COVID-19 PHE Renewed

Originally published in the January 12, 2023, issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra renewed the COVID-19 public health emergency (PHE) yesterday. This renewal extends the PHE through mid-April 2023 and has implications for Medicare telehealth, COVID-19 testing, and other waivers. HHS has reiterated its promise to give a 60 days’ notice before letting the PHE expire.

While many telehealth flexibilities are tied to the PHE, it is important to note that the recently passed Consolidated Appropriations Act, 2023, does ensure certain ones will remain in effect through Dec. 31, 2024, regardless of PHE status.

More information may be found in MGMA Government Affairs’ newly updated telehealth resource.

Congress Releases Year-end Legislation, Addressing Medicare Cuts and Telehealth

Originally published in the December 22, 2022, issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

Earlier this week, Congress released the text of their year-end spending package, which contains a handful of healthcare provisions that will impact medical groups.

Medicare physician payment: The legislation averts 6.5% of the scheduled 8.5% reduction to physician reimbursement in Medicare, resulting in an approximate 2% cut to the Medicare conversion factor for 2023. By way of background, in 2021, CMS shifted funds in the physician fee schedule to pay for an increase in work RVUs, which raised reimbursement for office visits. This shift resulted in a decrease to the conversion factor due to a statutorily mandated budget neutrality adjustment. Congress provided funds to offset the adjustment in 2021 and partially offset it again in 2022. Going into 2023, we expected a cut of 8.5%, resulting from both a decrease to the conversion factor (4.5%) and PAYGO cut (4%). For the third year in a row, we’ve urged Congress to address the de facto cuts — this year in the form of adding 4.5% back into the fee schedule and waiving PAYGO. Unfortunately, despite 10,000 letters from MGMA members, Congress did not have the appetite to fully waive budget neutrality requirements to address the slated 4.5% cut. Instead, Congress will only partially mitigate it by allowing a 2% cut in 2023. This is in addition to legislation waiving the 4% PAYGO for 2023 and 2024. MGMA has voiced its disappointment that Congress is allowing a 2% cut to occur in 2023 and will continue working to find a more sustainable and comprehensive solution.

Alternative Payment Models (APMs): The 5% incentive bonus is set to expire at the end of this year. The legislation would extend the bonus for an additional year, through 2023, at 3.5%.

Telehealth: Many telehealth waivers, including being able to treat a patient in their home, were extended through 2024. This is positive development supported by MGMA to ensure continuity from pandemic-era telehealth policies.

Lab cuts: Pending the passage of this legislation, practices will receive a one-year reprieve from the laboratory cuts of up to 15% that would have gone into effect in January 2023. This provision was also supported by #MGMAAdvocacy.

We expect Congress to pass this legislation into law by Friday. We will let you know if Congress modifies the current text.

UPDS: COVID-19 Practice Protocols Report

COVID-19 Practice Protocols Report

Since the beginning of the pandemic, the NCMS, the North Carolina Medical Group Management Association and Curi have been sending surveys regularly to our members to track the impact the pandemic is having on your practice. Thank you to everyone who consistently responds to this survey! Your participation allows us – and you – to get a snapshot of where medical practices in North Carolina are financially, with PPE supplies, telehealth and staffing among other issues. This valuable data helps inform our advocacy and resource development on your behalf.

The most recent survey examined trends in medical practice protocols in response to the pandemic, comparing how office procedures have evolved over time. View the survey data comparison at the button link below.

Thank you for taking time out of your busy day to complete these surveys. This data is made possible because of your participation.

Urgent Practice Data Survey 2020 Summary Report

On March 29th, NCMGMA, NCMS and Curi started distributing the same set of questions to a collective e-distribution list on a weekly basis. The goal: to garner a snapshot of North Carolina’s healthcare practices as we moved through the coronavirus pandemic.

The graphs and charts offer a 2020 snapshot of the financial concerns, staffing issues, access to PPE, use of telehealth and other ongoing challenges you face.

Thank you to everyone who routinely completed — and who continues to complete — the survey as we carry on with collecting this valuable data at regular intervals. All three organizations have used the information to develop resources to help you and to advocate on your behalf with policymakers.

Please follow the button link to view our 2020 data summary report.

A Note About the Urgent Practice Data Survey
The information and data collected has been compiled and used anonymously to better understand the most acute and immediate needs and to establish any trends to inform our policymakers on behalf of the physicians, PAs, practice administrators and the patients of North Carolina. Thank you to all of our members and practices who have contributed to these report-out results.

