Physician Practice Optimization

The majority of physician practices are not using their EHRs effectively from the standpoint of provider efficiency, performance in quality-based programs, and billing and coding. A few providers have had marked success clinically and from a business perspective through detailed EHR customization of their EHRs, allowing them to increase patient volumes while improving performance. HCIT Consulting  offers a service that represents the next phase of health information technology in physician practices regarding workflow and IT optimization to identify revenue generating opportunities and efficiency gains.

We assist with gap analysis of products, project management, and the effectiveness of prior implementations. Our turn-key physician optimization has delivered bottom-line results for providers and implemented best-practice change utilized in day-to-day operations, including the achievement of optimal MIPS scores ranging as high as 100 points. Our areas of focus include:

EHR Coding Optimization: Our team will assess the coding and compliance capabilities of your EHR and its content. Due to the complexity of the coding rules, clinicians often code at a level that is below what would be supported by medical necessity. We provide guidance on how to use your EHR to accurately document and code based on published guidelines which may vary from state to state and payer to payer. In general, Practices see clinical documentation improvements (CDI), improvements in efficiency, coding accuracy and patient throughput.

Workflow and Efficiency Analysis: We identify workflow solutions for your practice based on our experience  with practices of a similar size and specialty that have improved their productivity and revenue based on workflow analysis in context with available technologies in the practice.  Additional technologies that may benefit your practice (e.g. mobile applications, tele-health, patient kiosks, etc.) may be recommended if there is a clear advantage to your practice. We also assist with gap analysis of products, project management, and implementation as needed.

Compliance with Incentive Programs: There are currently several programs that may benefit you practice or even result in penalties if certain criteria are not met. These include well-known programs such as Meaningful Use, PQRS, and PCMH. Our suite of physician services includes support for optimization of  quality measures, MACRA, MIPS, APMs/ACOs, TCM, CCM, HCC, the Patient Centered Specialty Practice (PCSP), bundled payment models and other initiatives.

Audit Defense for Physician Practices: CMS, CMS contractors and private payers are increasingly performing audits of coding and billing practices. The Justice Department estimates that over $30 billion dollars a year are lost by the government to fraudulent healthcare practices. The current administration has made recovery audits a priority for the past several years.  An audit may result in administrative fines or in some cases criminal allegations. HCIT Consulting has extensive experience working with practices to review audits performed by contractors and external consultants.

  • Documentation review by an independent physician who is also a certified professional coder (CPC) and certified risk adjustment coder (CRC)
  • Review of supporting guidelines (e.g., LCDs, CMS guidance, private payer requirements, etc.)
  • Detailed factual rebuttals of negative audit findings
  • Development of evidence-based justifications based on a review of the scientific literature
  • Development of evidence-based protocols that include a review of the scientific literature and documentation and coding requirements provided by payers
  • Incorporation of these protocols into electronic health record content, clinical workflows, and documentation
  • Provider and staff education regarding best-practices and protocol adherence

Chronic Care Management (CCM), Principal Care Management (PCM), Remote Patient Monitoring (RPM), and Transitional Care Management (TCM) Services

The CMS initiatives for Chronic Care Management (CCM), Principal Care Management (PCM), Remote Patient Monitoring (RPM) and Transitional Care Management (TCM) are proving to be a valuable way to increase revenue in physician practices for work that is already being performed by care teams. These payment models may seem daunting to operationalize.  Especially in this era of Medicare Shared Savings, CCM, PCM, RPM and TCM will support the transition from ‘reactive’ patient care to ‘proactive’ patient care.  This paves the way for improved quality measures, better health outcomes for patients, reduction in readmissions-while increasing revenue.

The revenue potential of the CCM program alone is significant. For example, if a practitioner enrolls 400 patients in a CCM program, this translates into $201,600 in additional revenue per year.  In addition, Medicare estimates that approximately 2 of every 3 Medicare recipients have 2 or more chronic conditions, so this number may be conservative for many providers.

What’s the Catch?

There are a number of requirements that need to be met before practices can bill for these codes. Several nuances of the program create challenges for practices in the area of process management, workflow, and compliance.  HCIT Consulting has a proven consulting service that can maximize reimbursement and reduce penalties for your physician practice(s) in as little as 5-15 hours per physician for multiple reimbursement models.

With a 2500% ROI, we can have up to a 50-physician practice up and running with TCM and CCM in as little as three weeks!  Additionally, we can help practices identify potential APM opportunities in 2019 and beyond. A recent practice our consultants worked with scored 100% on the MIPS based on their 2017 data.

Further information on the CCM program is available at: Medicare’s CCM Program: Opportunities and Challenges.

Schedule a free 30-minute consultation regarding your readiness for TCM and CCM and see if you qualilfy for a free audit. Email us at info@hcit.consulting  for more information.