reimbursement Archives - Business RadioX ®

Hootan Shahidi, CODE and DentFirst

June 3, 2021 by John Ray

Dental Business Radio

Hootan Shahidi, CODE and DentFirst

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Hootan Shahidi, CODE and DentFirst

Procedure coding, billing, and reimbursements are not a dentist’s favorite subjects, to say the least, yet successfully navigation of these issues is essential to the bottom-line health of the practice. Hootan Shahidi joins host Patrick O’Rourke on the show to discuss these issues and much more. Dental Business Radio is underwritten and presented by Practice Quotient: PPO Negotiations & Analysis and produced by the North Fulton studio of Business RadioX®.

CODE

Cross Over Dental Enterprises (CODE) specializes in billing medical insurance for dental professionals with unparalleled support and training. CODE’s work enables their dental practice clients to bill to medical insurance at a far greater rate than they are accustomed to.

DentFirst

DentFirst Dental Care has been proudly serving the Greater-Atlanta area for 35 years! What makes DentFirst so incredibly unique is their dedication to making dental care for metro-area residents easily accessible, affordable and dependable. Their patients are their number one priority! DentFirst does everything they can to accommodate their needs while ensuring that the care and customer service they receive is rivaled by none.

DentFirst has 13 convenient locations around Atlanta which are always welcoming new patients. They understand that our patients have busy schedules, but still value easy access to their healthcare providers which is why they offer extended evening hours during the week and Saturday appointments. In addition to this, they want our patients to be able to receive all of their treatment needs under one roof.

Hootan Shahidi, Owner, CODE and Director of Clinical Operations, DentFirst

Hootan Shahidi was an office manager and a dental consultant for over 10 years before starting CODE. He is well versed in all matters of the dental field, including medical and dental insurance billing.

Hootan is the owner of Cross Over Dental Enterprises (CODE), a medical billing company for dentists and dental specialists.

He is currently also the Director of Clinical Operations for DentFirst, a regional DSO in metro Atlanta.

Connect with Hootan on LinkedIn.

About Dental Business Radio

Dental Business Radio covers the business side of dentistry. Host Patrick O’Rourke and his guests cover industry trends, insights, success stories, and more in this wide-ranging show.

The show’s guests include successful doctors across the spectrum of dental practice providers, as well as trusted advisors and noted industry participants. Dental Business Radio is underwritten and presented by Practice Quotient and produced by the North Fulton studio of Business RadioX®.

Practice Quotient

Dental Business Radio is sponsored by Practice Quotient. Practice Quotient, Inc. serves as a bridge between the payor and provider communities. Their clients include general dentist and dental specialty practices across the nation of all sizes, from completely fee-for-service-only to active network participation with every dental plan possible.

They work with independent practices, emerging multi-practice entities, and various large ownership entities in the dental space. Their PPO negotiations and analysis projects evaluate the merits of the various in-network participation contract options specific to your practice’s patient acquisition strategy. There is no one-size-fits-all solution.

Connect with Practice Quotient

Website | LinkedIn | Facebook | Twitter

Transition to MIPS – Top Docs Radio

July 29, 2016 by angishields

Top Docs Radio

Transition to MIPS - Top Docs Radio

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Transition to MIPS

On this week’s MAG episode, I hosted Dr. Adrienne Mims, Vice President and Chief Medical Officer, Medicare Quality Improvement for Alliant Quality, to talk about the transition to the Merit-based Incentive Payment System (MIPS).

Adrienne Mims, M.D., MPH, is the vice president and chief medical officer for Alliant GMCF. Board certified in family medicine and geriatrics, she has more than 30 years of primary care, consultative and home care geriatric experience. Dr. Mims serves on a number of boards, including the American Health Quality Association (the trade association for Medicare Quality Improvement Organizations), the Georgia Academy of Family Physicians, and the PCPI (the national organization that develops quality measures for all specialties).

In addition, the MAG member serves on the NCQA Geriatric Measurement Advisory Panel and the NCQA Clinical Programs Committee. Dr. Mims was the medical director of the Georgia Medicaid Management Program, and she was the director of prevention health promotion and research with The Southeast Permanente Medical Group in Atlanta.

Dr. Mims completed her undergraduate training at George Washington University, her medical school at Stanford University, her residency at the Martin Luther King Jr./Charles Drew Medical Center, and her geriatric fellowship at the West Los Angeles VA. She also has an MPH in epidemiology from UCLA. 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.

