Coffee with Coker

This episode of Coffee with Coker delves into the complex and nuanced topic of Modifier 25, a coding nuance critical for healthcare professionals to understand for billing and documentation.

Hosts Erika and Jaci unpack the definition, significance, and proper application of Modifier 25, emphasizing its opinion-based nature and the importance of clear, detailed documentation. They provide examples from healthcare scenarios, including preventive visits, urgent care, and procedures like cerumen removal, discussing the implications for billing and compliance.

The conversation highlights how insurance companies' interpretations can vary, impacting the application of Modifier 25. Further, they explore the challenges healthcare providers face in ensuring their documentation supports the use of Modifier 25, pointing out common pitfalls and offering guidance on best practices.

This discussion underscores the vital role of accurate coding and documentation in healthcare billing and the ongoing need for education and dialogue among practitioners.

• 00:32 Diving Deep into Modifier 25
• 01:49 Understanding the Definition and Application of Modifier 25
• 05:33 Exploring Real-World Scenarios and Challenges with Modifier 25
• 08:33 Navigating Documentation and Billing Challenges
• 15:04 Specific Cases and Auditing Insights
• 27:36 Concluding Thoughts and Future Topics
• 29:54 Engaging the Audience and Closing Remarks

Links to other resources:

• AMA | Reporting CPT Modifier 25 (https://www.ama-assn.org/system/files/reporting-CPT-modifier-25.pdf)
• Podcast covering Medicare Annual Wellness Visits (https://www.cokergroup.com/podcasts/episode-122-understanding-annual-wellness-visits-for-healthcare-organizations/)

In this episode, the discussion focuses on annual wellness visits, IPPE, and their implications for healthcare organizations. The conversation covers the requirements, coding, documentation, and common audit findings related to annual wellness visits. The speakers emphasize the importance of proper documentation, the use of resources, and a team approach to ensure compliance and successful reimbursement.

· Jaci Kipreos and Erika Fisch discuss annual wellness visits (00:18)

· Medicare's yearly benefit for beneficiaries called annual wellness visits (01:25)

· Initial Preventative Physical Exam (IPPE) and annual wellness visits (02:32)

· Difference between annual wellness visits and preventative physical exams (05:34)

· Resources for understanding annual wellness visits (08:06)

· Common audit findings for IPPE and annual wellness visits (14:16)

· Handling patient refusal to answer questions during the visit (18:57)

· Separate coding for additional services during the visit (22:58)

· Screening EKG and its requirements (25:12)

· Importance of a team approach to ensure proper documentation and billing (28:58)

· Checking with your MAC for additional requirements or recommendations (32:52)

· Next episode to cover the 25 modifier (34:55)

Extras

· Medicare Learning Network – Medicare Annual Wellness Visits (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html)

· Medicare Preventive Services Quick Reference Chart (https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html)

· Medicare Claims Processing Manual (https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf)

· Streamline Workflow to Perform a Thorough AWV (https://edhub.ama-assn.org/steps-forward/module/2757861)

Podcast Information

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We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.

· Please email us: [email protected]

· Connect with us on LinkedIn: Coker Group Company Page

· Follow us on Twitter: @cokergroup

· Follow us on Instagram: @cokergroup

· Follow us on Facebook: @cokerconsulting

In this insightful podcast for leaders of physician enterprises, we delve into the dynamic landscape of staffing trends within the healthcare sector. The discussion kicks off with a comprehensive exploration of both physician and non-provider staffing trends, providing valuable insights into the evolving workforce dynamics. The conversation then navigates through the intricate factors that contribute to staff turnover, shedding light on the challenges faced by physician enterprises in retaining their crucial personnel.

Episode Synopsis

The podcast guides leaders in analyzing their physician enterprises with a data-driven approach, offering practical strategies to create staffing targets aligned with the unique characteristics of their practices. As the discussion progresses, listeners gain actionable solutions to common staffing challenges, including addressing salary increases in a declining market and handling healthcare turnover amidst current market conditions. The podcast also explores staff retention tactics and best practices essential for physician enterprise success.

The latter part of the podcast delves into the impact of various technologies on staffing for physician enterprises, exploring the integration of AI and workforce automation. The discussion concludes by highlighting the crucial link between staffing, ROI, and the overall functionality of physician enterprises, providing valuable insights for leaders navigating the intricate landscape of healthcare management.

