According to Becker’s Clinical Leadership & Infection Control, April 2019 was the worst month on record for healthcare data breaches. Alone, there were three data breach occurrences which affected the disclosure of more than 439,000 patient charts.

Financial Impacts of A Healthcare Data Breach

According to www.hipaajournal.com, data breaches in healthcare are the highest of any industry in the United States. And as of July 2018, on average, a data breach costs the infected organization $408 per record. The average cost per record of data breaches in other industries averages $148 per record.

According to varonis.com, an industry-leading reporting and statistics website, there was an 80% increase in the number of patients affected by healthcare-related data breaches since 2017.

The history of data breaches reach back into the 1970’s with the first network virus ever reported as ‘The Creeper’.

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The post <a href="https://aaoe19.snoball.events/e/merem-healthcare-solutions">WE’RE EXHIBITING at the AAOE 2019 Annual Conference</a> appeared first on MEREM Health.

The AAOE Annual Conference is a great opportunity for orthopedic executives to:

>> Earn CEUs and access unlimited resources

>> Explore resources that can help you leverage and gain market share

>> Sharpen your skills and gain knowledge about the business side of healthcare 

>> Stay current with the latest industry trends and newest practice management techniques

MEREM Healthcare Solutions looks forward to this annual event each year. Founded by orthopedic healthcare executives, MEREM Healthcare Solutions began as a solution to their on-going billing and coding problems. For over 10 years, MEREM Healthcare Solutions has been working to provide orthopedic and sports medicine clients superior, outsourced medical billing, coding, and revenue cycle management solutions.

Every practice is unique; Orthopedics and Sports Medicine is no exception, so our billing team seeks to develop a customized solution to fit those unique needs. MEREM Healthcare Solutions builds on that mission to add what 10 years of experience in the medical billing field has taught us: that, no matter the size, healthcare organizations need a strategic partner and that is what we are here to provide.

MEREM Healthcare Solutions has developed a training process that allows us to be among the experts in Orthopedics and Sports Medicine. Our Specialized Orthopedics and Sports Medicine Coding Solutions Include:

• All clinical and surgical documentation reviewed by Certified Coders
• Coding completed within 48 hours from receipt of all source documentation
• Coding experts that can educate your staff to ensure appropriate documentation and compliance
• Regular internal audits to monitor coding performance, accuracy, and compliance
• Quarterly reports on provider-level coding and documentation performance

We are looking forward to the opportunity to meet with your team. Be sure to stop by our booth #106 to chat with fellow orthopedic practice executives about how we can help enhance your practice profitability and to discuss measuring metrics against the industry’s benchmark standards.

Plus, you can enter to win a $100 Giftcard!

Want to learn more about how MEREM Healthcare Solutions serves orthopedic executives? Check out these blogs:

• Optimizing Surgical Reimbursements for your Orthopedic Practice
• Three Reasons Orthopedic Surgeons Lose Revenue

The post Planning for AAOE 2019 – First Time Attendees appeared first on MEREM Health.

QUALITY PERFORMANCE

For CMS web interface users, the last day that registered groups may submit group data in the CMS Web Interface is March 22, 2019 at 8pm ET. To view and submit your data, you will need to go to https://qpp.cms.gov/

The last day to submit your year 2 (2018) MIPS data is April 2, 2019. Submissions will be open until 8 pm EDT.

PERFORMANCE YEAR 2018

The submission window is currently open through April 2, 2019, 8 pm EDT. Sign in to submit and update your data for PY 2018.

More information about 2018 Merit-based Incentive Payment System (MIPS) Participation & Overview can be downloaded here.

The post 2018 MIPS Data Deadlines appeared first on MEREM Health.

Now is the time to conduct a financial review of your medical practice’s 2018 financial performance. Whether you currently handle your billing and coding in-house or outsource to another company, MEREM Healthcare Solutions recommends that you should conduct an annual revenue cycle audit in order to:

1. Compare your practice’s performance against the previous year.
2. Compare against industry benchmarks.

Comparing year-end practice revenue and industry benchmarks

At MEREM Healthcare Solutions, it is our mission that all of our clients meet and exceed industry benchmarks. By following this mission, we are able to increase revenue by improving processes.

You should be looking at and comparing the following benchmarks and practice performance to the prior year. If applicable, net collections should be compared by payor as well as by provider or physician.

