Practice Management

PRACTICE MANAGEMENT

By Brent Hazelett, MPA, CAE NCAFP Chief Operating Officer

Managing Your Career and Your Practice: AAFP Resources at Your Fingertips

As a Family Physician, you are responsible for a great deal: caring for your patients, yourself, and your practice. When you have questions or need assistance in any of these areas, remember the AAFP has a tremendous number of resources for all three at aafp.org and familydoctor.org. While the latter focuses on providing the best care for your patients, bountiful resources exist at aafp.org for taking care of yourself and your practice. This includes everything from employment contracting to maximizing payment for claims, to alternative payment models and everything in between. Here are just a few areas you may find useful:

NEGOTIATE YOUR EMPLOYMENT AGREEMENT WITH CONFIDENCE

Whether you are a resident facing the daunting task of reviewing your first contract, or a seasoned veteran reviewing your fourth contract, it is wise to consult others when navigating this process. AAFP has a wealth of resources that may help you:

Family Practice Management Journal – AAFP’s indexed, peer-reviewed, practice improvement journal offers practical ideas for improving your practice environment. In the Fall 2021 career issue, the journal includes a guide to navigating employment contracts, as well as a wealth of other resources related to managing and optimizing your career in Family Medicine. Download the PDF here: https://www.aafp.org/ fpm/2021/0900/p17.html Family Medicine Practice Hacks – view the AAFP’s latest practice hack video, a five-minute overview of the four steps you can take to ensure you are informed throughout the contracting process. The video can be viewed by searching “practice hack videos” from the aafp.org home page.

A Family Physician Guide to Employment Contracts – AAFP has developed an extensive guide to better understand the provisions and elements of contracts and specifically the employment contract process. This includes potential pitfalls and red flags to watch out

for, as well as key questions to ask during the negotiating process. The full guide can be downloaded here: aafp.org/family-physician/practice-and-career/managing-your-career/employment-contracting.html

PRACTICE MANAGEMENT RESOURCES

The business of medicine has never been more complex than it is today. It is nearly impossible to keep up with the best patient care and manage an effective and efficient practice. Don’t forget that the AAFP provides a wealth of resources that may help you navigate some of the complexity around running a practice.

Ease the strain of administrative burdens such as prior authorizations by learning how to streamline your prior authorization process – AAFP provides a workbook to best manage the prior authorization process, as well as another practice hack video, which gives tips that help reduce the burdens of prior authorizations.

Starting, Closing, or Selling a Practice – AAFP has developed a tool to assist family physicians with the process of deciding whether to, and how to set up a new practice. In addition, for those physicians looking to close or sell their practice in the near or distant future, the AAFP can be a very helpful resource. The “managing your practice” section of their website has multiple resources, including an easy-to-use checklist of tasks needed to wind down your practice. While you will ultimately want to use financial and legal advisors to navigate the complexity of closing a practice, this resource is helpful for those just beginning the process.

Medical Billing and Coding – AAFP has a wealth of resources on their website to assist with the everchanging complexity of proper billing and coding. Examples of deep dives include: • Coding Basics • Coding for E&M Services • Medicare Wellness and Care Coordination • Hierarchical Condition Category Coding • Coding for Group Visits • Newborn Care Services • Vaccine Administration • Chronic Care Management • Getting Paid

Great patient care and an efficient practice won’t matter if you aren’t able to keep the doors open. Ensuring you get paid fairly and completely for the excellent care you provide is paramount. Many of the resources offered by the AAFP are targeted to maximizing your income.

Advanced Alternative Payment Models – whether it’s MACRA or MIPS or a litany of other acronyms in this arena, it’s important to know what existing payment models might apply to your practice and payer mix. It can be exceptionally confusing to navigate these options and AAFP’s website has many resources that can assist. Under the “Family Physician” tab on the AAFP website, select “getting paid” to find out more.

Value-Based Delivery and Payment Models – when it comes to being paid based on the value of care you provide, there are an increasing number of choices out there. On AAFP’s website, you can compare different care models, including accountable care organizations, direct primary care, and many more.

