HSCI Interview with Josh Johnson of Advanced MD: Episode 3

Advanced MD

In this week's episode, Lance King from Healthcare Compliance Solutions (www.hcsiinc.com), interviews Josh Johnson, the Executive Vice President of Advanced MD.  Advanced MD is a cloud-based service-provider for EMR (electronic medical record), billing, and telemedicine software.

Get to Know Josh Johnson

Josh Johnson has a passion for sports.  He grew up playing four high school sports and now enjoys coaching his children's teams. His father was a great example of not quitting and instilled that value in him.  Josh's favorite quote is from Henry Ford, “Whether you think you can or think you can't, you're right!”  

Josh Johnson as a Manager

Josh has relied on that philosophy of positive thinking and giving it his all throughout his career. He especially had to rely on it during times of transitions.  Josh worked as the VP of sales for ADP.  When ADP acquired Advanced MD, Josh made a lateral move to work for them and has since been promoted to Executive Vice President of Sales.  Josh Johnson recommends the book Culture Eats Strategy for Breakfast and tries to stick to it's principles when managing his sales team.  When acquiring new companies and instilling the new culture of commitment, Josh looks for people who are willing to not give up and want to have a long-term career with the company.  He prides himself on developing a positive culture where his salespeople can succeed if they're willing to put in the effort.  A key part of that culture development is the practice of giving nicknames to co-workers.  Giving everyone nicknames is just part of building a culture of success, motivation, and retention at Advanced MD.  

Advanced MD

Advanced MD is a nation-wide, cloud-hosted tech company that specializes in technology and software for medical offices as large as 25 or more practitioners or as small as a single doctor-owned practice that is just starting out. Within the software, they provide electronic medical record (EMR), patient portals so patients can access their information and fill out forms online, telemedicine
platforms where patients can receive healthcare remotely, as well as scheduling software and more.   Josh says that Advanced MD's biggest competitive advantage is their billing software.  Because of billing inefficiencies, physicians end up treating their first two patients of every day for free.  Advanced MD's billing products will help eliminate that inefficiency.  Besides offering billing software directly to clients, Advanced MD also offers software for billing companies, or can take over billing entirely.

Another competitive advantage of Advanced MD is their specialized sales and implementation teams.  These teams are familiar with the needs and nuances of specific specialties.  The implementation teams will walk everyone, established practice or brand-new start-up, through all aspects of the software.  This includes set-up, credentialing, billing, scheduling, reporting, and submitting claims.  Once the client understands the product, they are turned over to service specialists who continue to support the practice with any questions or continuing needs.  Advanced MD also offers additional products, such as analytic tools which can help a practice compare and contrast their performance with others in the same specialty or locality.  

  

Benefits

Doctors/business owners like to have control over data. Advanced MD offers that control through access to information and charts electronically. The efficiencies gained through Advanced MD allows doctors to use their time on patient care, instead of keeping track of papers. Doctors can enter information on a tablet or phone and it will be uploaded to the cloud. Electronic charting systems are also more effective in safeguarding patient information.  Advanced MD prides itself on billing efficiency so offices have higher bill-pay, thus becoming more profitable.  Advanced MD also offers continued support for their clients after purchase through product enhancements, question support, access to newsletters, and monthly webinars  Finally, if clients refer other practitioners resulting in a sale, the referring office earns discounts and other incentives.  Josh Johnson says Advanced MD's mission is to save the private practice by focusing on billing efficiency, continuous advancement, and putting the customer first.

Contact

Potential clients may visit Advanced MD's website at www.advancedmd.com; it's easy to navigate and offers access to webinars, information by specialty, and newsletter subscription.
Or call 800-825-0224 and anyone in the company would be happy to answer questions.

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CMS issues Final Rule

CMS Issues Final Rule & Changes to the Two-Midnight Rule

On October 30, 2015, CMS issued its final rule with comment period (Final Rule) for the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for calendar year 2016, as well as updates to the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program.  The Final Rule also finalized certain policies relating to the hospital inpatient prospective payment system (IPPS), including changes to the two-midnight rule.

CMS estimates that based on the Final Rule, total payments for CY 2016 to the estimated 4,000 facilities paid under the OPPS will decrease by a projected $133 million (0.4 percent) compared to CY 2015.  This impact is greater than the proposed rule’s estimated $43 million (0.2 percent) decrease in total OPPS payments.  Additionally, although the proposed rule estimated a payment increase to ASCs of 1.1 percent, under the Final Rule, CMS estimates that total payments to ASCs for CY 2016 will be approximately $4.221 billion, an increase of only 0.3 percent, or approximately $128 million, as compared to estimated CY 2015 Medicare payments. 

