8 Tips to Run a More Profitable and Efficient Medical Practice

Running a medical practice isn’t just about providing excellent patient care—it’s also about managing operations efficiently and maximizing profitability. With rising costs, complex regulations, and administrative burdens, many practices struggle to maintain financial health while delivering high-quality services.

The good news is that by implementing the right strategies, your practice can streamline operations, improve cash flow, and enhance the patient experience—all while boosting your bottom line.

Here are 8 essential tips to help you run a more profitable and efficient medical office.

1. Optimize Your Revenue Cycle Management (RCM)

Efficient RCM is the backbone of a financially healthy practice. Without a well-managed billing and collections process, practices can lose thousands of dollars in unpaid claims. Ensure accurate coding and documentation to prevent denials and regularly review accounts receivable and follow up on outstanding payments.

2. Leverage Automation and AI

Manual processes waste valuable staff time and increase errors. By using automation and artificial intelligence, your practice can eliminate inefficiencies and reduce administrative burdens. Assess your practice’s needs and choose automation tools that will integrate into your current systems.

3. Streamline Office Workflow and Processes

A disorganized office leads to wasted time, frustrated staff, and poor patient experiences. Optimizing office workflow ensures smoother operations and improved efficiency. Standardize processes for check-in, check-out, and documentation, and conduct regular workflow assessments to identify and eliminate bottlenecks in your operations.

4. Improve Patient Scheduling for Maximum Productivity

An inefficient schedule can lead to no-shows, long wait times, and wasted resources. Smart scheduling can help your practice maximize patient volume without overwhelming providers. Consider implementing a patient self-scheduling system that allows for easy rescheduling and appointment reminders.

5. Enhance the Patient Experience to Boost Retention

A positive patient experience directly impacts your practice’s revenue. Happy patients return, refer others, and leave positive reviews, driving new business. Implement a patient feedback system to track satisfaction and improve service quality. This can include follow-up with patients using automated reminders and surveys.

6. Strengthen Financial Management and Cost Control

A profitable practice is not just about increasing revenue—it’s also about controlling costs. Regularly review overhead costs and negotiate better vendor rates, if possible. Working with an accounting professional can also help you uncover hidden savings and boost profitability.

7. Invest in Staff Training and Development

Your staff plays a crucial role in practice efficiency. Investing in ongoing education ensures they are up-to-date on the latest billing, coding, and compliance changes. Provide regular training on new regulations and best practices and encourage cross-training to improve flexibility and efficiency.

8. Consider Outsourcing Non-Core Functions

Outsourcing can reduce operational burdens, cut costs, and improve efficiency. Consider outsourcing medical billing and coding to minimize errors and increase collections, or hire a practice consultant to identify workflow improvements and assess practice management. Outsourcing allows your team to focus on patient care while professionals handle complex administrative tasks.

Unlock Your Practice’s Full Potential

The most successful medical practices don’t just adapt to change—they lead it. Maintaining the status quo isn’t enough in today’s fast-paced healthcare environment. Proactive optimization is key to long-term success—streamlining operations, enhancing technology, and ensuring financial sustainability.

By implementing even a few strategies outlined here, your practice can become more productive, profitable, and future-ready. The key is to start now and commit to ongoing improvement.

Ready to unlock your practice’s full potential? Download our free eBook, The Modern Medical Practice: How to Run a More Profitable and Efficient Office, and gain insights to transform your practice today.

 Download the eBook

President Trump signed a short-term spending bill on Saturday, March 15, extending key telehealth provisions through September 30, 2025. The legislation includes:

• Medicare Telehealth Flexibilities (previously set to expire March 31, 2025):
  • Geographic & Originating Site Restrictions: Medicare beneficiaries can continue receiving telehealth services from any location, including their homes.
  • Expanded Practitioner Eligibility: Physical therapists, occupational therapists, and speech-language pathologists remain eligible to provide telehealth services.
  • FQHCs & RHCs: These facilities can continue serving as distant site telehealth providers.
• Audio-Only Telehealth Services: The authorization for audio-only telehealth services is extended.
• Acute Hospital Care at Home Program: Hospitals can continue providing hospital-level care in patients’ homes.