· Physician and non-provider staffing trends (2:05)

· Factors contributing to staff turnover (4:20)

· How to analyze your physician enterprise using a data-driven approach (4:50)

· How certain practice characteristics impact staffing levels (6:30)

· Create staffing targets that make sense for your practice (7:22)

· Solutions to staffing challenges (8:14)

· Addressing salary increases in a declining market (8:30)

· How to handle healthcare turnover in the current market (11:02)

· Staff retention tactics (13:39)

· Best practices for physician enterprise success (16:35)

· Critical issues plaguing independent medical practices (20:12)

· Embracing new trends and adjusting to patient expectations (21:30)

· Other technologies affecting staffing for physician enterprises (23:45)

· Addressing AI and workforce automation for your practice (25:00)

· How staffing impacts the ROI and functionality of the physician enterprise (26:40)

Extras

· Address Community Need with Physician Income Guarantee Arrangements (https://cokergroup.com/physician-income-guarantee-arrangements/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-121&utm_content=physician-income-guarantee&utm_campaign=performance-transformation&utm_source_platform=&utm_creative_format=&utm_marketing_tactic=)

· Lawmakers Grapple with Artificial Intelligence Regulation as Popularity and Utilization Grow (https://cokergroup.com/lawmakers-grapple-with-artificial-intelligence-regulation-as-popularity-and-utilization-grow/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-121&utm_content=ai&utm_campaign=performance-transformation&utm_source_platform=&utm_creative_format=&utm_marketing_tactic=)

· Quantifying Patient Access: Utilize Data to Identify Improvement Opportunities and Monitor Performance (https://cokergroup.com/quantifying-patient-access-utilize-data-to-identify-improvement-opportunities-and-monitor-performance/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-121&utm_content=performance-improvement&utm_campaign=performance-transformation&utm_source_platform=&utm_creative_format=&utm_marketing_tactic=)

Podcast Information

Follow our feedin Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!

We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.

· Please email us: [email protected]

· Connect with us on LinkedIn: Coker Group Company Page

· Follow us on Twitter: @cokergroup

· Follow us on Instagram: @cokergroup

· Follow us on Facebook: @cokerconsulting

Chris Torregosa interviews Louis Sallerson, the CEO of Converse Health, about their generative AI assistant for orthopedic surgery clinics.

Podcast Information

Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!

We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.

· Please email us: [email protected]

· Connect with us on LinkedIn: Coker Group Company Page

· Follow us on Twitter: @cokergroup

· Follow us on Instagram: @cokergroup

· Follow us on Facebook: @cokerconsulting

Episode Synopsis

Throughout the interview, Louis shares his passion for the healthcare industry and dedication to improving medical practice operations using generative AI. The heart of their product is communication, and their goal is to streamline patient navigation and communication for orthopedic surgeons.

Click to listen to the episode.

Extras

Learn More about Converse Health (https://www.converse.health/)

In this podcast episode, we delve into the critical topic of patient access and operational throughput. With growing demand for medical services and a looming physician shortage, it's essential to reframe patient access as a pivotal aspect of healthcare production, not merely patient satisfaction.

Episode Synopsis

Join us as we discuss current patient access challenges, highlight key focus areas for effective management, and explore the differentiation between patient access and operational throughput, emphasizing role clarity, optimizing staff utilization, and improving communication.

The episode also delves into trends in patient access management, including the role of Advanced Practice Providers and the strategic integration of technology to enhance access. Patient access has never been more vital, as patient demand is projected to exceed provider supply. We offer practical strategies for healthcare organizations to excel in patient access and operational throughput.

· Patient access and throughput in healthcare (0:11)

· Patient access and physician shortages in U.S. healthcare (4:37)

· Streamlining patient access and scheduling (9:20)

· Patient access and appointment metrics (12:01)

· Improving patient access and organizational performance (15:52)

· Improving medical practice efficiency (20:15)

· Improving patient access in healthcare (26:16)

· Improving patient access and reducing no-shows (32:03)

Extras

· Overcoming Obstacles with Performance Improvement for Critical Access Hospitals (https://cokergroup.com/overcoming-obstacles-with-performance-improvement-for-critical-access-hospitals/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-119-navigating-patient-demand-and-physician-shortages&utm_content=patient-access&utm_campaign=physician-services&utm_source_platform=podcast-app&utm_creative_format=blog&utm_marketing_tactic=solution)

· Quantifying Patient Access: Utilize Data to Identify Improvement Opportunities and Monitor Performance (https://cokergroup.com/quantifying-patient-access-utilize-data-to-identify-improvement-opportunities-and-monitor-performance/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-119-navigating-patient-demand-and-physician-shortages&utm_content=patient-access&utm_campaign=physician-services&utm_source_platform=podcast-app&utm_creative_format=blog&utm_marketing_tactic=solution)

Podcast Information

Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!

We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.

· Please email us: [email protected]

· Connect with us on LinkedIn: Coker Group Company Page

· Follow us on Twitter: @cokergroup

· Follow us on Instagram: @cokergroup

· Follow us on Facebook: @cokerconsulting

This episode delves into the complex world of compensation design within the healthcare industry, focusing on traditional hospital/employed provider models. We explore the common pain points experienced by clients of all types when incentivizing strategic goals.

