HHSC Extends Medicaid PEMS Revalidation
~Phil West, TMA
Health and Human Services Commission (HHSC) has provided an extension for physicians due for revalidation between Dec. 13 and May 31 through Texas Medicaid & Health Partnership’s (TMHP’s) Provider Enrollment and Management System (PEMS).
While the extension grants an additional 180 days to physicians due for revalidation between those dates, TMA advises physicians who are due for revalidation over the next six months to file online with HHSC as soon as possible.
2025 Medicare Outlook
1st Come, 1st Served
POET will host MGMA’s 2025 Medicare Outlook Web Event
Date: December 10, 2024
Time: 12 o’clock, noon
Where: POET Office 111 Gaslight Blvd. Ste.B, Lufkin, TX 75949
Lunch will be provided
Limited Seating Available
Call or Email to reserve your place.
Beware these malpractice landmines!
By Logan Lutton, Chris Mazzolini
~Physicians Practice
EHRs are increasingly leading to malpractice lawsuits. While EHR-related lawsuits still make up only a small number of lawsuits, user error is the cause of 64 percent of EHR-related malpractice claims, according to the Doctors Company. Practices need to focus on eliminating several common problems, mostly tied to user actions, which have led to the majority of EHR-related suits
Many doctors are tempted to copy a note from a prior encounter and make changes as appropriate. This leads to a few potential problems.
“Sometimes physicians forget to update the note with the appropriate changes when copying and pasting” David Troxel, MD, MeD & Sec. Doctor’s Company Brd. of Gov.
Drop-down menus can often be the source of a user error that leads to a malpractice suit. Not only can users click the wrong thing in the menu, such as the wrong patient symptom, but these menus lead to structured information that physicians can easily overlook when reviewing a note
Jeffrey Kagan, MD, a Newington, Ct.-based internist, has experience reviewing malpractice cases for attorneys. One trend he has seen related to EHR-induced malpractice suits comes from template use.
“Templates are supposed to help us do something more comprehensive, but often our templates have a lot of old information that carries forward,” he says. In order to avoid falling into this trap, He advises physicians to proofread and modify templates.
The e-prescribing module in an EHR is a potential landmine for malpractice. Alerts indicating when there is a problem with medication dosage or drug-drug interaction will pop up as practitioners are inputting data into the EHR. As a result, doctors get annoyed and develop alert fatigue, and they just turn the alerts off. While this is understandable, turning off the alerts could mean a potential significant problem could go undetected.
Another prompt that goes ignored, often to the determinant of the patient and the doctor, are clinical decision support (CDS) alerts. These are clinically relevant educational materials that come up as the practitioner is documenting in the EHR. Practitioners should ignore these at their own peril, Troxel says. If anything, physicians should document the reason why they overrode the CDS alert.
The idea of physicians missing a vital piece of information in the EHR can be either a user or a technical error. These types of problems are most likely to crop up when a physician is using a new system.
TMA Webinar Helps Equip Physicians for 2025
Medicare Fee Schedule
With the Centers for Medicare & Medicaid Services’ (CMS’) 2025 Medicare Physician Fee Schedule set to take effect Jan. 1, the Texas Medical Association is preparing physicians for changes in payment and coding, telemedicine, and quality and value-based care arrangements, among other areas.
2024 Payer Scorecard: How payers are failing practices and patients
Physicians Practice: November 11, 2024, By Keith A Reynolds
How would you characterize your prior authorization experience in the last year?
We’re doing more prior authorizations
74%
We’re doing fewer prior authorizations
4%
Prior authorizations are about the same
22%
Do you think there should be a CPT code requiring payers to reimburse for prior authorization work?
Yes
97%
No
3%
What is your biggest challenge with your biggest payer?
- Current systems don’t interact well with our billing systems requiring office staff to correct claims leading to delayed payment
- Reimbursement stinks. I Quit !!!!!!
- Staff the insurance companies contracted are mostly out of the country and do not know the issues we have and do not like to refer the questions or specific issues to any expert in the field.
