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Trumpeted New Medicare Advantage Benefits Will Be Hard For Seniors To Find

Emc NC — Thu, 29 Nov 2018 12:10:48 +0000

Trumpeted New Medicare Advantage Benefits Will Be Hard For Seniors To Find

Nursing and feeding senior sick woman in wheelchair

For some older adults, private Medicare Advantage plans next year will offer a host of new benefits, such as transportation to medical appointments, home-delivered meals, wheelchair ramps, bathroom grab bars or air conditioners for asthma sufferers.

But the new benefits will not be widely available, and they won’t be easy to find.

Of the 3,700 plans across the country next year, only 273 in 21 states will offer at least one. About 7 percent of Advantage members — 1.5 million people — will have access, Medicare officials estimate.

That means even for the savviest shoppers it will be a challenge to figure out which plans offer the new benefits and who qualifies for them.

Medicare officials have touted the expansion as historic and an innovative way to keep seniors healthy and independent. Despite that enthusiasm, a full listing of the new services is not available on the web-based “Medicare Plan Finder,” the government tool used by beneficiaries, counselors and insurance agents to sort through dozens of plan options.

Even if people sign up for those plans, they won’t all be eligible for all the benefits. Advantage members will need a recommendation from a health care provider in the plan’s network. Then they may need to have a certain chronic health problem, a recent hospitalization or meet other eligibility requirements.

Medicare counselors from California to Maine say key details are not included on the government’s website. In some cases, if insurers offer the new benefits, the plan finder “will indicate ‘yes’ or ‘no,’” said Georgia Gerdes a health care choices specialist at AgeOptions, the Area Agency on Aging in Oak Park, Ill., outside Chicago. That’s hardly enough, she said.

“There is a lot of information on the plan finder, but there is a lot of information missing that requires beneficiaries to do more research,” said Deb McFarland, Medicare services program supervisor at the Southern Maine Agency on Aging.

Nonetheless, officials say the added benefits will help Advantage members prevent costly hospitalizations. Federal approval of additional benefits is “one of the most significant changes made to the Medicare program,” Seema Verma, the head of the Centers for Medicare & Medicaid Services, told an insurers’ meeting last month. She said she expects plans to expand services in coming years.

Medicare Advantage plans, which are an alternative to traditional Medicare, serve 21 million beneficiaries and limit their out-of-pocket expenses. But they also restrict members to a network of doctors, hospitals and other medical providers. They often offer benefits not available in traditional Medicare, such as dental and vision care, hearing aids and gym memberships.

The federal government pays a set amount to the plans to help cover the cost of each member. The Trump administration gave insurers more money to spend on benefits next year — an average pay raise of 3.4 percent, seven times more than the rate of increase in 2018.

Enrollment is underway for Medicare Advantage plans, as well as for people in traditional Medicare who want to buy a policy for drug coverage. The deadline for choosing either type of plan is Dec. 7.

Among the new benefits that some Medicare Advantage plans said they will offer are:

Trips to the pharmacy or fitness center in addition to doctor’s appointments for plan members, depending on where they live or their health conditions.
A monthly or quarterly allowance for over-the-counter pharmacy products such as cold and allergy medications, eye drops, vitamins, supplements and compression stockings.
House calls by doctors or other health care providers, under certain conditions.
A home health care aide for a limited number of hours to help with dressing, eating and other daily activities, possibly including household chores and light housekeeping.

However, plans offering these and other services will likely have only some of the options and will have different eligibility criteria and other limitations. The same services likely won’t be available in every county the plan serves.

For example, next year an estimated 150,000 Humana Medicare Advantage members in Texas and South Florida — two of the 43 states Humana serves — who cannot be left alone at home will be able to get a free in-home personal care aide for up to 42 hours a year, so that their regular caregiver can get a break. And more than half of the members in Cigna-HealthSpring Advantage plans will have access to free transportation services in all but five of the 16 states and the District of Columbia where the company sells coverage.

