Medicare’s Merit-based Incentive Payment System (MIPS)

Posted on May 27, 2016May 27, 2016

Elizabeth Woodcock

Medicare’s Merit-based Incentive Payment System (MIPS)

On this week’s episode we continue our series with Medical Association of Georgia, talking about the changing reimbursement picture for physician practices by the Centers for Medicare and Medicaid Services. Medicare’s new Merit-based Incentive Payment System (MIPS) will change, yet again, physician reimbursement over the next couple of years and it is important for practice managers and physicians to make sure they understand all new requirements.

It is imperative for medical practices to make a successful transition to Medicare’s new Merit-based Incentive Payment System (MIPS). Instead of the EHR (Electronic Health Record) or the PQRS (Physician Quality Reporting System) or the Value-based Payment Modifier programs, the government will employ a single payment platform – which is the result of the Medicare Access and CHIP Reauthorization Act (MACRA) that was signed into law in 2015.

The new payment model will be based on a 100-point MIPS Composite Performance Score. That CPS will determine your Medicare payment adjustment – either up or down. This is scheduled to commence in 2019, and the Centers for Medicare and Medicaid Services will use the 2017 calendar year as the basis for the initial reimbursement – keeping mind this is not an optional process.

Elizabeth Woodcock is one of the leading third party payer and medical practice management consultants in Georgia. She is a professional speaker, trainer and author. Woodcock has focused on medical practice operations for more than 20 years. She has delivered presentations at regional and national conferences to more than 200,000 physicians and managers.

In addition to her popular email newsletters, she has authored 15 best-selling practice management books and published dozens of articles in national health
care management journals. Woodcock is a fellow in the American College of Medical Practice Executives and a certified professional coder. In addition to a degree from Duke University, she has an MBA in health care management from The Wharton School of Business of the University of Pennsylvania.

Special Guest:

Elizabeth Woodcock, Principal, Woodcock & Associates

Dr. Mark Beaty and Dr. Manny Rodriguez

Posted on March 21, 2016June 21, 2017

Podcast: Download

Dr. Mark Beaty

Dr. Manny Rodriguez

Dr. Mark Beaty and Dr. Manny Rodriguez

I was joined in studio by facial plastic surgeon, Dr. Mark Beaty, and I spoke with infectious disease physician, Dr. Manny Rodriguez about the Zika virus.

Dr. Mark Beaty specializes in elective aesthetic facial procedures to improve or reconstruct facial blemishes and flaws. Today we know there is more than simple vanity as reasons to consider improving the look of one’s face, particularly when you are a business professional.

Dr. Beaty shared information about recent studies that looked at individuals who underwent aesthetic procedures to address issues such as symmetry with regard to their earning over time. The study showed that business professionals in sales/leadership positions earned significantly more over time than counterparts who did not correct such issues.

We talked about some of the various ways Dr. Beaty is able to improve facial beauty, including some of the basic surgical procedures he performs, such as lifts and tucks, reconstruction of the nose, etc. He draws upon years of experience and refinement of his technique to offer what he calls, ProLIFT, allowing optimal aesthetic result with less recovery time.

He also discussed a number of innovative non-surgical procedures he is able to offer that hasten return to work with short recovery, minimal bruising or external thermal wounds. His CoolSculpting program creates the best value for non-surgical fat reduction through the use of a special device that is able to kill adipose cells, while protecting other tissues in the trouble spot.

He also explained the new Profound skin tightening procedure for non-surgical improvement of loose, saggy skin. Dr. Beaty is pleased to now have an office located in Midtown Atlanta to increase convenience for his in-town patients.

We’ve heard much about the Zika virus in the news lately, as several persons in the US have been found to be carrying the disease upon returning to the US (typically from Brazil). The virus has caused alarm due to the fact that it has recently been attributed as the cause for microcephaly in infants delivered to mothers who were infected during pregnancy.

Infectious disease physician, Dr. Manny Rodriguez took time to sit down and share some information about the virus for our listeners. In many ways, the zika viral infection is relatively benign, according to Dr. Rodriguez, with only a small number of persons exhibiting symptoms that alert them to the fact that they were exposed to the virus.