Episode Synopsis

Join us as we discuss the various considerations hospitals and health systems face, including concerns about provider compensation spending and fair market value. We also examine incentive structures designed to foster growth and meet strategic objectives, all while ensuring that compensation plans remain competitive in the challenging recruitment landscape.

But it's not just about the financial aspect. We'll also explore how compensation design can be a powerful tool, acting as a 'carrot' to drive productivity and achieve organizational goals. And when compensation design isn't enough, we'll delve into the other factors influencing low provider productivity.

Tune in for an insightful conversation on the critical intersection of compensation design and healthcare strategy.

· Aligning physician incentives with organizational goals (4:25)

· Designing physician compensation models (8:54)

· Analyzing audio transcript for insights (14:39)

· Redesigning physician compensation models (19:48)

· Designing and implementing fair and equitable compensation (26:30)

· Physician compensation model design (33:37)

· Provider compensation and performance improvement (37:15)

Extras

· Episode 111: The Intersection of Provider Compensation and Value-Based Reimbursement (https://cokergroup.com/episode-111-the-intersection-of-provider-compensation-and-value-based-reimbursement/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-118-how-provider-compensation-design-impacts-performance&utm_content=performance-improvement-compensation&utm_campaign=finance&utm_source_platform=podcast-app&utm_creative_format=podcast&utm_marketing_tactic=awareness)

· Case Study: Provider Compensation Misalignment (https://cokergroup.com/case-study-provider-compensation-misalignment/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-118-how-provider-compensation-design-impacts-performance&utm_content=performance-improvement-compensation&utm_campaign=finance&utm_source_platform=podcast-app&utm_creative_format=case-study&utm_marketing_tactic=solution)

· Compensation Best Practices for Physician Enterprises (https://cokergroup.com/compensation-best-practices-for-physician-enterprises/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-118-how-provider-compensation-design-impacts-performance&utm_content=performance-improvement-compensation&utm_campaign=finance&utm_source_platform=podcast-app&utm_creative_format=white-paper&utm_marketing_tactic=solution)

· Compensation Methodology Best Practices: True-Up Payments (https://cokergroup.com/compensation-methodology-best-practices-true-up-payments/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-118-how-provider-compensation-design-impacts-performance&utm_content=performance-improvement-compensation&utm_campaign=finance&utm_source_platform=podcast-app&utm_creative_format=blog&utm_marketing_tactic=awareness)

Podcast Information

Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!

We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.

· Please email us: [email protected]

· Connect with us on LinkedIn: Coker Group Company Page

· Follow us on Twitter: @cokergroup

· Follow us on Instagram: @cokergroup

· Follow us on Facebook: @cokerconsulting

The speakers will break down various areas they review when evaluating the revenue cycle and give examples of how they evaluated and helped clients achieve success around revenue cycle improvement. They will discuss some of the key pitfalls and areas where physician enterprises struggle, and offer advice, regardless of type and size, to consider as you optimize your revenue cycle processes and performance.

Episode Synopsis

In the context of revenue cycle management, it's essential to emphasize that the scope extends far beyond the billing office alone. The notion of "outsourcing the revenue cycle" often requires clarification, as it commonly refers to selectively outsourcing certain components, like billing or specific front-end operations. It's rare for an organization to entrust the entirety of its revenue cycle, spanning from initial patient intake and service provision to claims processing, payment reconciliation, collection endeavors, and comprehensive follow-up, to an external entity. This podcast episode delves into the intricacies of this comprehensive revenue cycle management process.

· Opening Introduction (0:11)

· Key pitfalls and areas to avoid when evaluating the revenue cycle (1:02)

· The interaction between each functional area (6:05)

· Why are we seeing more and more issues occur (9:28)

· How to diagnose billing and billing issues (12:13)

· Solutions and recommendations (18:37)

· What do the leaders and managers think of the reports? (24:26)

· Sustainability measures to help with implementation (27:40)

· Using dashboard reporting for key performance indicators (33:16)

· Question the status quo on revenue cycle management (38:07)

Extras

· How Is Inflation Affecting the Reimbursement in Your Managed Care Agreements?

· Revenue Cycle Management – Look Our for the Red Flags!

· Avoiding Four Common Pitfalls in Revenue Cycle Management

Podcast Information

Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!

We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.

· Please email us: [email protected]

· Connect with us on LinkedIn: Coker Group Company Page

· Follow us on Twitter: @cokergroup

· Follow us on Instagram: @cokergroup

· Follow us on Facebook: @cokerconsulting

This series aims to help physicians and practice administrators enhance their financial and operational performance across various domains.

Episode Synopsis

In this podcast series designed for physicians and practice administrators, our speakers will provide a deep dive into the reasons behind this series. They will emphasize the significance of performance improvement in healthcare organizations and specifically focus on physician enterprise performance improvement. Listeners will gain insights into how organizations can effectively evaluate their performance in relation to expectations, goals, and targets. 

