EMR Adoption, Selection and Implementation Checklist, medical records

The Obamacare Timeline – 2010 to 2018

by Nitin Chhoda PT, DPT | Sep 17, 2013 | Electronic Medical Records, Healthcare Practice Management, Physical Therapy Documentation, Physical Therapy Management

The Affordable Healthcare Act, also known as Obamacare, contains almost 500 different elements. Various features of the Act were designed to take effect over the course of the next eight years, with a complete implementation date of 2018.

It was one of the signature pieces of legislation on the Obama administration’s to-do list when the President Obama took office.

The Act was passed amid strong opposition and continues to be a topic of great debate.

The Congressional Budget Office estimates Obamacare will provide coverage for 25 million individuals who are now without healthcare, but will still leave approximately 31 million uninsured by 2033.

The following provides an overview of the Obamacare timeline.

March 2010

President Obama signed the Patient Protection and Affordable Care Act into law on March 23, 2010, marking the beginning of legislation designed to provide healthcare for all Americans.

July 2010

A pool was established to cover individuals considered high-risk by insurance companies. The government-operated pool provides coverage for those with a pre-existing condition until Jan. 2014 when that coverage is required by all insurance plans.

Sept. 2010

Beginning in 2010, insurance companies could no longer refuse coverage to those under the age of 18 with a pre-existing health or medical condition, nor could insurers cancel policies for frivolous reasons.

This component of Obamacare also allowed children up to the age of 26 to remain on parental policies as dependents.

Insurance companies were no longer allowed to place lifetime limits on an individual’s benefits.

An additional clause prohibits annual limitations on benefits, with a complete ban on the practice beginning in Jan. 2014. A maximum tax credit of 35 percent was made available to small businesses with 25 employees or less.

Jan. 2011

The much talked about “donut hole” gap in Medicare prescription plans began to close and will be completely eliminated by 2020. Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) can no longer be used to pay for over-the-counter medications.

A limit of $2,500 is placed on the amount individuals could place in an FSA, along with the type of medical items that can be purchased. Penalties for buying prohibited products were increased to 20 percent.

Oct. 2012

Enrollment in the Community Living Assistance Standards and Supports (CLASS) program were scheduled to begin. Designed to ensure long-term care for seniors, individuals would begin paying advance premiums to cover the cost of their care after retirement.

The program was suspended in Oct 2011.

Jan. 2013

The income tax deduction for claimable medical-related expenses increased from 7.5 to 10 percent.

Jan. 2014

Medicaid coverage will expand for those with income levels up to 133 percent of the poverty level. Healthcare exchanges, also known as marketplaces, will be established where individuals and small businesses can purchase their own insurance. Some states have opted not to participate in either of the components.

States that don’t set up their own marketplace will have one established for them and operated by the federal government. Marketplace enrollment begins in Oct. 2013.

The Individual Mandate Tax (IMT) also goes into effect, imposing individual fines of up to $285 on those who refuse to obtain healthcare insurance. Adults 18 and older can’t be rejected for insurance and those under age 30 can purchase catastrophic insurance coverage through the marketplaces.

Insurance policies must provide a core of essential services as determined by Obamacare. Small businesses with 25 or fewer employees can take advantage of a maximum tax credit of 50 percent. The credit expires at the end of 2015.

Jan. 2015

The IMT increases to a maximum penalty of $975 per person for those without insurance. The Independent Payment Advisory Board (IPAB) will begin making recommendations to reduce Medicare spending.

The panel will be responsible for determining which treatments and procedures provides the best results and are most cost effective.

Jan. 2016

Those without insurance can be fined a maximum of $2,085 under the IMT.

Jan. 2017

Large businesses with 100 employees or more will be able to access their state’s healthcare marketplace. Participation is dependent upon the individual state’s approval.

Oct. 2017

This was the earliest date that CLASS benefits could be paid out to recipients. The White House suspended CLASS in Oct. 2011.