We talked about the symptoms that are most commonly seen when symptoms manifest, how the infection is diagnosed, what to expect should one become infected, along with some useful information on how to avoid the infection to begin with.

As we approach the Olympic games that will be held in Brazil, I’m sure we will continue to focus on this issue. I’m pleased to share some information straight from the expert for our listeners!

Special Guests:

Dr. Mark Beaty of Beaty Facial Plastic Surgery

Doctorate in Medicine, University of Kentucky College of Medicine
Residency, University of Iowa Department of Otolaryngology
Fellowship, Facial Plastic Surgery, Emory-Affiliated Buckhead Facial Plastic Surgery
Board Certified in Facial Plastic Surgery and Otolaryngology
Recipient, Sir Harold Delf Gilles award for research evaluating effects of rhinoplasty techniques on nasal architecture

Dr. Manny Rodriguez, DO, Infectious Disease Services of Georgia

Doctor of Osteopathy, Nova Southeastern University
Master of Public Health, Nova Southeastern University
Residency, University of South Alabama
Fellowship in Infectious Diseases, The George Washington University
Board Certified in Infectious Disease and Internal Medicine

Project DAN and Georgia’s 911 Medical Amnesty Law

Posted on March 10, 2016March 16, 2016

Podcast: Download

Dr. Shonali Saha, CW Hall, Dallas Gay

Project DAN and Georgia’s 911 Medical Amnesty Law

We continued our series with Medical Association of Georgia this week, talking about Project DAN and Georgia’s 911 Medical Amnesty Law. Dallas Gay and Dr. Shonali Saha were my guests.

MAG Foundation ‘Think About It’ campaign Community Chair Dallas Gay and Shonali Saha, M.D. – an adolescent medicine and addiction medicine physician with the Georgia Behavioral Health Professionals practice in Smyrna – discussed naloxone and the state’s ‘9-1-1 Medical Amnesty Law’ on the ‘Top Docs Radio’ program on the Business Radio-X Network at 12:00 p.m., Tuesday, March 8.

Naloxone is an effective, non-addictive prescription medication that reverses the effects of opioid drug overdoses. Under Georgia’s 9-1-1 Medical Amnesty Law, naloxone can be delivered on an intranasal or intramuscular basis. Physicians in Georgia can prescribe naloxone via a standing order to a person who is at risk of experiencing an opioid overdose. And at their discretion, physicians can prescribe naloxone to pain management clinics, first responders, harm reduction organizations, or family members or friends or other people who are in a position to assist a patient who is at risk of experiencing an opioid overdose.

The 9-1-1 Medical Amnesty Law provides limited immunity for individuals who possess certain drugs and drug paraphernalia when they experience a drug overdose and are in need of medical care, for people who seek medical care for a person who is experiencing a drug overdose, and for certain underage drinking offenses for minors who seek medical care during an alcohol overdose.

Special Guests:

Dallas Gay, Co-Chair, “Think About It” Campaign

Board Member, Northeast Georgia Medical Center
MBA, Georgia State University
Member, Drug Free Coalition of Hall County
Former President, Protein Products, Inc
Former President, American Proteins, Inc.

Dr. Shonali Saha, MD, Georgia Behavioral Health Professionals

Doctor of Medicine, Mount Sinai School of Medicine New York University
Residency, Cambridge Health Alliance
Fellowship, Adolescent and Addiction Medicine, Johns Hopkins School of Medicine
Attending Physician, Ridgeview Institute

Cash Flow For The Medical Practice

Posted on February 22, 2016

Podcast: Download

Mr. Cash Flow

Cash Flow For The Medical Practice

I sat down with David Wiener, aka “Mr. Cash Flow” on this week’s episode. I connected with David first on LinkedIn a few weeks ago. After learning more about the various ways he is able to help a medical or dental practice recapture revenue that is currently being lost, I knew I needed to have him on the show.

David spent numerous years as a practice manager for a doctor’s office, so he knows very well the challenges these practices face trying to maximize the revenue they get to keep for the care they provide. With patient out-of-pocket obligations significantly on the rise, physicians are experiencing a corresponding increase in the number of patient balance bills they must collect upon to be paid for their services.

