payment – MD Update

Mandatory Reading

June 1, 2019September 4, 2019 James M. Schrader 20% add-on factor, add-on, area maintenance, Ask, budget purpose, Cam, commercial lease, commercial lease agreement, commercial lease center, common area maintenance, cost of janitorial service, expense, fine print, fixed rental obligation, footage, full-service lease, gross lease, guaranty, interior perimeter, janitorial service, landlord, language of the lease dictate, lease, lease agreement, lease center, lease dictate, lease document, lease term, major source of disagreement, mandatory Reading, measure tape approach, multi-tenant building, operate expense, operate expense of the building, operate expense of the property, payment, personal guaranty, recur common expense, recur common expense of utility, rentable square foot, rentable square footage, share of the common area, square footage, square footage of a commercial space, standpoint of an advisor, tape approach, tenant, tenant 's proportionate share, term of a commercial lease, triple net lease, usable square footage, zero-sum, zero-sum game

“Do you know the difference between education and experience? Education is when you read the fine print; experience is what

Read more

Compliance: The Best Risk Management Tool

May 1, 2019June 21, 2019 Lisa English Hinkle abuse compliance, Anti-Kickback, Anti-Kickback statute, Anti-Kickback statute 's prohibition, behavioral health service, big data, CMS, commercial health insurance plan, commercial insurance rule, compliance, compliance area, compliance plan, compliance professional, compliance program, compliance program effectiveness, compliance review, complicated medicare payment rule, controlled substance, core element of a compliance program, data analytics, documentation, effective compliance plan, effectiveness of compliance plan, EKRA, eliminate kickback, employer, enactment of the eliminate kickback, evaluation of employee, ever-expanding area, ever-expanding area of compliance, everyday routine of regulator, federal report requirement, Fee schedule rule, filing, final physician, good practice, good risk management tool, healthcare, healthcare provider, HI-TECH, HI-TECH report requirement, Hinkle, important element of a compliance plan, important new area, insurance, insurance rule, internal report system, Kasper, Kentucky, Kentucky board, laboratory test necessary, match originating-site facility fee claim, measure compliance program effectiveness, Medicaid, medical necessity, medical record code, Medicare, Medicare claim, medicare payment rule, monitor adherence, necessity, new area, new area of compliance review, new criminal penalty, new enforcement, originating-site, originating-site facility fee claim, patient broker, payment, prescription of controlled substance, privacy, privacy requirement, program administration, protected health information, provider, provider education, recovery home, regulator, regulator 's sight, regulatory sea ebb, resource guide, review of big data, review of policy, risk management tool, robust compliance program, safety of patient, sample of area, score compliance, sea ebb, stark law, substance, substance disorder treatment, telehealth, telehealth claim, thorough documentation of medical record, tool, topic of a study group, ultimate risk management tool, vendor

What is compliance, anyway? Something that you will know when you see it? What is an effective compliance plan? To

Read more

Hippocratic Medicine is Affordable Care

January 1, 2019 Cameron S. Schaeffer, MD $, $300 million dollar hole, 300, absence of price mechanism, affordable care, architect of Obamacare, bad manifestation, bad manifestation of third-party payment, basis of Hippocratic medicine, big incentive, called fascism, campaign-contribution, captured industry, cartel, cartel medicine, cheap facility, clinic system, Con law, concierge, continued existence of Con law, cost money, current medical system, debt, definition of a good gig, devalued currency, doctor, dollar hole, economic lunacy, education of doctor, employed physician, employed primary care physician, employer 's facility, fatal conceit, fatal conceit of Obamacare, free care, good deal, health cartel, high cost of cartel medicine, high price relative, high tax, Hippocratic medicine, immediate need of individual patient, insurance, insurance cartel, insurance company, insurance network, Kentucky 's budget, large clinic system, law of economics, law of scarcity, massive Medicaid expansion, Medicaid expansion, medical care, medical spend, medical system, medicine, moral pose, need law, nurse cost money, Obamacare, party payer, party payment, payment, physician, price tag, provider cartel, repeal certificate, repeal certificate of need law, sacred doctor-patient relationship, scarcity, socialized medicine, specialty referral in-house, specific CPT code, stuff, system subjugation, third-party payment, totalitarian neighbor, urologist, workarounds

