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This episode of Coffee with Coker delves into the complex and nuanced topic of Modifier 25, a coding nuance critical for healthcare professionals to understand for billing and documentation.
Hosts Erika and Jaci unpack the definition, significance, and proper application of Modifier 25, emphasizing its opinion-based nature and the importance of clear, detailed documentation. They provide examples from healthcare scenarios, including preventive visits, urgent care, and procedures like cerumen removal, discussing the implications for billing and compliance.
The conversation highlights how insurance companies' interpretations can vary, impacting the application of Modifier 25. Further, they explore the challenges healthcare providers face in ensuring their documentation supports the use of Modifier 25, pointing out common pitfalls and offering guidance on best practices.
This discussion underscores the vital role of accurate coding and documentation in healthcare billing and the ongoing need for education and dialogue among practitioners.
00:32 Diving Deep into Modifier 25 01:49 Understanding the Definition and Application of Modifier 25 05:33 Exploring Real-World Scenarios and Challenges with Modifier 25 08:33 Navigating Documentation and Billing Challenges 15:04 Specific Cases and Auditing Insights 27:36 Concluding Thoughts and Future Topics 29:54 Engaging the Audience and Closing RemarksLinks to other resources:
AMA | Reporting CPT Modifier 25 (https://www.ama-assn.org/system/files/reporting-CPT-modifier-25.pdf) Podcast covering Medicare Annual Wellness Visits (https://www.cokergroup.com/podcasts/episode-122-understanding-annual-wellness-visits-for-healthcare-organizations/) -
In this episode, the discussion focuses on annual wellness visits, IPPE, and their implications for healthcare organizations. The conversation covers the requirements, coding, documentation, and common audit findings related to annual wellness visits. The speakers emphasize the importance of proper documentation, the use of resources, and a team approach to ensure compliance and successful reimbursement.
· Jaci Kipreos and Erika Fisch discuss annual wellness visits (00:18)
· Medicare's yearly benefit for beneficiaries called annual wellness visits (01:25)
· Initial Preventative Physical Exam (IPPE) and annual wellness visits (02:32)
· Difference between annual wellness visits and preventative physical exams (05:34)
· Resources for understanding annual wellness visits (08:06)
· Common audit findings for IPPE and annual wellness visits (14:16)
· Handling patient refusal to answer questions during the visit (18:57)
· Separate coding for additional services during the visit (22:58)
· Screening EKG and its requirements (25:12)
· Importance of a team approach to ensure proper documentation and billing (28:58)
· Checking with your MAC for additional requirements or recommendations (32:52)
· Next episode to cover the 25 modifier (34:55)
Extras
· Medicare Learning Network – Medicare Annual Wellness Visits (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html)
· Medicare Preventive Services Quick Reference Chart (https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html)
· Medicare Claims Processing Manual (https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf)
· Streamline Workflow to Perform a Thorough AWV (https://edhub.ama-assn.org/steps-forward/module/2757861)
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
· Please email us: [email protected]
· Connect with us on LinkedIn: Coker Group Company Page
· Follow us on Twitter: @cokergroup
· Follow us on Instagram: @cokergroup
· Follow us on Facebook: @cokerconsulting
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In this insightful podcast for leaders of physician enterprises, we delve into the dynamic landscape of staffing trends within the healthcare sector. The discussion kicks off with a comprehensive exploration of both physician and non-provider staffing trends, providing valuable insights into the evolving workforce dynamics. The conversation then navigates through the intricate factors that contribute to staff turnover, shedding light on the challenges faced by physician enterprises in retaining their crucial personnel.
Episode Synopsis
The podcast guides leaders in analyzing their physician enterprises with a data-driven approach, offering practical strategies to create staffing targets aligned with the unique characteristics of their practices. As the discussion progresses, listeners gain actionable solutions to common staffing challenges, including addressing salary increases in a declining market and handling healthcare turnover amidst current market conditions. The podcast also explores staff retention tactics and best practices essential for physician enterprise success.
The latter part of the podcast delves into the impact of various technologies on staffing for physician enterprises, exploring the integration of AI and workforce automation. The discussion concludes by highlighting the crucial link between staffing, ROI, and the overall functionality of physician enterprises, providing valuable insights for leaders navigating the intricate landscape of healthcare management.