Special Guest:

Dr. Adrienne Mims, Vice President and Chief Medical Officer, Medicare Quality Improvement, Alliant Quality

AMA Talks Opioid Abuse and MACRA – Top Docs Radio

June 30, 2016 by angishields

Top Docs Radio

AMA Talks Opioid Abuse and MACRA - Top Docs Radio

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AMA Talks Opioid Abuse and MACRA

Patrice A. Harris, M.D., M.A., is a psychiatrist from Atlanta. She is the chair of the American Medical Association’s Board of Trustees (BOT), and she is the chair of AMA’s Task Force to Reduce Opioid Abuse. Dr. Harris has been the president of the Georgia Psychiatric Physicians Association, and she has served on the Medical Association of Georgia’s Council on Legislation.

In 2001, Dr. Harris was honored as the Georgia Psychiatric Physicians Association’s

Psychiatrist of the Year. After she earned her medical degree at West Virginia University, she did her residency in psychiatry and fellowships in child psychiatry and forensics at Emory.

She was also a Barton senior policy fellow at the Emory University School of Law. Dr. Harris was the director of Health Services for Fulton County, and she served as the medical director for the Fulton County Department of Behavioral Health and Developmental Disabilities.

Opioid abuse is a crisis in America. More than 40 people in the U.S. die from an opioid overdose every day, while many more are becoming addicted. The American Medical Association (AMA) Task Force to Reduce Opioid Abuse – which is comprised of 27 physician organizations and the American Dental Association – has announced several recommendations to address this epidemic.

It is urging physicians to register for and use state-based prescription drug monitoring programs (PDMPs) as part of the decision-making process when they consider treatment options. When fully-funded and available at the point of care, PDMPs are an effective tool for physicians to identify patients who may be misusing opioids and can be used to implement treatment strategies, including referral for those in need of further care.

AMA will also continue to work with the administration and Congress to develop balanced approaches to end prescription opioid misuse, as well as supporting congressional and state efforts to modernize and fund PDMPs. Finally, AMA has initiated an educational effort and communications campaign to promote safe,

effective and evidence-based prescribing within the medical profession.

Georgia PDMP registration: www.hidesigns.com/gapdmp

MACRA

According to the Centers for Medicare & Medicaid Services (CMS), the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changed how Medicare health care providers will be paid in several important ways. MACRA

1) eliminated the Sustainable Growth Rate (SGR) formula and 2) created a new framework to “reward health care providers for giving better and not just more care” and 3) combined the existing quality reporting programs (EHR, PQRS) into one new system. According to CMS, this new “Quality Payment Program (QPP)” will replace “a patchwork system of Medicare reporting programs with a flexible system that allows you to choose from two paths that link quality to payments: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models.”

Special Guest:

Dr. Patrice Harris, Chairman, Board of Trustees, American Medical Association

Blue Cross Blue Shield of Georgia – Top Docs Radio

January 18, 2016 by angishields

Top Docs Radio

Blue Cross Blue Shield of Georgia - Top Docs Radio

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Blue Cross Blue Shield of Georgia

On this week’s episode with our partner, Medical Association of Georgia, MAG CEO, Donald Palmisano, Jr., joined me in studio. We hosted Jeff Fusile, the recently-appointed President for Blue Cross Blue Shield of Georgia. Jeff joined the company in the lead role, coming over from Anthem in November of 2015.

Jeff Fusile is president of Blue Cross and Blue Shield of Georgia (BCBSGa), the state’s oldest and largest health insurance company. He oversees sales, account service, marketing, underwriting, and customer relationships. Jeff is involved in corporate strategy planning and execution, and he serves as the primary contact for state regulators to ensure compliance and manage any state-related matters.

Jeff previously served as Senior Vice President and Chief Financial Officer for the Commercial & Specialty Business Division of Anthem, Inc., which is Blue Cross and Blue Shield’s parent company. He joined Anthem in 2011 after spending 22 years as a strategic management consultant with PricewaterhouseCoopers. Jeff is a licensed CPA. He has qualified as an expert witness in insurance and the broader health care industry. He is widely recognized as an industry leader in health care strategy, corporate governance, compliance, enterprise risk management, HIPAA, and ICD-10.

As the health care landscape undergoes an unprecedented transformation, the traditional relationships between providers and payers are also evolving. With the largest network of providers in the state, Blue Cross and Blue Shield of Georgia (BCBSGa) serves more than 3 million Georgians and is the only plan offered in all 159 counties. BCBSGa President Jeff Fusile will discuss how BCBSGa is developing programs to facilitate better collaboration with providers, make health care more affordable for consumers and simplify the access to care. Reaching out to rural communities and the impact of technology on delivering innovative solutions was also discussed.

Special Guest:

Jeff Fusile, CEO, Blue Cross Blue Shield of Georgia