Here is a collection of original articles, news stories and blogs that have been put together by our team.

Common Culprits in Medical Claims Rejections

Common Culprits in Medical Claims Rejections Even the most experienced medical billers make mistakes once in a while. Sometimes insurance companies try to pull a fast one. In either case, every medical practice gets some claims rejected. Here are some of the most...

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7 Insights on progress toward value-based care

A survey of 302 primary care physicians with hospital affiliations and 150 health plan executives examines progress that must still be realized to achieve value-based care. These include achieving better alignment between providers and payers and improvements in electronic health records to bridge critical gaps. Some widely differing views exist between providers and insurers on common issues.

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Audit estimates CMS issued hundreds of millions of dollars’ worth of incorrect EHR incentive payments 

As part of a program to encourage providers to shift to EHRs, the federal government incorrectly paid hundreds of millions of dollars in incentive payments to healthcare professionals who did not actually meet Meaningful Use requirements. The HHS Office of Inspector General estimates that inappropriate payments to eligible professionals totaled $729 million between May 2011 and June 2014.

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Health Care Providers on the Problems of Patient Engagement Design

Better patient engagement is a nearly universal goal for health care providers, but real barriers exist, say health care leaders and clinicians. Nearly two-thirds (63%) of respondents to NEJM Catalyst’s latest Insights Council survey on patient engagement call the time investment required by health teams the biggest challenge in designing patient engagement into care delivery.The underlying issue is reimbursements, says Bertrand Ross, MD, FACC, FACP, Medical Director at Virginia-based Optima Health, a subsidiary of Sentara Healthcare providing health plan coverage to more than 450,000 members. “The problem is that incentives [for patient engagement] are not aligned. The time and effort to educate, motivate, and troubleshoot issues regarding patient engagement are not recompensed very well at present.” Create alignment, he says, and the time investment challenge will disappear.”

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Most healthcare providers don’t know cost of a common ER visit, study says

Researchers have found that an average of only 38 percent of emergency medicine healthcare professionals — including physicians, physician assistants and nurse practitioners — accurately estimated the costs for three common conditions seen in the emergency department. Improving that percentage has the potential to lower costs for patients and the overall healthcare system, according to a study published in The Journal of the American Osteopathic Association.

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ER Docs Blasted for Price-Gouging Patients

A sweeping analysis of billing records from more than 12,000 emergency physicians nationwide suggests dramatically inflated and wildly varying charges for services ranging from CT scans to wound suturing.

“There are massive disparities in service costs across emergency rooms and that price gouging is the worst for the most vulnerable populations,” says study senior author Martin Makary, MD, MPH, professor of surgery at the Johns Hopkins University School of Medicine, in remarks accompanying the report.

“This study adds to the growing pile of evidence that to address the huge disparities in healthcare, healthcare pricing needs to be fairer and more transparent,” he says.

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5 Ways to Reduce Costly Diagnostic Errors

Diagnostic errors, no matter their origin, are costly.

The National Academies of Sciences, Engineering, and Medicine—Health and Medicine Division found that 5% of U.S. adults who seek outpatient care each year experience a diagnostic error.

Diagnosis-related payments, Johns Hopkins researchers found, amounted to $38.8 billion between 1986 and 2010.

But there are things physicians and care teams can do to improve diagnostic accuracy.

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One Solution to Short-Staffed Medical Practices 

Top Reasons for Turnover

A poor cultural and community fit are consistently reported as the top reasons for turnover (72 percent). Moving to be closer to family members or due to a spouse’s job relocation ranked second (50 percent) in the same study. The rate of turnover is highest among new providers in their earliest years of employment, reflecting the challenges that practices face in vetting these issues beginning with the recruitment process.

The most recent surveys of physicians also point to the increasing bureaucracy of administrative duties, EHR demands, and quality reporting requirements as reasons for high job dissatisfaction. According to a recent study published in the Annals of Internal Medicine, doctors report that for every hour spent with patients, they now spend two more hours completing administrative tasks related to their visit.

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MACRA: Easing Physician-Practice Pain Points

In the high-stakes transition to Medicare’s new value-based payment system, physician organizations face looming deadline to attain full compliance with MACRA’s data reporting requirements, which will drive payment bonuses and penalties for clinicians.
With implementation of Medicare’s Quality Payment Program (QPP) shifting to high gear in January, most physician practices are either fine-tuning capabilities for the new value-based payment system or facing >multiple pain points.

In 2015, Congress established the QPP through the Medicare Access & CHIP Reauthorization Act (>MACRA). There are two payment tracks under QPP:

Starting in 2019, most clinicians receiving reimbursement through QPP will be paid through the Merit-based Incentive Payment System (MIPS), which features data reporting in four performance categories that drive payment bonus and penalty mechanisms
Clinicians participating in MACRA-approved alternative payment models (APMs) such as the Medicare Shared Savings Program can earn 5% payment bonuses.

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