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It’s easy to figure out what’s driving digital healthcare: physician shortages, graying population, lack of mobility in rural areas, frustration with health organization wait time and high costs, and of course, thanks to Google and Apple, the love of self-diagnosis! Patients now use their computers, tablets or smart-phones to teleconference with a doctor which is often less stressful and lower cost for treatment of chronic conditions. The fastest growing line of medical services is: one-time, on-demand visits with physicians 24-hours day, seven days a week via phone, video or email. No question healthcare is changing – physicians need to change with it. For the purposes of this article, we will be looking at telehealth and telemedicine. 

The telemedicine industry has been abuzz recently upon learning that “provider-friendly” legislation was included in the new federal Bipartisan Budget Act of 2018**, signed into law February 9, 2018. The bill introduces many significant changes to Medicare law to accommodate telehealth use.  Key elements of the bill include: (1) expanding stroke telemedicine coverage; (2) improving access to telehealth-enabled home dialysis oversight; (3) enabling patients to be provided with free at-home telehealth dialysis technology; (4) allowing Medicare Advantage plans to include delivery of telehealth services in a plan’s basic benefits; and (5) giving Accountable Care Organizations (ACOs) the ability to expand the use of telehealth services.

The 2018 Bipartisan Budget Act translates into increasing support for expanding Medicare telehealth reimbursement.  Telehealth providers should embrace the Act and use it as an opportunity to contribute to and develop meaningful telehealth reimbursement policies. Some changes take place immediately and others in 2019. Starting January 1, 2020, the patient’s home qualifies as an eligible originating site for telehealth services provided by a physician or practitioner participating in certain ACOs!  

Lobbyists are now turning their sights to getting Medicare to pay for treating opioid abusers and to allow the remote prescription of controlled substances to treat addiction, Also on the horizon, Medicare payment for remote care of patients in nursing homes. Legislation is being discussed to waive restrictions on the originating site of care if telemedicine is found to improve quality without reducing cost – or – reduce cost without impairing quality.

Although easily interchangeable, don’t confuse telehealth with telemedicine.  Telehealth may or may not include clinical services. Understand that Telemedicine is not a separate medical specialty and does not change what constitutes proper medical treatment and services, it is a delivery component. For both our New York and Florida physician clients and patients, “telehealth” means the use of electronic information and communication technologies by telehealth providers to deliver health care services, which shall include the assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient. Be aware that telehealth does not include audio-only telephone communication, fax machines, or electronic messaging (email/text) alone.

Telemedicine raises many legal and regulatory issues beyond the scope of this article. Health-care providers and regulators still face significant hurdles in adapting to new remote treatment. Some are regarding cross-state licensure, confidentiality and security, malpractice and liability, credentialing, prescribing rules, FDA as well as state regulations, electronic health records, and fraud prevention. Below is some helpful information to help you navigate within Fuoco Group practice areas in New York and Florida.

New York Definition and Details: “Telemedicine means the delivery of clinical health care services by means of real time two-way electronic audio-visual communications which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care, while such patient is at the originating site and the health care provider is at a distant site.”

New York has parity laws in place that allow coverage of telemedicine under private insurance and Medicaid. All specialties are covered by both Medicaid and private insurance. Eligible healthcare providers include: physician specialists, psychiatrists, psychologists, dentists, nurse practitioners, genetic counselors, licensed clinical social workers, and certified diabetes/asthma educators. Under the current Reimbursement Policy, Medicaid and private providers both provide live video. Private care plans may cover telemedicine at their own option and establish payment guidelines. Reimbursement Rate covers live video. Cross-state telemedicine licensing is allowed, however New York extends licensure reciprocity only to bordering tri-states New Jersey, Pennsylvania, and Connecticut.