While these extensions offer temporary relief, the long-term future of telehealth remains uncertain. Now is the time to assess your telehealth strategy and ensure compliance with evolving regulations. Yeo & Yeo Medical Billing & Consulting can help your practice stay prepared and avoid disruptions. Contact us.

Meridian Health Plan has announced a significant policy change that will directly impact medical billing and reimbursement for out-of-network services. Effective May 1, 2025, all out-of-network providers must obtain prior authorization before rendering services to Meridian members.

Key Impacts on Medical Billing:

• Claims Denials & Delays: Claims for out-of-network services without prior authorization may be denied, leading to delayed reimbursements and increased administrative work.
• Billing Workflow Adjustments: Billing teams must coordinate with providers to obtain prior authorization before services are performed, reducing rejected claims.
• Revenue Cycle Management Considerations: Practices that frequently bill Meridian for out-of-network services must adapt their processes to comply with this new requirement to avoid payment disruptions.

Some exclusions apply. For further details, visit Meridian’s official provider bulletin or contact their Provider Services department.

Contact Yeo & Yeo Medical Billing & Consulting for additional guidance on how these changes may impact your practice.

Several changes to telehealth billing and reimbursement policies are coming into effect in 2025, impacting healthcare providers. Here’s a summary of key updates:

1. Telehealth CPT Codes (98000–98016)

• Blue Cross and Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN): Will reimburse CPT codes 98000–98011 beginning January 1, 2025.
• Priority Health: Will reimburse CPT codes 98000–98016 for commercial plans but not for Medicare plans. Medicaid guidance is pending. Additional Priority Health billing guidance can be found here.
• Medicare and Health Alliance Plan (HAP): Only CPT code 98016 is valid for reimbursement. Other codes (98000–98015) are invalid. For audio-only services, use standard E/M codes with modifier “93.”

2. Guidance for Unrecognized CPT Codes

Since the Centers for Medicare & Medicaid Services (CMS) does not recognize the new CPT Telemedicine Services codes, CMS directs physicians to refer to the list of telehealth services for Calendar Year 2025 and choose the most appropriate code for the service rendered.

3. Extension of Telehealth Flexibilities

The American Relief Act of 2025 extended waivers on geographic, site-of-service, and practitioner-type restrictions through March 31, 2025. This means Medicare patients in non-rural areas and those accessing telehealth from home can continue receiving services without additional barriers.

It is crucial for providers to review payer-specific policies and confirm billing practices with each insurer, as telehealth coverage and reimbursement can vary significantly between Medicare, Medicaid, and commercial payers. Contact Yeo & Yeo Medical Billing & Consulting for additional guidance on how these changes may impact your practice.

On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued its final rule for the 2025 Medicare Physician Fee Schedule (PFS), with changes effective January 1, 2025.

Payment Rates

The conversion factor will decrease by 2.83% to $32.35 due to the expiration of a temporary increase and a 0% statutory update.

Telehealth Services

Unless Congress acts, pre-COVID geographic and provider restrictions for most telehealth services will resume in 2025. However, audio-only services will remain covered, and practitioners can use their enrolled address for telehealth provided from home.

Quality Payment Program

The Merit-Based Incentive Payment System (MIPS) performance threshold remains at 75 points, with six new MIPS pathways for specific specialties starting in 2025.

Additional Changes

• New coding and payment for caregiver training, primary care, cardiovascular risk assessment, post-op care, and behavioral health.
• Changes to the Medicare Shared Savings Program (MSSP), including a health equity benchmark adjustment and advance savings for successful Accountable Care Organizations (ACOs).
• The 1.88% APM Incentive Payment will end after 2024 unless extended by Congress, and CMS plans to increase the Qualifying APM Participant (QP) thresholds.

Additional information about the final rule may be found in the PFS fact sheet. Contact Yeo & Yeo Medical Billing & Consulting for additional guidance on how these changes may impact your practice.

Closing a medical practice can be complex and overwhelming. Every detail requires careful attention to avoid complications, from notifying patients to managing financial obligations. Yeo & Yeo understands these challenges and offers support to ensure a seamless transition.

Our Closing a Practice Checklist includes a list of preparations, notifications, and tasks that should be completed from 90 days out to the final day of closure.

