Practice Top 5

The AAN understands you face many complex practice issues. To help you on your way to mastering such matters, we've boiled each topic down to the Top 5 things you need to understand. Each list includes links to more in-depth background material and resources to further your knowledge.

View Top 5:

Top 5: Tips to Improve Patient Access
  1. Refer to your EHR vendor's manual or support services to automate processes such as flagging open slots and cancellations. 
  2. Consider an advanced access/open-scheduling model to allow for a certain amount of same-day or next-day appointments. Test the model with a single provider as a trial. 
  3. Tailor any increase in dedicated visit slots to match a specific demand. For example, increase the number of reserved new-patient appointment slots.
  4. Implement strategies to accommodate for or reduce no-shows. Consider strategic overbooking for patients with past “no-show” visits, use technology to remind patients of appointments, or reduce lead time by scheduling appointments no more than six months in advance.
  5. Ensure scheduling policies make efforts to maintain provider-patient continuity of care in group practices. 

Top 5: Things to Know About Advancing Care Information (ACI) Category of MIPS
  1. Ensure you meet all ACI base score measures, which are mandatory, to avoid receiving an overall ACI score of zero.
  2. Choose your measure set carefully to ensure you earn the highest score possible.
  3. Earn 10 ACI bonus points by using CEHRT to implement at least one  qualifying Improvement Activity (see slide 23).
  4. Enroll in the AAN Axon Registry® to earn five ACI bonus points, as well as fulfill other Improvement Activities measures.
  5. Report on all ACI performance score measures to take advantage of partial credit.  You do not need to score maximally on all performance measures to achieve the maximum overall ACI score.

Top 5: Ways to Be Successful in the Cost Category of MIPS
  1. Review your QRUR Report
  2. Ensure that your specialty is accurate by looking at Physician Compare
  3. Check whether your patients have Primary Care Physicians
  4. Verify that you are coding specifically to improve Hierarchical Condition Category/Risk Adjustment Factor
  5. Code prior diagnoses to improve Hierarchical Condition Category/Risk Adjustment Factor

Top 5: Reasons You Should Complete the Neurology Compensation and Productivity Survey
  1. Determine if you are being paid fairly relative to your peers based on your sub-specialty, region, and practice type.
  2. Use the data in contracting with payers and demonstrating your value.
  3. Understand where you excel and where you can improve practice inefficiencies.
  4. Benchmark your progress compared to peers in the transition to value-based payments.
  5. Receive the report and access to the customizable results dashboard in July for free ($600 value)!

Top 5: Important Actions in 2015 that Impact Your Practice
  1. Congress repealed the SGR, eliminating catastrophic physician payment cuts threatened by the formula, and instead implemented stable annual increase of 0.5 percent to Medicare physician payments through 2019.
  2. ICD-10 implementation occurred.  Neurology practices began submitting the new diagnosis codes on October 1, 2015.
  3. Congress passed new MACRA legislation, which is accelerating payment approaches that put the patient at the center of care.   Private plans and CMS announced that they are serious about these value-based payment models.
  4. In the final 2016 Medicare Physician Fee Schedule, CMS announced that neurologists may now be reimbursed by Medicare for the important work of engaging in advance care planning discussions with patients, such as establishing and documenting patient's care goals and preferences.
  5. Medicare made available Quality and Resource Use Reports to all physicians.  Download your report today to see how your Medicare reimbursement will be affected in future years under the Value-based Payment Modifier and Merit-based Incentive Payment System.

Top 5: Critical Monthly EHR Reports for Neurology Administrators
  1. Review your total charges monthly and be able to explain both positive and negative fluctuations.
  2. On a monthly basis, monitor your adjusted collection ratio (collections + adjustments + write-offs) as a percent of charges, which should hover in the 95% range for efficient practices.
  3. Track how many days in A/R that you carry; efficient practices should keep this number to around 30 days. Also, monitor what percent of your A/R is 90 days or older.
  4. Scrutinize your monthly total patient volume in your clinic and ancillary services provided by your practice.
  5. Track your third available date for a next new-patient visit slot on a monthly basis. If it is more than three weeks from today, you may be losing referrals and your no-show rate will rise accordingly.

