistent and stable work history, serious about working long term

Character: Do their values align with yours? Team player?

Culture: Does the worker reflect your company’s culture?

Compensation: Competitive pay for the positions- don’t over or under pay

With the right tools and training, most people will rise to whatever level of expectation and challenge you present them. People thrive with responsibility, give them the opportunity to do so.

MOTIVATION & RECOGNITION

A simple THANK YOU can have a lot more impact than money. Sometimes money can be seen by employees as part of their compensation, recognition that is separate from compensation is valued more by employees.

Examples of inexpensive ways to motivate employees:

Gift cards, employee spotlight, in-house massages, pot luck lunches, team meetings, pedicures at lunch, surprise shopping spree, early out Fridays.

THE BALANCE BETWEEN GRATITUDE AND ENTITLEMENT

Bonuses should not be a given- stretch goals may not always be met
Help them understand the reasons for the reward (i.e. we had a great month/year, you did exceptionally well at…)

Increase Your Revenue: How to Add New Services to Your Practice Successfully

By: Dan Crane, MBA with CE Medical Group

The days of single physician practices without ancillary services are nearly extinct. Physicians are working harder than ever to maintain similar income they received 5-10 years ago.

IT IS TIME TO ADAPT!

Potential Opportunities to Expand

Volume
PA/NP Support
Strategic marketing plan
Strategic partnerships
Labs
Group Alliances/MSOs
Diagnostic testing services
Ultrasound diagnostic services
PT or Massage Therapy or other complimentary services
Regenerative Medicine- Stem Cell & PRP Therapy
Other cash pay services- Aesthetics
Holistic treatments and vitamins
More sophisticated procedures
DME- Back braces or knee braces
Expanding treatment areas- headaches, knees or other joints
ASC ownership
Step 1: Increase volume

To support any expansion of services or capitalize on ancillary services, you need volume!

Recommendation before you start expanding in other areas:

Expand volume with mid-level support
Consider using a scribe
Step 2: It pays to be efficient

Streamline the processes in your office. If you can make room for even one more new patient per day, in a pain practice would mean, on average, an extra $50,000 per year!

In most situations, with simple adjustments, one can increase volume without additional staff or additional hours without sacrificing quality of care. Once running efficiently, you are ready to expand!

Step 3: Focus on your strengths and passions as you expand

It is much easier to build off your strengths and passions than to try and change your practice entirely.

Perform a SWOT analysis to determine what services would be best suited for your practice. Take into consideration your payer mix, demographic of your patients and commonly performed procedures. Also think about your passions a a provider and your goals for your personal life.

QUESTIONS TO CONSIDER BEFORE EXPANDING

Does it comply with anti-kickback and stark regulations?
Is the billing and coding strategy sound?
Does it fit into the practice’s scope and philosophy?
Is it good for the patient?
Can you afford it?
Can your staff give it the attention it requires to be successful?
To learn more about our consulting services visit www.cemedicalgroup.com

Information provided by CE Medical Group: The Pain Management Business Experts

Tips for Credentialing and Contract Negotiations

By: Dan Crane, MBA with CE Medical Group

Credentialing and contract negotiations can be very challenging. Here are some tips to help you get started!

8 Steps to Successful Insurance Contract Negotiations

#1: Start- decide you are going to do it, and follow through! Don’t avoid it just because it can seem intimidating. If you don’t have the resources in house to accomplish it, outsource it.

#2: Do your homework. Start by reviewing the numbers and your payer mix. Calculate revenue per visit and CPT comparisons.

#3: Decide which companies to start with. Determine what your breaking even point is (average monthly expenses divided by average number of patients per month) then what companies fall below this point are the ones to start with.

#4: Read your contracts thoroughly.

#5: Arrange a meeting.

#6: Know your alternatives to the negotiated agreed upon rates and what leverage you have. (i.e. If you see a large volume of patients of a certain company). Depending if you have leverage or not, you can decide how aggressive to be with the company.

#7: Prepare. Write letters to the insurance company stating your case and why you feel your rates should be better.

#8: Present your case.

If you have a contract in place and need to re-negotiate – keep these tips in mind:

Before you begin, know that this is a project that will take approximately 6 months and 100+ man hours to complete.
Try to focus on overall rate increase, not selected codes- ideally a percentage of Medicare.
Avoid increases based on RVU rates
Know your area and what your competitors are receiving.
Don’t forget important codes like labs or flouro or drugs.
Avoid forever renewing contracts. 2-3 years is ideal.
Make sure they send you a signed version of the new contract.
Consider the impact that dropping a contract could have on key referring physicians.
Check your EOBs to make sure they have converted to the new fee schedule once the contract is in place.
Don’t be tricked by CPT specific adjustments. (I.e. A 15% increase on E/M codes but a 5% cut in procedures could be worse than your current contract).
Start with a smaller insurance (in your payor mix).
Develop relationships with all your insurance reps.
Fees are not the only thing to negotiate (also can work on authorization process, period allowed for denials, period for submitting claim).
Questions to ask as you get started with credentialing:

In-Network vs. Out of Network? Consider the pros and cons.
Is the insurance company part of an IPA?
Are you credentialing as a group or individually?
Is the panel open or closed?
Is the provider already contracted under another entity? Can you add your entity to their existing contract?
If you are credentialing a midlevel, what insurances will contract with midlevel?
** **Keep in mind, every area, insurance company and situation varies**

To learn more about our credentialing services visit www.cemedicalgroup.com

Information provided by CE Medical Group

Documentation is key!
If it is not documented, it didn’t happen.