David provides access to a service that for only $12 per claim (instead of a typical % of the amount to be collected), that dramatically increases the success rate for bills collected to over 80% in the first 30-45 days from date of bill.

We also talked about other ways Cash Flow Strategies, Inc., is able to help their medical and dental practice clients drop more revenue to the bottom line. One such way is to enroll their staff into a wellness program as provided for by the ACA. Businesses that do so can save as much as $500 per employee per year on the Federal income tax they must pay for each of them. Additionally, as employees take advantage of these wellness benefits, they tend toward better levels of health, decreasing the company’s expenditure for health benefits.

David also talked about a company he’s partnered with that can help a business change all the lights within the building to LED lights, saving enormous amounts of money on utility bills. They offer a plan through which the business can pay for the lights over time, with the payments + new utility bills amounting to less than previous utility bills were, providing savings from the first month.

There are several other ways David is likely able to reduce amounts being spent by the business, such as procurement costs for necessary supplies through a competitive group purchasing organization and others. It is clear that any medical or dental practice can benefit from taking a few minutes to talk with David to determine just how much additional revenue they can capture—all without having to work longer or harder.

Special Guest:

David Wiener, “Mr. Cash Flow”, of Cash Flow Strategies, Inc.

MAG’s MEP 401(k)

Posted on February 12, 2016February 15, 2016

Podcast: Download

Kevin Rainwater talks MAG’s 401(k) plan

MAG’s MEP 401(k)

We continue our series with Medical Association of Georgia, hosting Kevin Rainwater of Atlanta Capital Group to learn about MAG’s MEP 401(k) plan. Kevin Rainwater is a managing partner with Atlanta Capital Group, specializing in retirement planning.

Kevin began his career in the financial services industry more than 16 years ago. He has a passion for helping employees, executives and business owners reach their retirement goals. Kevin provides investment and plan advisory services to companies and individuals throughout the nation.

He relies on his extensive knowledge of qualified plan design and investment offerings to provide business owners and participants with the most competitive retirement plan option available.

MAG member practices can save time and money and retain employees by participating in a MAG-sponsored 401(k) retirement plan that’s available through the Atlanta Capital Group and Transamerica.

The MAG 401(k) Plan is treated like one large plan from a government Form 5500 reporting standpoint. The result is a 401(k) plan with competitive investments, outstanding service, and someone else doing a majority of the plan maintenance leg work. With more than 7,800 members, MAG offers a large, unified plan.

When you utilize the MAG 401(k) Plan, you have all of the advantages and flexibility of a stand-alone plan, while avoiding the expenses and administrative headaches associated with sponsoring a stand-alone plan.

Member benefits include cost savings on the investments; No individual Form 5500 reporting; Minimal plan maintenance; Flexible plan features, including safe harbor; Roth and profit sharing; Customizable 401(k) plan design options involving eligibility, matches, and vesting schedules; No audit at member level.

By participating in the MAG 401(k) Plan, virtually all of the administrative tasks can be offloaded from the practice to Transamerica, ACG, and MAG.

Special Guest:

Kevin Rainwater, Partner, Atlanta Capital Group

BS, Marketing, University of Alabama
Previous Regional Sales Director, First Mercantile
Former Director, National Accounts, The Standard

Representative Sharon Cooper

Posted on February 1, 2016

Podcast: Download

Georgia State Representative, Dist. 43, Sharon Cooper

Representative Sharon Cooper

I hosted MAG CEO/Executive Director, Donald Palmisano, Jr., and Georgia State Representative, Sharon Cooper. We talked about 2016 legislative priorities affecting healthcare in the state. More information soon!

Special Guests:

Sharon Cooper, Rep. Dist 43, Georgia State House of Representatives (R)

MA Education
MSN, Nursing
Authored 2 books on psychiatric nursing
Chair, Georgia Health and Human Services Committee

Donald Palmisano, CEO, Executive Director of Medical Association of Georgia

JD Law, Loyola School of Law
Board of Directors, Physician Advocacy Institute
Medical Payment Subcommitte Member, State Board of Workers’ Compensation
Treasurer, Board of Directors, Physicians’ Institute for Excellence in Medicine
Former Director, Government Relations/General Counsel/Director, GAMPAC

Dental Deserts

Posted on December 23, 2015

Misty Mattingly, Charlie Craig, and Sarah Smith explain GA HB 684

Dental Deserts

In the state of Georgia, 118 counties out of 159 have too few dentists to treat those residents. 16 Georgia counties have NO DENTIST at all. Clearly, this leaves a large, rural population in the state with limited or NO access to even basic, preventive dental care.