Top 5: Things You Can Do Today to Prepare for MACRA
  1. Participate in PQRS.
  2. Know your QRUR scores.
  3. Meaningfully use your EHR.
  4. Investigate alternative payment model options in your area.
  5. Check out AAN programming- in person and webinar opportunities are available.

Top 5: Considerations for Incorporating Telemedicine into Your Practice
  1. Is there a needed service that you can provide remotely?
    • Cover remote hospitals for telestroke, tele-EEG, tele-ICU, emergency, or routine neurology consultations
    • Expand your services to outpatient clinics to provide remote neurologic consultations
    • Provide more continuous care for your existing patients who may be immobile or remote.
  2. Are you meeting all necessary requirements to provide those services?
  3. How will interruptions in care be handled?  
    • Interruptions in service or technical issues
    • Staff vacations
    • Service line agreements
  4. Do you have the appropriate technology in place to provide these services?
    • Secure, uninterrupted connectivity
    • HIPAA compliant
  5. Can you get reimbursed for these services?
    • As part of an accountable care organization or alternative payment model
    • Medicare, Medicaid, and private insurance
    • On a concierge or cash basis

Top 5: Strategies to Develop and Maintain Relationships with Payers
  1. Create and maintain a template that allows you to collect and organize key contact information for the payers with whom you contract.
  2. Develop a template letter to serve as an introduction to the payer before a specific issue arises.
  3. Set a goal to meet annually and in person with a medical director or other decision-maker from each payer on your list. Conference calls are an acceptable way to communicate and nurture an established relationship, but never underestimate the power of an in-person meeting as an opportunity for personal connection to build credibility and develop mutual trust.
  4. Effectively communicate by being prepared with all of the information ahead of time, speaking in a professional manner, avoiding inflammatory rhetoric, and listening. Get to know the "buzzwords" used by the payer and their meanings to the payer (e.g., some payers automatically deny a claim when certain terminology is used).
  5. Review the AAN Payer Relations Toolkit for insider tips and examples of template communications.

Top 5: Ways to Improve and Maintain Your Referral Network
  1. Proactively establish an identity for your practice by setting up a strong referral management program with a dedicated program liaison, if possible. Plan to personally visit key practices that serve as a referral source for you.
  2. Ensure your practice is running well and that patients receive an exceptional experience at your office and under your care. Develop analytics to track progress. Undersell and over perform.
  3. Know what information patients are seeing when they are searching online for qualified neurologists in your area. “ Google” yourself and your practice. Develop a webpage for the practice and proactively control what patients see. Use social media responsibly and professionally to represent the practice.
  4. Become aware of how payers are rating you in their designation programs (e.g., stars). These programs use quality and cost designations to financially incentivize primary care physicians' referrals to offer lower co-pays to patients who choose to see designated physicians.
  5. Commit to providing a note back to the referring physician within 48 hours of seeing the patient.

Top 5: Steps to Ensure You Are Ready for ICD-10-CM
  1. Perform a self-audit of 10+ records to ensure you are including the specific terminology to support a code choice.  Do you use terminology compatible with the ICD-10-CM.
  2. Budget funds and/or secure a line of credit to cover appropriate practice expenses and overhead costs in the event of payment delays post implementation. The financial impact will likely be felt for three to six months starting late 2015. 
  3. Identify the most commonly used ICD-9-CM codes to create an ICD-10-CM diagnosis summary sheet for your billing department using the CMS files. It is important to evaluate your EHR to ensure any crosswalks are complete and produce the full number of ICD-10-CM codes available.
  4. Ensure your pre-authorization forms for services on or after October 1, 2015, reflect an ICD-10-CM code and review your Medicare and other contracted carriers' coverage policies to familiarize yourself with their translations from ICD-9-CM to ICD-10-CM codes. Be prepared to review and respond to an increase in denied claims based on ICD-10-CM codes starting in late October.
  5. Register and participate in the AAN's webinar " ICD-10: Are You Ready?" Ask your vendors and payers these important questions to ensure they are ready to accept your claims.