Consider reviewing national specialty surveys in order to determine if your practice is improving. If not improving year over year, a complete revenue cycle audit may highlight why.

Industry Benchmarks

Industry benchmarks we follow closely to set goals for our clients, include:

• Gross Collection Percentage
• Net Collection Percentage
• Days In A/R
• A/R Ratio
• A/R in Excess Of 120 Days Old (Our Client Standard Focuses On 60 Days.)
• Collection Rates by Payor/ Physician (Payor Mix)
• Coding Accuracy
• Clinical/Procedure/Ancillary Encounters
• Charges by Payor
• Payor Collections by Physician
• E/M Coding Comparison
• Increase Marketing Efforts to Improve the Ratio
• Front Desk Collection Success (Copayments and Patients With A/R Balances)
• How Quickly Visits/Procedures Are Billed
• How Long Does It Take To Get Paid By Payors
• Percent of Insurance Eligibility Verifications Vs. Total Scheduled Patients
• Average Number of Missing Charges Vs. Services Rendered (Actual & Cpt Mistakes)
• Percent of Denied/Rejected Claims Vs. Total Claims Filed
• Percent of Denied/Rejected Claims Appealed Successfully Vs. Total Denial/Rejections
• Average Days Between Receipt of Payment and Payment Posted
• Average Number of Unpaid Claims Resolved by Day Per Collector

AUDITING WITH NO FEAR, NO FRUSTRATION, AND NO FAULTS

If you are struggling to meet or keep up with these standards, a billing and coding audit should be performed in order to help you understand the key areas where your clinical operations are weak and can help you to identify priorities and set goals toward making improvements that impact your revenue cycle.

Billing and Coding Audits are valuable tools to help improve your revenue cycle and maintain compliance with CMS and other regulatory bodies. Consider MEREM Healthcare Solutions as an outsourced solution for conducting a complete revenue cycle audit. Our FREE Revenue Cycle Audit tool will help you stay on track with current industry standards and provide unbiased industry comparison and revenue cycle audit report to assist physicians and practice managers with improving their practice performance. Schedule Your Free Revenue Cycle Audit Today!

The post Where does your practice stand among industry benchmarks? appeared first on MEREM Health.

MACRA combines parts of the Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VBM), and the Medicare Electronic Health Record (EHR) incentive program into one single program called the Merit-based Incentive Payment System, also known as MIPS.

In November, the Centers for Medicare and Medicaid Services (CMS) released their FINAL RULE for the 2019 Medicare Physician Fee Schedule. This Final Rule will go into effect January 1, 2019 for many clinicians and it is the start to the new physician payment provisions also known as the QPP. The CMS Quality Payment Program (QPP) has two tracks: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

What is MIPS?

This is a healthcare law that doctors across the country, who accept Medicare patients, need to abide by in order to maintain or qualify for an increase in their reimbursement payments from the government. These physician incentives are based on clinical performance in four specific categories, Quality, Cost, Promoting Interoperability, and Improvement Activities.

MIPS category change review according to “HIT Like a Girl” podcast.

These MIPS scoring weights have changed each year. The biggest changes in 2019 are

• Quality score reduced from 50% to 45%
• Cost score increased from 10% to 15%
• Improvement Activities: Interoperability bonus removed
• Eligible clinicians must use 2015 edition or newer certified EHR technology
• Performance Threshold minimum increased from 15 to 30 points. Exceptional Performance Range is at least 75 points.

For 2019, the Weights and MIPS final scoring rules, we found this webinar from Healthmonix to be extremely helpful.

In summary:

1. Quality (45%) – Requires 6 measures to be reported with 1 outcome measure or high priority (specialty measure set)
2. Cost Performance Reporting (15%) – based on 8 measures, 10 minimum procedural episodes such as knee arthroplasty, or 20 acute inpatient medical condition episodes
3. Promoting Interoperability (25%) – Must report at least a 90 day period, Must use 2015 ed. or newer CERTEHR technology
4. Clinical Practice Improvement Activities (15%) – 40 points required, based on weight.

If you are preparing for MIPS 2019 reporting, we hope this blog prepares your practice performance measures.