To find these supplemental benefits, seniors can use the online plan finder. After they enter their ZIP code and get a list of plans available locally, they can click on a plan name. That will take them to another page that offers more details about coverage, including a tab for health and drug plan benefits. That page might say whether the new services are offered.

But often the website will simply indicate that specific benefits are available — and perhaps not name them — and advise consumers to contact the plan for more information. A Medicare spokesperson confirmed that there is currently not an indicator on the plan finder for plans offering these expanded health-related supplemental benefits.

In addition to extra benefits, other variables should be considered when choosing an Advantage plan, such as which health care providers and pharmacies participate in a plan’s network, which drugs are covered and the costs.

Where available, several insurers say the new services will be free with no increase in monthly premiums.

“We certainly believe that all of the ancillary benefits we provide will help keep our members healthy, which is good for them, and it’s good for us in the long run,” said Steve Warner, head of the Medicare Advantage product team at UnitedHealthcare, which insures about 5 million seniors or 1 in 4 Medicare Advantage members.

Insurers are betting that services will eventually pay for themselves.

Dawn Maroney, consumer president at Alignment Healthcare, which serves eight counties in Southern California, said it’s much cheaper to give an air conditioner to someone with congestive heart failure to keep that patient healthy than to pay for more expensive medical treatment.

But if the new benefits are such a good idea, they should be available to the majority of older adults in traditional Medicare, said David Lipschutz, a senior policy attorney at the Center for Medicare Advocacy.

For free help with Medicare Advantage and drug plan enrollment, contact the federally funded State Health Insurance Assistance Program (www.shiptacenter.org), the Medicare Rights Center, 800-333-4114 or its website, www.medicareinteractive.org. The Medicare Plan Finder website is available at https://www.medicare.gov/find-a-plan/questions/home.aspx or call 800-633-4227.

What to look for in a good EMR/ EHR software

Emc NC — Tue, 05 Sep 2017 06:11:48 +0000

Medical people are not very tech savvy and they are often daunted by the software terminology and technology. The task of understanding the IT technology is made complicated due to the inherent culture of software people in inventing new terms at a faster pace than anyone can comprehend.

The research shows, medical people are often a late adopter of IT technology, be it social media or software to enhance practice. In practice management, it all started with various billing software that continued to add features for medical practice. Thus the early software of medical practice management were born. Soon many doctors adopted the electronic medical record (EMR) systems, shifting most of the paper information on electronic media, with some added features to manage patient scheduling, integration with billing, helping to monitor patient care, easy access to patient’s health history.

From EMR to EHR

The early EMR systems did help to manage the practice more efficiently, though they were not always easy to learn and had limited advantage over the traditional paper format. In fact, some of the doctors found them even slower than paper work. Thus leaving a bad taste in the mouth of some medical professionals.

But as the technology evolved, software improved at a quick pace, taking advantage of a better understanding of needs, improved connectivity. Modern practice management software understands the need of involving the patient and other healthcare partners, this gave birth to similarly sounding, yet much feature rich concept called electronic health record (EHR).

EHR is the big brother of EMR, and if a doctor is using EMR then there are serious reasons to upgrade. As the cell-phones have become smarter in a last decade or so, so have the practice management software. Now most of them would take the advantage of cloud technology, easy sharing of data between departments and locations. The patients also have access and control of their medical records. Integration with partners mean that results of lab tests can be directly added into the medical record of the patient by the lab. Use of connectivity means, better scheduling, reminding, information sharing. Newer practice management software is a completely new concept, thus not implementing the latest EHR is similar to refusing from the usage of the smart phone.

Basics of EHR

Good EHR does not have to be expensive

Cost is the first thing that comes to our mind whether we are implementing the EHR or looking for an upgrade. But things have changed a lot in last five years. These days EHR systems are not expensive, with many offering trial periods or even free versions to start with. You mostly pay for the premium features, and they will surely result in cost saving for you in the long run.