Jan. 2018

IPAB’s recommendations for trimming Medicare costs can be implemented. Those who have a “Cadillac” insurance policy, with premiums in excess of $10,200 for individuals and $27,500 for families, will pay a tax of 40 percent on their coverage, according to the value of the policy. Dental and vision benefits aren’t included when determining value.

Obamacare affects everyone in some way, but few have any knowledge about the different elements involved or how it will affect their healthcare and finances. Those that make no effort to learn about the Obamacare timeline will find they still have no medical coverage and the problem will be compounded by financial penalties.

What Large (and Small) Businesses Need to Know About Obamacare

by Nitin Chhoda PT, DPT | Sep 16, 2013 | Electronic Medical Records, Healthcare Practice Management, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Management

While the Affordable Health Care Act (Obamacare) will extend the availability of healthcare services to millions of uninsured Americans, it imposes a variety of mandates on businesses of all sizes that increases the cost of doing business.

Employers are not happy about Obamacare and many fear the effect on their productivity and profit margins.

Businesses with 50 or more employees, and those with workers who put in 30 or more hours per week, are required by Obamacare to provide their workforce with health insurance or face financial penalties of $2,000 per employee.

Many firms are choosing to pay the fine – it’s cheaper than providing insurance.

The outcry by the business community was so great that President Obama delayed the mandate’s effective date until 2015 to give employers time to prepare for the transition. Companies across the nation are looking at strategies to lighten the financial load when Obamacare is fully operational.

Shrinking Business Growth

According to a survey by the Society for Human Resource Management, 41 percent of participating small business owners indicated they would not be hiring new employees due to Obamacare.

Twenty percent said they were reducing their payroll and expansion projects are being placed on hold.

Some businesses will receive tax breaks to help alleviate the financial pain of health insurance premiums they pay for employees. The tax breaks only apply to companies with 25 employees or less and many entrepreneurs fear financial failure with the full implementation of Obamacare.

Reducing Workers and Hours

To elude the fines of Obamacare, many businesses have chosen to:

reduce their workforce
limit workers to 29 hours per week, and
transition to a four-day work week

All three strategies have a negative impact.

Higher unemployment rates and reduced hours will force individuals to utilize social service agencies to survive. According to the Bureau of Labor Statistics, only one full-time job was created for every four part-time jobs in 2012.

A survey conducted by Mercer found that 12 percent of all U.S. employers planned to reduce hours for full-time and part-time employees.

In a Reuters survey, a number of businesses indicated that they would be hiring more temporary employees.

That policy would allow employees to qualify for government subsidies to purchase their own insurance coverage through state operated marketplaces.

The strategy is being used by businesses of all sizes, along with educational institutions.

Companies that do provide insurance for employees are being forced to reduce covered benefits while increasing the cost to workers. Some are choosing to eliminate coverage for spouses and children. Insurance companies have raised their rates in response to the array of mandated services through Obamacare.

Economic Repercussions

The costs incurred by businesses through Obamacare mandates will be passed on to consumers. Companies will have to raise the prices on their goods to make up for a loss in productivity, fines and other costs associated with the healthcare Act.

The impact will be felt at all levels, from food and clothing to housing and the auto industry.

Fear of Obamacare has resulted in significant changes in the business community. To combat the cost of mandatory healthcare, businesses are being forced to lay off workers, cut hours and modify work weeks. The result is a loss in productivity that affects profits and limits the ability to expand and create jobs now and in the future.

Impact of Obamacare on Senior Citizens

by Nitin Chhoda PT, DPT | Sep 15, 2013 | Electronic Medical Records, Healthcare Practice Management, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

According to Health and Human Services Secretary, Kathleen Sebelius, 11,000 seniors are becoming eligible for Medicare each day. As new elements of the Affordable Healthcare Act are introduced, seniors will see changes in their Medicare coverage, out-of-pocket expenses, and even the physicians they see.

