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March 2021 Client Newsletter

HHS Public Health Emergency (PHE) Extended
Alex Azua, Secretary of HHS, has extended the Public Health Emergency (PHE) another 90 days to April 21st. That means that many of the copays will continue to be paid by insurers.
We now have one forward-thinking client doing Remote Physiologic Monitoring (RPM) and another still cogitating (that means thinking deeply!) on it. It appears to be working well. Devices that can be used include Automated blood pressure cuffs, glucometers, scales, oximeters, etc., and Medicare will pay you for the equipment and the time to manage the patient. 
Chronic Care Management (CCM) is another opportunity to add a service for patients with 2 or more chronic conditions expected to last 12 or more months. 
For both programs, the actual calls can be handled by your clinical staff (includes RN’s, LPN’s, medical assistants, etc.) with your supervision. 
AND, both are billable the same month. For patients who qualify, the above 2 programs can make a positive difference to their health - and for your revenue! 
Providing a Product or Service Below Your Cost
I was recently asked by a client about providing a vaccine when a certain insurer pays less than it costs. EVERY practice needs to know what each product they dispense costs. They then need to compare the reimbursement for that service or product for insurance company. 
Especially when the cost is greater than the payment, practices have to decline to provide it. Insurers will always try to pay the least they can but only can do that if providers are willing to subsidize those services or products. 
Subsidizing those costs is NOT a good business model. Providing that product or service is not adding to your profitability – it is DECREASING it. So, what do you lose by declining to give it?
If an insurance is fine with their patients getting their service/product elsewhere, why shouldn’t the provider? I understand that providers often feel it is better for the patient, but it makes zero sense (cents!). 
If patients ask why, they will understand when told the cost literally is greater than the payment.  
There should be a chart in each office that indicates which services/products/procedures the practice provides and paid by each insurance at a reasonable mark-up. As for the rest, consider giving the patient a Rx. 
Here is the link to a very interesting & informative article:
BTW, in smaller rural communities with no other sources, that strategy can give the provider the needed leverage to negotiate higher payment that at least fully covers the cost. 
Just my opinion, of course.  
2021 Client Newsletter Archive