· Physician and non-provider staffing trends (2:05)
· Factors contributing to staff turnover (4:20)
· How to analyze your physician enterprise using a data-driven approach (4:50)
· How certain practice characteristics impact staffing levels (6:30)
· Create staffing targets that make sense for your practice (7:22)
· Solutions to staffing challenges (8:14)
· Addressing salary increases in a declining market (8:30)
· How to handle healthcare turnover in the current market (11:02)
· Staff retention tactics (13:39)
· Best practices for physician enterprise success (16:35)
· Critical issues plaguing independent medical practices (20:12)
· Embracing new trends and adjusting to patient expectations (21:30)
· Other technologies affecting staffing for physician enterprises (23:45)
· Addressing AI and workforce automation for your practice (25:00)
· How staffing impacts the ROI and functionality of the physician enterprise (26:40)
Extras
· Address Community Need with Physician Income Guarantee Arrangements (https://cokergroup.com/physician-income-guarantee-arrangements/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-121&utm_content=physician-income-guarantee&utm_campaign=performance-transformation&utm_source_platform=&utm_creative_format=&utm_marketing_tactic=)
· Lawmakers Grapple with Artificial Intelligence Regulation as Popularity and Utilization Grow (https://cokergroup.com/lawmakers-grapple-with-artificial-intelligence-regulation-as-popularity-and-utilization-grow/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-121&utm_content=ai&utm_campaign=performance-transformation&utm_source_platform=&utm_creative_format=&utm_marketing_tactic=)
· Quantifying Patient Access: Utilize Data to Identify Improvement Opportunities and Monitor Performance (https://cokergroup.com/quantifying-patient-access-utilize-data-to-identify-improvement-opportunities-and-monitor-performance/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-121&utm_content=performance-improvement&utm_campaign=performance-transformation&utm_source_platform=&utm_creative_format=&utm_marketing_tactic=)
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
· Please email us: [email protected]
· Connect with us on LinkedIn: Coker Group Company Page
· Follow us on Twitter: @cokergroup
· Follow us on Instagram: @cokergroup
· Follow us on Facebook: @cokerconsulting
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Chris Torregosa interviews Louis Sallerson, the CEO of Converse Health, about their generative AI assistant for orthopedic surgery clinics.
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
· Please email us: [email protected]
· Connect with us on LinkedIn: Coker Group Company Page
· Follow us on Twitter: @cokergroup
· Follow us on Instagram: @cokergroup
· Follow us on Facebook: @cokerconsulting
Episode Synopsis
Throughout the interview, Louis shares his passion for the healthcare industry and dedication to improving medical practice operations using generative AI. The heart of their product is communication, and their goal is to streamline patient navigation and communication for orthopedic surgeons.
Click to listen to the episode.
Extras
Learn More about Converse Health (https://www.converse.health/)
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In this podcast episode, we delve into the critical topic of patient access and operational throughput. With growing demand for medical services and a looming physician shortage, it's essential to reframe patient access as a pivotal aspect of healthcare production, not merely patient satisfaction.
Episode Synopsis
Join us as we discuss current patient access challenges, highlight key focus areas for effective management, and explore the differentiation between patient access and operational throughput, emphasizing role clarity, optimizing staff utilization, and improving communication.
The episode also delves into trends in patient access management, including the role of Advanced Practice Providers and the strategic integration of technology to enhance access. Patient access has never been more vital, as patient demand is projected to exceed provider supply. We offer practical strategies for healthcare organizations to excel in patient access and operational throughput.
· Patient access and throughput in healthcare (0:11)
· Patient access and physician shortages in U.S. healthcare (4:37)
· Streamlining patient access and scheduling (9:20)
· Patient access and appointment metrics (12:01)
· Improving patient access and organizational performance (15:52)
· Improving medical practice efficiency (20:15)
· Improving patient access in healthcare (26:16)
· Improving patient access and reducing no-shows (32:03)
Extras
· Overcoming Obstacles with Performance Improvement for Critical Access Hospitals (https://cokergroup.com/overcoming-obstacles-with-performance-improvement-for-critical-access-hospitals/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-119-navigating-patient-demand-and-physician-shortages&utm_content=patient-access&utm_campaign=physician-services&utm_source_platform=podcast-app&utm_creative_format=blog&utm_marketing_tactic=solution)
· Quantifying Patient Access: Utilize Data to Identify Improvement Opportunities and Monitor Performance (https://cokergroup.com/quantifying-patient-access-utilize-data-to-identify-improvement-opportunities-and-monitor-performance/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-119-navigating-patient-demand-and-physician-shortages&utm_content=patient-access&utm_campaign=physician-services&utm_source_platform=podcast-app&utm_creative_format=blog&utm_marketing_tactic=solution)
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
· Please email us: [email protected]
· Connect with us on LinkedIn: Coker Group Company Page
· Follow us on Twitter: @cokergroup
· Follow us on Instagram: @cokergroup
· Follow us on Facebook: @cokerconsulting
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This episode delves into the complex world of compensation design within the healthcare industry, focusing on traditional hospital/employed provider models. We explore the common pain points experienced by clients of all types when incentivizing strategic goals.