Florida Definition and Details: “Telemedicine” means the practice of medicine by a licensed Florida physician or physician assistant where patient care, treatment, or services are provided through the use of medical information exchanged from one site to another via electronic communications. Telemedicine shall not include the provision of health care services through an audio only telephone, email messages, text messages, facsimile transmission, U.S. Mail or other parcel service, or any combination thereof.”

The standard of care shall remain the same regardless of whether a Florida licensed physician or physician assistant provides health care services in person or by telemedicine. Controlled substances shall not be prescribed through the use of telemedicine except for the treatment of psychiatric disorders. Prescribing medications based solely on an electronic medical questionnaire constitutes the failure to practice medicine with that level of care, skill, and treatment which is acceptable. Physicians and physician assistants shall not provide treatment recommendations, including issuing a prescription, via electronic or other means, unless certain elements have been met, including a documented patient evaluation, patient is inflormed regarding treatment options and the risks and benefits of treatment. Telemedicine does not alter any obligation regarding patient confidentiality or recordkeeping. Separate rulings have been issued regarding emergency medical services.

On a more financial note, implementation of private payer parity laws for telehealth has been spotty across the states. There is one in New York, but not Florida. A bill in Florida that would have created tax credit for health insurers and health maintenance organizations that cover telehealth services also failed. There are different tax implications for taxable vs tax-exempt providers regarding unrelated business income and definitions of what is a “patient.” Documentation of telehealth and telemedicine encounters are extremely important and must follow individual state rules regarding what is a recognized “originating site” and who approved practitioners are that may furnish and receive payment for telehealth services. Of course billing and coding for telehealth is a tangled web, but thankfully the GT modifier on professional claims for telehealth was just eliminated by the CMS (Centers for Medicare & Medicaid Services) on January 1, 2018. There are special rules for billing and payment for originating site facility fees, and as part of their expansion in telehealth reimbursement for 2018, the CMS is finalizing codes and payments for remote monitoring in both non-facility and facility settings.

Things are still a bit more complicated if telemedicine is being practiced by a Florida physician to a patient outside the state because that creates an interstate practice. Another challenge is that the treating physician needs to be licensed both in Florida and the state in which the patient is receiving care. New York rules are a bit more relaxed for the tri-state area as noted earlier.

The American Telemedicine Association and other organizations have started accreditation programs to identify top-quality telemedicine sites; the association also tells consumers to be wary of sites that sell products.

The American Medical Association approved new ethical guidelines for telemedicine, calling for participating doctors to recognize the limitations of such services and ensure that they have sufficient information to make clinical recommendations. 2018 legislative priorities include: modernizing state medical practice acts to lay the groundwork for adoption of telemedicine; promoting model legislation to ensure physicians are paid for the care they provide via telemedicine; and (very important) facilitating license portability through support of the Interstate Medical Licensure Compact.

In conclusion: This has just been a glimpse of the future – According to the Tampa Bay Times, BayCare Health System and Publix Super Markets are pairing up in telemedicine. Their product: convenience, as in going to the doctor while you shop for groceries! What started as an experiment will be expanding. There will be many opportunities within the changing landscape of digital healthcare no matter what you area of medical practice might be. Digital health apps, telehealth or telemedicine will NEVER replace the relationship with a primary care physician. Your professional accountants and advisors at Fuoco Group / TFG don’t want our physicians to be left behind or miss any financial opportunities while you do what you love: practice medicine, and make life better for your patients.

Have questions? Want to speak to your Fuoco Group advisor – contact us today! We are here to help you.

Gone are the good old days of the revenue cycle healthcare providers remember. They have been replaced by today’s reimbursement challenges and the problem of collecting final payments from patients after insurance has been billed. The new reality is that the final patient balance may take months to collect, unless the physician provider is pro-active, and that can wreak havoc on your revenue cycle.