At MEREM Healthcare Solutions, we want to be your strategic partner in making sure your practice needs are met and your practice improvement and profitability are the end result. Contact us today to learn how our knowledgeable and experienced professionals can help assist or consult you with EMR technology and MIPS and MACRA submissions for your physicians.

The post 2019 MIPS & MACRA – Are Your Physicians Hitting the Medicare Mark? appeared first on MEREM Health.

MEREM Health ranked among the Top 30 Medical Billing and Coding Blogs, Websites, and Newsletters to follow in 2018

According to Feedspot.com, MEREM Health was recently recognized as one of the Top 30 Medical Billing and Coding Blogs, Websites and Newsletters To Follow in 2018 because we are actively working to educate, inspire, and empower our readers with frequent updates and high-quality information.

These blogs selected in the list were ranked based on the following criteria:

• Google reputation and Google search ranking
• Influence and popularity on Facebook, Twitter, and other social media sites
• Quality and consistency of posts.
• Feedspot’s editorial team and expert review

Meredith Tibbs, Director of Coding for MEREM Healthcare Solutions was excited to be recognized among many of the organizational blogs that she follows and considers it a great achievement to be recognized among our peers. She said, “I use a lot of those other sites to keep updated within our industry!”

Anuj Agarwal, the Founder of Feedspot shared, ” This is the most comprehensive list of best Medical Billing and Coding blogs on the internet and I’m honored to have you as part of this! I personally give you a high-five and want to thank you for your contribution to this world.”

The post Top 30 Medical Billing and Coding Blogs To Follow in 2018 appeared first on MEREM Health.

As of June 6^th, Blue Cross and Blue Shield of Texas implemented a controversial new program in which it will not pay any expenses for an out-of-network emergency room visit if they determine that a patient should have gone elsewhere for treatment. Under the new policy, which was announced in April, a medical director hired by the insurer, will review and approve or reject claims after the ER visit. They will determine the reason a patient opted for the ER and if they should have or could have received treatment at a less expensive clinic.

According to the Houston Chronical, “critics continue to slam the program as harsh and punitive as it seeks to not only underpay providers but also forces patients to make untrained diagnoses.” Posing the potential of deterring patients to skip potentially life-threatening treatments out of fear that their medical bills will not be paid. The insurance provider has issued informative campaigns to help patients make informed decisions on choosing the correct medical care in order to avoid denials.

MEREM Healthcare Solutions and physicians around the country all wonder, could this become a national trend for insurers?

Luckily, we don’t have any clients in Texas at this time, so this policy hasn’t yet impacted our client’s reimbursements or their patients, but it is a serious policy that health care providers and consumers must consider.

Imagine your all-star high school athlete gets injured in an away game playing football. Instead of waiting hours in pain traveling home, you head straight to the local ER to address the shoulder injury and possible concussion. After MRIs, hours of waiting in pain, and a few evaluations, your insurance finds that your visit was unnecessary because there was a local Orthopedic Urgent Care, like OrthoExpress, nearby that offered Friday night Concussion clinics, or simply because the closest Emergency Room was out-of-network.

For more information, about this policy and the effects, check out this Houston Chronical update.

The post Texas May Deny Payments For Out-Of-Network ER Visits appeared first on MEREM Health.

Heads Up for Healthcare – 

NEW E/M Coding Changes Coming 2019

We all know that change is the only constant in the Medical Coding world. This recent CMS release of coding initiatives in 2019 proposes a pretty significant change for Evaluation and Management (E/M) coding that can impact doctor visits for both the patients and the providers in a good way.

According to CMS Secretary, Verma Seema, “Patients are demanding more accountability from healthcare providers and payers, and they want to see what they’re getting for the high insurance and co-pay amounts paid.”

What patients see, is the attention and time spent with their physician. Physicians complain that the time spent inputting information cuts into face-to-face time with the patient. The pressure to increase patient loads requires providers to keep visits short but effective. Time is the common denominator that will be addressed through these coding changes.

What does that mean for you? Less is more.

The #PatientsOverPaperwork Initiative focuses on value-based healthcare by simplifying the complexity of required documentation during an office visit. This change will enable physicians to return to focusing on attentive, quality care by spending more time with the patient rather than spending their time documenting visit to meet the paperwork requirements involved.