Episode Synopsis
Join us as we discuss the various considerations hospitals and health systems face, including concerns about provider compensation spending and fair market value. We also examine incentive structures designed to foster growth and meet strategic objectives, all while ensuring that compensation plans remain competitive in the challenging recruitment landscape.
But it's not just about the financial aspect. We'll also explore how compensation design can be a powerful tool, acting as a 'carrot' to drive productivity and achieve organizational goals. And when compensation design isn't enough, we'll delve into the other factors influencing low provider productivity.
Tune in for an insightful conversation on the critical intersection of compensation design and healthcare strategy.
· Aligning physician incentives with organizational goals (4:25)
· Designing physician compensation models (8:54)
· Analyzing audio transcript for insights (14:39)
· Redesigning physician compensation models (19:48)
· Designing and implementing fair and equitable compensation (26:30)
· Physician compensation model design (33:37)
· Provider compensation and performance improvement (37:15)
Extras
· Episode 111: The Intersection of Provider Compensation and Value-Based Reimbursement (https://cokergroup.com/episode-111-the-intersection-of-provider-compensation-and-value-based-reimbursement/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-118-how-provider-compensation-design-impacts-performance&utm_content=performance-improvement-compensation&utm_campaign=finance&utm_source_platform=podcast-app&utm_creative_format=podcast&utm_marketing_tactic=awareness)
· Case Study: Provider Compensation Misalignment (https://cokergroup.com/case-study-provider-compensation-misalignment/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-118-how-provider-compensation-design-impacts-performance&utm_content=performance-improvement-compensation&utm_campaign=finance&utm_source_platform=podcast-app&utm_creative_format=case-study&utm_marketing_tactic=solution)
· Compensation Best Practices for Physician Enterprises (https://cokergroup.com/compensation-best-practices-for-physician-enterprises/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-118-how-provider-compensation-design-impacts-performance&utm_content=performance-improvement-compensation&utm_campaign=finance&utm_source_platform=podcast-app&utm_creative_format=white-paper&utm_marketing_tactic=solution)
· Compensation Methodology Best Practices: True-Up Payments (https://cokergroup.com/compensation-methodology-best-practices-true-up-payments/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-118-how-provider-compensation-design-impacts-performance&utm_content=performance-improvement-compensation&utm_campaign=finance&utm_source_platform=podcast-app&utm_creative_format=blog&utm_marketing_tactic=awareness)
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
· Please email us: [email protected]
· Connect with us on LinkedIn: Coker Group Company Page
· Follow us on Twitter: @cokergroup
· Follow us on Instagram: @cokergroup
· Follow us on Facebook: @cokerconsulting
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The speakers will break down various areas they review when evaluating the revenue cycle and give examples of how they evaluated and helped clients achieve success around revenue cycle improvement. They will discuss some of the key pitfalls and areas where physician enterprises struggle, and offer advice, regardless of type and size, to consider as you optimize your revenue cycle processes and performance.
Episode Synopsis
In the context of revenue cycle management, it's essential to emphasize that the scope extends far beyond the billing office alone. The notion of "outsourcing the revenue cycle" often requires clarification, as it commonly refers to selectively outsourcing certain components, like billing or specific front-end operations. It's rare for an organization to entrust the entirety of its revenue cycle, spanning from initial patient intake and service provision to claims processing, payment reconciliation, collection endeavors, and comprehensive follow-up, to an external entity. This podcast episode delves into the intricacies of this comprehensive revenue cycle management process.
· Opening Introduction (0:11)
· Key pitfalls and areas to avoid when evaluating the revenue cycle (1:02)
· The interaction between each functional area (6:05)
· Why are we seeing more and more issues occur (9:28)
· How to diagnose billing and billing issues (12:13)
· Solutions and recommendations (18:37)
· What do the leaders and managers think of the reports? (24:26)
· Sustainability measures to help with implementation (27:40)
· Using dashboard reporting for key performance indicators (33:16)
· Question the status quo on revenue cycle management (38:07)
Extras
· How Is Inflation Affecting the Reimbursement in Your Managed Care Agreements?
