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CMS is funding a demonstration project called the Advanced Primary Care Demonstration. According to CMS: This initiative is designed to evaluate the impact of the advanced primary care practice (APCP) model, also known as the patient-centered medical home (PCMH), on improving health, improving quality of care, and lowering the cost of care provided to Medicare beneficiaries served by Federally Qualified Health Centers (FQHCs). Created by the Affordable Care Act, it will pay an estimated $42 million over three years to 500 FQHCs to coordinate care for almost 200,000 Medicare beneficiaries.
APCP Fact Sheet
More information can also be found on the APCP Home Page (Advanced Primary Care Practice)

The below link is to a CDC article. Included is a health risk assessment questionnaire in regards to forms for use in capturing the needed information for an AWV for Medicare patients.
http://www.cdc.gov/policy/opth/hra/FrameworkForHRA.pdf

The CMS MLN article linked below updates the enrollment timeline for providers to submit the 855 forms from 30 days prior to effective date to 60 days prior to effective date.
CMS MLN
   
CMS has designed a website to provide information on services covered by the Medicare Physician Fee Schedule (MPFS). It provides information on more than 10,000 CPT codes. The associated relative value units (work, practice expense, and malpractice), fee schedule amounts by geographic locality, global days, payment status for Medicare
CMS Fee schedule and RVU look up

Institutional providers (i.e., all providers except physicians, non-physicians practitioners, physician group practices and non-physician practitioner group practices) must submit an application fee or hardship exception when initially enrolling, revalidating their enrollment; or adding a new Medicare practice location. The CY 2012 fee of $523.00 is required with any Medicare enrollment application submitted on or after Sunday, January 1, 2012 and on or before Monday, December 31, 2012.
For more information about how the fee was calculated, see the Federal Register Notice. See MLN Article SE1130 to learn how to pay the fee for Medicare enrollment actions.

CHCs often have unique arrangements with lab, radiology, or other diagnostic firms that afford more optimal pricing in terms of self-pay patients or at times an agreement to provide self pay patient work for free. This is, of course, in exchange for their receipt of all insured patient work for which they can bill and be paid. This sort of arrangement, created to be certain ALL patients receive necessary care regardless of ability to pay, is a clear cut violation of the Federal Anti-Kick back statute. However, in 2007 an exception was created to legally protect CHCs in this regard. The link below discussed the exception in detail.
Health Center Safe Harbor

8 Qualities of Remarkable Employees
Forget good to great. Here's what makes a great employee remarkable.
http://www.linkedin.com/news

Published by CMS this manual describes Medicare benefits for each provider/service type. Chapter 13 concentrates on Rural Health Center (RHC) and Federally Qualified Health Centers (FQHC).
Medicare Benefit Policy Manual - Chapter 13 FQHC

Published by CMS this manual contains the billing requirements for each provider/service type. Use this manual in conjunction with the Benefits Policy Manual. Contents include rules, regulation and information on completing claims, payment methodology, allowable costs, and cost report detail. Chapter 13 concentrates on Rural Health Center (RHC) and Federally Qualified Health Centers (FQHC).
Medicare Claims Processing Manual - Chapter 9 FQHC

MLN Matters® are national articles designed to inform Medicare FFS providers about the latest changes to the Medicare Program. Articles are prepared in consultation with clinicians, billing experts, and CMS subject matter experts. They are tailored, by content and language, to specific provider type(s) who are affected by complex Medicare changes. MLN Matters® articles help explain critical provider information in an effort to reduce the amount of time providers need to incorporate these changes into their Medicare-related business functions. Since 2004, CMS has issued over 3,500 articles.
Medicare Learning Network

Our annual PPS report is now available on the "State Issues" webpage. This report is a compilation of PCA responses to an assessment conducted over the summer and provides a snapshot of what the PPS methodology and rules look like in each state.
http://www.nachc.com/client//2011%20PPS%20Report%20SPR%2040.pdf

This page contains a Compliance widget for our website.
http://oig.hhs.gov/compliance/provider-compliance-training/index.asp

The Office of Inspector General (OIG) of the U.S. Department of Health & Human Services (HHS) is the leader of the Nation's efforts to fight waste, fraud, and abuse in Medicare, Medicaid and more than 300 other HHS programs. The OIG has developed a series of voluntary compliance program guidance documents to encourage the development and use of internal controls to monitor adherence to applicable statutes, regulations, and program requirements.
OIG Compliance Guidance for Group Practices

The OIG Work Plan is published annually and provides brief descriptions of activities that OIG plans to initiate or continue with respect to HHS programs and operations in fiscal year 2012. The Work Plan describes the primary objectives of the OIG's work during a particular year.
OIG 2012 Workplan

Take a look at this site to see the entire Office of the Inspector General (OIG) Work Plan for 2012. Use this to see if your Compliance Plan for 2012 is adequate AND what key risk areas you want to address.
OIG Work Plan

CHC Billing Community News

As the only company dedicated to servicing the CHC Billing Community, we are proud to provide resources on this website that enable you to share ideas and discuss issues with other professionals and PMG experts.