Statistics on patient collections are compelling:

•    Collect “pre”-service = 80% to 90% capture
•    Collect “point-of-service” = 50% to 70% capture
•    Collect “post”-service = 40% capture

The cost of collections on patient receivables can be expensive, so here is what the professionals at Fuoco Group recommend as best practices to help physicians maximize collections:

•    Financial policies and collection procedures should be clear and well documented.
•    Staff must be trained regularly regarding prior authorizations and patient collections pre-, post-, and point-of-service.
•     Communicate expectations for payment to patients up front, either on registration forms, or practice website, etc.
•    Emphasize the importance of benefits verification and eligibility to staff.
•    Estimate costs and patient financial obligations at the first point of contact if possible, or as soon as possible.
•    Directly engage patients early in the process after deductibles and co-pays have been identified, be sure they are aware of their obligation for payment.
•    Be sure the “front desk” has a handle on the approach needed, and is incentivize to collect or follow up on balances.

Fortunately this is the new millennium and technology is available that can enhance collections. Enabling electronic transactions will lower operating costs and increase collections. Of course telephone calls help, but be sure to implement the following to increase your chances of payment:

•    Send timely statements and balance reminders by email as well as text, in addition to “snail-mail.”
•    Use secure click to pay links in those email and text reminders.
•    Accept multiple forms of payment, but also allow more than one way to securely pay: web portal, mobile phone “app,” credit card on file, debit cards, payment plans, even Care Credit!
•    If you have a high volume practice, an investment in medical collections software might make sense to help you mange both your patient and insurance collections process and follow up on accounts receivables quickly.

We’ve shared just one prescription that is part of our total care Rx for your financial health. Medicine is changing and so are your financial goals. Be a part of our New Financial Dialogue and see how our 360 degree approach can cut your risk, help you master the management of your practice, and bring you financial peace of mind for the future. Got questions? We have answers! Contact your New York or Florida Fuoco Group healthcare advisor at 855-534-2727.

No matter what type of healthcare business or medical practice you have, you will be able to benefit from most of these revenue enhancers and cost cutting ideas. 

Strategize Patient Collections

There is an increasing number of patients on high deductible insurance plans. One quarter of most medical practice revenue comes from patient co-pays, but only 60% of what’s due gets collected. Studies show when patients are informed of their responsibilities and asked to pay at the time of service, collection rates rise substantially. Make changes to your billing practices if you are invoicing small amounts by snail mail. Consider a payment portal on your website, and read our prior article on maximizing collections here: Physician Secrets For Maximizing Patient Collections

Get Social!

Most of you already have a practice website, but if you don’t have a social media presence, you’re falling behind your competition. 72% of patients now check out the internet for healthcare information and 62% are using online reviews to find new doctors, including facebook. An online presence is crucial to new patients finding you and your practice. Don’t forget to create or claim your profile on the major review sites like Vitals or Healthgrades. This will help your practice pop up in search results. 

Virtual Visits Have Value

Every medical or healthcare office experiences those seasonal scheduling nightmares! To replace lost revenue, consider telehealth which may or may not include clinical services. It covers the assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient and is reimbursable. Patients frozen out of the waiting room can now be accommodated, as well as the homebound who cannot get in to see you. Replace those after-hours urgent patient phone calls with reimbursable skype virtual visits! Read our prior article on increasing revenue with digital healthcare here: Telemedicine – What’s Driving Digital Healthcare?

Use Your Mid-Level Providers

Even small practices generally have a physician assistant or nurse practitioner on staff. Let them use and build their skill-set as much as possible – it is a great motivator. Having them handle quick patient requests and less complex conditions can get more patients in the door when your schedule is full. The more they’re doing at their pay grade – the more revenue you’ll be bringing in at less cost. Don’t have a PA or NP? You may want to consider hiring one after reading this article: What To Consider If You Are Considering Mid-Level Non-Physician Providers

Cut Down on No-Shows and Missed Appointments

No-shows and last minute cancellations can cost your practice thousands of dollars. Invest in an app that sends reminders out to cell phones about appointments. Installing a plug-in for your website with a patient scheduler may be helpful. Add a cancellation policy and charge a fee to let patients know you will not tolerate less than 24 hour notice. 