· Revenue Cycle Management – Look Our for the Red Flags!
· Avoiding Four Common Pitfalls in Revenue Cycle Management
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
· Please email us: [email protected]
· Connect with us on LinkedIn: Coker Group Company Page
· Follow us on Twitter: @cokergroup
· Follow us on Instagram: @cokergroup
· Follow us on Facebook: @cokerconsulting
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This series aims to help physicians and practice administrators enhance their financial and operational performance across various domains.
Episode Synopsis
In this podcast series designed for physicians and practice administrators, our speakers will provide a deep dive into the reasons behind this series. They will emphasize the significance of performance improvement in healthcare organizations and specifically focus on physician enterprise performance improvement. Listeners will gain insights into how organizations can effectively evaluate their performance in relation to expectations, goals, and targets.
Building upon these fundamental concepts, our speakers will explore the creation of a framework for achieving high performance. They will discuss practical methods for developing a data-driven culture that permeates throughout the organization, from leadership to staff to providers. Throughout the series, we will cover a range of important domains, including revenue cycle management, operational efficiency, physician compensation, and quality outcomes. By addressing these crucial topics, we aim to provide physicians and practice administrators with valuable strategies and knowledge to enhance performance and drive success in their healthcare practices.
Extras
· Overcoming Obstacles with Performance Improvement for Critical Access Hospitals
· How Is Inflation Affecting the Reimbursement in Your Managed Care Agreements?
· Invest in Developing Your Physician Practice Leaders While Helping Them Achieve Organizational Objectives
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
· Please email us: [email protected]
· Connect with us on LinkedIn: Coker Group Company Page
· Follow us on Twitter: @cokergroup
· Follow us on Instagram: @cokergroup
· Follow us on Facebook: @cokerconsulting
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Alex Kirkland joins Mark Reiboldt to discuss the state of physician compensation and what the future may hold. Hospitals have competed for physician market share in the post-pandemic world, and the influx of private equity investment alongside rising costs has pushed the survey data approach of funding physician compensation models to unsustainable levels.
Episode Synopsis
Many external factors have impacted physician compensation over the past several years. The extensive list includes pandemic-era volume reductions, volatile survey data, Medicare Physician Fee Schedule changes, rising inflation, and the list goes on!
If there is any constant, it is that change is inevitable.
With so much uncertainty, how can healthcare systems possibly plan for the future in terms of a sound physician compensation strategy? The answer lies in understanding expected shifts in the physician workforce, and the need for a nimble compensation structure that can adapt to market forces.
Extras
· Survey Says… What to Expect from the 2021 Market Survey Data (https://cokergroup.com/survey-says-what-to-expect-from-the-2021-market-survey-data/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-115&utm_content=link-website&utm_campaign=provider-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=article&utm_marketing_tactic=awareness)
· Compensation Best Practices for Physician Enterprises (https://cokergroup.com/compensation-best-practices-for-physician-enterprises/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-115&utm_content=link-website&utm_campaign=provider-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=white-paper&utm_marketing_tactic=solution)
· How do we address provider compensation misalignment? (https://cokergroup.com/case-study-provider-compensation-misalignment/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-115&utm_content=link-website&utm_campaign=provider-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=case-study&utm_marketing_tactic=solution)
· How are the 2023 E/M guideline changes impacting your organization? (https://cokergroup.com/2023-e-m-impact-calculator/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-115&utm_content=link-website&utm_campaign=provider-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=calculator&utm_marketing_tactic=tool)
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
· Please email us: [email protected]
· Connect with us on LinkedIn: Coker Group Company Page
· Follow us on Twitter: @cokergroup
· Follow us on Instagram: @cokergroup
· Follow us on Facebook: @cokerconsulting
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Justin Chamblee presented this webinar for the American Health Law Association. He analyzes the current state of the healthcare industry and take an objective look at options for physicians/physician enterprises, assessing some of the positives and drawbacks from each and what it may mean for the future.