Today, there are only 5 states that do not allow hygienists to operate under a dentist’s supervision unless the dentist is physically on site where the dental hygiene care is provided. One of those is Georgia.

President of Georgia’s Dental Hygienist Association, Misty Mattingly, stopped by, along with Sarah Smith and Charlie Craig of Solution Road to talk about a measure before the Georgia House of Representatives that will address the lack of access to preventive screenings and treatments that are provided by hygienists.

Currently, Georgia law requires that a dentist is ON SITE while a hygienist administers care. Obviously, this is impossible in 16 counties without some sort of medical mission on the part of dentist and hygienist, and limited in 118 Georgia counties. Under HB 684, hygienists would be able to be supervised remotely by a dentist rather than requiring them to physically be on site. This would empower hygienists to provide diagnostic screening and preventive care in these areas with limited to no access.

When problems requiring restoration such as a filling or crown would be identified by the hygienist during these visits, they would be referred to a dentist for appropriate care. Without question this is a win for all parties, particularly the patients who today, have problems often going undiagnosed until serious, often resulting in an ER visit for evaluation.

Insurance Reimbursement

Posted on December 15, 2015

Podcast: Download

John Oxendine talks insurance reimbursement.

Insurance Reimbursement

This week’s show was part of our monthly series with MAG and we focused our conversation on legal issues around commercial insurance reimbursement for physicians. Former insurance commissioner for the state of GA, attorney, and expert on the subject, John Oxendine, joined me in the studio to talk about some important things physicians need to know relating to commercial insurance reimbursement.

There are laws that lay out requirements for timeliness of payment and/or communications regarding submitted claims that must be adhered to by insurance companies. Additionally, there are also rules around documentation of assignment of representation that can be the difference between losing five or six figures to insurance company claw back or being able to deny those requests to return payment for previously-delivered care.

John Oxendine is uniquely qualified to provide advice and information to physicians on the subject of health insurance reimbursement. He spent over 15 years as Georgia’s State Insurance Commissioner. He has worked closely with MAG, the Georgia Association of Physicians of Indian Heritage, AMA, and numerous other health care provider organizations.

While Insurance Commissioner, John created a division at the Department of Insurance to help physicians with claims payment issues. Additionally, he was the first commissioner in the country to levy large fines against insurance companies not in compliance with the state’s prompt pay law.

Special Guest:

John Oxendine, Attorney, John Oxendine PC

Doctor of Law, Mercer University, Walter F. George School of Law
Former Commissioner, Georgia Department of Insurance, 1995-2011

Health Insurance Mergers

Posted on November 16, 2015

Podcast: Download

Donald Palmisano Jr.

Dr. John Rogers of Coliseum Northside Hospital

Health Insurance Mergers

On this week’s episode I continued my monthly series with Medical Association of Georgia. MAG CEO, Donald Palmisano, Jr., and MAG delegate from Bibb County, Dr. John Rogers joined me in studio to talk about the challenges and concerns arising from recently-proposed mergers between large health insurance companies that will significantly reduce amount of competition in the space for Georgians to choose from.

Aetna/Humana and Anthem/Cigna are in the process of merging. At the same time, health insurers are offering insurance policies to the public that do not have adequate coverage resulting in more out of network charges by physicians.

Aetna/Humana and Wellpoint/Cigna have proposed mergers in the health insurance market. If these inadequate policies are being offered in the current environment, MAG is concerned about how patients will be negatively impacted with a further narrowing of the networks and increased physician reliance on out of network charges.

MAG recently sent a letter to the U.S. Department of Justice to call for it to scrutinize the mergers for antitrust violations.

MAG believes the mergers would reduce competition and place physicians and their patients at an even greater disadvantage as a shrinking number of health insurance companies gain increasingly-dominant positions in the marketplace.

