Tier One Metrics for Revenue Cycle Management presentation – NY MGMA – March 23, 2016

Hi All,

I will be presenting to the New York chapter of the MGMA March 23, 2016.  My topic for discussion will be “Tier One Metrics for Revenue Cycle Management”.
Todays practice management professionals including administrators, financial analysts and billing managers all speak of measuring performance using “business intelligence” and “analytics”. Benchmarking, Metrics and Dashboards seem to rule the world of Best Practices. All intended to keep on an even keel, or when need-be, improve practice performance, provider performance, profits and receivable cycle management results. But which methods are right for your practice? Even to the most seasoned of departmental analysts, this question can be daunting at best.
Let’s first discuss some generalities of the world benchmarking which can be applied to many different practice management domains. Next we will examine benchmarking constructs in the domain of receivable cycle management (RCM). After a few words on RCM benchmarking methods, we will identify and examine in detail a selection Top Tier RCM management essentials.
Focusing on these Tier One Metrics for Receivable Cycle Management will provide your practice some practical tools that can significantly assist you in determining the health of your account receivables. Why are these important? How do we measure them? What are acceptable benchmarks? How do we know when things are going awry? How do we fix them? These and other open forum questions will be explored.

Come and join us!

With best regards,

Anthony Sarro

NYC/Metro Chapter Meeting
MLMIC – 2 Park Avenue, 25th Floor, New York, New York 10016
Date: Thursday, February 25, 2016 8:00 AM EST


HHS delays Stage 2 of Meaningful Use until 2014

The Department of Health and Human Services (HHS) announced that Stage 2 of the Medicare EHR incentive program (Meaningful Use) would be delayed until 2014. Under the current requirements, eligible professionals (EPs) that begin participating in the meaningful use incentive program this year would have to meet new and more challenging standards for the program in 2013. If an EP did not participate in the meaningful use program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. In an effort to encourage faster adoption, EPs are permitted to adopt an EHR this year, without meeting the new standards until 2014.

Read the HHS press release here.

Medicare Cuts Seem Inevitable

The center for medicare and medicaid services posted final medicare payment rules on tuesday which include cuts in physician reimbursement rates.


The first medicare payment reduction will be 23.6% Effective december 01, 2010. On january 01, 2011 there will be a further payment reduction of 6.5%. The national conversion factor will decrease from $36.8729 To $28.3868 On december 01, 2010 and decrease further to $25.5217 On january 01, 2011.

As an example code 99213 now pays $66.74 But with the new fee schedule being implemented in january 2011 it is estimated to drop to $51.81. The american medical association as well as other physician associations are currently lobbying for a temporary or permanent payment fix. Please have your staff and patients contact their members of congress to request they intervene to stop these cuts permanently or at least delay them. It can be as easy as sending an email or making a phone call. Click the link below to obtain their contact information.



How (NOT TO) to get PQRI Feedback Reports

I have worked with a number of clients who purchased EMR systems years ago and they all sit, unused or partially used.

It is interesting but it is so much more than the system itself that plays a role in it’s use, especially with the added levels CMS is requiring under teh MEaningful Use Guidelines they present (albeit in a half-$%^%$ manner).

What exactly do they want and by when?

Even with PQRI, it is a great mystery!  We asssit clients in delivering PQRI codes but try and access the reports from IACS (Individuals Authorized Access to the CMS Computer Services) – Nice Acronym!!

Well here is the answer to that:

The way it works is that an organization has to be first registered into IACS as an Organization. You must first work with the EUS (External User Support) not the IACS.

Once this is established, a Security Official Account has to be established. This can be done through IACS or Quality Net. Usually they tell me it is the President or officer of organization, but need not be.

Once this is done, a Group Administrator needs to be established. This user is yet another account that needs to be established then approved by the Security Official of the Organization. The Security Official cannot be the Group Administrator.  This Group Administrator can then create users and establish roles for those users under IACS (again approved by Security Official).  One of the Roles is access to the PQRI Data.