Known as Obamacare, the Act reduces payments for those with Medicare and who are enrolled in the Medicare Advantage program.

A significant amount of money to fund Obamacare over the next 10 years is being taken from Medicare coffers.

The Congressional Budget Office (CBO) estimates that reimbursement for Medicare-related services will be cut by approximately $716 billion between 2013 and 2022.

Seniors participating in the Medicare Advantage program will see cuts in that as well.

Seniors will face additional cuts through the creation of the Independent Payment Advisory Board (IPAB), which will have control of the Medicare budget in coming years. Insurance companies will be allowed to continue charging seniors and other groups higher rates for their healthcare.

On the plus side for the 49.5 million seniors on Medicare, Obamacare caps the amount seniors will pay for Medicare premiums. It also expands coverage for prescription medications and some preventative care services.

Reducing Payments to Control Costs

Medicare already pays less for services than many commercial carriers and those amounts will be reduced further in the coming years. Facing the prospect of decreasing Medicare revenues, many clinicians are either selling their practice, retiring early, taking employment at hospitals, or refusing to see Medicare patients at all.

A Deficit of Doctors

According to the Association of American Medical Colleges (AAMC), there will be an estimated deficit of 130,000 physicians by 2025. Fewer clinicians mean less access to healthcare for seniors and a longer wait for appointments.

Seniors could be forced to locate a new practitioner, be limited to clinicians within specific networks, and required to travel further distances to receive healthcare.

Medicare Advantage and Excise Taxes

Changes in Medicare Advantage programs could potentially eliminate or drastically reduce vision and hearing coverage. Obamacare raises taxes on medications and medical equipment. Patients will pay an excise tax on medical devices, ranging from wheelchairs and joint replacements to hearing aids.

Funds collected through the tax increase won’t be used for Medicare. The money is earmarked to pay for and sustain Obamacare programs.

The Act assumes that seniors will use the dollars previously used for Medicare Advantage plans to purchase insurance through commercial companies.

IPAB Controls Future Cuts

Further measures to control costs in the future will be in the hands of the IPAB. The 15-member board will have the power to cut Medicare spending where it sees fit to reach specific spending goals.

Cuts will automatically take effect unless Congress moves to counteract the changes with a super majority vote of three-fifths by the Senate. IPAB members are appointed and can’t be voted out of office.

The board essentially provides protection for Congress, absolving them of any responsibility for Medicare cuts.

IPAB will be charged with setting reimbursement rates for clinicians and deciding which medications, treatments and procedures will be covered.

IPAB will determine the most effective treatments for specific maladies and the cost for each treatment and procedure.

Most people agree that some type of healthcare reform was needed, but seniors fear Obamacare will limit their access to physicians, medications and treatments at a time when they need them most. One thing is certain. Obamacare will definitely impact the financial health of seniors.

Obamacare – The Problem it is Trying to Solve

by Nitin Chhoda PT, DPT | Sep 14, 2013 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Software

The goal of the Patient Protection and Affordable Health Care Act was fourfold: to increase access to healthcare, reduce healthcare costs, institute more consumer benefits and protections, and improve efficiency. As different portions of the Act go into effect, it will have a major impact on virtually every individual in the U.S.

The Act has both a human and financial component.

According to the Center for Disease Control (CDC) more than 45 million people had no type of health insurance in 2012.

Individuals at the lower end of the financial spectrum were the most likely to lack coverage.

The Congressional Budget Office estimates the Act will reduce the number of uninsured by 27 million between now and 2023, but will still leave approximately 26 million Americans uninsured and financially unable to purchase coverage.

Increasing Access to Healthcare

Obamacare establishes healthcare exchanges and provides subsidies for low income individuals to help them purchase coverage. Millions of Americans can stop living in fear of becoming ill.

They will no longer be turned down for a preexisting condition and children can remain on parental policies through the age of 26.

