Medix™’s Post

The ever increasing complexity of payer requirements causing a rising number of claim denials creates increased work demand on staff who is already overworked. This translates to decreased profits and increased stress for providers and takes away focus from patient care. Outsourcing revenue cycle management with a partner such as Allied Practice Management Solutions www.alliedpmsolutions.com can lower this burden and allow providers to focus on what they do best- caring for patients.

🚨 Maximize Your Revenue and Quality with the 2025 Quality Payment Program Final Rule Updates! 🚨 Centers for Medicare & Medicaid Services (CMS) has released the 2025 Quality Payment Program (QPP) Final Rule, and these changes can directly impact your bottom line. Here's what you need to know to optimize your revenue and improve quality metrics for the upcoming year: 🔑 Key Updates That Will Drive Revenue & Quality: 7 New Quality Measures: Along with modifications to 66 existing measures, and the removal of 10. These updates help align your practice with the latest healthcare priorities and can improve your MIPS scores. Cost Measure Scoring Overhaul: Changes to how cost measures are scored, along with 6 new episode-based cost measures, ensure that your practice is more accurately assessed, which can translate into better reimbursement opportunities. MVP Reporting: CMS is pushing for mandatory MIPS Value Pathways (MVPs), with 6 new MVPs across specialties like ophthalmology, dermatology, and gastroenterology. These will streamline reporting and improve performance tracking, helping you achieve better results with less administrative burden. Telehealth Flexibilities Ending: As telehealth restrictions return in 2025, adapting to these changes can help you manage costs and optimize care delivery. Updated CPT Codes: New and updated codes for gastroenterology and telehealth services ensure that you're capturing every opportunity for reimbursement, especially with the introduction of "audio-only" CPT codes. 📊 What This Means for Your Practice: Maintaining the 75-point performance threshold ensures that providers who meet the criteria are protected from payment penalties while focusing on quality improvement. Optimizing your reporting for Promoting Interoperability and Improvement Activities will drive higher quality scores and better reimbursement. Understanding the new cost measure methodology and utilizing the new MVPs will position you for higher performance scores and more efficient care, boosting both quality and revenue. 💬 Ready to Boost Your Revenue and Quality in 2025? With these impactful changes, now is the time to optimize your Revenue Cycle Management (RCM) processes and enhance your quality reporting. Let us partner with you to navigate these updates, maximize your revenue potential, and drive quality improvements. Reach out today to learn how we can help you succeed in 2025 and beyond! #Healthcare #RevenueCycleManagement #MIPS #QualityPaymentProgram #MedicalBilling #QualityImprovement #2025Updates Reference: https://lnkd.in/eeM6Pv-5 Daniel Jardin Anthony Fabrizio Paul Riley Steve Whitehurst Emily K Large, RHIA Brian Donahue James Ranck Scott MacDonald Scott Volpitto Ted Kennett Thomas J. Rende Eric Sieber Terese Masterson Renee Zepp Michael Tusing Valerie Collis Mark Crews

Anesthesia coverage, rising cost, and declining reimbursements pose significant threats to ASCs. Have you thought about how to tackle these challenges? Explore the recent blog from Becker's Healthcare for insights. #ASC #RCM #challenges #partnerships #services

The Push Button Blood Collection Set: Enhancing Safety and Efficiency   Recently, MEKON has been working to develop an innovative product, the push button blood collection sets, which has gone a long way in helping solve the problem of needlestick injuries in the healthcare industry.   Mekon push button blood collection set features a push button safety mechanism that protects workers from needlestick injury, a percutaneous piercing wound typically caused by needlepoint. It also features pre-attached holders that protect nurses from low-quality needlesticks, helping nurses better focus on delivering patient care. Moreover, the in-vein activation mechanism allows nurses to activate the push button without exposure to the contaminated needles, promising a higher security level and reducing occupational exposure while ensuring efficient workflow and patient safety. Additionally, we incorporate user-friendly elements in the designs that enhance comfort, further enabling healthcare professionals to perform their duties effectively and confidently. Mekon push button blood collection set holds the following outstanding benefits: Safety mechanism: reduce needlestick injuries by withdrawing the needlestick to avoid exposure to contaminated needles Convenience: pre-attached holders enhance ease of use and streamline the collection process. Pediatric patient-friendly: tiny needles ideal for pediatric patients, ensuring comfort and safety during procedures. One-handed in-vein activation: allow easy activation while attending to the patient simultaneously, improving workflow efficiency and minimizing disruption. Smooth penetration: technologies are used to sharpen the needle for seamless penetration, minimizing patient discomfort and enhancing overall satisfaction.   The Mekon push button blood collection set is poised to significantly influence the healthcare market by addressing critical safety and efficiency needs. With its innovative safety mechanism, it reduces the risk of needlestick injuries, which is a significant concern for healthcare workers. We aim to enhance patient care by allowing for quick and effective blood collection and promoting a safer work environment. Its user-friendly design caters to adult and pediatric patients, making it versatile across various healthcare settings. As hospitals and clinics prioritize safety and efficiency, this product stands out as an essential tool, likely driving widespread adoption and market growth.   If you want to learn more about the products or MEKON, please contact MEKON, we aim to provide the best quality products and services to you.

