There are a myriad of things that a physician in a small practice has to keep up with, but one of the most important (and perhaps most challenging) is risk and compliance. The federal government, state governments, and payers all have their own regulations, and failing to keep up can mean lost revenue or other negative consequences for your practice. As reimbursement rates continue to decrease, operational costs climb, and the volume of administrative tasks pile up for every physician, it can feel overwhelming.
Where to Focus
While this is not a comprehensive list of all the areas of governance, risk, and compliance concerns for practices, there are three areas where it is critical to keep your focus:
- Quality Reporting
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) created rules around privacy and security for the electronic exchange of patient health information. In today’s digital age, where most patient information is stored electronically, part of your HIPAA requirements include protecting that information from data breaches. If your patient data is compromised, you will be subject to serious fines and a requirement to notify your patients about the breach, which can lead to mistrust. You probably can’t afford to hire an entire cybersecurity team, but you can work with vendors like AdvancedMD that provide the highest level of data protection and encryption for EHR and medical billing information stored in the cloud.
Medical coding is an area where many physicians and even office managers may not have much experience. It’s also an area that can get you in trouble, because incorrect coding—especially “upcoding” or billing for a higher level of services than you actually provided—is illegal. Rather than trying to figure out medical billing or risk going to jail if you get it wrong, talk to AdvancedMD about how our partnerships with companies like symplrCVO can help. We have medical billing services that will do all the work for you, or software that easily integrates into your EHR to pull the correct information and send it straight to billing along with the necessary documentation to send a claim.
MIPS and MACRA requires physicians to report on quality metrics related to patient care and outcomes and failing to do so in 2020 could mean as much as a 9% reduction in Medicare reimbursement rates in 2022. Figuring out what to report and mining all the data on your own would be cumbersome (and maybe impossible), but AdvancedMD has MIPS & MACRA reporting built right into our software platform. You continue to take care of your patients, and our software will pull the information necessary for reporting.
To find out more about how AdvancedMD can reduce your compliance risks, talk to us today to schedule a demo and see what we offer.