Through our blog, community forum, WebEx training videos and FAQ’s we hope to provide a valuable service to the community. If you’d like to keep up to date on the latest developments, concerns and solutions you may register using the link below.

Our first community update will happen in early 2012 and you will receive them about once per month. You may opt-out at any time. Please take a few minutes to get involved in your community!

Newsletter Signup Thank You

Newsletter Signup Thank You

FAQs

Does PMG bill for Community Health Centers (CHCs)?
Yes, PMG has been billing for CHCs since 2000. We are one of the nation's leading CHC-centric revenue cycle management (billing) firms and have difficulty finding other firms with a similar focus.

Why does PMG concentrate on the CHC market?
We respect the mission-oriented nature of CHCs' work, particularly in caring for the uninsured and underserved. Unfortunately, CHCs too often cannot achieve fiscal solvency, or even sustained surplus/profitability, due to competing priorities and/or a lack of in-house expertise. PMG is committed to helping CHCs make the necessary changes to address this shortcoming.

What is revenue cycle management (RCM) as opposed to outsourced billing?
RCM encompasses a much broader array of services than traditional "billing-only" firms offer. Many think of billing as simply the entry, transmission and payment posting of health care claims. RCM includes those key components of billing in addition to EOB analytics, sliding-fee scale review/development, coding training, chart auditing, coding optimization (e.g. modifier addition or ranking of items), claim enhancement (e.g. multiple encounters on a single DOS, CCI scrubbing), denial reason code management, returned item analysis/management and KPI reporting/enhancement. We work claims as if they were our own — and to some degree, they are because PMG is paid a percentage of what our clients get paid. And we don't get paid until our clients do.

Does PMG understand what makes CHCs unique?
Yes. Members of our billing staff are trained on the idiosyncrasies of the CHC business, such as sliding-fee scales, PPS vs. cost-based encounter rate, Title X, Ryan White, employed physician staff, a multilingual patient base and UDS reports. We also appreciate our clients' mission-oriented, nonprofit nature and recognize that they have different needs than hospitals, surgical centers and private practices.

Why should I outsource our organization's billing?
Outsourced health care billing companies have been around since the 1970s and process tens of millions of claims each year. CHCs choose to outsource billing services for a variety of reasons, including the inability to retain quality in-house staff, a knowledge deficit within the organization, the savings achieved by outsourcing and the revenue increases that typically come with incentive-based outsourcing contracts.

Generally speaking, CHCs report that outsourcing their billing needs produces superior results. PMG's clients, for example, carry on average less than half "days in A/R" than centers managing billing with in-house staff. Also, since starting with PMG, all of our billing clients have increased net revenue (i.e. payments) per patient while gross revenue (i.e. actual charges) have increased negligibly.

What services does PMG offer besides billing?
PMG billing/revenue cycle management clients may take advantage of other PMG services, such as chart auditing (including evaluation and management chart auditing and ICD-10 chart auditing), onsite and WebEx training (e.g. coding, CHC encounter rate, front desk and the revenue cycle), payer-related research, sliding-fee scale analysis and process assessments pertaining to operational areas impacting billing optimization.

What are the qualifications of the PMG staff?
Everyone on the PMG team — from certified coders to seasoned billing professionals to members of senior management — is an expert on CHC coding, billing and reimbursement. And with clients in more than 40 states, our knowledge of the CHC market is always expanding. Couple this tactical experience with the dozens of regional and national programs/events at which PMG presents, and you won't find a more talented and engaged group of CHC revenue cycle authorities.

On what billing or EMR platforms does PMG work?
PMG works on a range of practice management (PM) software that interacts with a variety of EMR/EHR products. Our experience includes AllScripts, NextGen, eClinicalWorks, eMedsys, Dentrix, EHS, HealthPort and others. Moving forward, we will maintain our commitment to working with the leading PM products to which the CHC market is committed.