This is just awful. Patient's calling about EOB's and feeling threatened about subsequent payments and then of course you show them an invoice and it's like "Oh, I never got this, so I owe you money huh?" Yes, it is all a burden the actual task of a medical office especially when you have internal medicine and a "speciality" office. The reporting that all must be done to stay accredited "to ensure patients are getting optimal care" and now the billing. This can overwhelm the office staff, when there seem to be too few people to do the job. Medicare wants to do more by paying physicians money by "providing quality care" but it comes with the effort of reporting mechanisms that utilize EMR's or it can be done by using perhaps other billing systems who could be more tedious if all is not tabulated properly in that if what is in the EMR for billing reasons is not included in another billing software just designed to do billing then if can affect incentives although this is not to say it can't be done. The office staff in addition to their other duties may have a more difficult task at providing the necessary parameters for alternative payment methods or APM's which include this and maybe even more: PQRS, VBPM, MU and clinical practice improvements, manually to a billing facility so that payment can be submitted and generated to a physician's practice according to their medicare billing. Some physicians will be exempt from MIPS or merit based incentive payment systems because they have smaller practices and the actually payment begins in 2019. Hopefully, I will be in a more modern office one that I can design myself and inform the physicians I will be working for(yes, I feel pigeon holed, but either this or in one-hey you do what you gotta do). Anyways, I will be the advisor so to say about how a real medical office should be. This not only includes the patients but for the medical office staff who physicians really seem to thing boy "they can do everything." The problem here is that Medicare has been included with other traditional and non-traditional insurance companies, so that these companies can remain in business. As one ages or becomes disabled they become eligible for Medicare(red, white and blue) card. This means that those other insurance companies lose premium paying people. It becomes complicated because, do these MACRA incentives include all Medicare subscribers fom any type of Medicare based insurance company plan or are they just Medicare B(medical)? This presents a problem because due to the rather expensive supplemental plans, subscribers often choose a insurance plan from an insurance company as a medicare plan ie, Aetna Medicare. So if payment incentive is just based on Medicare part B and does not include other plans, then this drastically reduces what a physician can be eligible for due to how many patients actually have just Medicare B. What we really need is what is known as insurance link and by that I mean if the powers that be and those who are looking for all kinds of payment incentives for this and that to ensure that all is being done good by the patients; would just link the EMR systems(all of them) to a national registry that checks for eligibility and deductible, co-insurance for each insurer out there that would eliminate problem A. This way the front office staff/billing people can see what is owed to the office each day of a patient visit and then regarding problem B the actual break down of physician to patient performance can be listed according to PQRS, VBPM, MU and clinical practice improvements as these are done through the billing of each patient. So now within an EMR there are two new sections eligibility and MACRA : this will allow the front office staff to check a patient or select several patients to check or do a monthly, ckeck several months or a years worth of eligibility fo each insurance during the year and then do a MACRA check. It is important to note that a physician must sign off on their notes within two days and in doing so the MACRA portion within the billing must be completed or the physician will be unable to sign his or her note without it being done. This is precautionary so that all billing is complete and the results or indicators can be tabulated regarding eligibility, deductible and copayment and then into the MACRA section. Then all the overworked and underpaid front office staff has to do is to submit the eligibility and MACRA reports for the week to the billing clearinghouse for their specific EMR. The billing clearinghouse is responsible for posting payments to the patients accounts through the national registry which gets put into the EMR under the patients account. This way the billing gets done, the deductible co-insurance information is current and payment to the physicians gets sent electronically to them and most of all the MACRA information is automatically submitted and tabulated for physician incentive without causing too much of a burden on those people called the office staff. Get with it MACRA, how would you like to be all things to all people?
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