#Anesthesiasubsidy has been the big talk heading into this new year. I found this article very insightful—a guide for what healthcare costs should and shouldn’t be targeted for cost reductions in the industry. That said, and as an ASC administrator, tacking on a subsidy to offset lost revenue is not the answer. That only robs Peter to pay Paul and totally erodes the bottom line, thus limiting future quality of care. It’ll take everyone, from payers to providers, to resolve the ever-increasing healthcare cost crisis—but I’m a believer that there is a way. “…reimbursement for the professional component of anesthesia services would not be on my list of the top 1,000 ways to reduce waste in the health economy, especially if my company was already paying below FMV rates for the service.”

All-In-One OT: A Seamless Transition for New Clients In today's fast-paced healthcare environment. Ensuring a smooth and safe transition for new clients is paramount. All-In-One OT, in collaboration with National Neurological Services - National Care Group (NCG) and the Floyd unit, is committed to providing a seamless experience for patients, from discharge to admission. Understanding the Process When a client is discharged from one healthcare setting and admitted to another. There are several critical steps involved to ensure a safe and efficient transition. These steps include: 🌟Discharge Planning: 👉Collaboration: The All-In-One OT team works closely with the NGC and Floyd unit to coordinate discharge plans. 👉Assessment: A comprehensive assessment is conducted to identify the client's specific needs and requirements. 👉Care Plan Development: A detailed care plan is created, outlining the necessary interventions and support services. 🌟Transportation and Transfer: 👉Safe Transport: The client is transported to the new setting using appropriate transportation methods, ensuring their comfort and safety. 👉Secure Handoff: A secure handoff process is implemented, with clear communication between the discharging and receiving teams. 👉Documentation: All relevant documentation, including medical records and care plans, is transferred to the new setting. 🌟Admission and Orientation: 👉Smooth Admission: The client is admitted to the new setting in a timely and efficient manner. 👉Orientation: The client and their family members are oriented to the new environment, including their room, staff, and routines. 👉Needs Assessment: A comprehensive assessment is conducted to identify the client's immediate needs and preferences. Benefits of All-In-One OT Collaboration. By working together, All-In-One OT, NGC, and the Floyd unit can offer several benefits to clients: 🌟Reduced Stress: A seamless transition can help alleviate stress and anxiety for both the client and their family members. 🌟Improved Patient Outcomes: A well-coordinated discharge and admission process can lead to better patient outcomes. 🌟Enhanced Patient Safety: By minimising disruptions and ensuring a smooth transition, patient safety is prioritised. 🌟Efficient Resource Utilisation: Effective collaboration can optimise resource utilisation and reduce unnecessary delays. Conclusion All-In-One OT, NGC, and the Floyd unit are committed to providing exceptional care and support to clients throughout their healthcare journey. By working together and implementing a seamless transition process, we will ensure that clients receive the highest quality of care, from discharge to admission.

Anthem Blue Cross Blue Shield Reverses Policy Change Tying Payments To Length Of Time Patients Go Under Anesthesia The AP reports, “One of the country’s largest health insurers reversed a change in policy Thursday after widespread outcry, saying it would not tie payments in some states to the length of time a patient went under anesthesia.” In a statement, “Anthem Blue Cross Blue Shield said...that its decision to backpedal resulted from ‘significant widespread misinformation’ about the policy.” The statement said, “To be clear, it never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services. ... The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines.” The issue here is that there must be something done to reduce the costs of care (though I have not done a lot of research on this policy to determine if it was a "good" one or not) ... and no one in government, the medical industry, pharma, DME, etc., is doing anything to reduce the costs of care. Per Salary.com, as of December 01, 2024, the average annual pay of an Anesthesiologist in the United States is $438,200. Salary.com reports that Anesthesiologist salary in the US can go up to $550 or 600K ... the low end of the scale is about 325k. This is a substantial increase over average pay in 2020 or 2010 and well above inflation. One can assume that any effort to reduce the income or charges (whether it is an appropriate policy or not) will be met with an outcry. Shifting the costs of care to patients, employers, the governments and health plans is not sustainable without significant reductions in the cost of care - or the care provided.

