Business assistance so you and your staff can focus on the clinical side of your practice:

• Practice Operations and Workflows Assessment
  
• Transition of Practice Manager
  
• Front Office Operations
  
• Interim Practice Management
  
• Analysis and Improvement Recommendations
  
• Recruiting – Medical Assistant, Administrative Staff and Nursing Staff

If your practice is interested in any of these services, please contact Colleen George by email or phone at 410-652-5808

Common Practice Management Questions

• Appeal and Grievance
• Assignment of Benefits
  • Notice required to be provided to patients by physicians seeking assignment of benefits who are classified as non-preferred providers by the patient’s insurance company
    
• Guidelines for Successful Claim Appeals
  
• Late Payment
• Overview of House Bill 437/Senate Bill 537 Prescription Drug Monitoring Program
  
• Prior Authorization
• Retroactive Denials of Insurance Claims in Maryland
• Step Therapy

Coding & Billing

• MACRA 
  On April 27, 2016, the Department of Health and Human Services issued a Notice Executive of Proposed Rule making to implement key provisions of the Medicare Access and Summary CHIP Reauthorization Act of 2015 (MACRA), legislation that repealed the Sustainable Growth Rate formula and replaced it with the “Quality Payment Program."  This proposed rule requires physicians to participate in either the Merit-based Incentive Payment System (MIPS) or the Advanced Alternative Payment Models (APMs).  For more information on this, please click here.

De-Implementation

• De-Implementation Checklist
  In an effort to reduce unintended burdens for clinicians, health system leaders can consider de-implementing processes or requirements that add little or no value to patients and their care teams. Physicians themselves are often in the best position to recognize these unnecessary burdens in their day-to-day practice. The following list includes potential de-implementation actions to consider. Learn more on how to reduce the unnecessary daily burdens for physicians and clinicians at stepsforward.org.

Delegation Guidance

• Delegation rules with respect to cosmetic procedures
  The Medical Practice Act defines the “practice of medicine” as to “engage, with or without compensation, in medical diagnosis, healing, treatment, or surgery.” It specifically includes “diagnosing, healing, treating, preventing, prescribing for, or removing any physical, mental, or emotional ailment or supposed ailment of an individual by physical, mental, emotional, or other process that is exercised or invoked by the practitioner, the patient, or both, or by appliance, test, drug, operation, or treatment. HO 14-101(o).

Health Insurance

• Request for Confidential Communications Form
  This form lets you choose where your health information gets sent after your health care visit. Right now, if you do not complete this form, your health information will be sent to the person who pays for the insurance you use. You can ask that the information be sent to a different address or by other means that only you will see. You can do this if you believe that giving your health information to the person paying for your insurance would put you in danger.

Hearing Interpreters

• Hearing Interpreters - HIPAA covered entities and Recipients of Federal Financial Assistance
• Hearing Interpreters - Medical Interpreters and Disclosure of PHI
• Hearing Interpreters - Rules of Governing Medical Interpreters and Disclosure of PHI Powerpoint Presentation

Payment Issues

• April 9, 2019: Medicaid Non-Par Billing Instructions in Maryland - Letter from Maryland Department of Health to MedChi CEO, Gene Ransom

Physician Burnout

• Addressing Health Worker Burnout - The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
  A Surgeon General’s Advisory is a public statement that calls the American people’s attention to an urgent public health issue and provides recommendations for how that issue should be addressed.  Advisories are reserved for significant public health challenges that need the American people’s immediate awareness.  This Advisory contains steps that different stakeholders can take together to address health worker burnout. It calls for change in the systems, structures, and cultures that shape health care.  Given the nature and complexity of the challenges outlined, this Advisory is not intended to be comprehensive in its recommendations.
  
  
• AMA STEPS Forward™ Saving Time Playbook Offers Strategies to Improve Practice Efficiencies
  Physician burnout is an epidemic in the U.S. healthcare system, and time spent on non-patient-facing tasks in a clinician’s workday is contributing heavily to the problem. But saving time cannot be accomplished by simply telling physicians to become more efficient. Timesaving efforts need to come from organizational leaders who can affect large-scale change. Containing highlights from nine AMA STEPS Forward™ toolkits, the Saving Time Playbook offers strategies and tips that can significantly improve efficiencies in your practice.

• Practical Considerations for Starting or Joining Clinically Integrated Networks and Other Innovative Contracting Models
  The AMA’s prerecorded webinar, “Developing Clinically Integrated Networks and other Innovative Contracting Models,” highlights the strategic, financial, risk, legal, and regulatory considerations for physicians starting or joining a clinically integrated network or entering alternative value-based contracting models. Topics include tactics to achieve operational readiness before entering value-based arrangements, types of arrangements, and structural differences in each. To accompany this presentation, the AMA has published a new, related resource, a checklist designed to help physicians evaluate their preparedness for clinical integration.

• Report: Supporting and Promoting High-Performing Physician-Owned Private Practices
  The AMA has partnered with Mathematica, a global research and policy organization, to analyze and assess the factors that create and sustain high-performing, physician-owned private practices. The report highlights the findings from this qualitative research and provides insights into the nature of high-performing private practices, advantages and challenges to the practice model, and the changes that physicians in private practice foresee. The report concludes that physician-owned practices will continue to be an integral part of the health care ecosystem, but the success of the model will require the commitment and efforts of policymakers, educators, professional organizations, and other groups to remove obstacles and create equitable opportunities for success.

Privacy Protections

• Privacy Protections for Medically Related Internet Searches
  The HIPAA (Health Insurance Portability and Accountability Act of 1996) Privacy Rule applies to health plans, health care clearinghouses, and to any health care provider who transmits health information in electronic form in connection with transactions for which the Secretary of HHS has adopted standards under HIPAA (the “covered entities”).

Security

• Cybersecurity and Infrastructure Security Agency (CISA) Hospitals & Healthcare Facilities Security Awareness for Soft Targets and Crowded Places
  Hospitals and healthcare facilities face a unique set of challenges in an active shooter incident. These incidents have no patterns in victim selection or method, creating an unpredictable and quickly evolving situation that can lead to loss of life and injury. Numerous factors associated with hospital and healthcare environments complicate traditional response to active shooter incidents, including the “duty-to-care”, also known as “duty-to-act”, commitment and the varying levels of patient mobility and patient special needs. Additionally, staff must consider response planning for patients that require the greatest allocation of resources, as well as the unique characteristics within the hospital and healthcare environment.
  

Smoking Cessation, Alcohol, and Substance Use Disorder

• Smoking Cessation, Alcohol, and Substance Use Disorder Screening Guide
  This guide is to be a reference on billing codes, guidelines, and requirements of Smoking Cessation, Alcohol, and Substance Abuse Disorder Screening.

• A Guide for Health Care Professionals ‘Confidentiality and Reporting Requirements in Maryland: Responding to Abuse and Neglect of Children, Intimate Partners and Vulnerable Adults
  This guide is intended to help you determine in which situations you should report abuse and to whom. There is immunity from legal action for anyone who makes a report in good faith. Know that even when a report is not required, you can refer the person for help in the community.

• Non-Physician Scope of Practice: The Legalities
  PowerPoint Presentation by MedChi's General Counsel

• April 5, 2021 - CMS to Pay Physicians More For Evaluation and Management, Less For Other Services
  Effective January 1, 2021, the Centers for Medicare and Medicaid Services (CMS) implemented changes to physician reimbursement.  The general effect of these changes will be to increase Medicare payments to physicians providing a large volume of evaluation and management (E/M) services, and reduce payments to certain procedurally-based physicians.  More info on this topic is included in this Merritt Hawkins blogpost.