E/M Visit Payment Changes & Reimbursement Rates

• E/M Coding levels 2-5 will be consolidated to a single reimbursement code and must meet the following requirements
  • EPF History (a chief complaint with 1-3 HPI elements)
  • 1 review of symptoms
  • And EPF Exam
  • And a Straightforward MDM

• Add on codes may also be applied for additional reimbursement and payment adjustments.

+     $5 for additional resources in complex E/M visits associated with primary care service

+     $9 for additional resources in complex E/M visits involving non-procedural based care

–      Multiple procedure payment reductions when E/M visit and a procedure are furnished on the same day

+     Add-on for a 30-minute prolonged E/M visit.

• E/M Level 1 rates will be adjusted
  • $24 for established patients
  • $44 for new patients

The proposed changes depicted above are in a 60-day comment period. CMS welcomes and encourages provider feedback as a critical part of the coding change process. This is to ensure that all coding changes benefit not only the patient, but the providers that treat them as well.

“As part of @POTUS‘s Cut the Red Tape Initiative, CMS launched our Patients Over Paperwork Initiative to reduce unnecessary and redundant regulations so that doctors could focus on their primary mission – taking care of their patients.” #PatientsOverPaperwork

— Administrator Seema Verma (@SeemaCMS) July 25, 2018

If you have questions or would like to provide feedback about how these coding changes may effect your E&M visits and reimbursement, you can join the conversation via Twitter using hashtag, #PatientsOverPaperwork and tweet to @SeemaCMS and @MEREMHealth.

MEREM Healthcare Solutions is a Birmingham, AL-based company that has been providing exceptional medical billing and coding services to physician practices and ambulatory surgical centers since 2008. We pride ourselves on not just maintaining, but exceeding, the level of accountability, communication, and customer service that is valued in traditional, on-site billing departments.

Please check out our other blog posts, or contact us to learn more.

The post NEW E/M Coding Changes Coming 2019 appeared first on MEREM Health.

On Thursday, MEREM Healthcare Solutions hosted a special guest and credentialing specialist, Matt Waldrep to answer questions and offer crucial advice on provider enrollment. Credentialing new providers for insurance payors and enrolling providers for the facilities they serve is a time-consuming and detailed requirement of every medical practice. Failure to complete enrollment and submit proper (and often timely) credentials for an individual provider or physician, can lead to a significant revenue loss.

As a leader in outsourced Healthcare Solutions, MEREM Health has been providing weekly video tips every Tuesday to help keep the business end of medical operations top of mind for practice owners and administrators. During their first LIVE video, coined #ThinkAboutItThursdays, MEREM Health covered the most frequently asked questions they receive from their clients and prospective clients. (Click Here to watch NOW) They shared information about their unique services and solutions, yet focused on the critical topics that most practice owners face.

MEREM Health Offers Consulting Services

Some of the specific questions covered in the Lunchtime Live Q&A with MEREM Health included:

1. Which payors do you recommend being contracted with?
2. What is CAQH? And Are providers required to have CAQH?
3. What can you do if a provider starts without being fully credentialed?

Matt Waldrep also answered general questions for specialty medical groups looking to add on new providers. Matt offered advice on a projected lead time for beginning the enrollment process to successfully get a new provider enrolled with insurances and facilities. He also discussed specific documentation required and noted that “Not all applications are created equal.”

Lunchtime LIVE Q&A 
Credentialing and Provider Enrollment

If you have questions about the health and productivity of your revenue cycle, feel free to submit questions to MEREM Health through their website. You can even request a Free Consultation and Revenue Cycle Audit.

For more information about MEREM Healthcare Solutions, you can visit their new website. www.MEREMHealth.com. Be sure to Like and Follow MEREM Healthcare Solutions on Facebook.com, in order to be notified of their next Tip Tuesday and Lunchtime LIVE Q&A. Future topic information about the series will be announced soon on their Facebook page, and questions are encouraged to be submitted during the live stream or in advance. Submit your questions here.

MEREM Healthcare Solutions is a Birmingham, AL-based company that has been providing exceptional medical billing and coding services to physician practices and ambulatory surgical centers since 2008.  We pride ourselves on not just maintaining, but exceeding, the level of accountability, communication, and customer service that is valued in traditional, on-site billing departments.

Please check out our other blog posts, or contact us to learn more.

The post Ask The Experts – Credentialing & Provider Enrollment appeared first on MEREM Health.