Future of IoT in Healthcare Brought into Sharp Focus

Reda Chouffani, Biz Technology Solutions – Published by

2020 Alliance sponsor feature article courtesy of Biz Technology Solutions

With faster broadband speeds, better analytics, technological improvements and more competitors in the space, the future of IoT has a greater opportunity to make a positive impact on the healthcare industry.

In the last few years, numerous vendors have entered the IoT market space. The 2020 consumer electronic event CES saw a record number of companies in the market with healthcare IoT products, such as care robots, intelligent home camera systems for tracking seniors at home and, of course, smart speakers. By 2025, experts predicted that the wearable technology market will reach $74.03 billion. This is a significant increase from its valuation in 2019 of $27.91 billion. Wearable technology is especially important to healthcare because it will introduce more devices to the market that patients can use to monitor activities, vital signs and several healthcare data points.

Why the internet of medical things is the future of healthcare

Beyond the growing market for healthcare IoT, the COVID-19 pandemic has spurred conversations around the future of IoT in healthcare and how it can safely connect healthcare professionals and patients. Hospitals and clinics were forced to quickly evaluate telehealth to continue to treat some patients without increasing their risk of infection by bringing them into care facilities. Hospitals are also under constant pressure to identify ways to reduce costs. Wearable devices that enable some patients to be treated and monitored at home could reduce the number of resources needed at the healthcare facility.

Another technology contributing to the future of IoT in healthcare is the introduction of 5G networks, which provide 100 times faster speeds for connectivity than traditional 4G networks. IoT devices rely on connectivity to communicate and transfer data between patient and care provider. Faster cellular data transfer provides IoT flexibility in terms of the volumes of data it can exchange and at a much faster rate. With these improvements, new healthcare IoT uses include devices that assist patients with their medication adherence at home; sleep monitoring devices that can track heart rate, oxygen levels and movements for high-risk patients; remote temperature monitoring tools; and continuous glucose monitoring sensors that connect to mobile devices and alert patients and clinicians to changing blood sugar levels.

This new pandemic experience combined with the progress and recent advancements will increase the adoption of IoT and encourage those who might have otherwise ignored the technology in the past to get on board.

What would future applications of healthcare IoT look like?

With the increasing use of cloud services combined with AI, IoT devices are getting smarter and are going beyond just transmitting data from patient to healthcare professional. For example, IoT devices that use cloud services for data analysis are the smart glucose monitoring system and smart insulin pen. These two technologies not only continuously capture information regarding glucose levels, but also upload the data to a cloud service or a mobile app to be analyzed. Based on the outcome of the analysis, the insulin pump can then inject the patient with the appropriate dosage of insulin. Another example is the use of smart nanny cameras for monitoring elderly patients. These smart cameras recognize when routines deviate from the norm, such as if an elderly person goes into the bathroom but does not come out after a short period of time. Another application of the camera is for fall detection, which would then alert emergency services or caregivers.

Other uses of IoT that will begin to trend in the future include the use of bots or virtual agents to interact with patients. By combining sensor information collected by different IoT devices and sensors and using voice-enabled speakers, seniors can have access to a personal virtual assistant to remind them to take their medication, survey them for any relevant information that relates to their health or pain levels, and react to any collected information from their devices, such as glucose levels, fall detection or oxygen levels.

Beyond wearables and patient-specific interactions, healthcare organizations will adopt IoT in facilities for inventory management and equipment tracing. This technology — generally referred to as real-time location systems — continues to improve because of advancements in wireless technology and the size of the sensors. By tracking the movement of equipment and general use, hospitals will get better visibility of potential equipment shortages and who may have come in contact with the equipment. This is especially important for preventing the spread of infection, such as how the COVID-19 pandemic forced hospitals to track equipment and staff who came in contact with infected patients.

History of IoT in healthcare

In the past decade, internet-connected devices have been introduced to patients in various forms. Whether data comes from fetal monitors, electrocardiogram machines, temperature monitors or blood glucose monitors, tracking health information is vital for some patients, though many of these measures require follow-up interaction with a healthcare professional. The use of IoT devices has been instrumental in delivering more valuable, real-time data to doctors and lessening the need for direct patient-physician interaction. Early on, the purpose of many of these devices was to transmit data to provide visibility of a patient’s condition through reported vitals. For many physicians, the data was not sufficient and needed analysis to provide greater value. That’s the direction healthcare IoT has been moving toward.

AI will continue to convert many traditional internet of medical things from data collection points to smarter devices that can facilitate meaningful interactions with the data. With the increased rollout of wearables, IoT technology will continue to see significant growth in healthcare.

