How do physicians choose an outsourced medical billing provider?

The best way to choose a medical billing service is to understanding the needs of your practice. After that check the accuracy and the amount of time they take for claims filing and the collection percentage.

Accuracy, timeliness and collection percentage.

Accuracy – How accurate are the claims that are going out. Do they go to the right insurance company? Do they contain all of the information necessary for payment? Do the payments go to the right lock box or bank account? Who is responsible for errors? What kinds of reports are available? Often known as slicing and dicing, what kind of accurate reporting can the vendor supply that can help the practice with productivity, planning, forecasting, etc.

Timeliness – How quickly does the information provided by the practice get turned around? What is the process for handling claims denied for timely filing? This is usually a negotiation to determine who is at fault when this happens. Making sure these terms are fair to the client as well as the vendor is key here. How soon are reports available for the practice? (Daily, weekly, hourly) How quick is the response to questions, issues, requests. How available is the vendor?

Collection percentage – Who does claim follow up? Who works denials? Percentage of clean claims that go out? How much is collected on the billed dollar? How much work does the practice do to resolve the AR and how much is taken care of by the billing company?

These are common concerns when shopping for a billing company.

What is MACRA and MIPS?

What is MACRA?

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MACRA is the Medicare Access and CHIP Re-Authorization Act. MACRA replaces the current Medicare reimbursement schedule with a new pay-for-performance program that’s focused on quality, value, and accountability. The Centers for Medicare and Medicaid Services (CMS) stated that MACRA enacts a new payment framework that rewards health care providers for giving better care instead of more service.

President Obama signed into law the Medicare Access and CHIP Re-Authorization Act (MACRA) on April 16, 2015. It passed with a 392 to 37 vote in the House of Representatives, and a 92 to 8 vote in the Senate. That bipartisanship indicates the legislative support for MACRA and the significance of the bill in U.S. healthcare reform.

MACRA combines parts of the Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VBM), and the Medicare Electronic Health Record (EHR) incentive program into one single program called the Merit-based Incentive Payment System, or “MIPS”.

 

What is MIPS?
MIPS is the name of a new program that will determine Medicare payment adjustments and is an acronym for the Merit-Based Incentive Payment System. Using a composite performance score, eligible professionals (EPs) may receive a payment bonus, a payment penalty, or no payment adjustment.

The Composite Performance Score is based on four performance categories:

  • Quality
  • Resource use
  • Clinical practice improvement activities
  • Meaningful use of certified electronic health records (EHR) technology

Performance for MIPS will start on January 1, 2017 and will annually measure eligible providers in four performance categories to derive a “MIPS score” (0 to 100). The MIPS score can significantly impact a provider’s Medicare reimbursement in each payment year from -9% to +27% by 2022. The four performance categories are weighted:

50% for quality (PQRS/VBM)
25% for Meaningful Use
15% for clinical practice improvement
10% for resource use

The points provided for each category will shift over time to place an increasing focus on more resource use.

 

What should I be doing now to get ready?

The best way to get ready for MACRA and MIPS is to satisfy Meaningful Use Stage 2 requirements and continue to work on achieving PQRS requirements. CMS has stated that providers already attesting to Meaningful Use and PQRS will likely have no net new requirements. mips-macra-next

The MIPS proposed rule is expected in the summer of 2016 and the final rule is expected in November. The final rule will determine how points are earned within each component.