microscopeOnce you have obtained a copy of the signed and executed contract from the payor, review the document carefully to ensure that it is signed and executed by both parties. As you review the contract you may wish to summarize key information on a cover sheet that includes all major terms.

contractThe first step to assessing your payor contracts is to obtain a copy of the signed and executed contract from each contracted payor. If you do not have a copy on file, you can request a copy from the payor.

docatdeskMost physician practices know the plans in which they participate.  They know they have a contract in place that covers payment terms and rates.  They just don't know where that contract is or what it includes.  They vaguely remember signing something a long time ago and have left it at that.

In an bulletin issued January 16, 2014, CMS announced the submission timeframes for 2014 PQRS data.

PQRS provides an incentive payment to individual eligible professionals (EPs) and group practices that satisfactorily participate or satisfactorily report data on quality measures for covered Medicare Physician Fee Schedule (PFS) services. Additionally, those who do not meet the 2014 PQRS reporting requirements will be subject to a negative payment adjustment on all Medicare Part B PFS services rendered in 2016.

CMSIn a last minute move, CMS released newly-updated national Medicare RVU files for 2015 on December 30, 2014.

CMSEligible professionals (EPs) and Group practices (GPs) who believe they have been inappropriately penalized for the PQRS reporting period of January 1, 2013 – December 31, 2013 may appeal their results via an informal review process to CMS during the time period of January 1, 2015 through February 28, 2015.

Starting in January 2015, Medicare payments will be determined by the 2015 Medicare Physician Fee Schedule. The rule brings a number of changes that are critical for doctors and practice managers to understand.

Join us as we review the key highlights of the CMS ruling, including:

Today, 13% of all US health systems offer health plans in one or more markets --commercial, Medicare Advantage (MA), or managed Medicaid. Together, these 107 systems operate health plans covering about 18 million members, about 8% of all insured lives. And there are more coming, with ten more provider-led plans being offered on the public exchanges in 2015.

25percentIf the government gives you money, you can expect that it will look to audit your results. Since 2011, CMS has disbursed nearly $20 Billion under the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs, to nearly half a million eligible professionals. It should come as no surprise that CMS now intends to audit at least 5% of Meaningful Use attesters.

What are your top practice priorities for 2015? According to research from MedData Group, physicians identified the successful implementation of ICD-10 as their top practice management initiative. At MDeverywhere we agree. The transition to ICD-10 will be catastrophic for the unprepared. As the code set increases dramatically, practices that are not fully prepared will likely experience an increase in denials, ballooning AR and reduced cash flow.