The downside is an influx of new patients to practices that are already working to capacity. A poll for the Physicians Foundation showed that 40 percent of medical professionals intend to sell their practice or retire early due to Obamacare, resulting in a shortage of available clinicians and longer wait times to obtain an appointment.

Reducing The Cost of Healthcare

One of the tenants of Obamacare was the control and reduction of skyrocketing healthcare costs. The Act reduces the amounts paid by Medicare to practitioners, but allows hospitals to collect more for the same services.

The inequity is prompting many clinicians to stop accepting Medicare patients, further limiting access to care.

Clinicians are under pressure to reduce the number of tests they order and utilize the least expensive modes of treatment whenever possible. Many healthcare professionals fear the drastic reductions in reimbursements will drive potential physicians into other fields.

Healthcare costs also come in the form of copays, premiums and deductibles. Patients are already seeing an increase in all three, as insurance companies raise prices in response to the services the Act forces them to reimburse for.

With insurance companies placing limitations on reimbursements, pharmaceutical firms are reducing or eliminating medications as unprofitable to produce.

The cost of Obamacare comes in other guises. In 2018, a 40 percent tax will be placed on healthcare plans, dependent upon their value, and collected through tax returns. Fines will be assessed on individuals without insurance.

Employers with more than 50 workers must offer insurance or face financial penalties for each person they employ.

Benefits and Protections

Obamacare provides patients with some perks along with coverage. Insurance companies can’t place an annual limit on benefits, nor can they cancel policies for frivolous reasons, but the Act limits the amount individuals can place in Flexible Spending Accounts (FSAs) and purchases that can be made with the funds.

Improving Delivery and Efficiency

The Act’s components are intended to increase the overall efficiency and delivery of healthcare services. To accomplish that goal, the Act mandated use of an electronic medical records (EMR) system.

The technology is expected to allow clinicians to treat a greater number of patients per day and eliminate paper records.

Accountable Care Organizations (ACOs) encourage networks of providers, with financial incentives for clinicians that provide a better level of care.

The focus of healthcare would begin a transition to a system of preventatives measures rather than reacting to treat disease after it occurs.

The Act also creates a panel of individuals to determine and recommend preferred treatment options.

Obamacare has four major goals through the Affordable Healthcare Act. In an effort to solve the glaring problems in the healthcare system, it will change the way clinicians practice their profession and deliver care. Patients will have greater access to clinicians, but only time will tell if Obamacare creates a nation of healthier individuals and more efficient practitioners.

The Impact of Obamacare on Physical Therapy Private Practice – Part 1

by Nitin Chhoda PT, DPT | Aug 31, 2013 | Electronic Medical Records, Healthcare Practice Management, Physical Therapy Management

As different elements of the Affordable Health Care Act (a.k.a. Obamacare) unfold, it’s emerging that this law has had a radical impact on private practices of all types. In Part 1 of this THREE PART article series, founder and CEO of In Touch EMR, Nitin Chhoda discusses the outlook for physical therapy private practices in the Obamacare economy.

2013 has been a very interesting year, and we still have three months to go.

In the last 8 months, the pressure on private practice owners has increased substantially, in more ways than one.

Regardless of the intentions of the administration, a disturbing result of the legislation is that clinicians are closing their practices and many are joining the ranks of hospital-employed providers.

Physical therapists are spending less time with patients and more with their EMR-enabled devices filling out digital paperwork to satisfy government requirements, all under the guise of improving patient care.

Medicare continues to reduce reimbursement amounts and tighten the nooze on private practices. Functional limitation G code reporting, PQRS reporting and manual medical review are just the tip of the iceberg.

The fact is, practitioners are opting out of insurance programs entirely, instituting cash only clinics, or closing up shop.

Results of a survey by the Doctor Patient Medical Association…

An increasing number of clinicians are selling their practices or joining the ranks of hospital-employed providers to combat their loss of revenues. In a 2012 study by the Doctor Patient Medical Association, ninety percent of practitioners polled indicated that private practice is losing out to the business side of medicine and 83 percent were thinking of leaving the profession.