Documentation provides evidence of the clinical service provided to the patient. It is used to communicate to other clinicians, billing and coding, insurance companies and other healthcare entities.

Why it matters:
• Provide the best patient care
• Ensure consulting physicians have accurate information
• Justify level of service and necessity of ancillary services
• Obtain appropriate reimbursement
• Protect your practice from audits

New Patient vs. Established patient
• New patient visits require 3 of the 3 components to be documented
• Established patient visits require 2 of the 3 components documented
Common mistakes in physical exam documentation:
• A new patient needs a least 6 bullet points to code a 99202
• We often down code to a 99201 because 5 or less exam bullets are documented
• Copied or duplicated notes from prior visits
• Not reporting negative findings
o If you examine a body area, mention it even if it is normal.
o Documentation of benign finding is important as it allows the biller to assign additional diagnosis codes.

Questions or concerns about your documentation? Contact CE Medical Group today to learn more about auditing and consulting services. Email: services@cemedicalgroup.com

EDUCATIONAL SERIES: TIPS TO HELP YOU SUCCEED
Thinking of Switching EMR System?
By CE Medical Group

Choosing and converting to an EMR system can be over whelming. Here are 8 tips for choosing a new EMR system.
1.Purpose
Knowing the purpose of your new EMR system first is key. Knowing specifics on how you need it to operate will help in the over decision of choosing your EMR system. Are you a specialty clinic such as Pain Management, Dermatology, or Neurology? The needs of these specialties are unique and require specific software characteristics to be efficient. Customized EMR systems give you specialty-specific features and customized templates that will help immensely with your practice workflow.
2. Make a List
Start by making a list of all requirements your practice needs. This may include: automatic billing, scheduling features, e-Prescribing, patient portal, and lab integration to name a few.
It is important when choosing a new EMR/EHR system to involve all the physicians and staff in the office in the development of making the list. This ensures that all aspects of office flow have been considered. A decision like this, however, requires leadership and understanding of the needs of the practice. It is advised that a physician oversee the overall decision.
3. Budget
Besides the initial cost for the EMR system, which can be costly, there is also hardware, implementation, training, integration, and maintenance expenses to consider when purchasing a new system. The benefits of an EMR system long term, however, will help your practice save money.
4. Systems Structure
The system architecture of the EMR software, web-based or client/server, is something that also should be considered. One type is not better than the other, yet, one may be better for your practice. Ease of use, performance, utilization, and reliability is important. When choosing an EMR software you will need to consider which will best exemplify these characteristics for the needs of your practice’s workflow.
In addition, make sure that whichever EMR system you choose to go with has been certified as an ONC-Authorized Testing and Certification Body (“ONC-ATCB”).
5. Get advice
The best way to know if an EMR system may be the right one for your practice workflow is to see in use. If possible, you may want to visit a practice that is currently using the EMR software you are considering using. Talking to physicians and the staff will help you better understand the EMR you are considering and spot if there are any potential issues you will run into.

6.Support
Having an understanding of what type of support you will be receiving with the EMR software is important. You may need support after-hours, or even weekends, if your practice has irregular office hours. A majority will offer 24/7 support. The extent of support you will receive should be understood. Not only is the technical assistance crucial, but in the future, you may want additional help in installing new features, upgrades, and fixing software bugs. These should questions should be asked before purchasing the EMR.
7.Review the Agreement
Purchasing an EMR is a big commitment. Having a lawyer to review the agreement to ensure that the contact includes everything that was promised can ease your mind. They will be able to help you understand the costs, and any additional fees that could be associated the purchase of the EMR Software. Also, be sure to review the cancellation terms, in case it is does not meet your expectations.
8. Transition and Installation
After initial installation of the new electronic medical records system, transitioning your medical records on to it can take a lot time and effort. Do not underestimate the time that will be necessary. Manually scanning or inputting paper records onto the new system most likely will be necessary. Hiring additional help may be needed during this time as it can be time-consuming and be disruptive to daily work flow. It is recommended that fewer scheduled appointments be made during this process.
CE Medical Group (http://www.cemedicalgroup.com) specializes in practice management for Interventional Pain Management groups. Visit our website to learn more about our services.
www.cemedicalgroup.com
888-909-5866

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