- We mastered our deductible management protocol to maximize collections from payers and patients alike. We finally beat, for the most part, the dreaded February cash flow slump with a combination of targeted holds, systematic tracking and release, and special collection projects.
- We launched Checkflight, our data platform for clients with tools we originally developed for our own use. The most popular, so far, is the Denial Queue report, a detailed daily list of all the prior day's denials and recoupments categorized for accountability and completion. In addition to improved denial response times, we used the aggregate data to reverse-engineer process improvements to prevent recurrence and lower overall denial rates. Hooray!
- We launched Where Are They Now?, a platform for tracking each sales dollar to its ultimate resolution. You would be shocked to know what percentage of AR represents phantom sales.
- We launched MiraVista 101, a training program for internal billing departments based on our own staff training. I think, hands down, the best sessions are the Denial Management and Research Workshops because they teach staff how to solve the unanticipated problems without overreliance on a single manager or expert.
- We launched Never Mind the Trick, of course.
Whew! 2016 has been a challenge. As it draws to a close, I thought that remembering the highlights would be great way to launch 2017. Here are a few of my favorite things:
By and large, there are not many notable differences in payment between 2017 and our current prices. CMS deployed a 0.7% increase to general DME items, but with the rollout of Round 2 Recompete, the bid pricing factored a further reduction for all items subject to competitive bid nationwide. For exempt DME you will see a minimal increase, but for bid products you will likely see a minimal DECREASE.
However, the rates for stationary oxygen did notably decrease netting an $8-9 reduction based on how CMS calculates oxygen payments. Per statute, when CMS added a separate payment class for oxygen generating portable equipment in 2006, they required that each year the stationary and portable oxygen contents be reassessed to remain budget neutral. This protocol forced additional cuts to the stationary, however it is not apparent why this resulted in such a notable decrease.
Nearly a full year after CMS published its final rule on prior authorization for general DMEPOS along with a master list of 135 items potentially subject to authorization, the process is beginning to take shape. As MiraVista predicted last February, the initial implementation is very limited.
CMS announced the national prior authorization rollout on Monday, December 19 for two HCPCS codes:
The rollout will take place in two phases. Beginning March 19, 2017, CMS will initiate a targeted rollout to suppliers in the following four states (one in each DME MAC Jurisdiction):
On July 17, 2017, CMS expects to implement prior authorization for these codes nationwide.
But this advancement is MUCH bigger than the first two codes. This is a welcome innovation that HMEs can get behind, and it will soon be available to ALL suppliers. MiraVista projects that CMS will deploy a much more meaningful expansion for 2018.
Please join us on January 31, 2017 as we host a special online forum to discuss the benefits and requirements of the authorization program, prepare for the concrete elements of the mandate, and contemplate the necessity of direct practitioner involvement as implementation guidance is being shaped.