Download the Checklist

Whether you’re starting, buying, selling, or closing a practice, our dedicated team has the experience and insight to guide you every step of the way.

Download the Checklist

Starting your own medical practice is a significant step in your professional journey, filled with excitement and challenges. As a healthcare professional, you’re likely facing several questions and concerns, such as:

• How do I navigate the complex legal and regulatory landscape?
• What financial and tax-smart considerations should I prioritize?
• How can I ensure my practice is operationally efficient from day one?
• What are the best practices for medical billing and revenue cycle management?

Establishing a medical practice involves a meticulous series of steps, and these are just a few of the critical issues you’ll need to address. At Yeo & Yeo, we understand these challenges. Our dedicated and credentialed healthcare team, comprised of practice management consultants, healthcare CPAs, billing specialists, personal financial planners, and more, has guided numerous practitioners through the process.

As you start a new medical practice, use this checklist to help you stay organized and focused. By following these steps, you’ll be well-equipped to set your practice on a path to thrive. For guidance navigating your journey, reach out to Yeo & Yeo.

Healthcare Common Procedure Coding System (HCPCS) code G2211 is an add-on code with the code set of 99211-99215. The intent behind the creation of the G2211 code is to improve patient care and outcomes by better managing serious and complex health issues through a longitudinal care plan. This plan is followed throughout all phases of the patient’s care to improve overall outcomes and quality of care.

Reporting G2211

The relationship between the provider and patient is paramount in deciding whether to report this HCPCS code. You should consider using this code if:

• You are the continuing focal point for all needed services.
• You provide ongoing care for a single, serious or complex condition.

If these criteria do not apply, you should not report G2211.

When reporting G2211, ensure your documentation clearly identifies the history, current treatment plan, goals of care, and any previous episodic similar events with adverse outcomes. You will also want to list any concerns or considerations of the current episode of care. Ensure you continuously update your longitudinal care plan with the patient’s events or episodes. Remember that according to the AMA definition, a problem must be evaluated and treated at the encounter by the provider who is reporting the service and not just pulled forward from a list of previous conditions.

When Not to Report G2211

You should avoid using this code if:

• Your relationship with the patient is of a discrete, routine, or time-limited nature, or comorbidities are not present or not addressed.
• You do not plan to take responsibility for subsequent, ongoing medical care for the patient with consistency and continuity over time.

Additionally, the code is not to be reported if you are billing for other services that would be considered a separately identifiable service and would require reporting a 25 modifier on the office or other outpatient visit, code set 99211-99215. Please note that these guidelines could change in 2025, pending the Medicare fee schedule and Quality Payment Program final rule.

In summary, this code should not be reported for every patient you treat. It is to account for the extra time, effort, and resources that go into building a long-term relationship with a patient and providing consistent care for their healthcare needs.

The CMS G2211 FAQ document and G2211 Reference Card help answer questions related to the use of the add-on code. Contact Yeo & Yeo Medical Billing & Consulting for additional billing and coding guidance.

Yeo & Yeo Medical Billing & Consulting (YYMBC) proudly celebrates 26 years of dedicated service and innovation in medical billing and practice management consulting. Since our inception in 1998, we have evolved into a trusted partner, supporting physicians, group practices, and healthcare organizations throughout Michigan in achieving operational excellence.

Roots in excellence and innovation

Our roots trace back more than a century when Yeo & Yeo CPAs began serving the healthcare industry in Saginaw, Michigan. What started as a small team has grown to a diverse group of over 30 consultants, medical billers and coders focused on helping physicians and medical practices thrive.

Under the leadership of YYMBC President Kati Krueger, the company has embraced technological advancements and implemented cutting-edge solutions, including robotic process automation (RPA), to streamline workflow. These innovations ensure efficient operations and enhance client experiences. Through web-based connectivity, our clients have transparency into every outstanding claim. This transparency brings peace of mind, knowing that everything is working as it should.

Krueger emphasizes, “Embracing the latest technologies is pivotal in our commitment to exceptional service. Applying these technologies, we enhance accuracy, streamline processes, and empower our team to help our clients succeed.”

