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Top Considerations When Running A Value Based Medical Office

Top 10 Considerations When Moving To A Value Based Medical Practice

 

The Medical System

The Medical System

Physicians and other involved persons are being required to move from the old compensation method to a new value based service. For many this will mean a completely new way of practicing. No longer will client quantity be the basis of payment rather the value of service will be. What do practices need to do to successfully move to this new model? Below are the top 10 items that will need to be addressed.

What is Value?

Currently, there is no definition of value as used in a medical practice. This defining will be an important first step for all practices. Different payer groups may well define value in different ways. The lack of a consistent definition may cause confusion for doctors within a practice.

There is a need for leadership in attempting to define value. Today the first step is compliance with the Healthcare Data and Information Set. However, this compliance is merely a first step.

 

How Should Physicians Report

How Should Physicians Report

How Should Physicians Report on Value?

After the definition of value has been determined the next question of how to report information must be decided. The practice will have to determine how it’s going to report on different measures. It must be a system that can track, monitor and report the new measures. It must also ensure that the appropriate data has been extracted for proper reporting.

How will Value be recorded?

There will need to be a method to document the doctor’s work within the electronic health record. Often this group will have different ways to record this information and to ensure that the appropriate data is extracted. According to Best Practices, this documentation needs to have an identifiable field to record each measure. It should also be easily communicated and reported.

 

New Compliance Standards

New Compliance Standards

Does Your Incentive Program Help with New Compliance Standards?

The incentives or penalties for compliance must be clearly understood by everyone in the group. The incentives must be large enough to encourage doctors to practice in a new way. Penalties on the other must be severe enough that the physician will try to avoid it. For this stage, there are many models that can be used or groups may develop their own.

The Importance of Education in Value Based Practices

The education of practicing doctors in the new measures is vital. Perhaps it’s the most important aspect of all. This knowledge or lack of it could save or break a practice. Physicians may feel overwhelmed as they will be asked to change how they practice as well as how they document. Periodic educational sessions will be needed to ensure everyone understands what is expected of them.

 

Uncertainty

Uncertainty

Living in an Unclear World – The Burden of a Value Based Practice.

During the early stage of this transition, doctors may feel they have been asked to carry an extra burden. They will be required to meet the additional steps to a value-based system while still working in a fee-for-service practice. Physicians will be required to spend a longer time with clients or in documentation duties.

The greatest burden will be placed on primary care physicians. It will be essential to the transition that they are not asked to make so many changes at once. If this transition is not done slowly and with a plan, the doctor may feel so overwhelmed that they leave the practice.

 

total compensation

total compensation

How Value-based Practices Affect Total Compensation?

Doctors, as well as other key persons, will need to understand how the incentives or penalties that are used will affect their total compensation. To start it needs to be determined at what % do the incentives and penalties affect payment. More importantly does the employment contract need to be rewritten in light of these penalties or incentives? The area of compensation may be a little tricky at first but given time and support it will most likely be accepted.

The Timeliness of Reporting Deficiencies to Physicians

It should be stressed that the timeliness of reporting is vital in all types of practices. Those who oversee the quality of training must allow doctors a reasonable chance to correct the deficiencies of their practice. This reporting will allow them time to make changes before penalties are assigned. Reporting defects is a large part of making sure that physicians understand what they need to do and how to do it during the transition.

 

Payer Partners

Payer Partners

Payer Partners Must Be Considered During the Transitioning

Different Payer partners may have different needs when it comes to measuring various values. They should be consulted early if possible. It will be essential to find out their needs. They should express their needs clearly in order to support the transition. Groups must be open and honest with payers as they attempt to establish programs to meet all of the payers needs without having several different ones.

Value based practice in one of the largest changes that have occurred in the last several decades. It needs not be difficult if everyone works together with a common goal.

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Critical Tips to Choosing a Medical Billing Vendor

Key Advice on Selecting a Medical Billing Vendor

 

Good Advice

Good Advice

When it comes to finding a medical billing vendor, there are a number of things that you have to consider very carefully. First and foremost, you want to know that you are doing everything possible to get a company that is reputable and that places customer service as its number one priority. You also want to ensure that you are getting someone that knows what they are doing and is able to provide reliable performance each and every time. It can be difficult to find a vendor that you want to work with on a regular basis so it is equally important that you take the time to do your research before you actually sign anything or pay a company for services rendered. This will help you avoid a lot of frustration later on.