Strategies for Managing Your Revenue Cycle During COVID-19 and Beyond

2020 Alliance sponsor feature article courtesy of Availity

COVID-19 has forced most healthcare organizations to restructure the ways they operate. Practices and hospitals not on the frontlines of fighting the pandemic have seen reduced—or non-existent—in-person patient visits, and perhaps an increase in telehealth visits. As we head into summer, many states have started loosening shelter-at-home restrictions, and patient volume is beginning to increase for non-urgent and elective procedures. But it’s possible that many organizations won’t see a return to pre-COVID levels for some time.

Whatever happens over the next few months, revenue cycle staff must stay focused on cash flow. How can your organization optimize operations to reduce claim errors, manage denials, file timely appeals, and maintain patient satisfaction? Here are some strategies to consider:

1. Submit transactions electronically

The pandemic has demonstrated how much we still rely on printers, faxes, and postage meters to process paper-based claims. When staff is at home without access to that equipment, it can delay timely processing. One of the most impactful things you can do to streamline operations and reduce costs is to make sure your organization is leveraging all the ways it can submit electronic transactions.

Availity RCM users can use the Drop-to-Paper Claims Report/Unmapped Payer Report to see if there are any payers marked as drop to paper that can be set to electronic. You can also ask your account manager to run an ERA gap analysis to identify all remits that are being sent via paper. Check to see if those payers now offer electronic ERA enrollment and take the time to complete the enrollment process. And it may be time to finally upgrade to one of Availity’s paper-to-electronic solutions, such as Workers’ Compensation and Automobile Liability, Drop-to-Paper for Secondary Claims, or All-Payer Attachments for Medical Claims.

2. Clean up claim errors

Whether your organization has been holding COVID claims to ensure they are as clean as possible before submitting, or you’re seeing reduced volume because of fewer visits, now is a good time to focus on cleaning up all outstanding claim submission errors and getting them out the door. Availity RCM users can check the Edit/Error queue, which allows you to sort and filter claims to determine what to prioritize. You can also use the Edit/Error Management Report to track errors and identify trends. Consider implementing new edits to stay on top of these trends.

3. Follow up on account receivables

How many times have you wished you had a few extra hours in the day to get ahead of your account receivables? With patient volume down, this is your chance to focus staff on critical follow-up activities and get cash flow moving. Start by reviewing your oldest claims and your high-dollar claims. Are there claims waiting for supporting medical documentation? Are you filing appeals wherever possible? Availity RCM users can leverage the Remit Delivery Report to track remits and monitor any delays in payments and the Remit Adjustment Detail Report to better understand denial reasons.

As you complete this work, consider what processes can be put in place to prevent denials in the future. Can you address common coding errors with targeted staff training? Are there adjustments to the check-in process that will reduce eligibility issues? Investing the time now to identify the root cause of problems can pay off when the office gets busier.

4. Review your organization’s financial policies

The unemployment rate is rising as a result of the economic slowdown, so you should expect to see more patients without health insurance coverage. As you prepare for questions from patients and staff, your organization may want to reevaluate its financial policies as they relate to charity care, bad debt, and patient payments.

If you decide to make changes, be sure to communicate the new policies to the entire organization. Too often, financial decisions are made and disseminated among back-office staff, but the information is not effectively rolled out to the individuals answering patient questions at check in. Also, if you have financial scripts integrated into your pre-service workflow, make sure those are updated with the revised talking points.

5. Reassign responsibilities with staff strengths in mind

Many organizations have had to reduce staff hours or temporarily reassign employees to other roles. In making decisions about how best to deploy resources, consider leveraging overlooked skills. For example, do you have an employee who is a Medicare expert who can focus on working those denials? Or are there experienced patient account representatives who can temporarily handle patient registration and intake? This may also be an opportunity for less experienced employees to shadow seasoned staff members. Cross-training staff in different roles can help your organization build capacity for when operations return to normal. Don’t forget: Availity RCM has several reports that provide insight into staff productivity.

Transitioning to Telemedicine

2020 Alliance sponsor feature article courtesy of TriMed Technologies

Given the crazy circumstances of 2020, telemedicine has become an invaluable resource for most practices, but what exactly is telemedicine? Telemedicine is a technology tool designed for healthcare professionals which allows them to communicate with, evaluate, and even treat patients remotely. While we naturally think of telemedicine as video conferencing, many providers offer audio-only telemedicine as well.