When asked why; government intervention was cited as the root of the problem.

In a 2013 Deloitte survey, fifty percent of respondents said the practice of medicine is in jeopardy. Sixty-two percent indicated they were going to retire early as a result of Obamacare, and seventy five percent voiced the fear that fewer individuals will pursue a career in medicine in the future.

Athenahealth and Sermo both conducted their own surveys with similar results. Their polls also showed that 93 percent of participants were very concerned that they wouldn’t be adequately compensated for their services and expected their revenues to dip dramatically when Obamacare is fully implemented.

The Winds of Change

There are many factors influencing providers – loss of income, tremendous amounts of documentation and additional compliance based reporting, and the fear that legislation will become the motivating force behind medicine. Under new regulations, special G codes and modifiers aren’t payable and many procedures will be bundled for a flat fee.

Reduced incentive payments and Medicare reimbursements, bundled payments and reimbursements based on metrics, along with more regulatory reporting, disclosure and compliance requirements, are creating an insurmountable force that can make private practice unprofitable for those who do not adapt.

We are living in a new economy, called the ‘post medicare’ or the ‘Obamacare’ economy.

The writing is on the wall. There is a reason that CMS is collecting data with functional limitation G code reporting and PQRS reporting. Physical therapists are concerned that the Centers for Medicare and Medicaid Services will use the information obtained through additional reporting to limit services or not pay for them at all. Payment and services would be based on paperwork and statistics instead of a physical examination.

Clinical Care Driven by Numbers?

For example, there is a distinct possibility that Medicare says “Statistically, an ankle sprain patient improves from severity modifier CI to severity modifier CM in ten visits, based on the data we have collected, and the reporting of the functional limitation G code by clinicians in your area. Therefore, you need to get the patient better in ten visits, and we won’t pay for more than ten visits”.

As clinicians, we know this sounds ridiculous since every single patient is different, and may have different goals and other limitations. No two patients are the same. The question is – will this even matter in the Obamacare economy?

I hope I’m wrong, but this could be where things are headed.

If I’m right, we’re talking about healthcare driven by statistics, not by clinical expertise.

Physical therapists are already feeling the impact of PQRS, Functional Limitation G codes and Multiple Procedure Payment Reduction (MPPR). The APTA has estimated a 6 – 20% reduction in Medicare payments for physical therapists in private practice. In fact, they have indicated that some practices may go out of business with these new changes.

Concerns from Private Practice Owners

Clinicians say there are too few doctors to care for the influx of new patients under Obamacare and this has the potential to eliminate the sanctity, the integrity of the patient-clinician relationship. It has the potential to significantly lower standards of care.

It’s likely that there will be a significant influx of Medicaid patients, with very few clinicians to care for them. Incidentally, Medicaid pays approximately fifty six percent of what commercial carriers reimburse. In addition, some estimate an estimated twenty seven percent reduction in Medicare payments.

An oversight panel has been charged with reducing Medicare costs and determined the most effective treatments. Practitioners say it will place uninformed individuals in charge of dictating patient treatments based on cost rather than need.

Hospital-Employed Physicians and Monopolies

An increasing number of private practice owners are choosing employment in hospitals where they often earn more than in private practice, with no overhead, better hours, greater lifestyle flexibility and less administrative burdens. An article in the New England Journal of Medicine attributed the trend to Obamacare, noting that more than half of all physicians are now employed in hospitals.

Under Obamacare, hospitals typically receive higher reimbursements for specialty services than those in private practice. The end result will be alliances between hospitals and insurance carriers, where hospitals hold a monopoly among payers and offered services. Hospitals and payers who saw the financial potential embraced the new legislation.

Obamacare was never about containing escalating healthcare costs – at least not completely. Insurance companies and hospitals agreed to play the Obamacare game with the Affordable Health Care Act, using it to establish themselves as “too big to fail” in the eyes of the government, thereby obtaining the power to call the shots on how healthcare is delivered and reimbursed. For private practice owners, this was always a tough battle to win, if they continued to do business the same way.