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
· Please email us: [email protected]
· Connect with us on LinkedIn: Coker Group Company Page
· Follow us on Twitter: @cokergroup
· Follow us on Instagram: @cokergroup
· Follow us on Facebook: @cokerconsulting
Episode Synopsis
In the not-too-distant past, the majority of physicians were in private practice. Then, the market experienced a shift wherein a number of physicians chose to be hospital affiliated, with either private practice or hospital affiliation seemingly being the only options. In recent years, the market has shifted again. Private equity money has created options for physicians that have not existed in the past, entities like VillageMD and Privia Health are rapidly developing employment models providing additional options, and health systems are assessing the financial viability of maintaining their physician enterprises in the legacy state, looking for future potential alternatives.
Learning Objectives
Survey the evolution of alignment options for physicians/physician enterprises over the past several decades. Dive deep into the current market, looking at current alignment trends and the positives/drawbacks from each. Ponder what the current alignment options may mean for the future of the healthcare industry.Extras
· Is employment the only option to keep physician practices alive?
· What’s next in the evolution of professional services agreements?
· How do we address provider compensation misalignment?
· What’s the value of the non-compete agreement?
· How are the 2023 E/M guideline changes impacting your organization?
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Jana Sizemore joins Mark Reiboldt to discuss clinical co-management arrangements as an alternative alignment model for healthcare organizations and physician groups. Clinical co-management allows physician groups to align with hospitals and health systems without becoming employed or implementing a professional services agreement.
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
· Please email us: [email protected]
· Connect with us on LinkedIn: Coker Group Company Page
· Follow us on Twitter: @cokergroup
· Follow us on Instagram: @cokergroup
· Follow us on Facebook: @cokerconsulting
Episode Synopsis
Primarily used with surgical specialties, a hospital will partner with independent physician groups to support or grow the service line. While each situation is unique and different, Jana highlights why hospitals should consider a clinical co-management agreement, how they differ from other forms of alignment, and when to use the co-management structure.
Retaining autonomy and independence is a big selling point for independent physician groups considering clinical co-management. The physicians can affect changes to the service line that would improve quality outcomes and patient care at the hospital by developing the service line and improving staff and patient satisfaction.
Extras
· Physicians in Practice: Ways to Align and Remain Independent
· Aligning Hospitals and Physicians with Clinical Co-Management Agreements
· Hospital/Physician Alignment and Clinical Integration
· Episode 102: How do you Align Provider Compensation with Health System Goals?
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Jaci Kipreos, Alex Kirkland, and Matt Jensen join Mark Reiboldt to discuss the evaluation and management coding section changes and announce the update to our popular E/M Impact Calculator. What does your organization need to do to address these changes?
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
· Please email us: [email protected]
· Connect with us on LinkedIn: Coker Group Company Page
· Follow us on Twitter: @cokergroup
· Follow us on Instagram: @cokergroup
· Follow us on Facebook: @cokerconsulting
Episode Synopsis
Alex, Jaci, and Matt present what the road map looks like and what prompted CMS to give a directive. Outpatient changes started in 2021, and the inpatient changes were effective on January 1, 2023. Their advice is to treat 2023 as a preparation year, measuring high volume codes and conducting operational reviews by the provider to determine if the documentation will meet the new guidelines. These changes will also affect your compensation plans because there are material changes to the wRVUs.
The impact calculator estimates the potential economic impact your organization may face with a partial listing of changing codes. Please note that the results of the calculations include the national Medicare reimbursement impact based on the volume input. As such, the calculation results are meant for planning purposes only and do not represent an estimation of value. For a more in-depth assessment of your providers’ payment calculations and how this may affect your commercial and other payers, please contact us to speak with one of our physician compensation experts.
Estimate the impact on key E/M codes
https://cokergroup.com/2023-e-m-coding-calculator/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-112&utm_content=link-website&utm_campaign=provider-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=calculator&utm_marketing_tactic=tool
Extras
· Keeping up with the Changes: A Review of 2023 E/M Guidelines (https://cokergroup.com/keeping-up-with-the-changes-a-review-of-2023-e-m-guidelines/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-112&utm_content=link-website&utm_campaign=coding-assessments&utm_source_platform=podcast-app&utm_creative_format=white-paper&utm_marketing_tactic=solution)
· Major Changes to Split/Shared Billing Affect Advanced Practice Providers and Physicians (https://cokergroup.com/major-changes-to-split-shared-billing-affect-advanced-practice-providers-and-physicians/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-112&utm_content=link-website&utm_campaign=provider-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=blog&utm_marketing_tactic=awareness)
· The Intersection of Compliance and Fair Market Value: Are You Sure Your Arrangements Coincide? (https://cokergroup.com/the-intersection-of-compliance-and-fair-market-value-are-you-sure-your-arrangements-coincide/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-112&utm_content=link-website&utm_campaign=fmv-cr&utm_source_platform=podcast-app&utm_creative_format=blog&utm_marketing_tactic=awareness)
· Case Study: Provider Compensation Misalignment (https://cokergroup.com/case-study-provider-compensation-misalignment/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-112&utm_content=link-website&utm_campaign=fmv-cr&utm_source_platform=podcast-app&utm_creative_format=case-study&utm_marketing_tactic=solution)
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Justin Chamblee joins Mark Reiboldt to discuss value-based reimbursement and provider compensation. He recently presented this topic at the MGMA conference with the goal of answering questions that naturally arise when considering the intersection of value-based reimbursement and provider compensation.