Specialized knowledge and comprehensive solutions

YYMBC stands apart with its commitment to staying ahead of industry changes. Our team provides specialized knowledge in coding, compliance, chart audits, and practice management consulting. We combine our consultative services with offerings from Yeo & Yeo CPAs & Advisors, Yeo & Yeo Technology and Yeo & Yeo Wealth Management, presenting comprehensive solutions for healthcare professionals. Our goal is to ensure efficiency, compliance, and profitability in an ever-evolving landscape.

 “We have a great team of medical billers who work hard and strive to get the maximum reimbursement for our clients. We continually educate our staff so they know the ever-changing policies and rules,” says Krueger.

Denise Garrett, Billing Manager at YYMBC, emphasizes the sense of security and support our clients experience: “You have a team of people available who have specializations in multiple areas, especially now that billing is more complicated than ever.”

Investing in our community

Beyond our professional endeavors, YYMBC is proud to invest in our community through the Yeo & Yeo Foundation. We believe in giving back and supporting initiatives that make a positive impact. Some of the organizations we proudly support include Aaron’s Gifts from Home, Child Abuse and Neglect Council, Michigan Special Olympics – Area 9, Humane Society of Bay County, and many more. 

Our gratitude

Reflecting on this remarkable 26-year journey, we express our gratitude to all past and present clients and colleagues. Your trust and collaboration have been instrumental in our success. Krueger sums it up beautifully: “We want to create the best experience for our clients and our people.” With an enthusiastic, specialized team, YYMBC looks forward to the next chapter.

Here’s to 26 years of excellence and to many more ahead!

This article was updated on June 24, 2024.

Health insurance giant UnitedHealth Group confirmed a ransomware attack on its subsidiary, Change Healthcare (CHC). The cyberattack began on February 21 and continues to disrupt hospitals and pharmacies nationwide.

Change Healthcare continues to address the matter and is working to understand the impact on members, patients and customers. Change Healthcare has a high level of confidence that only Change Healthcare was affected by this issue and that Optum, UnitedHealthcare and UnitedHealth Group systems are unaffected.

In a recent statement, Change Healthcare said, “We are working on multiple approaches to restore the impacted environment and will not take any shortcuts or additional risk as we bring our systems back online. We will continue to be proactive and aggressive with all our systems and if we suspect any issue with the system, we will immediately take action and disconnect. We will provide updates as more information becomes available.”

On June 20, CHC began providing notice to customers whose members’ or patients’ data was involved in the incident. In late July, CHC plans to send direct notice (written letters) to affected individuals for whom CHC has a sufficient address.

To meet HIPAA requirements, CHC has provided a substitute notice link for customers to add to their website to provide information about the incident for their patients/members even if they have not been identified as impacted: https://www.changehealthcare.com/hipaa-substitute-notice.

The notice helps individuals understand what happened and gives them information on steps they can take to help protect their privacy, including enrolling in two years of complimentary credit monitoring and identity theft protection services.

More information, including frequently asked questions for CHC customers and individuals, is available here: changecybersupport.com. Call center support is also available Monday through Friday, 8:00 a.m. – 8:00 p.m. at 1-866-262-5342.

Yeo & Yeo will provide an update when more information becomes available from Change Healthcare.

Yeo & Yeo Medical Billing & Consulting is pleased to announce that Eva Rudich has earned the Certified Professional Compliance Officer (CPCO^®) Credential. The CPCO credential recognizes Rudich’s knowledge of healthcare compliance, including internal compliance reviews, audits, risk assessments, and staff education and training.

The CPCO designation is awarded to medical billing professionals who, through rigorous examination and experience, have a proven knowledge to effectively develop, implement, and monitor healthcare compliance programs. To earn the credential, Rudich passed a comprehensive exam covering topics including daily operational aspects of compliance programs, key laws and regulations, and policies used to address potential fraud and abuse, including associated penalties and fines.

“Earning the CPCO credential is a tremendous accomplishment,” said Kati Krueger, President of Yeo & Yeo Medical Billing & Consulting. “Eva’s increased knowledge of healthcare compliance will continue to benefit clients and YYMBC, ensuring accuracy in billing, reducing risks, and maintaining the highest ethical standards.”

