Medicare Physician Fee Schedule

The new Medicare Physician Fee Schedule 2021 caught many post-acute long-term care providers and practitioners by surprise with its reduction of key reimbursement to post-acute long-term care practices in the challenging environment of COVID-19. One of the critical changes in the MPFS 2021 that will directly and immediately impacts providers is the reduction in conversion rate.

Even with recent adjustments from the new COVID relief bill, providers will still see a reduction in payment this year that will put your stability and growth in jeopardy. Here are some strategies that you may consider to mitigate those negative impacts.

1. Improve Your Productivity

Many PALTC provider practices are updating their productivity standards for providers and monitoring their achievement more closely. The goal is to make the best use of all clinical personnel to make up for the reduction in revenue from the reduced reimbursement.

To prepare for new productivity requirements, providers need to make sure they have an optimized infrastructure. Some of the key areas to monitor are provider scheduling systems, integrated patient registration and documentation through an EHR built for the industry, clear reporting to identify opportunities to provide care and avoid incomplete or delayed notes, and productivity monitoring tools.

TheSNFist™ Suite with built-in communication tools, electronic health records (EHR) and reporting and back-office management systems will help streamline and optimize your operational processes.
Speak with a specialist for a complimentary practice assessment and learn how you can build for a long-term productivity boost in 2021.

2. Reduce Your Expense

Given the revenue impact under this fee schedule change, providers will need to examine major practice expenses. The most considerable expense every practice has is staff expense. It is important and vital for practice owners and executives to determine that every role in an organization is necessary and every person in that role is high-functioning.

In addition to this level of examination, you can evaluate opportunities to reduce expenses by outsourcing functions that can be performed equally well or better than in-house. Revenue cycle management is one of those functions that are critical to the practice but also costly.

Outsourcing revenue cycle management (RCM) can help an organization improve reimbursement and cash flow while reducing the number of internal expenses relevant to staffing a department. The right RCM vendor is someone who understands your business model and specializes in your area of healthcare.

In the post-acute industry, your RCM vendor must excel in the work and collection of secondary insurance claims, as well as continuous tracking and learning from denials. Tight management of the accounts receivable and timely collection of proper payments are more critical in 2021 than ever before.

Along with reinforcing your financial stability through strong revenue cycle management, PALTC practices need to maximize payment by ensuring the proper enrollment and credentialing with the large majority of payors in their payor mix. Very few payors will backdate enrollment. Providers and practices need to be proactive and initiate enrollment at the earliest point possible. Timeliness and accuracy are key success factors in the enrollment process with payors.

Transferring your revenue cycle management and enrollment processes to a team of experts in PALTC practice management, enrollment and billing can address these two challenges. It will save you time, money, stress and effort to focus on your priority: caring for your patients.

3. Consider Expanding Your Clinical Services

Many practices are considering expansion or diversification of services as a strategy to weather the impact of the fee schedule change, especially when many PALTC providers may already be performing some services that could be separately billable under the right circumstances.

Key evaluations needed to formalize such changes include the providers’ patient volume capacity, the infrastructure and reporting to identify and schedule those additional services, and the impact on your compensation model. Additionally, some billable services require that a provider is documenting in a certified EHR.

Before considering bringing additional services, make sure you have the right infrastructure for your existing services that can sustain any additional workload that an expansion will bring on.

Start a complimentary assessment to identify potential system gaps and opportunities to build a good foundation for growth and stability.

With the ongoing pandemic and changing political climate, practices and providers can expect further changes in regulations that may support or impact the industry. Best practices for navigating this environment is to make sure that you have a strong foundation that can sustain growth and quickly adapt to changes.

We will continue to monitor regulatory changes to the PALTC industry, the implementation of the 2021 MPFS and other trends and changes during the year and will continue to share with you the latest updates here.

If you want to take a step ahead and continue your preparations for 2021, let’s talk!