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
Please email us: [email protected] Connect with us on LinkedIn: Coker Group Company Page (/company/coker-group) Follow us on Twitter: @cokergroup Follow us on Instagram: @cokergroup Follow us on Facebook: @cokerconsultingEpisode Synopsis
Government programs initially led value-based reimbursement (VBR) initiatives, but commercial payers are making the shift. CMS proposes to expand access to ACOs, modernize coverage for behavioral health services, colon screening, and dental services. There are also new and exciting value-based care programs being announced outside of CMS.
Justin and Mark look ahead at the value-based care initiatives on the horizon, and how these programs should intersect with provider compensation.
Learning Objectives
Further understanding of how value-based reimbursement is manifesting itself in the market Answer questions that naturally arise when considering the intersection of value-based reimbursement and provider compensation Equip attendees with practical steps to further align their provider compensation strategies with current reimbursement environmentExtras
Major Changes to Split/Shared Billing Affect Advanced Practice Providers and Physicians (https://cokergroup.com/major-changes-to-split-shared-billing-affect-advanced-practice-providers-and-physicians/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-111&utm_content=the-intersection-of-provider-compensation-and-value-based-reimbursement&utm_campaign=value-based-strategies&utm_source_platform=podcast-app&utm_creative_format=blog&utm_marketing_tactic=awareness) The Intersection of Compliance and Fair Market Value: Are You Sure Your Arrangements Coincide? (https://cokergroup.com/the-intersection-of-compliance-and-fair-market-value-are-you-sure-your-arrangements-coincide/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-111&utm_content=link-website&utm_campaign=fmv-cr&utm_source_platform=podcast-app&utm_creative_format=blog&utm_marketing_tactic=awareness) Case Study: Provider Compensation Misalignment (https://cokergroup.com/case-study-provider-compensation-misalignment/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-111&utm_content=link-website&utm_campaign=provider-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=case-study&utm_marketing_tactic=solution) -
Beth Balcom, Brandt Jewell, Alex Kirkland, and Richard Romero presented this webinar for the American Health Law Association. Our team will cover upcoming billing and coding changes affecting healthcare organizations in three areas: coding and compliance, operations, and finance.
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
Please email us: [email protected] Connect with us on LinkedIn: Coker Group Company Page Follow us on Twitter: @cokergroup Follow us on Instagram: @cokergroup Follow us on Facebook: @cokerconsultingEpisode Synopsis
Upcoming billing and coding changes will affect healthcare organizations in three areas: coding and compliance, operations, and finance. Our team will cover these areas as they discuss how billing changes will impact physician practice operations and economics, including provider compensation and fair market value considerations.
Learning Objectives
Understand the financial impact of critical changes within the Medicare Physician Fee Schedule proposed rule and what they may mean from a valuation perspective. Discuss the operational implications and considerations resulting from the Medicare Physician Fee Schedule proposed rule. Provide an overview of the expected coding changes and associated compliance considerations.We recommend you speak with your key stakeholders about performing three actions to prepare for the upcoming changes which go into effect on January 1, 2023:
Develop a coding communication plan that considers tools and checklists to help front-line resources acclimate to the changes Audit current EHR scheduling templates to ensure they consider the changes Conduct a chart audit to verify the accuracy of coding and documentationIf Coker Group can assist you with developing a plan or implementation for any of the above, please get in touch with us to schedule a free consultation to discuss the specific needs of your client(s) or organization.