Strategies which may be implemented to attract more patients and residents to hospitals and nursing homes Increasing business for hospitals and nursing homes requires a multi-faceted approach which focuses on improving patient care, enhancing operational efficiency, and developing effective marketing strategies. Here are some suggestions to help boost business for hospitals and nursing homes: 1. **Improve Patient Care and Satisfaction**:               * staff training and development for ensuring high-quality care.               * Implement patient-centered care models and personalized care plans.               * Enhance patient amenities, such as comfortable accommodations, nutritious food, and engaging activities.               * Encourage patient feedback and respond promptly to concerns. 2. **Develop Strategic Partnerships**:               * Collaborate with primary care physicians, specialists, and other healthcare providers to increase referrals.               * Partner with insurance companies and payers to negotiate favorable reimbursement rates.               * Develop relationships with local businesses and organizations to offer occupational health services, wellness programs, or educational seminars. 3. **Expand Services and Offerings**:               * Develop specialized programs, such as rehabilitation services, palliative care, or behavioral health programs.               * Offer ancillary services, like pharmacy, lab, or imaging services, to increase revenue and convenience.               * Consider developing outpatient services, such as urgent care or ambulatory surgery centers. 4. **Foster a Positive Reputation**:               * Encourage patient reviews and testimonials to build credibility and attract new patients.               * Develop a strong reputation management strategy to address online reviews and feedback.               * Participate in quality improvement initiatives and accreditation programs to demonstrate commitment to excellence. 5. **Develop a Strong Referral Network**:               * Build relationships with discharge planners, case managers, and social workers to increase referrals.               * Offer incentives, such as referral fees or bonuses, to encourage referrals.               * Develop a referral tracking system to monitor and analyze referral patterns. 6. **Invest in Staff Development and Engagement**:               * Provide ongoing training and education to ensure staff are equipped to deliver high-quality care.               * Foster a positive work environment through employee recognition, rewards, and benefits.               * Encourage staff to participate in quality improvement initiatives and share ideas for improvement. 7. **Monitor and Analyze Performance**: * Track key performance indicators (KPIs), such as patient satisfaction, readmission rates, and financial metrics. * Conduct regular market analysis to identify trends, opportunities, and competitors.

The COVID-19 pandemic and the Change Healthcare cyberattack are just two of the budgetary challenges facing anesthesia providers, according to a May 6 post by medical revenue cycle management group Coronis Health. Read more here. https://bit.ly/3wREkzO

Improper Payments in E&M Service Types (Part 2 of a 3-Part Series)- I posted part 1 of my improper payment series last month. Today we will dive into E&Ms.   Evaluation and Management (E&M) services represent one of the most error-prone areas in the Medicare Fee-for-Service program, with improper payments amounting to $3.92 billion in 2024. This category’s 10.3% improper payment rate reflects ongoing challenges with accurate documentation and coding practices. Top E&M Codes with High Improper Payment Rates: 99233 (Subsequent hospital inpatient/observation, high complexity): $481.7 million in improper payments, with a 20.4% error rate. 99223 (Initial hospital inpatient/observation, high complexity): $324.8 million in improper payments, with a 20.8% error rate. 99214 (Office outpatient, moderate complexity): $564.6 million in improper payments, though the improper payment rate is lower at 5.0%. 99215 (Office outpatient, high complexity): $210.3 million in improper payments, with an 11.2% error rate. Why These Errors Occur: -Insufficient Documentation: Providers often fail to include detailed notes that substantiate the medical necessity or complexity of the service provided. -Incorrect Coding: Misalignment between clinical documentation and the submitted E&M codes is a recurring issue, especially in determining the correct level of service. Improper payments in E&M services underscore the importance of coding precision, rigorous claim reviews, and improved documentation practices. Providers and revenue cycle teams must collaborate to bridge these gaps and reduce audit risks. How are you addressing E&M errors in your organization? In the final post of this series, we’ll explore improper payment trends in Part A Hospital IPPS claims, another significant area of concern. https://lnkd.in/ejXP7Zs8