Updating Fee Schedules

Transcription

1 HOT IN DECEMBER 2015 TIP OF THE MONTH: Updating Fee Schedules View Article A new year brings new opportunities to serve you better. For many, the start of a new year is filled with a renewed sense of purpose and a commitment to be better, do better or serve others better in the coming months. Whether it s spending more time at the gym, less time in front of the television or reading more books, these resolutions are a fun way to challenge ourselves (and each other) and continue to improve our own lives as well as the lives of our friends, families and neighbors. At Pulse, it s no different. Our commitment to you remains the same: we will continue to treat your practice as if it were our own and base our actions and decisions on what will best position you our clients and partners to be successful. Still, we like to think of each New Year as an opportunity to re-examine the way we re taking care of our clients and make adjustments, if needed, to ensure we re providing you with the very best service possible.

2 This year we have a number of initiatives focused on further improving the way we serve and support you and enhancing the way you care for your patients, including: : Updates to the Physician Quality Reporting System (PQRS) for 2016 and enhancements to our secure messaging capabilities, claims and denial management system, and E-commerce support capabilities, as well as significant improvements to the Patient Portal 2.0 and Pulse Mobile. : New tools to improve the way you do business, such as Pulse Note, aimed at making documenting patient encounters easier, and PulseCloud, the next evolution of practice management and EHR cloud applications, as well as a new cloud-based fax solution, efax. Additionally, we ll continue to engage with you through one-on-one conversations, focus groups and other communication tools to keep a pulse on your needs (pun, somewhat intended) and make adjustments to our products and services, as needed. We re grateful for the role you ve entrusted us to play in the success of your practice and look forward to another rewarding year in Happy New Year! Jeff Burton President & Chief Executive Officer Pulse Systems, Inc.

3 Updating Fee Schedules We are in the beginning of the New Year, and for many practices, this means it s time to implement a new fee schedule for Here are some helpful tips for setting your practice s fee schedule: Keep It Simple & Update Simply put, fee schedules are a specific dollar amount that will be paid by a payer to a provider for specific services rendered. Many practices set their fee schedule based on Medicare s allowed rates. Medicare s allowed amounts often accurately approximate a practice s long-run, multi-payer reimbursement averages. Additionally, Medicare s fee schedule is easy to access and manipulate. The Medicare Physician Fee Schedule can be downloaded from the Centers for Medicare & Medicaid Services website. Find out what other practices in your area charge. It s important to know how your practice compares to the regional average before you raise your fees. Choosing where to set your prices is a balancing act. Most payers will pay the lesser amountof your charged amount or your contractual allowed amount. Therefore, your charged amount should always equal or exceed your best payer s allowed amount for any given service, or you may be leaving money on the table.

4 Setting Your Fee Schedules Setting your charges at an even multiple of Medicare s charges makes for easy mental math when calculating how much you can expect to be paid for a service. If your charges are at 200% of Medicare s allowed amount, for example, you can easily estimate that you should collect half of what you charged. Use Your Vendors As Consultants Don t hesitate to call Pulse for any questions or concerns in updating your fee schedules. Our goal is to help our clients be the most successful they can be!

5 Increasing Revenue Using Key Performance Indicators Metric #7 Patient Co-Pays Each month we speak about Key Performance Indicators (KPIs) and their importance in your office in terms of benchmarking, goal setting and changing workflow to create improvement. This month s KPI is Patient Co-Pays. Why is this KPI important? As a result of the changes occurring in insurance in today s medical offices, more responsibility is being shifted to the patient. Collecting a Patient Co-Pay is vital to maintaining a healthy accounts receivable. Under today s Affordable Care Act (ACA), more consumers have access to health insurance. But this same access has increased patient responsibility for the balance. The payers in this new ACA era have plans with higher deductibles and co-payments, which providers must collect directly from patients. Patient responsibility amounts have been continually increasing each year. While patient pays used to be 20%, patient pays now are averaging 30 to 35% of the total bill, according to reports by Intuit, the MGMA and McKinsey reports. From 2005 to 2013, high deductible plans increased from 1 million to 15.5 million (defined as an annual deductible of $1,250 or more). If patient payments are not managed, THEY CAN COST 3 to 5 X MORE TO COLLECT THAN PAYER PAYMENTS, according to Trends

6 in Healthcare Payments Annual Report. The best time to collect patient co-pays is BEFORE the patient sees the provider. Waiting until after the patient visit sending a statement later drastically reduces the likelihood of collecting the patient portions, as shown in the McKinsey report, indicating patients likely to pay percentages. So how do you increase collecting Patient Co-Pays? : Using a Patient Portal, encourage paying the co-pay before the visit. : On your statements, remind them to pay the co-pay if it was not collected and remind them to bring a copayment on their next visit. : Collect at the time of the appointment using either the portal or via phone. : At the time of check-in (preferred) or check out. : Ask for the co-pay and the balance in all scenarios. : Use of credit card as a tool to increase collections.

