Independent healthcare practices face a range of challenges in managing payments and maximizing revenue, but recent developments in patient expectations and legislation provide fresh challenges and opportunities. Here’s how independent practices can leverage these changes effectively.
E/M Guideline Updates
Just this year, the Centers for Medicare & Medicaid Services (CMS) aligned its evaluation and management (E/M) coding guidelines with the changes adopted by the American Medical Association (AMA). This shift allows providers to bill for previously overlooked activities related to patient care, such as time spent reviewing patient records, consulting with other providers, and coordinating care.
This is a game-changer for independent practices. By optimizing E/M coding while adhering to the updated guidelines, practices can increase revenue and improve operational efficiency.
Practices will want to train staff on the new E/M coding guidelines to ensure compliance using tools like electronic health record (EHR) systems to streamline documentation.
Remote Patient Monitoring
Remote patient monitoring (RPM) enables providers to track patients’ health data remotely, allowing for early intervention and better chronic disease management. Beyond telehealth, incorporating remote patient monitoring tools for conditions like diabetes and hypertension can support patients in staying on course. Research indicates that patients who use monitoring devices consistently track health metrics. Moreover, the provider can better catch changes in a patient’s condition because data is automated, which means any changes necessitating scheduling an in-person appointment or adjusting medications could be noticed sooner.
By integrating RPM into practice operations, healthcare providers can reduce hospital readmissions, improve patient satisfaction, and qualify for additional reimbursements under Medicare and other payer programs.
Surprise Billing Legislation
It’s worth noting that the No Surprises Act, effective since 2022, protects patients from unexpected out-of-network bills. This includes emergency services and ancillary care provided by out-of-network providers at in-network facilities. While this primarily applies to hospital services, compliance from independent practices is vital to avoid penalties and maintain patient trust.
Independent healthcare practices can overcome payment challenges by staying ahead of industry changes. By leveraging updated E/M coding guidelines, adopting remote patient monitoring, and ensuring compliance with surprise billing legislation, providers can deliver exceptional patient care while maximizing revenue to secure their financial future.