Rudich is a medical biller and account manager with more than 32 years of medical billing and coding experience. She also holds the Certified Billing & Coding Specialist (CBCS) credential and the Certified Professional Coder (CPC^®) credential. Her areas of specialization include managing accounts for internal medicine, family practices, hospitalist groups, and gastroenterology. She is a member of the American Academy of Professional Coders and the National Healthcare Association.

Rudich said that continuing education is invaluable when it comes to serving clients. “Rules and laws change regularly, especially in healthcare. While I have become quite familiar with healthcare compliance through the years, earning this credential has given me even more knowledge that I can use to assist and educate providers and their staff.”

The Centers for Medicare & Medicaid Services (CMS) released the final 2024 Medicare Physician Fee Schedule (PFS) rule, which in addition to major payment implications, includes changes to the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) participation options and requirements for 2024. The final rule:

• Sets the 2024 Medicare payment rates for physician services. For 2024, CMS finalized a conversion factor of $32.7442 and $20.4349 for Anesthesia (a decrease of -3.4% and -3.3%, respectively, from final 2023 rates);
• Implements E/M add-on code G2211 and defines the “substantive portion” of a split (or shared) E/M visit to mean more than half of the total time spent by the physician or nonphysician practitioner or a substantive part of the medical decision making;
• Reimburses telehealth services furnished to patients in their homes at the typically higher, non-facility PFS rate;
• Allows direct supervision by a supervising practitioner through real-time audio and video interaction telecommunications through 2024;
• Continues coverage and payment of telehealth services included on the Medicare Telehealth Services List through 2024;
• Pauses implementation and rescinds the Appropriate Use Criteria program regulations;
• Maintains the performance threshold of 75 points for all three MIPS reporting options;
• Adds five new MIPS Value Pathways related to women’s health, prevention and treatment of infectious disease, quality care in mental health/substance use disorder, quality care for ear, nose, and throat, and rehabilitative support for musculoskeletal care;
• Makes numerous changes to the Medicare Shared Savings Program (MSSP) such as revising the MSSP quality performance standard, modifying the program’s benchmarking methodology, and determining beneficiary assignment under the MSSP; and,
• Ends the 3.5% APM Incentive Payment after the 2023 performance year/2025 payment year, and transitions to a Qualifying APM Conversion Factor in the 2024 performance year/2026 payment year.

The calendar year 2024 PFS final rule is one of several final rules that reflect a broader Administration-wide strategy to create a more equitable health care system that results in better access to care, quality and affordability.

For more detailed information, refer to the PFS fact sheet and the 2024 Quality Payment Program Final Rule Resources within the QPP Resource Library.

Yeo & Yeo Medical Billing & Consulting (YYMBC) proudly marks a significant milestone, celebrating 25 years of dedicated service and innovation in medical billing and practice management. Established in 1998, the company has evolved into a trusted partner, supporting physicians, group practices, and healthcare organizations throughout Michigan in achieving operational excellence.

A legacy of growth

Yeo & Yeo Medical Billing & Consulting has roots dating back more than 100 years when Yeo & Yeo CPAs began serving the healthcare industry in Saginaw, Michigan. In 1998, Affiliated Medical Billing, as it was known then, started with a small team and quickly grew with a focus on streamlining physician practices and enhancing business functions.

In 2017, Kati Krueger became president of YYMBC. With her leadership, the company has embraced technological advancements, implementing cutting-edge solutions like robotic process automation, ensuring efficient operations and enhanced client experiences.

“Embracing the latest technologies is pivotal in our commitment to providing exceptional service,” said Krueger. “Applying these technologies, we enhance accuracy, streamline processes, and empower our team to help our clients thrive.”

Denise Garrett, billing manager at YYMBC, emphasized how technology has transformed their services, stating, “With today’s web-based connectivity, our clients can see every outstanding claim. It is more transparent now for the client and gives them peace of mind that everything is working as it should.”

A testament to excellence

YYMBC stands apart with its commitment to staying ahead of industry changes, providing specialized knowledge in coding, compliance, medical audits, and practice management. Their consultative services, combined with offerings from Yeo & Yeo CPAs & Advisors and Yeo & Yeo Technology, present comprehensive solutions for healthcare professionals, ensuring efficiency and compliance.