In the Final Rule, CMS has finalized a number of changes for CY 2016, including the following changes to OPPS and the ASC payment system:

• An Outpatient Department (OPD) fee schedule increase factor of 1.7 percent (which is based on the final estimated hospital IPPS market basket percentage increase of 2.4 percent, less the final 0.5 percentage point multifactor productivity (MFP) adjustment, and less an additional 0.2 percentage point adjustment mandated by the Affordable Care Act);   
• Reducing the CY 2016 conversion factor by 2.0 percent to account for an approximately $1 billion inflation in CY 2014 OPPS payments that resulted from excess packaged payment for laboratory tests that were projected to be packaged into OPPS payment rates, but continued to be paid separately in CY 2014; 
• Requiring that laboratory tests be conditionally packaged  on a claim with an OPD service that is assigned a certain status indicator, irrespective of the date(s) of service, unless an exception applies or the laboratory test is “unrelated” to the other OPD service(s) on the claim;  
• Setting a statutory default of average sales price plus 6 percent for payment for the acquisition and pharmacy overhead costs of separately payable drugs and biologicals that do not have pass-through status; 
• Expanding the set of conditionally packaged ancillary services to include three new ambulatory payment classifications; 
• Establishing for the Hospital OQR Program for the CY 2017 payment determination and subsequent years, the following requirements, among other changes: (1) removing the OP-15: Use of Brain Computed Tomography (CT) in the Emergency Department for Atraumatic Headache measure, effective January 1, 2016; (2) revising from November 1 to August 31 the deadline for withdrawing from the Hospital OQR Program; (3) shifting to a new payment determination timeframe that will use only three quarters of data for the CY 2017 payment determination; (4) changing the timeframe in which data may be submitted for measures submitted via the CMS QualityNet website to January 1 through May 15; and (5) changing the deadline for submitting a reconsideration request to the first business day on or after March 17 of the payment year at issue;
• Establishing for the Hospital OQR Program for the CY 2018 payment determination and subsequent years the following  requirements, among others:  (1) adding a new measure: OP-33: External Beam Radiotherapy (EBRT) for Bone Metastases (NQF #1822) with a modification to the proposed manner of data submission; and (2) shifting the quarters on which CMS bases payment determinations to again include four quarters of data;
• Increasing payment rates under the ASC payment system by 0.3 percent for ASCs that meet the quality reporting requirements under the ASCQR Program; 
• Establishing a revised process of assigning ASC payment indicators for new and revised Category I and III CPT codes that would be effective January 1; and
• Setting the final ASC conversion factor of $44.177 for ASCs that meet the quality reporting requirements, based on the product of the CY 2015 conversion factor of $44.058 multiplied by the wage index budget neutrality adjustment of 0.9997 and the MFP-adjusted CPI–U payment update of 0.3 percent.

Under the Final Rule, CMS has also modified its prior “exceptions” policy under the two-midnight benchmark, which previously was limited to cases involving services designated by CMS as inpatient-only and those other exceptions published on the CMS website or in other sub-regulatory guidance.  CMS will now allow exceptions to the two-midnight benchmark to be determined on a case-by-case basis by the beneficiary’s responsible physician, subject to medical review.  CMS is careful to note that it expects that stays less than 24 hours would rarely fall into an exception. 

The Final Rule also finalized certain proposed changes from the FY 2015 IPPS Proposed Rule to the Medicare regulations governing provider administrative appeals and judicial review relating to appropriate claims in provider cost reports.  Specifically, CMS has finalized revisions to the cost reporting rules requiring providers to include an appropriate claim for a specific item on their cost reports—either by affirmatively claiming reimbursement or expressly self-disallowing the cost by filing a cost report item under protest—in order to be eligible to potentially receive Medicare reimbursement and/or to be eligible to appeal their reimbursement (or lack thereof) to the Provider Reimbursement Review Board.  CMS has eliminated the duplicative requirement to do the same in order to meet the “dissatisfaction” requirement for Board jurisdiction.  CMS has also specified procedures for Board review of whether a provider’s cost report meets this substantive reimbursement requirement of an appropriate cost report claim for a specific item.

Any comments on the payment classifications assigned to HCPCS codes identified in Addenda B, AA, and BB with the “NI” comment indicator and on other areas indicated in the Final Rule must be received no later than 5 p.m. EST on December 29, 2015.

The CMS Fact Sheet on the Final Rule is available here.  An additional Fact Sheet on the Two-Midnight Rule is available here.  The Final Rule is scheduled to be published in the Federal Register on November 13, 2015.  Our Health Headlines article summarizing the proposed rule is available here.

Source(s): HCSI, www.cms.gov, Christina Ann Gonzalez @ http://www.lexology.com/

For more information on this and other healthcare topics related to HIPAA, OSHA, Medicare and HR compliance please email support@hcsiinc.com or visit our website at http://www.hcsiinc.com 
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