Time to say it. Third party payment undermines the sacred doctor-patient relationship, the basis of Hippocratic medicine, and has been

Read more

Physician Activity Now Under OIG Scrutiny: Revenue Impacts

September 1, 2018November 9, 2018 Shawn Stevison claim data, global period, global surgery period, incentive, item, new work plan item, OIG, OIG scrutiny, open payment data, open payment database, open payment program, payment, payment data, payment database, payment program, physician, physician activity, physician practice, post-operative service, practice pattern, proactive review of surgical case, receipt of incentive, required reported data, review of claim, review of post-operative service, surgery period, utilization pattern, work plan item

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) routinely issues new Work Plan items. This

Read more

Identifying Revenue Leaks within the Medical Practice

October 1, 2017 Adam Shewmaker, FHFMA appropriate medical code, back-office responsibility necessary, bad debt collection agency, balance, balance amount, bill question, business office, cash, cash collection, cash post, chart documentation review, code audit, coder, compliance concern, cross-training, Dean Dorton, dedicated focus, employee, employee dread, employee dread take time, excellent staff, follow-up, high patient satisfaction, identify revenue leak, medical code, missed revenue, patient balance, patient balance amount, patient insurance, patient visit, payment, physician, physician inquiry, physician practice, potential collection, practice 's code habit, practice administrator, professional coder, profitable outcome, R follow-up, R., recent twelve month period, reimbursement, revenue cycle, routine medical code assessment, single cure, single point of data, small portion of the back-office responsibility necessary, staff concern, task, team member, underpayment, unique patient mix, work go

With reimbursement shifting towards quality care and patient outcomes, it’s necessary for medical practices to take a fresh look at

Read more

Special Section

A Joint Effort

August 1, 2017 Jim Kelsey adult reconstruction surgeon, adult reconstructive fellowship, average age, BSN, bundled payment care initiative, bundled payment structure, care of the patient, clinic, CMS, cost save, CRRN, director of total joint replacement, Dr. Tharun Karthikeyan, effective orthopedic patient care, expectation, Famer, flat amount, flat payment, former Pittsburgh steeler, Gil Dunn, hall of Famer, hip, hip replacement, hospital stay, Jerome Bettis, joint effort, joint replacement, Joseph, Joseph hospital, Joseph hospital orthopedics, Karthikeyan, knee, knee center, knee replacement, leader of a cohesive team, Lexington, Lexington clinic, Lexington clinic orthopedics, Lexington repair, OrthoCarolina, OrthoCarolina hip, orthopedic surgeon, orthopedic surgery residency, orthopedics, outcome, patient navigator, payment, payment care initiative, photo, physical therapy, Pittsburgh, Pittsburgh steeler, positive patient outcome, posterior approach, procedure, provider, quality of care, reconstruction surgeon, replace knee, replacement, replacement program, RN, seminar, significant cost save, sport medicine, steeler, surgeon, surgery residency, Tharun Karthikeyan, therapist, total joint replacement, total joint replacement program, total knee replacement, trauma fellowship, unfair shift, university of Pittsburgh school of medicine

LEXINGTON Repairing and replacing knees and hip joints is what Tharun Karthikeyan, MD does for a living. He’s well trained

Read more

Watch Out MCOs

April 1, 2017 Lisa Hinkle administrative hear, administrative review, appeal, appeal process, available long-awaited relief, beneficiary, calendar, calendar day, care organization, denial, denied Medicaid managed-care claim, department of insurance 's policy of review claim, determination, DMS, DRM, DRM request, enrollee, external review process, find of overpayment, firm 's Lexington office, Franklin circuit court, health care provider face denied claim, healthcare, healthcare provider, insurance 's policy, Kentucky, Kentucky 's department, Kentucky 's Medicaid, Kentucky Medicaid, Kentucky Medicaid business, Kentucky provider, KRS §205.646, Lexington office, long-awaited relief, managed-care, McBrayer, MCO, MCO payment denial, MCOs, Medicaid, Medicaid managed-care claim, Medicaid MCO, Medicaid MCO 's final decision, Medicaid MCOs, Medicaid overpayment determination, Medicaid service, misrepresentation, negligent misrepresentation, new process, overpayment, overpayment determination, payment, prompt payment, provider, recoupment, regulation, reimbursement, reimbursement issue, reported revenue, request, review claim, review process, Senate Bill 20, statute, subject of a new action, third-party review, third-party review of denied Medicaid managed-care claim, time frame, WellCare