Naturally, a global pandemic requiring social distancing makes any remote care tool (secure messaging, patient portal, remote check-in kiosks, etc.) a valuable resource. Telemedicine, in particular, is perfectly suited for 2020. During lockdown, many practices pivoted to seeing patients almost exclusively via telemedicine which increased the volume of telemedicine visits many times over. In addition, many plans are paying at parity for the foreseeable future so it’s a great time to jump onboard with telemed.

As practices are returning to normal, or at least the new normal, they are not leaving telemedicine behind. For those who chose a good telemedicine solution, the genie is out of the bottle. While providers benefit from telemedicine, patients too are realizing the benefits. Why go into the office for something as simple as a rash? Telemedicine makes “visiting” your doctor, under the right circumstances, safer and more convenient from the comfort of your own home.

As more folks sign onto telemedicine, the technology will step up to meet increased demand. In addition to longer term enhancements such as lower latency and higher resolution video feeds vendors such as Tytocare are even offering the ability for providers to record basic vitals via a telemedicine visit. Innovative software vendors will continue to push forward in the space and create even better ways for providers and patients to utilize telemedicine.

TriMed has been on the cutting edge of seamless, integrated telemedicine visits while also offering telemedicine for free at the beginning of the COVID crisis. To date, we’ve hosted over 115,000 telemedicine visits since March. Have questions about how TriMed’s EHR and Telemedicine solution could directly benefit your practice? Reach out to us using or by calling 866-874-6339 x1 and we will be happy to assist!

To get a first hand look at how a local NC pediatric practice has embraced telemedicine, ​check out this Fox 8 News feature​.

TriMed Technologies ​(EHR, PM, Telemedicine, Mobile, Check In, Patient Portal)
4148 Mendenhall Oaks Pkwy
High Point, NC 27265
(866) 874-6339 x1

MGMA to Congress: Expand Medicare telehealth beyond COVID-19 pandemic

Originally published in the August 6, 2020 issue of MGMA’s Washington Connection. Reprinted with permission from MGMA.

MGMA joined over 200 organizations in support of the Protecting Access to Post-COVID-19 Telehealth Act of 2020. If signed into law, this legislation would remove geographic restrictions on where a patient must be located to utilize telehealth services, enable patients to receive telehealth services in their homes, allow federally qualified health centers and rural health centers to furnish telehealth, and give the Secretary of Health & Human Services (HHS) permanent waiver authority for future emergency periods and for 90 days past the expiration of the current public health emergency. Absent congressional action, the ability for patients to utilize telehealth in nonrural settings and in their homes is only in effect during the public health emergency. MGMA urges Congress to act before the public health emergency ends to avoid a scenario where providers are abruptly unable to treat most Medicare beneficiaries via telehealth.

Help #MGMAAdvocacy: Urge Congress to support physician practices during COVID-19 pandemic

Originally published in the August 6, 2020 issue of MGMA’s Washington Connection. Reprinted with permission from MGMA.

As Congress continues to negotiate the next COVID-19 package, it is imperative that they hear from physician practices. Use MGMA’s template letter to tell Congress that any final legislation must:

  • Include direct financial support to medical groups experiencing an adverse economic impact from COVID-19;
  • Continue telehealth flexibilities past the expiration of the public health emergency;
  • Add flexibilities for Medicare accelerated and advance payments, such as eliminating interest rates and lowering recoupment amounts; and
  • Amend the Paycheck Protection Program (PPP) to provide a more simplified process for borrowers seeking PPP loan forgiveness, including personal protective equipment as eligible covered the cost, and allow for 501(c)(6) nonprofit organizations to be eligible for PPP loans.

Thank you for joining our advocacy effort and supporting medical practices during the COVID-19 pandemic!

Take action now: Tell Congress to extend Medicare Telehealth Waivers

Once the Secretary of Health & Human Services (HHS) lifts the COVID-19 public health emergency (PHE) declaration, many of the telehealth flexibilities allowed during the PHE will end. Since declaring the end of a PHE is at the sole discretion of the Secretary, it is difficult to predict when he will exercise that authority. It is possible that he could end it before patients feel comfortable or safe seeking treatment in an office. To avoid a situation where providers can no longer treat patients via telehealth regardless of their location, Congress must act soon. MGMA drafted a template letter that members can send to their congressional representatives urging them to extend the Medicare telehealth flexibilities beyond the conclusion of the PHE. Since the letter is editable, we encourage members to include anecdotes on how telehealth flexibilities during the COVID-19 PHE have benefited their practices and their ability to treat patients. You can access the letter here or through our Contact Congress portal.