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- 2016 revenue goals proved elusive for many physician practices
More than one-quarter of physician practices fell short of revenue goals in 2016, according to a poll released January 17 by the Medical Group Management Association.
The poll, which gathered more than 1,000 responses, asked respondents whether or not 2016 net revenue goals were met. A plurality (30%) said revenue fell short; however, 29% said their practices exceeded revenue goals. Rounding out the top three, 27% said 2016 revenue was on target.
- ACA repeal would put more pressure on practices
While most analysts agree that any substantial changes to the Affordable Care Act (ACA) are unlikely this year, even minor changes to the ACA could result in millions of newly insured people losing insurance, and millions of fewer new-patient office visits in 2018 and beyond. And those changes could come at a time when physicians are struggling with escalating costs and flat reimbursements from Medicare and Medicaid.
To date, more than 20 million previously uninsured U.S. residents have acquired healthcare coverage through Medicaid expansion or with the help of federal subsidies. And while it’s too early to tell how far President Donald Trump will go regarding his campaign promises to dismantle the healthcare law, any effort is likely to leave a good chunk of those newly insured people without coverage. A study released January 17 by the bipartisan Congressional Budget Office estimates 18 million people will lose their health insurance if the ACA is repealed without a replacement plan.
While a repeal-without-replacement strategy is unlikely, any changes to healthcare reform could affect access to care for patients and the type of care they need.
“It could really hurt patients who lose insurance completely or if their coverage is weakened to take away coverage of preventive care,” says John Meigs Jr., MD, a family physician in Centreville, Alabama, who has been in practice for more than 30 years.
- Q&A: You’ve got questions! We’ve got answers!
Q: Is modifier -PN used instead of or in addition to modifier -PO in a non-excepted department? Do we still need to add modifier -PO in general?
- Expanding the CDI focus to the outpatient arena
The focus for clinical documentation improvement (CDI) specialists has historically been on the inpatient hospital stay. Review of the chart for conditions that are not fully documented and/or evidence of conditions not documented at all has been standard practice.
However, with so many changes in the industry facing providers in their outpatient practices, the importance of CDI in places of service such as physician offices, ambulatory clinics, and urgent care clinics is even more vital.
As mentioned, the healthcare industry has undergone a change of focus, and this focus is still evolving. Each year, CMS offers regulations that change inpatient surgeries to those covered only in outpatient settings. Inpatient stays are down, and more patients are being admitted to observation status.
With the new MACRA and MIPS/APM regulations for physician practices, quality over quantity is in effect. Hierarchical condition categories (HCC) are more in focus, with Medicare Advantage plans and other insurers offering risk-adjusted reimbursement for providers caring for patients with long-term chronic conditions. Finally, with the specificity requirements of ICD-10-CM, documentation needs to be even more robust to ensure correct capture of the most appropriate diagnosis code.
- How to succeed in a Medicare ACO
Medicare and commercial accountable care organization (ACO) models are not created alike.
- CPT Manual moves laparoscopic ablation of uterine fibroid tumors from Category III codes
CPT has granted coders a new code, 58674 (laparoscopy, surgical, ablation of uterine fibroid(s), including intraoperative ultrasound guidance and monitoring, radiofrequency), effective January 1 for the laparoscopic ablation of uterine fibroid tumors.