7 Increase your copay collections and try to benchmark your success using these standard Best Practices: Calculations are based on per physician data. Source: MGMA, Cost Survey for Multispecialty Practices: 2014 Report Based on 2013 Data

8 Assigning Cover Rights for Physicians User In Pulse Pro, use the Assigned Providers tab in the Physician and Staff tables to configure coverage rights. This function can be applied to prescriptions, tasks, documents and scheduling. 1. In Pulse Pro, select System Tables from the navigation pane. 2. In the System Tables menu, click Staff or Physicians to begin configuring coverage rights. 3. Search for and select the appropriate staff or physician. 4. With the user selected, click the Assigned Providers tab. 5. Select the desired permissions for the select providers/staff from the list. 6. Click Save to save the coverage assignments. 7. The assignments will appear with a green highlight once saved.

9 Pulse Mobile Pulse Mobile will be available in the app store in January! This release introduces support for charge entry workflows including access to both existing in-progress and pending charges as well as the ability to create a new charge for a patient without an encounter. The solution uses charge templates and charge entry lists, and integrates with the Pulse Pro product. The next planned release will add support for tasking for which we are currently in design review. Patient Portal 2.0 We ve been hard at work finalizing the rollout of this new product and are currently putting on the finishing touches. This new solution enhances ease of use and improves function across multiple platforms, thus significantly reducing the time you will spend helping patients access and use the portal. Please contact your Pulse Client Manager if you are interested in the new Pulse Patient Portal 2.0 platform.

10 Pulse Note Our work on the new Pulse Note solution will continue in January as we work with early adopters to gain feedback on the solution in practice. This period helps us to fine tune the current solution and will support the client-driven design of future enhancements in the module.

11 PUG 2016: We re extending Early Bird registration for two more weeks! Early Bird registration rates for Pulse User s Group are now extended through Friday, Jan. 15. Register you and your staff today for hundreds of dollars in savings! Registration Details Early Bird Attendee Registration: $ Early Bird Guest Registration: $ Register Now! * Regular Registration: Attendee: $ / Guest: $ * Register by Jan. 15, 2016, to receive the early bird discounted rate.

12 Class Description Snapshot: Secure Messaging Keeping Pace with the Government PQRS and MU Editing Through Document Generator Optimizing Orders Workflow and Beyond Patient Reminders through Practice Management Transforming Data Into Reports Pulse Reporting 101 Ridgemark Enhancements and Roadmap NHA Enhancements and Roadmap Claims Management Optimization Pulse Cloud 101 Answers to the Most Common Support Questions Scheduling Templates Revitalized Class list subject to change. Check periodically for updates. Register Now!

13 Get To Know Your Software Through these monthly newsletters, Pulse is beginning to assist our clients in getting to know the people behind the voices in our Software Support department. You already know their voices from calling our helpdesk. The first spotlight in the series, here s a little more about one of our team members Jason Stafford Software Support Specialist Jason Stafford joined the Pulse team in September of 2014 in our Software Support Department. He works directly with our clients to research and ultimately resolve issues within the software. We asked Jason what his favorite part of working for Pulse is, and he stated, I like the problem solving aspect I enjoy doing research to discover the root cause of client issues. His passion for this type of research makes him a great fit for...

14 ...the Pulse family and a source of great support to our valued clients. His secondary support role for Pulse is to monitor the Rx hub for error messages related to prescriptions, which involves reconciling these errors to ensure that client prescriptions are processed correctly and timely. Jason is 33 years old and was recently married on Aug. 1 of last year. He received his Bachelor s Degree from the University of Kansas in 2004 and remains a devoted Jayhawk Basketball fan to this day. In his youth, Jason played the bass in several rock bands, and today he claims the Beatles as his favorite music group.

15 January Focus Group Pulse Mobile 2.0 (January 14, 2016; 12:00 1:00 p.m. CST) This focus group will specifically review and discuss our design for Tasking in Pulse Mobile 2.0. We will also discover what else you want to see in Pulse Mobile for the first half of Register Now! Pulse efax (January 21, 2016; 12:00 1:00 p.m. CST) The Pulse product team will be sharing our plans to bring you a new and powerful cloud-based efax solution. In this session, you will learn the features and benefits of this solution and will have an opportunity to share your thoughts with the team. Register Now! After registering, you will receive a confirmation containing information about joining the webinar.