Book Your Free Consultation ---> https://cokergroup.com/contact/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-110&utm_content=book-your-free-consultation&utm_campaign=coding-assessments&utm_source_platform=podcast-app&utm_creative_format=link&utm_marketing_tactic=contactExtras
Major Changes to Split/Shared Billing Affect Advanced Practice Providers and Physicians (https://cokergroup.com/major-changes-to-split-shared-billing-affect-advanced-practice-providers-and-physicians/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-110&utm_content=major-changes-to-split-shared-billing-affect-advanced-practice-providers-and-physicians&utm_campaign=physician-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=blog&utm_marketing_tactic=awareness)
How the CY 2022 PFS Final Rule Affects Split/Shared Visits and Critical Care Services (https://cokergroup.com/how-the-cy-2022-pfs-final-rule-affects-split-shared-visits-and-critical-care-services/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-110&utm_content=how-the-cy-2022-pfs-final-rule-affects-split-shared-visits-and-critical-care-services&utm_campaign=physician-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=blog&utm_marketing_tactic=awareness) Episode 107: How will Split/Shared Visits Change Between APPs and Physicians? (https://cokergroup.com/episode-107-how-will-split-shared-visits-change-between-apps-and-physicians/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-110&utm_content=how-will-split-shared-visits-change-between-apps-and-physicians&utm_campaign=physician-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=podcast&utm_marketing_tactic=awareness) -
Alex Kirkland and Matt Jensen join Mark Reiboldt to discuss the results of our inaugural advanced practice provider strategy and oversight survey. The survey contains insight from 60 organizations employing 3,067 advanced practice providers and represents 4,356 physicians and 28 states.
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
Please email us: [email protected] Connect with us on LinkedIn: Coker Group Company Page Follow us on Twitter: @cokergroup Follow us on Instagram: @cokergroup Follow us on Facebook: @cokerconsultingEpisode Synopsis
Advanced Practice Providers (APPs) are at the forefront of healthcare delivery. They directly impact organizational goals, such as patient access, care coordination, care outcomes, and population health initiatives.
A straightforward APP compensation framework that recognizes market rates, specialization, and experience is essential to an organization's success in retaining and growing its APPs. Aligning APP compensation models with physician compensation model structures promotes team cohesiveness and enables providers to maximize their unique value to meet strategic goals and objectives.
Do you want to learn more about APP strategies and oversight? Listen to the episode and learn how APP strategies and oversight are changing.
Extras
Download the 2022 survey results Major Changes to Split/Shared Billing Affect Advanced Practice Providers and Physicians How the CY 2022 PFS Final Rule Affects Split/Shared Visits and Critical Care Services Episode 107: How will Split/Shared Visits Change Between APPs and Physicians? Episode 102: How do you Align Provider Compensation with Health System Goals? -
Jack Liu and Dr. Hamlet Benyamin join Mark Reiboldt to discuss the shift from a one size fits all approach to precision medicine which is individualized to each person. Dr. Benyamin defines precision experience as the unique experience a person needs as they enter the healthcare workforce.
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
Please email us: [email protected] Connect with us on LinkedIn: Coker Group Company Page Follow us on Twitter: @cokergroup Follow us on Instagram: @cokergroup Follow us on Facebook: @cokerconsultingEpisode Synopsis
How do we assess the barriers and processes for the healthcare workforce so we can deliver better care for everyone?
Covid-19 shed light on the healthcare delivery process, particularly within the patient and provider dynamic. Precision experience is essential to all aspects of the healthcare delivery process, from physicians and advanced practice providers to supporting staff.
Healthcare can use the insights as a jumping-off point to leap forward and improve processes that have been problematic for years. An opportunity arises from a crisis to improve the system for the people it serves.
Click to listen to the episode and learn more about the precision experience for healthcare.
Extras
Precision Experience: What it is and Why it Matters to Healthcare Now? Learn more about ProCARE Portal Precision Experience: The Solution to Creating a Shared Vision -
Alex Kirkland and Chris Marrs join Mark Reiboldt to discuss changes to the split or shared billing between advanced practice providers and physicians. Alex and Chris encourage healthcare organizations to understand these changes and update processes before the changes take effect in 2024.
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
Please email us: [email protected] Connect with us on LinkedIn: Coker Group Company Page Follow us on Twitter: @cokergroup Follow us on Instagram: @cokergroup Follow us on Facebook: @cokerconsultingEpisode Synopsis
A split/shared visit, defined as “an E/M visit in a facility setting that is performed in part by a Physician and an NPP who are in the same group,” is billed based on which provider performed the “substantive portion” of the service.
