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MMP’s depth of expertise greatly benefits our clients, and we would like to share with you some of that industry knowledge in the white papers listed below. |
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| Are You Ready? The "RAC Attack" Expands To Two Programs |
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Hit with improper provider payments that totaled nearly $11 billion in 2007, the Centers for Medicare & Medicaid Services (CMS) fought back with an aggressive new program designed to root out fraud, waste and abuse at virtually every level of the Medicare program.
The Medicare Recovery Audit Contractors Program initiative, now commonly known as RACs, marked a major shift in the way CMS pursued improper provider payments.
 Complete White Paper PDF |
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| Staking Today's Claims With A Clearinghouse: Why Filing Directly Proves Obsolete For Optimum Claims Management |
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Due to dreary economic conditions that include dwindling payor rates, Medicare cuts and increasing internal operating costs, how practices are managing their revenue plays a crucial role in their profit. In today's complex reimbursement environment, practices are faced with more risks and burdens in accounts receivable (A/R), and while the demand for physician services continues, achieving an increase in profit is challenging for many.
Complete White Paper PDF |
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| Billing Transparency: “See-Through” Processes Improve Every Step of the Billing Cycle |
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There are many buzz words floating around the medical billing community – “transparency” being no exception. But while it may seem that the term is self-explanatory, its meaning suggests that every participant in the billing cycle is allowed to see what is going on – from large-scale strategies to tiny details. On a large scale, a practice might consider total cash flow in a given time period, the status of claims, and quality measures. From a smaller standpoint, a practice might wonder about individual claims: their creation, history, validity, corrections, submissions, and reconciliation until payment, in order to understand the big picture.
Complete White Paper PDF
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| “ACE” in the (Black) Hole: How Emergency Physicians Can Prepare for Payment Bundling |
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As part of a three-year demonstration that began May 1, 2009, the Acute Care Episode (ACE) is a program from the Centers for Medicare & Medicaid Services (CMS) that strives to improve efficiency and quality while allowing patients to share in the cost savings. It is designed to align incentives and provide flexibility to hospitals and physicians by bundling all related Part A and B patient services into an episode of care with a single global payment.
Essentially ACE changes how Medicare pays for healthcare services, with CMS bundling payments into a lump sum instead of paying the hospital and physicians separately. ACE is also intended to change how providers are "incentivized" for quality of care and cost reductions and to reward providers when patient outcomes are deemed by CMS to be better than the norm, for example, a hip replacement patient who is discharged in two inpatient days versus four or more.
Complete White Paper PDF |
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| Mapping Out Managed Care Contracts for Prime Reimbursement Requires Close Attention for Negotiations, Follow up on the Back-End |
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It is important that managed care contracts be closely scrutinized from many angles to assure emergency medicine practices are getting the proper reimbursement. Many savvy practice leaders and physicians understand that complex language within a contract requires strict attention to assure reimbursement is met and follow through in what is stipulated. However, many facets of managed care contracts outside of the language can be overlooked and therefore directly affect a practice’s reimbursement. This paper will address both complex language and negotiation tactics that can directly and positively impact reimbursement.
Complete White Paper PDF |
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| Effective Emergency Medicine Chart Reconciliation Ensures Lowest Risk of Lost Revenue |
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Most emergency medicine practices may readily admit that chart reconciliation is an important process to perform in order to prevent lost charges for services provided. Many practices may not be aware that even small miss rate percentages of charges can create large pockets of revenue loss. If implemented and maintained, chart reconciliation allows emergency medicine practices to fill in gaps on lost charges and thus reduce risks for lost revenue. Many emergency medicine practices and third-party billing vendors claim 100 percent chart reconciliation, but there are many pieces to consider before this claim can be made accurately.
Complete White Paper PDF
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Physician Ownership Provides Key Benefits For
Newly Independent
Emergency Practices |
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Shifting hospital priorities and continued growth in emergency department volume have led many emergency departments to reconstitute themselves as stand-alone, independent practices.
Making the successful transition from employed physician to independent group requires a clear strategy about how best to organize and staff the enterprise. Most emergency groups today are structured around either independent contractor relationships, physician employees or owner-partner physicians.
Complete White Paper PDF
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| Essentials Of Critical Care Documentation and Coding |
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The core competency that defines emergency medicine as a specialty field is centered in our ability to bring to bear critical interventions on patients presenting with organ or life threatening illness and injury. While we routinely handle debilitating ankle sprains, patiently help a young child through his first finger laceration as painlessly as possible, or reassure a middle-aged man that his chest pain is not from a heart attack, our ultimate value to our hospital and our community is our availability and competence in the delivery of complex, skilled intervention to those who would suffer extreme morbidity or mortality were we not present.
Our timely interventions in severe infectious, ischemic, traumatic, surgical and other emergent scenarios obviously have a direct impact on patient outcome. Not so obvious, but only slightly less important in the prevailing climate of rising and scrutinized healthcare costs, what we do well in the first hour of a patient’s presentation can significantly reduce downstream costs for care.
Complete White Paper PDF
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| The Road Ahead |
| Strategic Planning Sessions Vital for Physician Group Success |
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Physician groups often find it difficult to carve out time for long-term strategic planning amid the relentless demands and frequent turbulence of day-to-day operations. Yet stepping back to develop solid business objectives has never been more important for medical groups.
Complete White Paper PDF |
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