Know the platform

It is important that the solution must be available for use on the maximum number of the platform, on your computers and laptops, mobile phones. These days cloud based solutions are quite common, meaning that they are not dependent on the platform or location, and data sharing is also easier. So you will have your EHR system available even if you are on your tab or phone and attending the conference. With every technology do come to some challenges. With cloud based platforms it is very important to know about the security and data privacy. Some of the companies offering cheaper or free service may be making money by selling the patient’s data.

Know the scope of EMR for your practice

One size does not fit all, each EMR is made by keeping in mind different categories of users. Some systems are better for hospitals while other for ambulatory conditions. Size of practice also matters a lot, some systems are made for large teams, while other are better suited for the individual independent practitioner.

Most sought after EMR features

Below is the list of features that most practitioners find useful, this it is important that good EMR system should include each of them;

E-prescribing
Easy access to patient information
Allow other team members to access and edit patient information
Allow for drug interaction and allergy check
Incorporation of data from clinical lab test results
Provide clinical summaries of visits to the patients
Billing system integration
Auto-reminders
Document scanning
Medication tracking

What to know before buying or changing your EMR/EHR

Below is the list of things you must know and ask yourself and the vendor before you choose a EHR system for your practice or institution, these questions are based on the recommendation of American Medical Association;

1. What are your exact needs?

It is you who have to identify the exact needs and expectations from the EHR, you should have a clear understanding of problems that you expect EHR system to solve. You need to carefully analyze your workflow, know the needs of integration of EHR with pre-existing systems being used in billing, lab, colleagues.

2. Does EMR offer all the functions for your needs?

Know about the features, and ask about the customization options and costs related to it.

3. How will you transfer your existing data to the new platform?

Does the vendor provide such services, or it can be done easily and automatically, or all have to be transferred manually?

4. Does vendor provide fully functional trial?

This will help you to test the features in real life conditions, after testing you can identify the missing features.

5. What is vendor’s experience in providing such services?

For how much time vendor has been in business? who are the important clients who could recommend their product? Who are the clients of the vendor (hospitals, private practitioners, their specializations)?

6. Are real costs of the product understood?

Pay special attention to the hidden cost, like product may not be expensive but customization may be very expensive. Per user license fee, maintenance costs, costs of future upgrades.

7. Is training cost included in the products?

8. Where does your data reside, and as per agreement who has the access to the data?

9. What happens if the system fails or you are not satisfied?

10. What are the warranties?

So before attending the sales call from any vendor, you must do your own research and be prepared with the questions and information so that nothing is missed.

Do Small Physician Practices Have a Future?

Emc NC — Thu, 02 Jun 2016 06:10:45 +0000

There’s a lot to absorb in the proposed rule for implementing “MACRA”—the sprawling, bipartisan law passed in 2015 aimed at moving Medicare physician payment from rewarding volume to rewarding value. One question attracting scrutiny is whether the reforms will favor larger practices at the expense of smaller ones. This debate was partly prompted by the Centers for Medicare and Medicaid Service’s own projections that the law would reduce payments for most solo practices.

The controversy over MACRA (the Medicare Access and CHIP Reauthorization Act) raises broader questions. How has physician practice size evolved in recent decades, and what has been driving these changes? And, more generally, would it be a problem if the number of solo and small practices dramatically diminished, or even if they mostly disappeared?

How is practice size changing?

A quick glance at the historical record shows that solo practice has been on the wane for most of the past three decades, so the decline can’t be attributed wholly to MACRA, or the Affordable Care Act (Exhibit 1). Between 1983 and 2014, the percentage of physicians practicing alone fell from 41 percent to 17 percent. Over the same period, the percentage of physicians in practices with 25 or more doctors grew fourfold (5% to 20%).

And yet, despite these changes, small practices remain common. Four of 10 physicians are in practices with fewer than five physicians. These are especially common in rural areas, where lower demand can make larger practices less viable.

What’s driving the decline of solo and small practices?