Find Someone You Can Trust

 

Find someone trustworthy

Find someone trustworthy

This might sound simple, but the reality is that it is much harder than you might think. Unfortunately, the few companies out there that do not care about doing a good job can give all of the companies a bad name. It is not unlike any other business, meaning that you have to be able to develop a business relationship that works for both parties in order for the work to be done efficiently and effectively. Failing to do so often means that the job fails to get done and in turn, your practice suffers and even the patient suffers. As a result, it is imperative that you find a vendor that you can trust and that you take your time in doing so.

Set Guidelines Right Away

 

Business Guidelines

Business Guidelines

This is not something that is unique to medical billing vendors. In any type of business relationship, you have to set guidelines that are expected for both sides right away or you run the risk of someone not holding up to their end of the bargain. Even when you find a vendor that you can trust, it is important to take the time to look over any contracts and negotiate deals in writing so that everyone has a clear picture of what is expected of them. This clears up any potential problems about getting things done on time or meeting certain benchmarks when it comes to accuracy. In reality, it saves a lot of time and hard feelings later on if this is done right away.

Make Sure You Are in Charge

You are effectively seeking out a vendor to handle your medical billing on your behalf. That does not mean that you are giving up control of the information that is contained in the charts, nor does it mean that you are willing to give up control of the projects in their entirety. You are essentially contracting work out to someone else because you are probably too busy to handle it all yourself. Make that clear from the beginning. You are the person that is in charge. If you are hiring a contractor, they work for you and you will ultimately make the decisions regarding whether or not they will continue to be employed by you.

Keep Lines of Communication Open

 

Open Communication

Open Communication

One of the biggest mistakes that people make in all types of business relationships is failing to communicate accurately. Regardless of how efficient the company is or how long they have been doing the job, it is inevitable that deadlines will sometimes be missed and mistakes will sometimes be made. Unfortunately, closing off the lines of communication makes it virtually impossible to accurately remedy any of these problems. This negatively impacts both companies so it is important to ensure that any and all issues are dealt with rapidly and professionally.

Have Quality Control in Place

Quality control is one of the most important things that you will ever do to ensure accuracy of the work you are responsible for. Even if you are contracting your services out to someone else, your patients see you as the individual who is responsible for their records. Therefore, if the records are wrong your patients will have a negative impression of you or your practice. As a result, you need to have quality control in place and work closely with the vendor to ensure that they do the same.

Efficiency is Key

 

Efficiency

Efficiency

Obviously, the goal is to get the work done as quickly as possible without giving up accuracy. If you work with the right vendor, you should expect to have all of the information back to you within a day or two without compromising accuracy. Keep in mind, it is just as important that you be efficient as it is that the information contained in the charts be correct.

Summary

If you follow all of these guidelines, it will be much easier for you to find a medical billing vendor that can get the job done. This in turn can help you run your practice as efficiently as possible. It also gives you time to do the things that you need to do to ensure that everyone you see gets the best care possible as opposed to worrying about completing paperwork.

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Leadership Re-introduces a Bill to Minimize Offshore Tax Havens

Legislators Re-introduce a Bill to Reduce Offshore Tax Havens

 

Reduce overseas tax havens

Reduce overseas tax havens

 

American frustrated with paying more taxes than certain billionaire corporations may soon find their concerns addressed in Congress. Texas Representative Lloyd Doggett and Rhode Island Senator Sheldon Whitehouse have re-introduced their 2013 legislation to reduce overseas tax havens for U.S. corporations.

Tax Haven Abuse Act

Tax Haven Abuse Act

 

What Is the Tax Haven Abuse Act

The Tax Haven Abuse Act aims to reduce the abuse of foreign tax havens, a common way for American businesses to avoid paying taxes. In addition, the tax break for offshore revenue also creates an incentive for American corporations to move factories and other operations to foreign countries, reducing the jobs available in the United States. The tax breaks for operating in another country are deep enough to actually encourage multinational businesses to move jobs to other countries, a poor decision for the American economy.