- Small practice is ignored. They would not negotiate fees. For more than 15 years no increase in fees, only steady decrease. It is a shame, no respect any longer for providers.
- Prior authorizations waste so much time for what should be a simple process
- Lack of urgency or even motivation to provide basic service
The verdict is in for how practices feel about their payers, and it isn’t good.
How can payers improve their relationship with practices?
- Streamline systems to allow for clean claims the first time
- Have a dedicated Provider Relations contact so we know who to talk to, and who to call to get responses to critical questions, not have to send emails to faceless representatives that have a low rate of resolution.
- Communicate. Show WHY they deny, and what EXACTLY can be done to help the patients who pay them. Do not simply deny with NO guidance.
- Pay us enough to survive. Instead, they raise hospital payments. Paying us more so we could hire more doctors and physicians assistants and keep people OUT of those hospitals.
- Stop putting technology problems and carrier losses on the provider and their patients.
- Instead of looking at me as an expense, look at me as a tool to care for their beneficiaries.
- Stop requiring PAs for generic meds and obviously necessary medications.
Medicare Solidifies Pay Cut
In a final rule that solidifies a nearly 3% Medicare pay cut for physicians in 2025, the Centers for Medicare & Medicaid Services (CMS) also set the trajectory for physician practices over the next year with a mixed bag of changes related to telemedicine, coding and payment, and the Merit-Based Incentive Payment System (MIPS), among others. ~By Phil West
While TMA analyzes what it sees as some isolated, positive changes resulting from CMS’ finalization of the 2025 Medicare Physician Fee Schedule, it is also urging physicians to act now to show their support for House Resolution 10073
LAST CHANCE
Compliance Training
There is still room at the table for POET’s last compliance webinar, November 5th, Noon.
Two topics will be represented: “OSHA for Medical Practices” and “Establishing and Maintaining a Healthcare Compliance Program”.
Come network with other Physician office managers and staff.
Get a bite to eat (you will need to submit your order for Chick-fil-a).
And concur some of that compliance training you have on your to-do list.
Call POET (936) 637-7638
Is Your Plate Full?
Saving Time Playbook
This playbook will provide strategies to organizational leaders to enhance processes, implement time-saving workflows, increase the efficiency of their practice, and improve physician well-being
POINTS OF INTEREST:
- The Burnout Problem Is Organizational, Not Personal
- Stop the Unnecessary Work
- Getting Rid of Stupid Stuff
- Share the Necessary Work
- Advanced Rooming and Discharge
- Tasks Medical Assistants or Other Team Member Can Complete
- Make the Case to Leadership
- And Much, Much More: Graphs, podcast, practical tools, checklist, and toolkits
NOW YOU KNOW
Every business, especially a medical practice, needs to run like a well-oiled machine
Just as oil prevents an engine from drying out and freezing up, your medical practice must have a well-developed denial management program in place. This is the first proactive step.
Security Training Tips for Frontline Employees
The shift towards digital solutions has had a profound impact and benefit. However, it has also introduced new challenges, particularly concerning security, which is why your frontline employees need to be properly trained to ensure your business and customers are protected.
As frontline sectors continue to embrace technology, the dependency on digital tools and platforms grows. Employees now rely on various devices and software to perform their duties, from processing transactions and managing customer interactions to accessing sensitive information. Point-of-sale systems, digital customer service platforms, electronic health records, and mobile apps are now standard tools in these environments.
The Importance of Security Training for Frontline Workers
Frontline workers extend beyond emergency responders. It’s an encompassing term to describe individuals who are the first point-of-contact between a company and its customers. They can handle sensitive information, greet patrons as they enter facilities, or provide direct support when needed
Why is front line training so vital?
- Direct Customer Interaction
- Protecting Sensitive Information
- Identifying Threats
- Compliance with Regulations
- Building Customer Trust
For Additional Helps and Tips Visit: Vector Security’s Security Blog.
Recent Comments