In Touch EMR and In Touch Biller Pro – Your Competitive Options in this New Economy

In this economy, your choice of an EMR and billing software is critical. In fact, never before has it been more critical.

The right system can lower costs, improve efficiency and make you and your staff happy and productive. The wrong one can create a never ending cycle of frustration, pain and agony.

Cost effective systems such as In Touch EMR and In Touch Biller Pro provide solutions that help private practices streamline the before, during and after patient experience by providing the following benefits:

Complete eligibility verification online
Create patient records with one click (auto patient chart creation)
Create custom templates with a point and click template builder
Scrub claims, submit claims automatically with one click (automatic claims batching)
Post ERAs with one click
Generate patient statements automatically and much more…..

The future of medicine, how it’s delivered, and the private practice are imperiled. As more patients enter the system, the number of therapists in private practice will decrease. Patients will have less access to care, a situation Obamacare was supposed to remedy. The bottom line is that socialistic medicine favors conglomerates over small businesses like your own private practice.

The Importance of Live Events and Workshops

Attending live events and workshops like the upcoming Private Practice Retreat in Las Vegas is the best one to stay one step ahead of the curve, and prepare your practice for the ‘Obamacare’ economy.

Click here to register for the 2013 Private Practice Retreat.

Private Practice Retreat

Learn more about the impact of Obamacare on patients in Part Two of this series, and the action plan your practice needs to combat Obamacare in Part Three of this article series.

Medical Billing Professional Groups and Associations – A Useful Tool

by Nitin Chhoda PT, DPT | Aug 29, 2013 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Software

Professional groups are an important element for medical billing specialists. They provide professional information, support and assistance, allowing billers to remain cognizant of rules, regulations and changes within the profession. In this informative article, Nitin Chhoda examines the advantages of biller-related associations and groups.

Education Opportunities

There are a number of organizations with a focus on the medical billing profession.

The groups offer an extensive array of services, from classes to achieve certification to continuing education for those who have already attained employment.

The organizations advocate for higher wages and conditions within the work place.

Many classes are provided online, allowing medical billing staff to study when it’s convenient without interrupting their employment. Those working to become certified medical billing professionals can attain their credentials through accredited classes and programs.

Aspiring billers can familiarize themselves with terminology, legal issues, anatomy and physiology, and dealing with payers.

Industry Changes

Standards can change quickly within the profession and the groups distribute industry information to help medical billing professionals keep abreast of the latest updates and changes. One of the most important changes is the transition from ICD-9 codes to ICD-10 coding and billers can learn how the changes will affect them, accepted medical billing practices and the benefits. Some groups even provide online trainers, along with in-depth information on maintaining HIPAA-approved security.

Conferences, Conventions and Supplies

Professional medical billing associations conduct an extensive number of conferences, conventions, seminars and webinars, and exhibitions on all aspects of the industry. The special events provide medical billing people with information and demonstrations on new products, methods and industry trends, along with educational opportunities and technology.

Budding billers have access to starter programs, medical billing software, and practice programs to familiarize novices with the type of forms and information with which they’ll be working. Books and manuals on HIPAA compliance and associated computer tools are offered.

EMRs and Technology

The Affordable Health Care Act has mandated the use of electronic medical record (EMR) technology to maintain patient records and facilitate medical billing. Professional biller organizations offer extensive data on EMRs, their benefits and information on what to expect when working with the integrated software systems.

Professional medical billing associations and organizations assist individuals obtain credentials and provide ongoing information on all facets of the profession.

The groups provide essential services and products for billers at all levels of expertise.

The groups are committed to providing recognition for member contributions, continuing education, networking among peers and advocating for wages appropriate to the individual’s level of education and experience. They’re important resources for those considering a career in medical billing and those who are already professionals in their field.