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We all had a lot on our plates running a practice with daily operations and planning before healthcare reform. Because we are working to be proactive in preparing for reform, let’s not overlook what we still need to be doing in managing our groups.
Are we collecting every dollar we are entitled to?

The best way to answer this is to have a third-party analyze the past 12 months to determine the net collection rate. The reason that you may want to have a third-party analyze this data is because it can be time-consuming. After conducting a number of collections analyses, this third party can say a practice falls into one of three categories:
• Only fine-tuning is needed,
• Process improvements are needed, or
• Major new processes are needed.

Are you aware of the 13 preventive services that CMS requires Medicare Part B to pay 100 percent?

Are you aware of the 10 percent payment incentive for primary care services furnished by physicians enrolled in Medicare with a primary care specialty designation? CMS will use historical claims data to determine that at least 60 percent of a provider’s total annual allowed Medicare charges are from office, nursing facility or home visits. This bonus will be paid on a quarterly basis.

The regulation also implemented a 10 percent payment incentive for general surgeons enrolled in Medicare with a primary specialty designation of 02-general surgery, furnishing major procedures (10-day or 90-day global service period).
Similar to the PQRI program, CMS retained the 2010 reporting mechanisms available to professionals for its e-prescribing incentive program and expanded the reporting option.

These include claims-based and registry approaches. In addition, CMS outlined that that an EHR-based reporting mechanism is available for this program. CMS plans to keep the 2011 program period and process consistent with the 2010 program. Claims for calendar year Jan. 1, 2011 through Dec. 31, 2011 must be submitted no later than Feb. 28, 2012, with CMS multiple reporting methods and a minimum of 25 prescribing events. It adds a challenging new wrinkle to the reporting process.

Claims-based reporting must be used to report at least 10 eligible electronic prescribing (e-prescribing) encounters during the first six months of 2011 or your payments will be reduced by 1 percent in 2012. Similarly, those using the group payments will be reduced by 1 percent in 2012. Those using the group practice reporting option will need to report the measure 75-1,875 times on claims, depending on the size of the group.

For the full analysis of the final 2011 Medicare Physician Fee schedule, visit mgma.com/feeschedule2010/.

Bill Appling, MBA, FACMPE, is president of Watkins Uiberall Health Care Consulting. He has faculty appointments at the University of Memphis in the Fogelman College of Economics and Business, where he teaches in the Masters of Health Care Administration program.

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