Now here is another rub, PQRI data is only available (in NY) the November following the year the data is submitted.  So, 2007 data is available in a report in November 2008 and so on.

So how does one know if the data is received, processed, compliant for the specialty and sufficient in the meantime?  Good Questions.  I am seeking answers and will update you when I get some.

Oh Sigh!!


RAC Audits Simply Defined

RAC Audits are a reality. What is an RAC? An RAC is a Recovery Audit Contractor contracted by the CMS Office of Program Integrity. They completed their demonstration Project in 2005 – 2008 in the states of FL, SC, NY, MA and CA. The result, they recovered more than $450M (Well they had to return some of on appeal…but who’s counting?). Now there is a Permanent RAC Program, which was established in 2009. Look it up at www.cms.hhs.gov/rac. There they list who are the Contractors and what they are looking for specifically in each geographic region they cover. And by the way, each RAC auditor looks at the others to see what they are doing/did and who recovered more money. RACs conduct audits of paid claims and recover improper payments AND identify underpaid claims. They are paid a % of recoveries – No recovery = no commission. MPI is aware of this and track these audit’s “de jour” on-line.


Introduction to Meaningful Use of EMR

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs will qualify for incentive payments through Medicaid and Medicare. CMS’ plan proposes phasing in meaningful use requirements over three stages between now and 2013.

The first stage of the meaningful use criteria emphasizes:

Collecting electronic health data in coded formats;
Implementing clinical decision support tools;
Reporting clinical quality measures and public health data; and
Using EHR data to track conditions and coordinate care

The Stage 1 criteria call for physicians to submit at least 80% of their orders electronically. The proposed rules also call for health care providers to use EHRs to check for potential drug interactions. In addition, the rule requires health care providers to provide patients with electronic copies of their medical records within 48 hours of a request. A full list of Stage 1 criteria for physicians is forthcoming (from me). Of course we are tracking a moving governmental target and even what is listed below is subject to change in August when CMS issues final determinations.

Originally the Stages were tied to years (Stage 1 – 2011, Stage 2 – 2012 and Stage 3 – 2013). This has changed and is still under discussion as to when each stage will become enforceable. Also, some of the original deadlines (i.e. Jan 1, 2011) to qualify for full Stimulus money has changed and are still in flux until the final rules come out in August (if they come out in August).

The Stage 2 criteria are expected to focus on structured data exchange and continuous quality improvement. CMS is scheduled to release the second phase criteria by the end of 2011.

The Stage 3 criteria are expected to center on advanced decision support and population health. CMS is scheduled to publish the third phase criteria by the end of 2013.

The HITECH Act offers providers up to $44,000 each if they demonstrate meaningful use as will be defined in phases for 2011, 2012 and 2013 (and beyond).

Future stages will involve Patient Portals, Standardized Interoperability, Disease Management, Health Maintenance, Protocol Management, Pay for performance reporting, migration to ANSI 5010 (in 2012), migration to ICD-10 (in 2013) to name a few. The specific implication of each of these is omitted here lest this document turn to a tome.


ICD-10 Is coming in 2013 – Don’t Wait!

ANSI 5010 migration is coming in 2012. ICD-10 is coming in 2013. Remember that not all Plans will follow CMS day one with ICD-10. This means that providers will have to maintain usage of ICD-9 while deploying ICD-10 in the practice in 2013. In fact, Worker’s Comp and NYS No-Fault are exempt from ICD-10 requirements.

You need to plan now and put together strategies that migrate your practices in the direction of ICD-10. It is important to understand the costs in loss of productivity as well as in training.

Your Practice Management software should handle the technology piece and guide you on the mechanics, but proper planning and close collaborative effort with your billing service or practice administrator is essential to get it right.

Starting out with delay, doubt, fear or misguided expectations will not achieve the required goal.

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