Explore the Medical Bill Format in Word for Product Quality

Medical bill format in word for Product quality

Those quality measures do not necessarily define you as a doctor! No matter which specialty you're in or which level of practice you're in, whether you just graduated, whether you've been in practice for a long time, it's very important to understand how insurance companies pay you. There's various levels of compensation be that from an HMO Plan, PPO Plan, or Medicare. For the time being most HMOs compensate you based on computation with come sort of incentives depending upon what kind of care you provide for your patients. There's a certain set of "quality measures" that if you perform well you will get a bonus from your HMO plan. For instance, if your asthmatic patients get albuterol or if your diabetic patients get A1Cs checked twice year, even if you're a specialist, if you still care for those patients and if those patients get those "quality markers" you will get a bonus from your HMO plan, but certain HMO plans will not pay you for service. For years, some physicians would take advantage of this opportunity where they would not necessarily see their HMO patients, just collect computation and sort of profit from that but things are changing. This is no longer going to be the case going forward for most HMO plans because the emphasis will be on quality. They want to make sure you don't just have those patients in your panel but you do quality care and based on that you'll get a bonus. What that bonus is depends on your plan. As far as the PPO plans, of course, for the time being you're being paid for service. You see the patient in the office, you do a procedure in the office, or you follow them in a hospital, it doesn't matter, you code for that level of service and you get paid. This will also be changing in the next couple of years because, again, insurance plans will tie a lot of your compensation into quality measures. There's a debate going on right now whether those quality measures are really measuring quality. For instance, the way that you taking care of your hypertensive patients is measured by the last blood pressure in the chart for the year. Well, something could have happened that day and your patient may have a high blood pressure and based on that you don't get checkpoint for that quote unquote "quality measure." I keep saying quote, unquote because those quality measures do not necessarily define you as a doctor. They do not necessarily tell patients that you're better or worse doctor if you don't have a 100 percent score on certain quality indicators but the truth of the matter is that those are the things that we have to do, that we have to sort of be governed by and it's up to us to report those measures and it's up to us to let insurance companies see that we doing all that and the important thing is that moving forward even PPO plans will concentrate more on quality rather than quantity. So when you just see the patient in the office and you provide a certain level of service, you still bill for it but in years to come you won't just get that particular compensation from seeing them in the office a lot of it will be tied to quality measures. And Medicare, of course, beginning this year you've all heard of MIPS and MACRA provisions. MIPS are the MACRA provision and it's a very complex structure. It is not very difficult to implement but it is quite cumbersome. It will be interesting to see what many physicians do with that because again the burden is on the doctor to show that you're doing good work. It's kinds like the opposite of, you know, you're guilty until you're proven innocent. So basically it's assumed that you're not doing the right work until you actually show it. Depends on your setting, depends on your electronic medical record and which setting you practice in. It's obviously much harder to comply with all these measures if you're an independent physician and it is much easier if you are employed by a large organization, such as a hospital, because they do many things for you. In all, this leads us to the actual billing and coding. How to actually code for your visits... What do you do in the office... and we'll talk about this at greater length in a later video and of course at our seminars. We hope you enjoyed the video. Reimbursement Rx was founded to educate residents and practicing physicians on how to navigate the business of medicine from the doctor's side. To stay up-to-date with our latest insights, please like Reimbursement Rx on Facebook, subscribe to Reimbursement Rx on YouTube and check us out online at reimbursementrx.org. Thank you for watching.