Top 5: Ways for Solo or Small Practices to Remain Financially Sustainable Without Losing Their Identity
  1. Look for opportunities in your community or state to join forces with other practices in non-financially dependent entities.
  2. Align with other practices through an independent physician association (IPA). These often include primary care, though specialty-specific IPAs are developing (article starts on page 8).
  3. Join a management services organization (MSO) for greater support and more alignment. An MSO can help you with managed care contracting, quality reporting, and administrative support (article starts on page 20).
  4. Expand your referral base by joining additional health system physician networks.
  5. If independence is of primary importance and the current revenue system is untenable, then evaluate the concierge practice model.

Top 5: Tips to Ensure Your First Value-based Contract Is a Success
  1. Choose a payer with whom you have an established, positive relationship. Involve leaders-including both providers and administration-in the contract negotiations.
  2. Review evidence-based quality measures developed by the AAN to see if you can incorporate them into the contract.
  3. Consider what type of feedback reports you will need from the payer and articulate your preferred timeline for receiving the data.
  4. Invest in technology and other resources that help you to know your data and costs.
  5. Consider your market and outliers. Identify any areas for improvement and start there!

Top 5: Reasons You Should Sign at Least One Value-based Contract
  1. Get ahead of the curve and gain experience! In an attempt to pay for higher-quality, lower-cost care, Medicare and commercial payers are rapidly embracing a move to value-based reimbursement over current fee-for-services systems.
  2. The AAN has laid the groundwork. The Academy develops and disseminates evidence-based quality measures for neurologic diseases that can be used as a basis to negotiate value-based contracts.
  3. Showcase strong neurologist leadership and involvement. Your efforts to start the conversation do not go unnoticed. Think of the payer as a partner at the table collaborating on ways to get better care to patients at a lower cost.
  4. Open lines of communication with your payers. You can use the development and negotiation of a value-based contract to build trust and discover the types of payer data available to you.
  5. Learn about opportunities to improve the care you provide to your patients. It's important to start somewhere. Choose a topic with which you are comfortable and interested.

Top 5: Things You Need to Know About Value-based Contracts
  1. CMS and commercial payers are transitioning away from traditional fee-for-service payments toward value-based contracts. CMS announced a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016.
  2. Value-based contracts pay physicians based not only on services provided, but on  the quality of care, the appropriate utilization of services, and the diagnosis of coding.
  3. Specific quality measures will be used to evaluate your performance.
  4. Attract referrals from primary care physicians by delivering the best care in the most appropriate setting at a competitive cost.
  5. It's important to evaluate the benefits and risks of your participation based on an objective assessment of your market size,  practice data, and your ability to capture required data.

Top 5: Ways to Get into the Value Mindset
  1. Opposite from traditional ways of thinking under fee-for-services payment systems, it's important to recognize that using services creates expense-rather than revenue-in risk arrangements.
  2. Accept that different incentives and new reporting structures are needed in order to set providers up for success in improving patient outcomes and reducing health care costs.
  3. Make care delivery a team sport! Everyone has an important role to play. Use advanced practice providers (e.g., NPs, PAs) to the tip of their license. Learn how neurologists can function as a Medical Home Neighbor.
  4. Seek out evidence-based resources from the AAN (e.g., guidelines, quality measures, shared decision-making tools) and provide evidence-based services to all patients, regardless of payer agreements.
  5. Learn about new payment and care delivery models.

Top 5: Steps to Get Started with Meaningful Use
  1. Make sure you are eligible. All doctors of medicine are eligible, assuming you see Medicare patients.
  2. Register. CMS provides a step-by-step user guide on how to register.
  3. Use certified EHR technology. Verify your product is certified for either the 2011 or 2014 edition, as they will have slight differences in requirements.
  4. Demonstrate meaningful use for 90 consecutive days in the first year.
  5. Attest that you have used certified EHR technology. CMS developed a step-by-step user guide on attesting.

Top 5: Mistakes to Avoid when Joining an Accountable Care Organization (ACO)
  1. Signing a contract without reading it or getting your own legal review. Understand Physician Employment Agreements Under ACO.
  2. Failing to understand both the financial obligations and reimbursements. Access AMA ACO Resources.
  3. Underestimating the demand for clinical information exchange. Familiarize yourself with best practices for using technology to support success in an ACO.
  4. Relying on non-neurologists to serve on the leadership and quality committees. Participate to ensure the specialist perspective is considered.
  5. Joining without considering an exit strategy. Read more questions to consider when talking to an ACO.

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