physician reimbursement Archives

Frazier & Deeter’s Business Beat: Scott Ballard, Northside Anesthesiology Consultants

May 22, 2019 by John Ray

Business Beat

Frazier & Deeter's Business Beat: Scott Ballard, Northside Anesthesiology Consultants

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**Dr. Scott Ballard, Northside Anesthesiology Consultants, Jen Portilla, Frazier & Deeter, and Roger Lusby, Frazier & Deeter, on “Business Beat” presented by Alpharetta CPA firm Frazier & Deeter**

Show Summary

Dr. Scott Ballard of Northside Anesthesiology Consultants joins Frazier & Deeter’s “Business Beat” to talk about managing the growth of his practice, the business challenges in medicine today, and recruiting physicians for a growing practice. This inspiring story of business success is brought to you by Alpharetta CPA firm Frazier & Deeter.

Dr. Scott Ballard, Northside Anesthesiology Consultants

Dr. Scott Ballard is the Chairman and a practicing anesthesiologist at Northside Anesthesiology Consultants. Northside Anesthesiology Consultants (NAC) is one of the largest anesthesiology groups in the country. By the end of the summer we will have 75 anesthesiologists and nearly 170 anesthetists. NAC covers all three of the Northside hospitals as well as about 18 surgery centers. NAC partnered with a large corporate partner in late 2015, now known as Envision. Envision is the largest employer of physicians in the country. NAC is the sole aneasthesiology provider in the Northside system.

Frazier & Deeter

The Alpharetta office of Frazier & Deeter is home to a thriving CPA tax practice and Employee Benefit Plan Services group. CPAs and advisors in the Frazier & Deeter Alpharetta office serve clients across North Georgia and around the country with services such as personal tax planning, estate planning, business tax planning, business tax compliance, state and local tax planning, financial statement reviews, financial statement audits, employee benefit plan audits, internal audit outsourcing, cyber security, data privacy, Sarbanes-Oxley (SOX) and other regulatory compliance, mergers and acquisitions, and more. Alpharetta CPA professionals serve clients ranging from business owners and executives to large corporations.

Roger Lusby, host of Frazier & Deeter’s “Business Beat,” is the Alpharetta Office Managing Partner for Frazier & Deeter. He is also a member of the Tax Department in charge of coordinating tax and accounting services for our clientele. His responsibilities include a review of a variety of tax returns with an emphasis in the individual, estate, and corporate areas. Client assistance is also provided in the areas of financial planning, executive compensation and stock option planning, estate and succession planning, international planning (FBAR, SFOP), health care, real estate, manufacturing, technology and service companies.

Find Frazier & Deeter on social media:

LinkedIn: https://www.linkedin.com/company/frazier-&-deeter-llc/
Facebook: https://www.facebook.com/FrazierDeeter
Twitter: https://twitter.com/frazierdeeter

Past episodes of Frazier & Deeter’s “Business Beat” can be found here.

Medicare’s Merit-based Incentive Payment System (MIPS) – Top Docs Radio

May 27, 2016 by angishields

Top Docs Radio

Medicare's Merit-based Incentive Payment System (MIPS) - Top Docs Radio

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Medicare’s Merit-based Incentive Payment System (MIPS)

On this week’s episode we continue our series with Medical Association of Georgia, talking about the changing reimbursement picture for physician practices by the Centers for Medicare and Medicaid Services. Medicare’s new Merit-based Incentive Payment System (MIPS) will change, yet again, physician reimbursement over the next couple of years and it is important for practice managers and physicians to make sure they understand all new requirements.

It is imperative for medical practices to make a successful transition to Medicare’s new Merit-based Incentive Payment System (MIPS). Instead of the EHR (Electronic Health Record) or the PQRS (Physician Quality Reporting System) or the Value-based Payment Modifier programs, the government will employ a single payment platform – which is the result of the Medicare Access and CHIP Reauthorization Act (MACRA) that was signed into law in 2015.

The new payment model will be based on a 100-point MIPS Composite Performance Score. That CPS will determine your Medicare payment adjustment – either up or down. This is scheduled to commence in 2019, and the Centers for Medicare and Medicaid Services will use the 2017 calendar year as the basis for the initial reimbursement – keeping mind this is not an optional process.

Elizabeth Woodcock is one of the leading third party payer and medical practice management consultants in Georgia. She is a professional speaker, trainer and author. Woodcock has focused on medical practice operations for more than 20 years. She has delivered presentations at regional and national conferences to more than 200,000 physicians and managers.

