Cardiovascular Business - November/December 2008 - (Page 7)

Maximize Reimbursement Increase Productivity Quality Reporting Scheduling Two sources of claims underpayments come from the payor accessing inappropriate discounts or not following the terms of the contract. Honeycutt says that athenaCollector’s ability to generate a monthly payor mismatch report to make sure new contracts are getting paid according to schedule is a major benefit of the software. The practice was able to completely recoup the software’s cost within the first year of go-live, with the overall collection rate increasing from 44 percent of charges to 45.2 percent. “In a declining fee schedule environment, a net 1 percent gain is extraordinary,” she says. Honeycutt says they can track practice activity and claims in real time through athenCollector’s Workflow Dashboard, which allows her to see, understand and manage practice operations up to the minute, from anywhere. She monitors clinic productivity to see how well CT is performing, how far out echoes or nuclear slots are, and to gauge the use of the outpatient cath lab—all to make adjustments when and where needed, as opposed to getting lengthy monthly productivity statements. Additionally, hold and eligibility buckets are all on a dashboard for staff to view workloads for claims holding, no-shows and rescheduled appointments. “Every day I can look at this to see what is waiting in the buckets and catch work that is pending or not done,” she concludes. Data Mining billed and what was documented in the EMR. “This is where a lot of people may not do as well with Physician Quality Reporting Initiative (PQRI), since you have to have billing and the EMR tweaked for the initiative, for things such as outpatient consult codes,” Biga says. Many practices are participating in quality reporting and payfor-performance (P4P) initiatives to maximize reimbursements. Honeycutt confirms her practice’s need to document quality metrics. “AthenaCollector helped to ensure that our physician’s work and care were documented and indicators were completed prior to submitting a claim. We received a maximum award for the six months, which is approximately 1.5 percent of our Medicare receipt for six months,” she says. In 2008, a Centers for Medicare & Medicaid Services (CMS) P4P demonstration project resulted in extra savings of $16.7 million for 10 large group practices across the U.S., for reporting quality measures related to patients with diabetes, coronary artery disease and congestive heart failure. The demonstration was one of the agency’s value-based purchasing (VBP) initiatives designed to tie Medicare payments to performance on healthcare cost and quality measures. Under another VBP initiative, the PQRI, physicians can receive a 1.5 percent increase in Medicare reimbursement for reporting the same quality measures. As part of athenaNet, athenahealth’s centrally hosted, on-demand PM and EMR service network, all nine offices of Virginia Cardiovascular Specialists were able to leverage the PQRI requirements, since the measures were built directly into the office workflow. To participate in PQRI, athenaCollector built measures for Virginia Cardiovascular Specialists, which in turn, chose what Quality reporting to boost reimbursements Quality reporting is an interesting and complex initiative, says Cathleen Biga, president and CEO of Cardiovascular Management of Illinois, a practice management company. Insurance companies use claims data but quality data has to come from both PM software and the EMR, to know what was CardiovascularBusiness.com Cardiovascular Business 7 http://www.CardiovascularBusiness.com

Table of Contents Feed for the Digital Edition of Cardiovascular Business - November/December 2008

Cardiovascular Business - November/December 2008 Contents First Word Cover Story: Practice Management Software Moves Beyond Bean Counting The Death of CME as We Know It? Clinical Study Digets: Triple-Antiplatelet Therapy; Ex-Vioxx Users Beware Shockwaves Subside from the FDA's Echo Contract Warning Burning Question: Does Laser Heart Therapy for Angina Really Work? Advanced Visualization Adds New Practive Dimension Coronary Calcium Scoring Program Reaps Dividends Interventionalists Get Pumped Up About Mechanical Chest Compression Trials Force Physicians to Re-Examine Oral Anti-Diabetic Drug Protocols News & Views Calendar Reader Resources The ACC Corner

Cardiovascular Business - November/December 2008

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