Foreign Account Tax Compliance Act

Foreign Account Tax Compliance Act

 

Reducing Incentives, Raising Penalties

The bill aims to reduce incentives to move offshore by strengthening FATCA, or the Foreign Account Tax Compliance Act. FATCA requires disclosure of checking accounts and other foreign income while mandating that foreign holdings and investment companies owned by Americans file tax returns. In addition, this bill would require foreign banks to report apparent money laundering to the IRS. Although foreign banks cannot be forced to comply, the newly strengthened FATCA would forbid American banks from dealing with banks that do not comply, which would mean that these foreign banks’ checks and debit cards would not work in the United States. Under the new proposed law, money or income put in a foreign account would be considered taxable income.

Multinational Corporations

Multinational Corporations

 

How Are Multinational Corporations Currently Using Offshore Tax Havens?

There are many ways that US multinational companies currently use foreign tax havens to avoid paying American income tax. Many will set up a sham corporation in a country with no taxes, such as the Cayman Islands, and continue to do business in the United States while revenues are placed in this offshore account. The people owning the company can spend this untaxed money in the United States, using foreign debit and credit cards. This is a form of money laundering that is currently legal in the United States.

Corporate Tax Inversion

Corporate Tax Inversion

 

An End to Corporate Tax Inversion?

Corporations also use a practice known as corporate tax inversion to avoid paying in taxes. In corporate tax inversion, a large US conglomerate will merge with a much smaller foreign company and then claim that they are now a foreign conglomerate despite continuing to do the majority of their business in the United States. In many cases, the conglomerate has actually created the foreign company that they are merging with in order to avoid taxes in this manner.

Current US tax code allows these companies to avoid taxes if the new company has less than 80 percent of the same shareholders, known as the 80-20 test. The new proposed law would lower the 80 percent to 50 percent, so that companies that are more than half American will be taxed as American companies.

House Ways and Means Committee

House Ways and Means Committee

 

The Battle Ahead

Senate and House Republicans were resistant to this bill when it was introduced in 2013, which is why it never left the floor. However, Rep. Doggett and Sen. Whitehouse appear ready to take on a conservative majority this time around. Whitehouse is a member of the Senate Budget Committee while Doggett is a senior member of the House Ways and Means Committee, which writes tax code. Both feel that the current laws regarding offshore tax havens harm Americans by moving jobs overseas while also putting tax-paying small businesses at a sizable disadvantage.

Doggett was quoted on Monday as saying, “While most Americans contribute their fair share to our national security and vital public services, some large corporations still are not.” Doggett cited examples of billionaire corporations paying tax rates in the single digits, less than the average American middle class family. He called the current situation a perversion of tax laws. Whitehouse agreed in a similar statement, saying that “Big corporations should be allowed to play games with tax code and benefit from shipping jobs overseas.

American tax code

American tax code

 

Although the new bill would raise $278 billion in new tax revenue, it faces steep opposition from Senate and House Republicans. Many of the same lawmakers who kept the 2013 version of the bill from even being debated are still in Congress. Similar bills have been introduced over the past two decades by other lawmakers and have not been passed. However, Doggett and Whitehouse remain optimistic about their chances at leaving a last mark on American tax code and the corporate culture of offshoring.

With all this said, a CPA or Tax preparer should always be on the lookout for ways to serve their clients without breaching any legal guidelines. This article should have you thinking about ways to advise your business clients on possible ways the Tax Haven rules could affect their bottom lines. On top of this, think about improving your processes this season. If you’re not efiling your tax forms, you should give it a try.

Choosing to efile 1099 and other tax forms could save you lots of time, and the expense of printing and mailing copies to recipients. Not a bad outcome for your practice at all. Like most tax professionals, you may have clients with employees and contractors dispersed geographically. If you’re manually sending out forms, you can slash that time and effort by 60% very shortly. Simply use eFile4Biz.com to file 1099 online for clients, and use the spare time however you choose. The video below will show you exactly what I mean.

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