The new Aetna (58 percent) and Anthem (30 percent) entities would control nearly 90 percent of the individual market in Georgia. In the small group market, Aetna would control more than 49 percent, while Anthem would control more than 33 percent. Each new company would control about 26 percent of the Medicare Title XVIII marketplace. And for large group market, Aetna would control more than 12 percent while Anthem would control nearly 55 percent.

Physicians have little-to-no leverage to negotiate contract terms with these multi-billion dollar conglomerates – which are imposing take-it-or-leave it agreements and unilateral, mid-term amendments with growing impunity.

Gone unchecked, a few insurers will be in a position to manipulate the marketplace to institute policies that will exacerbate the physician shortage and undermine the economic viability of the practice environment in the state and limit the accessibility of care and individual patient choice.

Georgia Department of Insurance has expressed concerns that the Aetna/Humana merger would violate Georgia’s standards for competition. Specifically, DOI has shared that the Aetna/Humana merger may violate Georgia’s competitive standard in the individual, small group, and Medicare Title XVIII markets while raising concerns of substantially reduced competition in the large group market.

More than 30 percent of the physicians in Georgia who participated in a survey that MAG conducted in the last several months said that they believe that the Aetna/Humana merger would threaten the long-term viability of their practice.

Special Guests:

Donald Palmisano, CEO, Executive Director of Medical Association of Georgia

JD Law, Loyola School of Law
Board of Directors, Physician Advocacy Institute
Medical Payment Subcommitte Member, State Board of Workers’ Compensation
Treasurer, Board of Directors, Physicians’ Institute for Excellence in Medicine
Former Director, Government Relations/General Counsel/Director, GAMPAC

Dr. John Rogers, Co-Medical Director, Coliseum Northside Hospital

Member, Board of Directors, Bibb County Medical Society
Vice President, American College of Emergency Physicians
Doctor of Medicine, University of Iowa Carver College of Medicine
Residency, Medical Center of Central Georgia

Interventional Radiology

Posted on October 23, 2015

Podcast: Download

Dr. John Lipman joins CW Hall talking interventional radiology

Interventional Radiology

We talked interventional radiology with Dr. John Lipman of Atlanta Interventional Institute on this week’s show. Interventional radiologists are radiologists who are trained to perform a wide array of procedures using various radiologic images to guide their work.

In fact, as Dr. Lipman explained, it was interventional radiologists who invented the technology to perform procedures such as balloon angioplasty that was later used to open blocked arteries in the heart.

We talked about uterine fibroid embolization, a minimally-invasive procedure where a catheter is passed into the femoral artery and maneuvered to the arteries feeding uterine fibroids, where a chemical is instilled, caused the vessel to occlude. This blocks bloodflow to the fibroid, causing it to shrink and die, allowing for easy removal.

The alternative for these women is hysterectomy, which is the surgical removal of the uterus, after which, the woman will need to take hormones to compensate for its loss. Additionally, it takes days longer to recover from the surgery and bears the risk of anesthesia and post-surgical infection.

Dr. Lipman talked about other procedures interventional radiologists are able to perform such as treatment of migraine headaches, and reversing infertility related to blocked fallopian tubes.

It is important for patients and their loved ones to be sure to ask lots of questions and to inquire about other available treatment options when surgery is recommended, particularly when it involves removal of an organ or amputation.

In this way, patients can limit risk associated with surgery in many cases, and save cost and time away from work. Dr. Lipman offered a number of questions patients and loved ones can ask to determine if an interventional radiologist is the one they should choose.

Special Guest:

Dr. John Lipman, MD, FSIR, Atlanta Interventional Institute

Doctorate of Medicine, Georgetown University School of Medicine
Radiology Residency, Brigham & Women’s Hospital, Harvard Medical School
Fellowship, Vascular & Interventional Radiology, Yale New Haven Hospital, Yale University School of Medicine
Board Certified, Radiology, Vascular & Interventional Radiology
Fellow, Society of Interventional Radiology

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Medicare’s Merit-based Incentive Payment System (MIPS)

Medicare’s Merit-based Incentive Payment System (MIPS)