Annually Renegotiate Your Payor Contracts

Every year you should renegotiate your payor contracts to increase fee schedules. Track the data that shows your practice is getting great care outcomes in a cost-effective way, and you have the leverage to tell payors you deserve a raise. Hiring a qualified healthcare business advisor to assist with this initiative is well worth the cost.

Consider a Direct Payment Model

A direct payment model allows healthcare providers to deal with patients directly for payment, cutting out the insurance payors along with the red tape. This model, an alternative to fee-for-service insurance billing, typically charges patients a monthly, quarterly, or annual fee that covers all or most primary care services including clinical, laboratory, consultative services, along with care coordination and comprehensive care management. Advantages to physicians are the reduction of documentation requirements, prior authorization, electronic health records and burdensome desk duties known to contribute to doctor burnout. Advantages to patients include substantial savings, and a greater degree of access to and time with their physicians. This is not the same as “concierge care!” Find out more here: Direct Primary Care Payment Model Has Distinct Advantages

Outsourced IT

Work environment has a big impact on a provider’s empathy, focus, stress levels and overall performance. Keeping up with technology changes is important to your success. For healthcare, advances like electronic health records, cloud hosting and security software are critical pieces of the ability to care for patients. Does your system need a tune up? A change of carrier? Is your staff is always complaining about slow systems, hardware that’s down, and frequent stoppage and interruptions to workflow? It may be time to outsource your IT and tech support for more efficiency, especially if your staff is always waiting for it to work. After all – “time is money!” 

Examine Expenses Quarterly

Taking a regular look at your financial statements will allow you to spot overhead items that appear to be out of line or a drag on the bottom line. Look at what you are paying for copiers, postage machines, paper and office supplies. Don’t be afraid to shop around when your lease is up or move to sharing a single networked printer for everyone at your office rather than maintaining — and buying ink — for multiple printers. Ask vendors for discounts on shredding services, cleaning services, disposal services, and even basic medical supplies like gowns, gloves, etc. Look at kitchen items like water and coffee and snacks for staff, often there are savings to be had buying in bulk or from warehouse clubs. Very often the local Chamber of Commerce or Medical Society offers discounts for members on things like insurance, supplies, business services, etc.

Got Space?

Search for someone to share or lease that extra office space, it will generate income but could also initiate a synergistic relationship that yields new clients. Think of an esthetician if you are a dermatologist or plastic surgeon, massage if you are a chiropractor. Adding services may make a lot of sense if you have a loyal patient base. Depending on your practice, you could offer weight management and nutrition counseling for example. If you have the space and staff, consider adding a complementary line of facial products, nutritional supplements, medical tech accessories, etc. We have some more great ideas here: If You are Looking for More Profitability Look into Adding Product Lines

Join the Local Medical Society

Not only will you get discounts on insurance and office supplies, but you get FREE advertising in the form of a directory with public access, and a chance to network at events with peers who might refer you a patient. Just like folks check out the local Bar Association when looking for a lawyer, many tend to go to the local Medical Society to find a doctor practicing locally in a certain specialty.

Know the Numbers

Do you have an idea of what your revenue per patient is? What your revenue per employee is? Do you have a monthly, quarterly, or annual budget? Might be time to call in a healthcare accountant who is also a business and financial advisor. Did you know that building a better budget can boost your practice’s performance? Your practice’s budget is a tool that tracks your revenue and expenditures, but also helps you plan for the future. When it comes time to make decisions about adding or reducing staff, moving to new space or purchasing/leasing new equipment, your budget will be invaluable in helping identify which options will work best and when. Your budget can also provide warning signs of financial trouble or suspected fraud, and make big changes less disruptive to cash flow. See why else it is important here: Budgeting For The Health Of Your Medical Practice

Go Green 

Spending money on energy efficient office and medical equipment and using “green” technology often comes with a rebate as well as lower electric bills. Motion-sensor interior light switches are not expensive, yet save plenty $$$. Having staff turn computers to energy saving settings at night save lots $$$ over time.