Building upon these fundamental concepts, our speakers will explore the creation of a framework for achieving high performance. They will discuss practical methods for developing a data-driven culture that permeates throughout the organization, from leadership to staff to providers. Throughout the series, we will cover a range of important domains, including revenue cycle management, operational efficiency, physician compensation, and quality outcomes. By addressing these crucial topics, we aim to provide physicians and practice administrators with valuable strategies and knowledge to enhance performance and drive success in their healthcare practices.

Extras

·        Overcoming Obstacles with Performance Improvement for Critical Access Hospitals

·        How Is Inflation Affecting the Reimbursement in Your Managed Care Agreements?

·        Invest in Developing Your Physician Practice Leaders While Helping Them Achieve Organizational Objectives

Podcast Information 

Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!

We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes. 

·        Please email us: [email protected]

·        Connect with us on LinkedIn: Coker Group Company Page

·        Follow us on Twitter: @cokergroup

·        Follow us on Instagram: @cokergroup

·        Follow us on Facebook: @cokerconsulting

Alex Kirkland joins Mark Reiboldt to discuss the state of physician compensation and what the future may hold. Hospitals have competed for physician market share in the post-pandemic world, and the influx of private equity investment alongside rising costs has pushed the survey data approach of funding physician compensation models to unsustainable levels.

Episode Synopsis 

Many external factors have impacted physician compensation over the past several years. The extensive list includes pandemic-era volume reductions, volatile survey data, Medicare Physician Fee Schedule changes, rising inflation, and the list goes on! 

If there is any constant, it is that change is inevitable. 

With so much uncertainty, how can healthcare systems possibly plan for the future in terms of a sound physician compensation strategy? The answer lies in understanding expected shifts in the physician workforce, and the need for a nimble compensation structure that can adapt to market forces.

Extras 

·         Survey Says… What to Expect from the 2021 Market Survey Data (https://cokergroup.com/survey-says-what-to-expect-from-the-2021-market-survey-data/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-115&utm_content=link-website&utm_campaign=provider-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=article&utm_marketing_tactic=awareness)

·         Compensation Best Practices for Physician Enterprises (https://cokergroup.com/compensation-best-practices-for-physician-enterprises/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-115&utm_content=link-website&utm_campaign=provider-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=white-paper&utm_marketing_tactic=solution)

·         How do we address provider compensation misalignment? (https://cokergroup.com/case-study-provider-compensation-misalignment/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-115&utm_content=link-website&utm_campaign=provider-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=case-study&utm_marketing_tactic=solution)

·         How are the 2023 E/M guideline changes impacting your organization? (https://cokergroup.com/2023-e-m-impact-calculator/?utm_source=libsyn&utm_medium=podcast&utm_term=episode-115&utm_content=link-website&utm_campaign=provider-comp-strategy&utm_source_platform=podcast-app&utm_creative_format=calculator&utm_marketing_tactic=tool)

Podcast Information 

Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!

We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes. 

·         Please email us: [email protected]

·         Connect with us on LinkedIn: Coker Group Company Page

·         Follow us on Twitter: @cokergroup

·         Follow us on Instagram: @cokergroup

Justin Chamblee presented this webinar for the American Health Law Association. He analyzes the current state of the healthcare industry and take an objective look at options for physicians/physician enterprises, assessing some of the positives and drawbacks from each and what it may mean for the future.

Podcast Information

Follow our feed in Apple Podcasts, Google Podcasts, Spotify, Audible, or your preferred podcast provider. Like what you hear? Leave a review!

We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes. 

·        Please email us: [email protected]

·        Connect with us on LinkedIn: Coker Group Company Page

·        Follow us on Twitter: @cokergroup

·        Follow us on Instagram: @cokergroup

·        Follow us on Facebook: @cokerconsulting

Episode Synopsis

In the not-too-distant past, the majority of physicians were in private practice. Then, the market experienced a shift wherein a number of physicians chose to be hospital affiliated, with either private practice or hospital affiliation seemingly being the only options. In recent years, the market has shifted again.  Private equity money has created options for physicians that have not existed in the past, entities like VillageMD and Privia Health are rapidly developing employment models providing additional options, and health systems are assessing the financial viability of maintaining their physician enterprises in the legacy state, looking for future potential alternatives. 

Learning Objectives

1. Survey the evolution of alignment options for physicians/physician enterprises over the past several decades.
2. Dive deep into the current market, looking at current alignment trends and the positives/drawbacks from each.
3. Ponder what the current alignment options may mean for the future of the healthcare industry.

Extras 

·        Is employment the only option to keep physician practices alive?

·        What’s next in the evolution of professional services agreements?

·        How do we address provider compensation misalignment?

·