Private Payer Issues – both the NCAFP and the AAFP are advocating on your behalf with the major state and national payers. At the state level, the NCAFP is working with payers to reduce administrative burden and reward family medicine for its vital role in providing low cost/high quality care, ultimately making it easier to take care of your patients and find a work/life balance that is rewarding and healthy.

Make it a point to regularly visit ncafp.com and aafp.org to learn more about the issues facing you and your practice, and more importantly, find resources to help you make the most of your career, provide the best care for your patients, and ensure your practice is healthy and strong for years to come.

PRACTICE BRIEFS

Curi Launches New Advisory Business to Support Physicians & Medical Practices

Raleigh-based Curi, a firm that advises physicians and medical practices, recently announced the launch of Curi Advisory, a new business unit dedicated to helping independent physician practice leaders protect, optimize, and grow their businesses via a business intelligence platform and related data-driven consulting. The unit’s core offerings at launch include the Arrowlytics technology platform and a host of practice operations, risk solutions, and health policy consulting services.

In a press release announcing the launch, the new unit represents a natural evolution for Curi, stemming from its mission to continually develop solutions that help physicians in medicine, business, and life.

“We have been focused on growing and diversifying our advisory offerings for many years now, always with an eye toward how we can best support physicians and their practices,” said Curi CEO Jason Sandner. “The launch of Curi Advisory represents an important milestone in our long-term strategy of being a trusted partner for the member-owners and customers we serve and the physician community at large.”

Curi Advisory will offer the Arrowlytics Platform, software designed to help practices drive new patient volume, increase per-patient margins, and optimize overall practice performance. Arrowlytics pulls critical data from disparate sources, including various practice management systems and social media, into a single platform—giving practice leaders total business insight.

Complementing Arrowlytics, Curi Advisory will also deliver practice and risk management consulting services through a team with deep expertise. Broadly, these offerings are expected to help practice leaders protect, optimize, and grow their businesses with confidence. To learn more, visit curi.com/advisory.

PAYMENT

COVID-19 Vaccination Outreach Code Reimbursement

NC Medicaid-enrolled providers can now bill code 99401 with HM modifier for telephone outreach to unvaccinated Medicaid beneficiaries, effective Oct. 22, 2021. The goal of the outreach is to educate the beneficiaries on the COVID-19 vaccine and assist them in scheduling an appointment, ideally in the office where the outreach originated.

Billing Specifications:

• CPT 99401 HM has a limit of one call per beneficiary per day. The code can only be billed for successfully connecting with the beneficiary. • Medicaid-enrolled providers must bill CPT 99401 HM with a CR modifier to indicate a PHE code.

• There is no requirement for a specific diagnosis code associated with the code.

Providers are encouraged to counsel Medicaid beneficiaries following CDC guidance for qualifying for vaccination. Parents or guardians of Medicaid children can be counseled on the benefit of receiving the COVID-19 vaccination even if the parent or guardian is not enrolled in NC Medicaid. The counseling session (99401) for the parent or guardian can be billed to the child’s Medicaid ID, but only one code can be billed per day per ID.

CAREPOINTS

Controlled Substance Reporting System Now Covering Integration Fees for BiDirectional EHR Connections

Great news for practices! The Controlled Substance Reporting System (CSRS) is now able to provide financial support to practices by fully covering the initial integration fees for a bidirectional EHR connection to the CSRS.

The North Carolina Department of Health and Human Services will cover the licensing fees associated with the integration service for approved prescribers and pharmacists in North Carolina to connect their EHR to PMPGateway and NarxCare. Additional fees, in which the practice is responsible for, may be assessed by their EHR/PM vendor. The practice will need to consult with your vendor representative if you have questions.

Please take a moment to take a look at the inset flyer for specifics on the advantages of the integration. The benefits of the bidirectional connection are that the provider/user has access to the CSRS from within the EHR and does not have to log into another system. The bidirectional connection also decreases the search time by making the information more accessible in the EHR and within the established workflow. Results have shown that processing time is reduced from several minutes to several seconds per transaction.