Hire an Intern

Need an extra set of hands? Hire a college student or senior-soon-to-be-grad who wants to discover the healthcare industry, examine a practice niche up close before picking a major, or learn the ropes of running a practice. They can start with basic administrative tasks that are overwhelming your staff. Lower your labor costs and make your staff smile, while you inspire and mentor a future healthcare practitioner!

Contact Us: Building a budget, being aware of excess expenditures, and actively looking for ways to add revenue and cut costs can make you more efficient and save your medical practice money. Our healthcare CPAs and medical accounting professionals have the perfect prescription for you and your practice to be more profitable. Let’s have an honest conversation about your current situation and financial goals so we can help to minimize the surprises and maximize your cash flow – then help you keep more of that newly found profit in your pocket. Contact us toll free at 855-534-2727.

Exit Planning is a simple strategy to build a business that is transferable through strong human, structural, customer and social capital. The future of you, your family, and your healthcare practice are addressed by exit planning through creating value today. There are many tools available to help individuals get into business, but, unfortunately, there are few that help them get out. That is where we can help.

It is inevitable, you will exit your business sooner or later. Exit planning can be complicated. Most business owners have 90% of their net worth tied up in their business but have no succession plan. Why not prepare now?

What are some of the challenges facing today’s physicians, doctors, dentists, clinicians, and other healthcare providers? 75% of business owner that sold, regret it later because they did not plan properly. Business owners are leaving too many $$$ on the table because they are focused on income generation but not on enterprise value. 70%-80% of business put on the market don’t sell, and 50% of businesses do not survive the death of their owner. Be wary of the “5 D’s:” Death, Disability, Divorce, Distress, and Disagreement.

The Solution: Build, Harvest and Preserve Wealth! Focus on implementing an exit strategy that integrates your business, financial and personal objectives into one master plan to build, harvest and preserve wealth. Remember, “value is about the ability to “transfer.”

How can TFG Health Services help?

To create your Exit Plan, we coordinate your goals, your advisors and implement a customized strategy based on your timetable.  As members of BEI Network of Certified Exit Planning Advisors (CEPA) we know how to guide you to your successful exit.  Using a systematic exit planning process developed over the last 25 years, you ultimately decide: When to leave your business, to whom to sell or transfer your business to, the amount of cash you need when you exit, and all while remaining in complete control.

Read more about our Exit Planning Process here.

Contact Lou Fuoco, CPA, CEPA, today to discuss your Exit Planning objectives; 561-209-1101.

 

 

 

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Let our accounting and financial experts help you Identify opportunities for increasing revenue and reducing costs, while better serving your patients or clients. Our mission is to help healthcare practices not just survive, but grow and blossom. The professionals at TFG Business Advisory have created a unique suite of financial, operational and risk management services designed to give you the advantage over your competition. Whether you have short term cash flow needs, long-term business goals or want to take advantage of a unique business opportunity, we are here to assist you. We understand your challenges of revenue cycle and eroding margins, and can provide payor and practice management assessment as well as compensation modeling, audit and accounting, valuation and tax services.

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Help your workforce save for a secure financial future with a sound, well-designed retirement plan. Retirement plans are a key benefit for your organization. A solid plan with a variety of investment options is an asset to both recruiting and retention.

Understanding the latest regulations, working out cost projections, responding to market changes and engaging plan participants with educational opportunities probably requires more time than you likely have – that is why it’s good to have a partner like TFG Financial Advisors. Learn More.

 

Do you have Medicare patients with 2 or more chronic conditions that have lasted 12 months or more? Here is a turnkey solution for you to take advantage of reimbursements under CPT Code 99490.