Inspector General's Report on Medicare Advantage Plans
Medicare Advantage plans now cover more than 1/3 of all Medicare beneficiaries and that number is on track to rise to 50% by 2021.
But a new report from the Inspector General found that Medicare Advantage plans have "widespread and persistent problems related to denials of care and payment."
Also, Medicare Advantage plans often have onerous and unnecessary prior authorization requirements that traditional Medicare does not. Medicare Advantage reimbursement also tends to be well below what traditional Medicare pays.
Relatively few people appeal denial of Medicare Advantage claims, leaving insurers free to avoid payment. But nearly 75% of appeals are successful with Medicare Advantage plans!
You need a billing company who is working to get you paid every cent you are owed! Contact us to see how Medicare Advantage plans are impacting your payer mix and your bottom line.
Learn more about the Inspector General's Medicare Advantage Report:
https://www.nytimes.com/2018/10/13/us/politics/medicare-claims-private-plans.html
Progress Report Requirements: Get the Low Down
Documentation is extremely important because it serves as a record of patient care, including report of patient status, physical therapy management, and the outcome of physical therapy. Each insurance has different requirements for what must be included in specifically in progress report documentation.
Here are some highlights that you should be aware of every time you are completing a progress report:
Medicare:
Date that the report was written
Date of the beginning and end of the reporting period that this report refers to
Objective reports of the patient’s subjective statements, if they are relevant
Objective measurements (preferred) or description of changes in status relative to each goal currently being addressed in treatment, if they occur
Assessment of improvement, extent of progress (or lack thereof) toward each goal
Plans for continuing treatment, reference to additional evaluation results, and/or treatment plan revisions should be documented in the clinician’s progress report
Changes to long or short term goals, discharge or an updated plan of care that is sent to the physician for certification of the next interval of treatment
Signature, and professional identification, or for dictated documentation, the identification of the qualified professional who wrote the report and the date on which it was dictated
Blue Cross Blue Shield:
Time period covered by the report
Start of Care Date
Medical and therapy treatment diagnoses
Statement of the individual’s functional level at the beginning of the progress report period
Statement of the individual’s current status as compared to evaluation baseline data and the prior progress report, including objective measures of the individual’s function that relate to the treatment goals
Changes in prognosis and why
Changes in plan of care and why
Changes in goals and why
Consultations with other professionals or coordination of services, if applicable
Signature and title of qualified professional responsible for the therapy services
Have other main payers in your payer mix that you want to learn more about requirements for? Contact us inquiries@lincolnrs.com with questions.
Are You Ready for MIPS?
By now, you have heard about MACRA, MIPS, APM, VBC, etc. but what do these acronyms mean, why do they apply to you, and what are you doing to prepare for future payment changes?
The Medicare Access and CHIP Reauthorization ACT of 2015 (MACRA) repealed the SGR and required CMS to come up with formula to pay providers based on quality.
MACRA created the Merit-Based Incentive Payment System aka MIPS.
So what is MIPS?
Streamlines several quality reporting programs under Part B into one program. Includes PQRS, the value-based modifier program, and meaningful use of HER technology.
Unlike PQRS, MIPS is performance based and the therapist’s performance will be scored using performance benchmarks.
Currently you can “pick your pace” but the more advanced you choose, the higher the potential incentives.
MIPS adjustments for payments can be anywhere between +/- 5% in 2018, 7% in 2020, 9% beyond 2020.
MIPS is a revenue neutral program. Winners are paid by the losers! Not all metrics and Quality Measures are created equal. To find out how you can differentiate yourselves and prepare yourselves to succeed in the coming years under MIPS, contact us - the MIPS experts - at inquiries@lincolnrs.com
#ChoosePT
October is National Physical Therapy Month!
The American Physical Therapy Association is focusing this year’s awareness month on highlighting how physical therapy is a safe and effective alternative to opioids for the treatment of chronic pain conditions.
The ongoing opioid crisis in the United States reflects the unintended consequences of a nationwide effort to help individuals control their pain. The health care system has, since the mid-1990s, employed an approach to pain management that focuses on the pharmacological masking of pain, rather than treating the actual cause(s) of the pain when its source can be identified.
Chronic pain can be considered a disease state and can persist for months or years. When PTs work with patients in pain, they use tests and measures to determine the causes of that pain and to assess its intensity, quality, and temporal and physical characteristics.
PTs also evaluate individuals for risk factors for pain to help prevent future pain issues. Some of these risk factors might include: disease history, cognitive and psychological factors, beliefs, and sedentary lifestyle. To help address the pain causes, PTs can implement exercise programs, manual therapy, sleep hygiene and stress management.
Join us in celebrating National Physical Therapy month and help raise awareness about physical therapy as a first step in pain management. #ChoosePT
Learn more: http://www.apta.org/NPTM/
Learn more: http://www.apta.org/uploadedFiles/APTAorg/Advocacy/Federal/Legislative_Issues/Opioid/APTAOpioidWhitePaper.pdf