Stephanie Johnson at CSRS has graciously provided her email address if physicians and/or practices have initial questions: stephanie.johnson@dhhs.nc.gov on the program. Practices wishing to move forward, should contact the CSRS via CSRSUtilization@dhhs.nc.gov. Practices may also contact NC AHEC Practice Support at practicesupport@ ncahec.net for more information.

Know the Facts EHR/CSRS ofIntegration

The North Carolina Department of Health and Human Services will cover the licensing fees associated with the integration service for approved prescribers and pharmacists in North Carolina to connect their EHR to PMP Gateway and NarxCare. Additional fees, in which you are responsible for, may be assessed by your EHR/PM vendor. Please consult with your vendor representative if you have questions.

Eliminate the need for delegate searches and increase the speed of search times. Integration also eliminates the need to log into other tabs and leaving your EHR.

Let us know your needs and request technical assistance and/or education on using the system as a clinical tool by emailing: CSRSUtilization@dhhs.nc.gov

Start the integration process today:

Integration is on a first come, first serve basis. Please allow processing time and verification of all documents for completion and accuracy.

HAVE A SINGLE POC (LIKE BUSINESS ADMIN MANAGER) WHO HAS SIGNING PRIVILEGES FOR THE ENTITY TO COMPLETE THESE STEPS:

1.

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3. Create an Account in Customer Connect then verify the email address by following the instructions in the email sent to you. https://connect.hc.appriss.com/ Complete the License Questionnaire and sign the Terms & Conditions Prescriber List- Template located here, have prescribers full name, DEA and NPI numbers and NC Professional License Number ready for the practice- https://files.nc.gov/ncdhhs/documents/files/NC _presciber _ list _ template.xlsx

and the more they confided in me.

Patients told me their hopes, their fears, and their concerns about and dreams for their children, who were often also my patients. Sometimes, only after years, did they reveal histories of abuse that they had told no one. And, once I knew, I could help.

As far as I know, healthcare systems have not sworn to put your interests first, nor been educated to respond to your innermost fears. Their decisions, as well as those of insurance companies and drug and device companies, often prioritize market share over patient care.

Trust is a fundamental, if underrated, ingredient in the success of medical care. We have seen this only too painfully in vaccine resistance during the pandemic. Trusted primary care physicians can play a crucial role in vaccine acceptance. And during this pandemic, patients need trusted physicians to help them with illness, fear and loss.

When doctors are treated as interchangeable parts in someone else’s machine, we are not in positions to establish that trust. Patients suffer, and doctors suffer as forces distance us from the sanctity of the relationships with patients that called many of us into medicine.

None of us should give in to this.

Patients: Be vigilant and watch out for financial decisions taking precedence over your care. If your healthcare system claims to be patient-centered yet is willing to sever the doctor-patient relationship, let them know that violates your trust.

Fellow physicians: Don’t stand for it. We took oaths, we belong to a venerable profession, we walk— or should be walking — in the footsteps of giants: Hippocrates, Rebecca Crumpler, Sir William Osler, Arnold Relman, to name a few.

Medical practices: Have respect for the doctor-patient relationship and let patients know if their doctor can be seen elsewhere. Forego a short-term business advantage for the long-term welfare of patients.

Medicine has changed. Our forebears would be fascinated with the worlds opened by MRIs and genetic testing. I would hope they would recognize the benefits of the gender and ethnic diversity they would see in the faces on hospital rounds. But they would undoubtedly be appalled by the idea of the business of medicine. In fact, Osler, the father of modern medicine, said so explicitly:” The practice of medicine is an art, not a trade; a calling, not a business.”

Nearly 30 years ago, I wrote in the Charlotte Observer about “Musical Doctors,” when, as though they were children playing musical chairs, patients were abruptly forced to change doctors because of changes in insurance. I decried the interference in the doctor-patient relationship. I quoted Hippocrates, who said “. . .some patients, though conscious that their condition is perilous, recover their health simply through their contentment with the goodness of the physician.”

Instead of nurturing the relationship between doctors and patients, we have moved in the opposite direction. If we want to recapture the benefits to all of us, we need to let our institutions know how important those relationships are to us.

Dr. Jessica Schorr Saxe is a retired family physician in Charlotte. She is chair of Health Care Justice North Carolina.

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