Krueger said, “We have a great team of medical billers who work hard and strive to get the maximum reimbursement for our clients. We continually educate our staff so they know the ever-changing policies and rules. We remain committed to growth and constantly evolving our service offerings to meet the changing needs of the healthcare landscape.”

Traci Cook, account manager at YYMBC, added, “There is a sense of security and support because you have a team of people available who have specializations in multiple areas, especially now that billing is more complicated than ever.”

A bright future ahead

As Yeo & Yeo Medical Billing & Consulting’s professionals celebrate this remarkable 25-year journey, they express their gratitude to all past and present clients and colleagues for their trust and collaboration.

“We want to create the best experience for our clients and our people,” Krueger said. “Our success wouldn’t be possible without their continued trust and hard work. We are proud to celebrate this milestone and excited for the opportunities the future holds.”

For more information about Yeo & Yeo Medical Billing & Consulting and its services, please visit www.yeoandyeomedicalbilling.com.

Yeo & Yeo Medical Billing & Consulting is pleased to announce that Denise Garrett has earned the Certified Professional Biller (CPB^®) Credential. The CPB credential recognizes Garrett’s knowledge in maintaining all aspects of the revenue cycle, particularly patient and payer billing and collections.

The CPB designation is awarded to medical billing professionals who, through rigorous examination and experience, have proven knowledge of submitting claims compliant with government regulations and private payer policies. CPBs are expected to follow up on claim statuses, resolve claim denials, submit appeals, post payments and adjustments, and manage collections. To earn the credential, Garrett passed a comprehensive exam covering topics including the application of payer policies, compliance rules, healthcare regulations, CPT^® procedure codes, HCPCS Level II procedure and supply codes, and ICD-10-CM diagnosis codes.

“Denise is a distinguished member of our team,” said Yeo & Yeo Medical Billing & Consulting President Kati Krueger. “Earning the CPB credential is an accomplishment that underscores her unwavering dedication, extensive knowledge, and the multitude of credentials she has acquired over the years to help better serve our clients. Her passion for her work and her drive to improve her skills continue to set her apart as a leader in her field.”

Garrett is a billing manager with more than 20 years of medical billing and coding experience. She holds many credentials, including the Certified Professional Coder (CPC), Certified Physician Practice Manager (CPPM^®), Certified Professional Compliance Officer (CPCO™), Certified Professional Medical Auditor (CPMA^®), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), and Certified General Surgery Coder (CGSC). Her areas of specialization include coding diagnoses, services, and procedures for physician practices, as well as meeting the business needs of healthcare entities through finding operational efficiencies, staff training, and technology solutions. Garrett serves on the national board of directors of the American Academy of Professional Coders Chapter Association (AAPCCA). She is also a member of the National Alliance of Medical Auditing Specialists.

Garrett said that continuous learning and earning credentials like the CBP have helped her elevate the level of service she can provide to clients. “I continue to stay current with new developments in medical billing and gain knowledge in all areas of revenue cycle management, so I am armed with the tools necessary to help our healthcare clients succeed.”

As of April 10^th, 2023, the Biden Administration has announced that the end of the Public Health Emergency (PHE) Covid-19 will be on May 11^th ,2023. Included in the end of the PHE, the Department of Health and Human Services (HHS) Office of Civil Rights (OCR) has stated that the Notifications of HIPAA Enforcement Discretion will also end on My 11^th, 2023. Previously, the Administration guaranteed a 90-day warning for providers to come into compliance to HIPAA rules relating to telehealth services. This 90-day grace period is meant to help avoid “creat[ing] wide-ranging chaos and uncertainty throughout the health care system — for states, for hospitals and doctors’ offices, and, most importantly, for tens of millions of Americans,” (HHS Press Office). OCR said it would continue to exercise its enforcement discretion and not impose penalties on covered providers for noncompliance during the 90- day transition period, ending on August 9^th,2023.

During the public health emergency, providers did not have to be licensed in the state where the patient was located, they were allowed to treat patients in other states via telecommunication. Under the PHE, non-HIPAA compliant platforms were allowed if they were not public facing. Both flexibilities are coming to an end.

In 2020, when the PHE was first declared, the federal government changed or halted many of its rules and regulations on how care is delivered. During the PHE, rules were relaxed regarding staff training in nursing home facilities. There was also easier virtual access to prescribe medications pertinent in treatment relating to addiction.

