Q3 2023 Newsletter - PMRG

Practice Management Systems

Choosing the best practice management (PM) system for a practice is a challenging undertaking, and even more so if you’re considering changing from one PM platform to another. All things considered, this is a much bigger deal than changing electronic medical records (EMR).

What are the implications in making this sort of change and can PMRG continue to support you if you do opt to change systems?

Answering the second question first, it is likely PMRG can support you. We currently work on the major ophthalmology specific platforms – Nextech Practice +, Modernizing Medicine and Compulink. Our largest footprint remains AdvancedMD, which account for nearly two thirds of our clients. In addition to the above-mentioned PM systems, we also work on EPIC and NextGen. We have successfully supported clients moving from one system to another and those that have switched have found our expertise useful in making a switch.

What are the implications in making this sort of change? There are several to consider that can have a significant impact on your practice and cash flow:

Since virtually all your staff interacts at some point or another with the PM system, it requires a complete retention of your staff, and since every system deals with all the data in their own unique way, the training can be difficult.
Each system handles the financials/general ledger differently making migrating the financial data from one system to the next largely unworkable. This likely means running two systems for 3 to 6 months while the AR is worked down in the old system.
The all-important clearing house where all charges are routed to the insurance carriers, and all electronic payments get routed back to you. When changing systems, it may mean that you will be changing clearing houses as well. This requires filing new paperwork with Medicare and your private carriers to get the proper agreements in place for the exchange of healthcare data – this takes time and can impact your cash flow.
Do you currently utilize an EMR? If so, will the new system interface effectively with your existing EMR or are you also planning on changing that system as well, which only increases the level of disruption?

Our recommendation is to only entertain this change if you are feeling real, tangible pain with your current PM system. If you do plan on making a change, we can be your advocate in supporting you to find the best system for your needs.

Billing for Patients in a Skilled Nursing Facility (SNF)

Consolidated billing was established by the Centers for Medicare & Medicare Services (CMS) in 1998 to help eliminate duplicate billings for services rendered to SNF residents by multiple providers. With consolidated billing, an SNF receives a basic per diem rate per level of care for each resident. CMS excludes some categories of services from consolidated billing because they are costly or require specialization.

For Medicare beneficiaries in a covered Part A Skilled Nursing Facility (SNF), providers can seek reimbursement for excluded services directly through Medicare Part B. One excluded service is a medical examination performed in a provider’s office. A provider that sees a resident of a SNF in the office for an examination would bill the examination directly to Medicare; however, a provider must obtain reimbursement for services included in SNF consolidated billing from the SNF itself. Ophthalmological services included in the SNF consolidated billing are the technical component (-TC) of any test, post-cataract glasses and injectable drugs.

Follow these steps to avoid denials of claims for SNF residents:

Confirm where patients are residing if it’s outside the home. The typical stay in a SNF is 20 days.
Train your front desk to be mindful of patients who arrive at the office via transportation services. This can be an indication that the patient came from a facility.
Train your workup/pre-screen technicians to ask the patient if he/she is currently residing in a skilled nursing facility.
- A nursing home is not a Skilled Nursing Facility. Your staff may have to ask additional questions if the patient uncertain which kind of a facility they are currently residing.
Contact the facility before providing care and confirm that it will pay for these non-covered services.
Skilled nursing facilities are not required to reimburse the provider so request all authorizations for payment be sent in writing to your office to keep on file in the patient’s chart.
If you will be administering a high-cost drug to a patient in a SNF, consider using a sample from the manufacturer.

Obtaining payment from a SNF can be challenging. Make sure your practice is doing everything it can to ensure you are paid for the services you provide to your patients.

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