In addition to her popular email newsletters, she has authored 15 best-selling practice management books and published dozens of articles in national health

care management journals. Woodcock is a fellow in the American College of Medical Practice Executives and a certified professional coder. In addition to a degree from Duke University, she has an MBA in health care management from The Wharton School of Business of the University of Pennsylvania.

Special Guest:

Elizabeth Woodcock, Principal, Woodcock & Associates

Senate Bill 158 – Top Docs Radio

April 20, 2015 by angishields

Top Docs Radio

Senate Bill 158 - Top Docs Radio

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Senate Bill 158

On this week’s show we continued our monthly series with the Medical Association of Georgia. MAG’s CEO/Executive Director, Donald J. Palmisano, Jr. stopped by for a discussion on the state of Senate Bill 158, changes in the insurance contracting arena, and other topics on the MAG agenda. Donald also shared how he and a colleague were able to raise over $40,000 to support the Think About It campaign to raise awareness and fight prescription drug abuse/addiction in Georgia, participating in a 100 mile race and completing it in under 24 hours. In the days since Donald joined us on the show, Senate Bill 158 was passed.

MAG continues to take steps to enhance the relationship between health insurer Blue Cross Blue Shield of Georgia, Inc. (BCBSGa) and physicians in the state.

At the end of 2014, Georgia Insurance Commissioner Ralph Hudgens rescinded physician contract amendments that BCBSGa had put into place in Georgia following “numerous complaints from physicians (and their practices).”

First MAG/BCBSGa “Physician Advisory Group” meeting took place on February 12. It is forum for physicians to express their concerns, it will give Blue Cross the opportunity to disseminate information about new payer initiatives, it will be a venue for improving communications, and it will serve as a mechanism for physicians to weigh in on Blue Cross’ clinical policies, operations and contracting practices.

The advisory group consists of four MAG member physicians as well as MAG Health Policy and Third Party Payer Advocacy Department Director Susan Moore and BCBSGa Senior Clinical Officer Mark Kishel, M.D., and BCBSGa Director of Network Management/Georgia Provider Solutions Hayden Mathieson. They will meet a minimum of three times a year.

Rental Networks

MAG supports legislation that would limit rental networks in Georgia. A rental network involves a health insurer that rents or sells its network of physicians to another health insurer. These second-level insurers then include the physicians in their health insurance plans – and pay the physicians an even deeper discount – even though they don’t have a contract with the physicians.

It’s not uncommon for physicians to offer their services to a health insurer at a discounted rate because the higher patient volume offsets the costs. However, the aforementioned insurers rent or sell their networks without the physician’s knowledge – so the physicians often aren’t aware that they are in a given network or that they are contractually obligated to deliver patient care at a greater discount.

Rental networks result in mass confusion and higher administrative costs (e.g., the additional staff time that is required to verify a patient’s health insurance coverage and/or confirm the proper payment). Rental networks can also reduce the accessibility of care because physicians are forced to accept the lower (i.e., “re-priced” or “re-rented”) payment or refuse to see the patient for any follow-up or future care.

Rental networks are an inappropriate, profit-driven tactic that undermines the practice environment in Georgia that will exacerbate the physician shortage in the state. Sixteen states have now adopted laws that regulate or limit or prohibit rental networks.

Insurers are prohibited from using rental networks in federal employee health benefits plan contracts.

All-Products Clauses

Insurance companies use ‘all-products or all-or-nothing’ clauses as a cost-control tactic to force physicians to participate in every health insurance product that they offer or be blocked from caring for patients in the insurer’s plan altogether.

By forcing physicians and their practices to agree to all-products clauses, health insurers are undermining the economic viability of the medical profession in Georgia – keeping in mind that a report that was prepared by IMS Health for the American Medical Association determined that physicians in Georgia “created a total of $29.7 billion in direct and indirect economic output (i.e., sales revenues) in 2012… [and] each physician supported $1,559,494 in [economic] output.” It is also worth noting that the report found that “…physicians supported 205,869 jobs (including their own)…[and] $1,089.6 million in local and state tax revenues in 2012.”

Because physicians are constantly wrestling with these manipulative contract provisions, they have less time to spend with their patients.

All-products clauses violate several individual rights, including the right to contract and an owner’s right to operate a business in a free and autonomous way.

Physicians and medical practices in Georgia should be free to accept the health insurance products of their choice versus the ones that’s imposed on them by profit-driven insurance companies.

Eleven states have enacted prohibitions on all-products clauses, including Alaska, Arkansas, Florida, Indiana, Kansas, Kentucky, Maryland, Massachusetts, Minnesota, Ohio, and Virginia – as well as Washington, D.C.

Special Guest

Donald Palmisano, CEO, Executive Director of Medical Association of Georgia