In hospitals, the broader use of nurse practitioners and physician assistants was implemented to ensure there were enough healthcare workers to treat patients. Another hospital exception that will be terminated once the PHE ends is “CMS allowing hospitals to make broader use of nurse practitioners and physician assistants when caring for Medicare patients. New physicians not yet credentialed to work at a particular hospital — for example, because governing bodies lacked time to conduct their reviews — could nonetheless practice there,” (Pradhan, Rachana – CBS News). Regarding monitoring the disease, because the Department of Health and Human Services will no longer be able to require labs to report Covid-19 testing data, the way local and state public health departments monitor the spread of disease will change. It is expected that while at-home test kits will no longer be free, and hospitals will most likely provide Covid-19 data less frequently, that surveillance will need to be strategized.

Sources

“From Addiction Treatment to Nursing Homes, End of COVID Emergency Will Bring Changes across U.S.

Health Care System.” CBS News, CBS Interactive, https://www.cbsnews.com/news/covid-public

health-emergency-impact-hospitals-addiction-treatment-nursing-homes/.

Morse, S. (n.d.). Providers granted 90 days following end of phe to comply with HIPAA Telehealth Rules. Healthcare

Finance News. Retrieved April 17, 2023, from https://www.healthcarefinancenews.com/news/providers

granted-90-days-following-end-phe-comply-hipaa-telehealth

rules#:~:text=The%20Office%20of%20Civil%20Rights,Health%20and%20Human%20Services%20OCR.

(OCR), Office for Civil Rights. “HHS Office for Civil Rights Announces the Expiration of COVID-19 Public Health

Emergency HIPAA Notifications of Enforcement Discretion.” HHS.gov, 11 Apr. 2023,

https://www.hhs.gov/about/news/2023/04/11/hhs-office-for-civil-rights-announces-expiration-covid-19

public-health-emergency-hipaa-notifications-enforcement

discretion.html?mkt_tok=MTQ0LUFNSi02MzkAAAGLGX8tEWzg_owkte8B

voTgAz5e8NZFXHeT2ZNUj2hj38TVJy-9oAeDOyF7gM3xSRl_qyap6MztJK9sIwPx53UBkcaBbTB1v

H_b6QH9MsPA.

Watson, Kathryn. “Biden Signs Bills to Reverse D.C. Criminal Code Changes and Declassify Info on Covid

19 Origins.” CBS News, CBS Interactive, 20 Mar. 2023, https://www.cbsnews.com/news/biden-dc-crime-bill-covid-19-origins/.

On November 1^st, the Centers for Medicare and Medicaid Services (CMS) released their final Medicare Physician Fee Schedule (PFS). This new and final 2023 ruling affects not only Medicare payout to physicians, but the Merit-based Incentive Payment System (MIPS), and the alternative payment model (APM) as well.

“Anesthesia Conversion Factor, work Relative Value Units (RVUs) for several pain medicine codes, and policy updates for the 2023 QPP performance year will be effective January 1, 2023. Absent Congressional action, all physician practices – including anesthesiologists and their groups – will face significant Medicare payments cuts next year,” (American Society of Anesthesiologists). Anesthesia being the most affected, with a 4.47% decrease from the rates in the current year of 2022. This decrease may seem small, but it will make a big impact as the year goes on.

With this finalized ruling, we will also see extended telehealth provisions that was put in place due to the public health emergency. Once the PHE is declared as finished, to ensure a smooth transition, they have chosen to extend the provisions by 151 days – “including allowing payment for RHCs and FQHCs for furnishing telehealth services as distant site practitioners (though note that mental health visits can be furnished virtually on a permanent basis) under the payment methodology established for the PHE, allowing telehealth services to be furnished in any geographic area and in any originating site setting, including the beneficiary’s home, and allowing certain services to be furnished via audio-only telecommunications systems,” (CMS.gov).

“MGMA submitted detailed comments in response to the proposed rule in September. Be on the lookout for a more detailed analysis of the final changes to physician payment policies and the Quality Payment Program (QPP) in the coming weeks,” (MGMA Regulatory Alert).

