The Journal of medical practice management : MPM最新文献

The passage of the Medicare Access and CHIP Reauthorization Act in Apri 2015 set the stage for the Part B reimbursement changes set to take place in 2019 based on the 2017 reporting period in relation to performance within core Medicare initiatives through the Merit-Based Incentive Payment System (MIPS) These changes will reflect the new "fee-for-performance" approach to reimbursements through individualized changes to an individual or practice group's conversion factor used in the RVU reimbursement calculation. The metrics being used as a basis for eligible provider competitive ranking for either positive or negative reimbursement changes are in proportion to performance on chosen Physician Quality Reporting System measures, value-based payment modifier calculations, compliance with Modified Stage 2 or Stage 3 Meaningful Use as part of the Electronic Health Record Incentive Program, and ongoing participation in clinical practice improvement activities. This article describes the core elements that make up MIPS and discusses the likely criteria that will be used as the core elements necessary for competitive reimbursement rankinq.

In 2010, with the passage of the Affordable Care Act, Congress created an obligation for healthcare providers to return overpayments that they receive within 60 days, or risk False Claims Act exposure. This year, CMS finally published regulations that clarify this statutory language. The regulations, however, impose strict standards on healthcare providers, wherein constructive knowledge can be imputed to a healthcare provider if that provider failed to exercise reasonable diligence. This article explores the new regulations, examines the practical implications of these new standards, and discusses the risks providers may face if they fail to engage in ongoing compliance efforts.

A practice manager wears many hats. He or she is responsible for the smooth running of the practice and all that that entails. Practice managers often come in early, stay late, and are involved in all aspects of running the practice. The question is, does the physician realize how much his or her manager does and how valuable the manager is? As a practice manager, it is important to meet with the physician, share ideas, and discuss the revenue and profits to ensure a successful practice.

Just a few years ago, the advances in technology in the medical office were the electronic medical record, a website, and electronic prescription writing. Today those are necessary requirements for any medical practice, regardless of size. Most large practices now have patient portals, e-mail reminders and e-mail newsletters, and automated patient appointment reminders. Now small practices also can have access to affordable technology that improves the efficiency and productivity of the office practice and also helps patients live healthier lives. The advances in technology could help save money in healthcare costs and improve patient treatment. This article discusses technology that is helpful for small practices and that can be implemented into a practice easily and inexpensively without the assistance or employment of IT specialists.

The healthcare industry is in a state of confusion and has been for the past 15 years. Physicians are faced with dwindling reimbursement rates, demanding administrative tasks, and changing federal and local rules and regulations. On the flip side, hospitals and healthcare networks are interested in pur- chasing physician practices. Should you consider keeping the status quo, turning over many of the administrative headaches, or just retir- ing all together? As a provider, should you take over or continue a solo practice, join a multispecialty group, or become an employee of a hospital? Buying or selling a practice can be life changing. The process is complex, and involves legal, tax, accounting, valuation, and psychological issues. It takes time and due diligence. It involves an entire team of professionals, which can and should include accountants, lawyers, and consul- tants all of whom specialize in this area. The intent of this article is to establish a starting point on wlhere and how to begin. It addresses major issues that should be considered in the beginning of this complex process. Whether you are a buyer or a seller, you will face many of the same processes and questions. A host of legal and practical issues will confront you, and this article explores your options.

In simpler times, it made sense for medical practices to hire unskilled, noncre- dentialed clinical coders. The trend continued with the introduction of electronic medical records-where software seemingly made the physician's coding de- cisions after a few points and clicks. However, with the confluence of ICD-10 changes, more fraud and abuse audits, and increasing fines for noncompliant coding, the time has come for medical groups to rethink their clinical coding strategy. Employing a certified coder and building an effective coding compli- ance program is no longer an option-it is a necessity. Credentialed coders make decisions that nearly always result in stronger reimbursement and also stand up under scrutiny by the Office of Inspector General. This article explores common myths about clinical coding, identifies ways practices get into compli- ance trouble, and provides specific avenues to implement an effective coding compliance program.

Physicians may head off allegations of negligence by developing a comprehensive understanding of why patients sue physicians and by appreciating what activities commonly lead to patient injury. With this knowledge, physicians can develop risk management strategies to reduce the likelihood of being named in a negligence lawsuit. We outline the common reasons why patients sue physicians, and what activities frequently lead to patient harm. The case examples emphasize the factors that can lead to allegations of negligence and patient harm.

Effective leadership starts with communication, and progressive leaders need to understand how to ensure that their interventions lead to positive outcomes. The good news is that most leadership communication falls into a few repetitive categories. This article explains the four conversations that leaders must get right, and how to make sure you do.