In part, the shift from small to large practices reflects what social scientists call a “cohort effect”—younger doctors are 2.5 times less likely than older doctors to be in solo practice, and so as solo practitioners retire they are not being replaced. Younger physicians appear to prefer larger practices for the more predictable income and work–life balance they can offer. They may also shy away from the business and entrepreneurial responsibilities demanded by solo practice.

But this generational shift is not the end of the story. There is a secular trend away from small practices among physicians of all ages.

Market dynamics partly drive this development. Practices feel pressure to grow in order to compete with other local providers, and to strengthen their negotiating position with insurers. These pressures can create an arms-race mentality, leading to ever greater consolidation. This leads not only to larger practices, but also to the distinct but related trend of hospitals buying up physician practices to shore up their position.

In addition, public and private actions that create more administrative burdens play a role in the decline of small practices. Employers, insurers, and government are requiring levels of transparency about cost and quality – including through laws like MACRA – that are difficult for small groups and solo practitioners to manage. They often lack the infrastructure needed to collect, manage, and report data, particularly in the age of digitized health information.

Finally, care coordination requires a higher level of organization and new personnel, both of which can be difficult for small practices to afford. As patients and insurers demand seamless, integrated care, larger practices may increasingly gain the upper hand.

How much of a problem would the disappearance of small practices be?

The evidence on whether quality is better in large or small practices is mixed. On one hand, larger practices are more likely to adopt quality improvement strategies that benefit from economies of scale, such as health information technology, multidisciplinary care teams, and after-hours access.

But an important study by Lawrence Casalino et al., funded by The Commonwealth Fund, revealed that patients of physicians practicing in solo and small practices have lower rates of preventable readmissions than those in larger practices. Furthermore, many patients and physicians deeply value the personal relationships that smaller settings can cultivate.

Regardless of the pros and cons, small practices are likely to remain common in rural areas, and some doctors and patients will always prefer them. They will continue to have a role in our health care system.

So the question becomes how to help small practices transition to the new paradigm being created by MACRA and other changes in the health care system. There are several strategies available to both policymakers and private stakeholders, including:

Encouraging physician networks (e.g., independent practice associations) that enable small practices to share resources.
Providing technical support to solo and small practices, as the HITECH Act did through a system of regional extension centers.
Developing payment models that include upfront grants or loans for practices to invest in necessary infrastructure.
Improving health information technology so that it reduces—rather than increases—the burdens of solo practice.

In recent statements, CMS has affirmed it is looking for ways to help solo physicians and small groups adapt to MACRA, including making $100 million available for technical support. In the coming years, special attention will need to be paid so that small practices are able to keep up with changes that will, hopefully, raise the performance of medical providers of all sizes.

By David Squires and David Blumenthal, M.D.

Welcome

Emc NC — Mon, 08 Feb 2016 06:00:37 +0000

Elite Management Solutions LLC is a professional billing service dedicated to meeting all of the insurance and patient billing needs of your practice. We would like to first welcome you to our company site. At Elite Management Solutions we strive for excellence. We are dedicated to solving your practice needs because we care.

With all that is going on in healthcare today, it can be hard to stay abreast with the changes. With that being said, we are now four months into ICD10. This is the optimal time to assets your current billing and account receivables to ensure you are get the most out of ICD10 code. With the ICD10 transition you want to make sure your denials and rejections have not increased. You can optimize your revenue cycle management by analyzing reports, performing a coding audit and reviewing your A/R processes.

You can run denial reports on a quarterly basis to look for trends and patterns for why claims are being denied. Some denials can be prevented by simple staff education. Auditing your code against your medical records for accuracy and specificity on a regular basis will also help with this. This should also be done on a quarterly basis to keep it manageable. With the changeover to ICD10 this is an ideal time to do this.

Did you know that medical practices never collect on an estimated 18% of claims. 70% of claims are paid the first time they’re submitted. 30% are either denied (20%) or lost or ignored (10%). 60% of those 30% are never resubmitted to payers. It is advantageous for a practice to keep or with their A/R weekly.

This is where Elite Management Solutions would like to help. Give us a call or contact us here and let us see how we can improve your revenue cycle.