For more information, and to keep up to date on policy changes, please follow the following links or sources:

PFS Fact Sheet, FAQ

 

Sources:
“Fact Sheet Calendar Year (CY) 2023 Medicare Physician Fee Schedule Final Rule.” CMS, https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule?utm_source=email&utm_medium=marketo&utm_campaign=gov-washingtonconnection-oct-2022-regalert1031&mkt_tok=MTQ0LUFNSi02MzkAAAGH1B6DQSAYQZNXcZCy3E_z53VOq5t7ZbNvsM5maFQZnsPwXfV3TSCRCRJOnFGeC08dWNFDKMtCP8mJhXaa8C_S9kuhEONhijo_bV39AX_9cQ.

“CMS Provides Little Relief for Anesthesia Groups in Release of 2023 Payment Rules.” American Society of Anesthesiologists (ASA), https://www.asahq.org/advocacy-and-asapac/fda-and-washington-alerts/washington-alerts/2022/11/cms-provides-little-relief-for-anesthesia-groups-in-release-of-2023-payment-rules#:~:text=CMS%20has%20finalized%20significant%20cuts,2022%20anesthesia%20CF%20of%20%2421.5623.

My husband is in the Reserves, and he served overseas in 2004. From that experience, I know how much our troops appreciate care packages and mail, which is why I began volunteering with Aaron’s Gifts From Home more than three years ago.

Aaron’s Gifts was founded in 2012 by the parents of Aaron Ullom, a service member in the Navy who was killed in action in Afghanistan. In honor of Aaron’s memory, the organization sends care packages to soldiers stationed overseas. The packages include comic books, DVDs, snacks and games – anything a service member might enjoy.

Roughly three times a year, a group of us get together to pack hundreds of boxes for active-duty service members. I am proud that I have the opportunity to give back to those serving our country and protecting our freedoms. Aaron’s Gifts is truly a great organization, and I am so appreciative that I get to be part of it.

I give back because I want to support those who serve our country.

A vote is expected to be made soon within the Senate regarding the extension of COVID-19 temporary waivers; The House of Representatives voted 416-12 to pass the “Advancing Telehealth Beyond COVID-19 Act.” This legislation would continue Medicare patient access to telehealth services, including audio-only services. This extension, if passed within the Senate, will extend temporary waivers that have been put in place due to the PHE all the way through December 31, 2024. Below is a list of continuing waivers from Karen Zupko & Associates Inc.:

• Continuing the pause on geographic restrictions limiting the patient’s location to a metropolitan statistical area (MSA) or a rural health professional shortage area (HPSA) (some exceptions). The patient’s home is still an acceptable location.
• Allowing the expanded list of eligible providers (i.e., PT, OT, SLP, and audiologists) to continue to provide telehealth services on the Medicare approved list within their scope of practice.
• Continuing coverage for non-mental health audio-only visits.
• Continue allowing FQHCs and RHCs to be distant site telehealth providers for non-mental health visits.
• Delaying certain mental health visit requirements for in-person visits.
• Allowing telehealth to satisfy face-to-face encounters before hospice care recertifications.

Sources:

kpage_drupal. “House-Passed Bill Would Extend Medicare Telehealth Flexibilities : AHA News.”

American Hospital Association | AHA News, https://www.aha.org/news/headline/2022-07-28

house-passed-bill-would-extend-medicare-telehealth

flexibilities#:~:text=The%20House%20yesterday%20voted%20416,COVID%2D19%20public%20

ealth%20emergency.

“KZA Telehealth Solutions Center.” KZA Telehealth Solution Center – Access Page,

https://karenzupko.com/KZA-telehealth-solution-center-access.

During the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) enacted several temporary emergency declaration blanket waivers. The waivers were intended to provide health care providers with extra flexibility.

On April 7, 2022, CMS issued memorandum QSO-22-15 that will end many of the blanket waivers for specific providers in 30 and 60 days from publication of the memo.

Of note, one waiver that will end provides the capacity for physicians and practitioners to conduct visits via telehealth options. Effective May 7, 2022, visits to nursing home residents must be performed in person.

Providers are expected to take immediate steps so that they may return to compliance with the reinstated requirements.

Please contact Yeo & Yeo if you have questions or need assistance.