Practice Financial Management – Insights & Tips From MedCV That You Need to Quickly Maximize Your Income

Financial Improvement

Hospitals and medical groups are finally shaking off the economic fallout of the Covid-19 Pandemic, but now historic inflation and looming economic uncertainties continue to place significant pressure on them to improve their financial performance. That’s why John Rezen (FACHE, MHA) in collaboration with MedCV have brought back this series of 2-3 minute reads on how You can assess and improve your practice financial performance in 12 essential areas. Each installment will help you and your team quickly add cash to your bottom line by allowing your practice to work smarter and harder. The following checklist of performance measures will help physician enterprises identify financial opportunities and accelerate their improvements. Below are the 12 topics, to read a previous segment, click on the name/link. The current segment is in Blue and upcoming segments are in Black.

Even if you are not directly responsible for the management of your practice, knowing this information will help you make sure you are making the income you and your team have earned. So let’s get started!

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Tip 6 of 12 – Offer value or risk losing money! CMS offers incentives you need to take advantage of!

Focus on Value Based Care and Population Health:

a. Assessment: In recent years, CMS has recognized the need to focus on preventing periods of acute illness as well as promoting health and wellness. As a result, they have added payments for services that support these objectives. One such service is the Annual Wellness Visit (AWV), which updates the provider on the patient’s health history and helps to create a personalized prevention plan. Next, the Chronic Care Management (CCM) code enables providers to bill for continuing support services outside of the face-to-face visit for patients with multiple chronic conditions. Providers must properly document the time and services provided for these CCM claims. Transitional Care Management (TCM) is a third service promoted by CMS involving physician follow-up with patients post-hospital discharge. These follow-up calls and visits should prevent gaps in care and reduce the probability of re-admissions for the same illness. CMS also pays for Remote Patient Monitoring (RPM) services, which focus on patients with chronic conditions such as COPD, heart failure, or diabetes. RPM services function to prevent periods of high acuity and increase the capacity of the physicians’ medical team. Such reduced periods of high acuity will also result in a reduction in emergency visits and hospital admissions.

The opportunity for each of these codes can be assessed as follows:

• AWV: This value is projected by totaling the number of Medicare patients on your primary care panels and multiplying that total by the average reimbursement. The CPT codes are G0438 (initial) and G0439 (subsequent). The average reimbursement is $132.
• CCM: To project this annual value, identify the total number of Medicare patients with two or more chronic conditions on your primary care panels. Then multiply that number by the average reimbursement per month and multiply the result by 12. The CPT code is 99490 and the average reimbursement is $42—assuming that patient services for each patient consume 20 minutes per month.
• TCM: Use historical data to identify the number of annual hospital discharges for Medicare patients on your physician panels. Multiple this number by the TCM reimbursement rate. CPT code 99495, at a reimbursement of $175, is charged on moderately complex patients if contacted within two days of discharge and a face-to-face occurs within 14 days. CPT code 99496, at a reimbursement of $237, is charged on highly complex patients if contacted within two days of discharge and a face-to-face occurs within 7 days.
• RPM: Four CPT codes apply to this service. The first code, 99453, is for the equipment set-up and patient education. CMS pays $19 for this one-time service. Next, code 99454 is for the equipment and daily monitoring. The CMS rate for this service is $64 every thirty days of use. The intervention and treatment services resulting from the RPM pay $51 for the first 20 minutes and $42 for each additional 20 minutes each month. These services are assigned codes 99457 and 99458, respectively. Your revenue potential from this opportunity can be projected by working with your physicians to identify the patients who will benefit from this service and then applying the above reimbursement rates to the resulting volumes.

b. Improvement Action:

Physician education is a foundational step toward pursuing the population health opportunities.  Assigning a physician population health champion who leads by example is also essential.  Next, the process of care must be clearly identified for each of the four services with key access points established and required actions defined to initiate these services. 

Quantifying the opportunity at the provider level and instituting population health performance factors in the compensation system will also help improve participation.   While some organizations may find the above steps sufficient to institute these population health services, others will find the need for additional support to accomplish their population health goals.

Fortunately, several vendors offer software and support services that reduce the effort required of the provider to accomplish these services.  Some vendors provide no risk contracts with their fees established as a percent of the additional revenue generated by the service.

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As a physician, if this sounds like a lot of work and maybe even has your “business anxiety level” up a few notches, you are not alone. The great news is that your role in this should just be to make sure it gets done and that those who are going to be responsible and accountable for this can explain and report details about what the plan looks like and its status to you.

Share this article with your practice manager, group administration, or hospital administration to make sure they are working on this or see what resources they have to get at this work. If they need help in getting started, they should consider connecting with John Rezen at Value Health. The key is to be able to have your baseline, you would expect your team to report to you the improvement(s) made and the results.

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Stay tuned for Part 7 of 12: Staffing Minutes per Encounter next week. If you can’t wait that long, no problem, just contact John for the full 12-part series. Again, it’s in your best financial interest to make sure each of these 12 Key Performance Indicators are optimized, you understand them, and take action, even if the action you take is to share the series and your new found business insight with your group or hospital administration.