For non-critical care split/shared visits in 2022, a “substantive portion” is considered “all or some portion of the history, exam or medical decision-making key components of an E/M service.” However, for critical care visits in 2022 and all applicable visits beginning January 1, 2023, a “substantive portion” is more specifically defined as greater than 50% of the time spent on the encounter.
If the physician spends more than 50% of the time with the patient, CMS will reimburse the visit at 100%. However, if the advanced practice provider spends more than 50% of the time with the patient, they will reimburse the visit at 85%. The provider attached to the service will also receive the wRVU credit for those professional services.
Listen to the episode and learn how these changes could impact how your providers are reimbursed and compensated for their professional services.
Extras
Major Changes to Split/Shared Billing Affect Advanced Practice Providers and Physicians American Medical Association Releases 2023 E/M Updates How the CY 2022 PFS Final Rule Affects Split/Shared Visits and Critical Care Services -
Brandt Jewell joins Mark Reiboldt to explain the management principles for developing a data-driven culture. Brandt walks through examples of utilizing data to manage staff and engage providers as leaders, mentors, and champions with common group-level objectives.
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
Please email us: [email protected] Connect with us on LinkedIn: Coker Group Company Page Follow us on Twitter: @cokergroup Follow us on Instagram: @cokergroup Follow us on Facebook: @cokerconsultingEpisode Synopsis
Data validation is essential to gain buy-in and consensus from all stakeholders, particularly providers. Sharing data with providers and staff establishes consistent communication and dissemination of information.
When developing a data-driven culture, you should:
Simplify the data to focus on key metrics and actionable information Provide clear and actionable direction regarding how daily responsibilities of all roles can impact the metrics Communicate performance expectations to meet operational objectives Build realistic near and long-term goals Use consistent metrics across the group to avoid making exceptionsA strategic direction coupled with a shared vision, aligned incentives, operational support, and peer accountability through data and communication will develop a high-performing culture.
Extras
Building a High-Performing Physician Enterprise Developing a High-Performing Physician Enterprise Submit your information to request a 30-minute consultation -
Jeffery Daigrepont interviews Dan Stewart, the president of Jackson Health Tech Advisors, one of our partners providing cybersecurity advisory services. Dan has been in the healthcare information technology and services industry for more than 30 years, with the last ten years focused on cybersecurity risk management and mitigation services. That includes a Cyber Liability Insurance Services program we will discuss today.
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
Please email us: [email protected] Connect with us on LinkedIn: Coker Group Company Page Follow us on Twitter: @cokergroup Follow us on Instagram: @cokergroup Follow us on Facebook: @cokerconsultingEpisode Synopsis
The last two years have seen a new era of cyber-attacks with increased hacker sophistication, a propensity to pay in ransomware cases, and a geopolitical environment that has upended the cyber insurance market in general, particularly in healthcare.
In 2020, healthcare-related cyber-attacks increased by more than 55%, of which ransomware attacks comprised 28% of the total. According to Cybersecurity Ventures, in 2021, the US healthcare system lost $21 billion caused by ransomware attacks alone.
Covid-19 further exposed the weaknesses in healthcare cybersecurity systems as the industry was forced to institute or expand telehealth services and remote working functions rapidly. These factors caused significant losses for the insurance carriers that were providing cyber insurance resulting in several major market changes that are affecting healthcare providers.
Extras
Key Elements of a Cyber Liability Insurance Policy for Healthcare Providers Cybersecurity Tips Episode 57: HCIT: Security Risk Assessment Episode 103: What is a Security Risk Analysis, and Why Do I Need One? Contact Jeffery Daigrepont -
Richard Romero joins Mark Reiboldt to explore non-compete and other restrictive covenants in the healthcare industry. Richard explains the purpose and the value of these restrictive covenants.
Podcast Information
Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!
We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.
Please email us: [email protected] Connect with us on LinkedIn: Coker Group Company Page Follow us on Twitter: @cokergroup Follow us on Instagram: @cokergroup Follow us on Facebook: @cokerconsultingEpisode Synopsis
There are three types of restrictive covenants: non-compete agreements, non-solicitation agreements, and non-disclosure agreements. Depending on who you ask, these covenants can be a tool to protect the business or perceived as a way to limit a physician’s ability to choose their employer.
No matter how they are perceived, if a restrictive covenant does not protect a legitimate business interest, it may be unenforceable. The law does not prohibit ordinary competition.
Extras
Physician Employment Non-Compete Agreements: The Value Behind the Valuation Where’s the Value in Physician Practice Valuations? - もっと表示する
