With the alarming shortage of primary care physicians facing the United States, one has to wonder if Nurse Practitioners and PAs are going to represent the new Primary Care providers.  This is already one of the fastest growing segments of the healthcare industry and with the continuing shortage of family practice, internal medicine, and pediatricians, one can assume that it will not be changing anytime in the near future.

What is the answer to the shortage?  Well, some say more money but how much more and how do you force the commercial insurance industry to comply with standards adopted by Medicare.  There currently is no regulation specifically requiring commercial insurance companies to follow the guidelines produced by CMS.  So even if CMS does what many have suggested and increase the physician fee schedule for Medicare, what makes anyone believe that commercial insurance carriers are going to just fall in line.

I hope for the sake of our healthcare system that we come up with a solution fast or we are going to be in for a rude awakening as the wait times and locations continue to dwindle.

Paying for payment reform

The House-passed Medicare physician payment reform bill would cost the federal government an estimated $210 billion over 10 years. Nearly $260 billion in higher pay would go to physicians and health plans to treat seniors and military members over that time. But beneficiaries would make up roughly $50 billion of that through higher premiums.

Source: Congressional Budget Office Cost Estimate on H.R. 3961Medicare Physician Payment Reform Act of 2009, Nov. 4 (www.cbo.gov/showdoc.cfm?index=10704)

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Senate plan for reform

Senate Democratic leaders unveiled their version of a health system reform bill Nov. 18, and the full Senate will begin debating the measure when lawmakers return from their Thanksgiving break. The bill would extend coverage to an estimated 94% of Americans at a projected cost of $848 billion over 10 years. It also would cut the deficit by an estimated $127 billion in its first decade. It includes proposals for:

• State health insurance exchanges by 2014 that residents could use to obtain coverage.
• A public health insurance option that allows individual states to opt out of participation.
• A requirement that most individuals obtain coverage by 2014 or pay a penalty.
• Affordability credits for those earning up to 400% of the poverty level.
• Medicaid eligibility expansion to 133% of the poverty level.
• New health insurance coverage and market reforms.
• Replacement of the 21.2% Medicare physician fee cut in 2010 with a 0.5% increase.
• A 40% excise tax on “Cadillac” health plans, as well as additional fees on health plans, hospitals, and drug- and device-makers.
• Higher Medicare payroll taxes for higher-income workers.
• A 5% excise tax on voluntary cosmetic surgical and medical procedures.
• A Medicare ban on new physician-owned hospitals.
• An extension through 2014 of the Medicare Physician Quality Reporting Initiative.
• A new federal Center for Medicare and Medicaid Innovation to test alternative payment and delivery models.
• A national, voluntary Medicare payment bundling pilot program.

It also includes more help for Primary Care in the form of an additional 1% over GDP.  The House Medicare pay bill sets a new spending growth rate target for physician services that would be equal to the gross domestic product plus 1%. Preventive care and evaluation and management services would have a separate target of gross domestic product plus 2%, allowing primary care pay to increase at higher rates over time.

Source: The Patient Protection and Affordable Care Act

It is important to note that this bill is unlikely to pass the senate in its current format.  We should know what the Senate will do in the next couple of weeks as they should finish before the Christmas holidays.

Two primary care clinics will close as part of 93 layoffs announced Nov. 11 by the Jackson Health System in Miami.

The closures and layoffs, scheduled to occur in January 2010, come as the county-run hospital system has tried to cut a $168 million budget shortfall. The system previously was able to cut $61.7 million. But it said it also needs to close the primary care clinics, as well as a liver transplant unit, a heart-and-lung transplant unit, a wound care unit and a mental health unit.

Attempts to convert the primary care clinics into federally qualified health centers were not successful, according to Jackson officials.

The system did not disclose if any doctors would be laid off. Jackson Health uses a combination of doctors affiliated with the University of Miami Miller School of Medicine as well as its own employed physicians.

Jackson began hiring its own doctors and expanding its services several years ago when the University of Miami, which had used Jackson Memorial Hospital as its teaching facility, considered getting its own facility. In 2007 the university bought Cedars Medical Center, across the street from Jackson.

While University of Miami doctors continued to work at Jackson, tensions between the two sides began running higher, culminating in a Nov. 2 summit in which school officials criticized the quality of doctors that Jackson was hiring and the hospital system’s expansion strategy.

Meanwhile, Jackson leaders accused the university of sending private insurance patients to Cedars and the poor and uninsured to Jackson.

The Jackson system is funded by property and sales taxes, both of which, the hospital said, have dropped considerably over the past few years because of the economic recession and the rapid drop in the area’s land values. The recession also has brought increased demand from uninsured patients.

Closing the clinic and other units will not be enough to fill the rest of the budget gap, so hospital executives are still looking for more areas to cut.

The employee cutbacks were announced in a year that already has seen a large number of mass layoffs at hospitals. As of Sept. 30, the Bureau of Labor Statistics said there had been 127 layoffs involving 50 or more employees. That already exceeds the 112 mass layoffs for all of 2008, and nearly double the 67 for 2007.

7 Step AR Recovery Process:

This plans takes for granted that you have adequate staff and sufficient practice management software. If you do not have these things we recommend that you contact the experts at Physicians World Online for a free consultation. info@physicianworldonline.com

1. VERIFY PATIENT INSURANCE ELIGIBILITY( this and accurate demographics are a must for collecting Insurance and Patient AR)

2. Evaluate Insurance Contracts to ensure they adhere to current CPT guidelines.

3. Adjust your charges with a consistent formula based on a percentage of Medicare.(This allows for an accurate gross and net collection percentage)

4. Scrub your claim and use a coder with knowledge of your specialty to ensure proper modifiers and diagnosis codes are appended.

5. Submit claim electronically to decrease the payment cycle of claim.

6. Do not wait to receive something in the mail, call when the claim is older than the contract allows.(Medicare 20 days, BCBS and other commercial carriers is usually 30 days)

7. BE PERSISTENT and don’t let them get away without paying you. Call and send documentation if required. Make sure to write down patterns with denied claims and send supporting documentation with original claim if needed.

This blog is dedicated to ensuring that Physicians, Owners, and Practice Admins within Primary Care are updated on the ever changing Medical Billing Industry. We will provide you industry experts, important news, and answer questions with our independent consultants to bring you the highest quality of information anywhere. Look no further for answers to your medical billing questions!

Regards,
PCMB Admin