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March 2017 Client Newsletter

It's Not Too Late to Succeed with PQRS. 


It's not too late to avoid the 4 percent penalty in 2018 and succeed with PQRS for 2016!  Deadline for submission is March 31st, but you need to address now before the last minute rush.  Registries will not accept last minute clients.  We have two high-quality registries we have experience with.  If you need assistance, please contact Rich. 

Reminder - February is a SHORT Month

 For Total Charges and Payments purposes, most practices will be down compared to months with 30-31 days simply because February only has 28 days this year. 


2017 Medicare- MIPS, MACRA, etc. - Holy Cow, Batman!

 At the end of December, the Centers for Medicare and Medicaid Services (CMS) unveiled a number of resources and information critical to participating in the Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs) in 2017, including the highly-anticipated 2017 quality measure specifications and performance benchmarks practices will be scored against, a new fact sheet and measure specifications for the MIPS EHR category known as advancing care information (ACI), as well as an updated comprehensive list of APMs.

Just a reminder to be sure you are participating in one  of the Medicare Quality programs which are available to independent providers as well as groups.  Solo providers do not need to sell their practice to a group and become employees in order to meet the requirements.  2017 is a transition year with relaxed requirements that are easy to meet in order to avoid a cut in 2019. 

Not meeting the MIPS requirements in 2017 will result in a 4 percent decrease in Medicare payments in 2019.  The penalty increases in 2020 to 5 percent, 2021 is 7 percent, and 2022 and beyond is 9 percent. Meeting the requirements either avoids a decrease or allows as much as the same amount of increase. 

Call Rich if you would like to discuss. 


The Challenge of Collecting Patient Balances - and the New Healthpac Eligibility Layout 

One of the speakers at the February Healthpac users meeting talked about the challenge of collecting patient balances and the effect of the high deductible plans and higher copays. She said statistically, 30 percent of payments are now owed by patients! That means having a strong patient financial policy is critical.  The first lines of "defense" are:

  • Verify insurance when each appointment is made and check eligibility electronically during the call.  If the patient requires a referral for specialists, remind them to bring it.  This can be done through NaviNet, Healthpac, etc.
  • Make a photocopy of the insurance card and photo ID when the patient arrives for the appointment, and electronically re-verify insurance.  Insurance can and does change for some people between the time the appointment was made and the date of service.  If the insurance does NOT verify - best options are to either reschedule the patient, or collect cash/check/credit card payment. 
  • Collect all co-pays and any unpaid balances upon arrival - before the patient is taken to an exam room.  For those using the Healthpac Scheduler, you have access to real time ledger balances. 

We have updated the Healthpac eligibility output view to make it easier to read.

Liquidation of Health Republic

The New Jersey Life and Health Insurance Guaranty Association (LHIGA) Fund has been activated to pay claims for medical services rendered to patients covered by Health Republic Insurance of New Jersey, which was New Jersey's only Consumer Operated and Oriented Program (CO-OP). Claims will be paid at 80 percent by the fund and physicians may not bill patients for the remaining 20 percent. Physicians should watch their mail this month for a Proof of Loss form. Physicians will be required to file the form for the remaining 20 percent before August 2, 2017. Physicians are urged to file all claims for services in the normal course as soon as possible. Read the updated FAQ.

We will keep members apprised of developments in the liquidation process.

2017 Client Newsletter Archive