With reported revenues in the billions of dollars and net profits not far behind, insurance companies providing a Medicaid Managed

Read more

Legislative Update: SB4 – Medical Review Panels

February 1, 2017 Stephanie Wurdock bill, breach, broad overview of SB4, chosen panelist, core provision, dispute resolution agreement, expert opinion, flow of medical malpractice claim, healthcare, healthcare cost, healthcare practitioner, healthcare provider, Indiana, Indiana 's lead, individual provider, injured patient 's path, Kentucky, lawsuit, legislative update, licensed internist, malpractice, malpractice claim, malpractice complaint, medical malpractice claim, medical review panel, medical talent, member of the Kentucky legislature, merit of proposed malpractice complaint, national practitioner data bank, opinion, opponent claim, panel, panel process, panelist, patient 's path, payment, practitioner, practitioner data bank, proponent of SB4 claim, proposed malpractice complaint, provider, R-Winchester, Ralph Alvarado, requirement of SB4, review panel, rise healthcare cost, SB4, SB4 claim, Senate Bill 4, state court, tort, tort reform, valid alternative dispute resolution agreement, violation of a statute, written malpractice claim

According to the National Practitioner Data Bank, Kentucky reported an average of 269 payments each year from 2011 through 2015.

Read more

Healthcare Business Legal

What Healthcare Providers Should Know About MACRA

January 1, 2017January 19, 2017 Lisa English Hinkle adjustment, administrative regulatory process, alternative payment model, announced appointment, announced appointment of Tom Price, APM, APM program, APMs, apprehension loom, clinician, clinician service, CMS, educate clinician, efficient care, election of Donald trump, eligible clinician, eligible clinician service, encourage participation, establish payment, everyday term, final rule, future of the ACA, generous roll time period physician, growth rate formula, growth rate methodology, HHS, HHS team, improved care, incentive, independent clinical practice, legacy program, MACRA, Medicare, Medicare patient, Medicare payment, Merit-Based, Merit-Based incentive payment system, MIPS, new acronym, new payment system, nurse, option, outcome-focused, participation, pay incentive, payment, payment adjustment, payment model, payment penalty, payment system, physician, president-elect trump 's inauguration, provider, provider burden, qualified participant, quality measure, quality payment program, regulation, repeal of the sustainable growth rate methodology, replacement of the sustainable growth rate formula, resource-effective, submission, sustainable growth rate formula, sustainable growth rate methodology, system delivery, time period physician, trump, trump 's HHS team, uncertainty

With the election of Donald Trump and the announced appointment of Tom Price as secretary of Health and Human Services,

Read more

KentuckyOne Health Partners Preparing Providers for MACRA

September 1, 2016 Donald Lovasz ACO, ACO status, advanced APMs, Alagia, alternative payment model, APM, APM track, APMs, bonus, change move physician more, chief physician executive, Chip Re-Authorization, Chip Re-Authorization act, Damian P., eligible advanced APM, eligible APM, fee-for-service payment model, flat fee-for-service payment model, group practice, healthcare, healthcare provider 's service, home model, Kentucky, KentuckyOne, KentuckyOne health, KentuckyOne health partner, KentuckyOne health partner prepare provider, KHP, Louisville physician, MACRA, MACRA legislation, MACRA resource center, medical home model, Medicare, Medicare access, Medicare part B, Medicare payment, Medicare provider payment, Merit-Based, Merit-Based incentive payment system, metrics, MIPS, new payment system, new payment track, P., participant, partner, patient care, payment, payment model, payment track, physician, physician executive, physician payment, provider, QPP, qualify participant, quality payment program, result of MACRA, result of the Medicare access, SGR, SGR formula, small practice, Stephanie Mayfield Gibson, sustainable growth rate, upcoming change

LOUISVILLE Physicians across the United States are preparing for a new payment system, as a result of the Medicare Access

Read more

← Previous