Start your year off right

January 21, 2019

A new year brings new beginnings – and an opportunity to set your practice up for success in the year ahead. The Practice Management Committee outlines 11 key things every allergy and immunology practice should do to be profitable, safe, prepared and in compliance for 2019.

1. Review your fee schedule.

If you haven’t reviewed and updated your fee schedule in the past year, you might be leaving revenue on the table. Get paid fairly for the services you provide by reviewing your fee schedule at least annually. 

2. Review contracts with payers.

Check expiration dates on your payer contracts to determine whether you’ll need to renegotiate or renew them in the next year. Also, update relative value unit tables and insurance reimbursement tables if you use these to evaluate productivity and revenue.

3. Review and evaluate vendor contracts.

Check vendor contract expiration dates, fee increases and evaluate potential vendor changes. Consider getting bids for new vendors/suppliers where appropriate. 

4. Review coding changes for 2019.

Beginning in 2019, Medicare will pay separately for interprofessional consults and brief, virtual check-ins with patients by telephone or other technology.

  • Providers are no longer required to re-record elements of history and physical exams when there is evidence the information has been reviewed and updated.
  • The chief complaint and other historical information entered in the medical record by clinical staff or by patients can simply be reviewed and verified by providers rather than re-entered.

5. Review 2019 Merit Based Incentive Payment System (MIPS) requirements and determine if you have to participate.

If so, figure out your plan. Do you want to simply avoid a penalty, or do you want to maximize your bonus? What measures will you report, and how?

6. Review state regulatory rule changes.

Check with your state medical or allergy society for details, and make sure you’re aware of and compliant with new requirements. For example, in Illinois, Public Act 100-0726 now allows school nurses to keep asthma medication prescribed in the school's name. Another act requires every licensed professional to complete sexual harassment prevention training before renewing their license.

7. Plan for training staff on allergy extract mixing and other clinical concerns.

The College recommends annual training for everyone who mixes allergy extract in your office. That includes passing the written Allergenic Extract Quiz and completing a media fill test, which is a physical demonstration that the extract preparer can transfer material, in a sterile fashion, from one vial to another (a list of media fill test vendors are included with the College’s extract quiz). We’re planning on offering a special mixing course covering the new requirements at the 2019 Annual Scientific Meeting, Nov. 7-11 in Houston, which is another great opportunity to practice this skill. Also, plan other annual clinical training for staff, such as CPR, proper documentation and administration of allergy shots, spirometry use, etc.

8. Plan for annual emergency training (anaphylaxis, fire, hurricane, etc.)

Everyone in the office should receive annual training for anaphylactic reactions, with a focus on individual roles (physician, nurse, medical assistant, front desk, etc.). You should also hold an annual fire drill as well as drills for natural disasters specific to your geographic area (hurricanes, forest fires, earthquakes, etc.)

9. Plan for annual HIPAA and OSHA training.

Physicians and staff should participate in annual HIPAA and OSHA training. See the College’s Risk and Compliance toolkit for details. In addition, Kevin McGrath, MD, FACAAI, vice chair of the Practice Management Committee, recommends annual sexual harassment training for all providers and staff.

10. Plan to do an annual risk assessment.

HIPAA mandates that practices perform a security risk assessment, and the Office of the National Coordinator for Health Information Technology has a downloadable Security Risk Assessment Tool that can guide you through the process. The risk assessment includes planning for cyber security events, electronic health record outages, and HIPAA breaches. Tom Derrico, member of the Practice Management Committee and practice administrator for Certified Allergy & Asthma Consultants in Albany, New York, recommends taking it one step further. “Consider performing a disaster recovery test to identify and plug any holes in your disaster recovery plan,” he said.

11. Review financial and operational metrics for 2018.

The new year is the perfect time to take stock of your performance in 2018 and compare it to the previous year. J. Kelly Davis, BS, CMPE, member of the Practice Management Committee and practice manager of Covenant Allergy & Asthma Care in Chattanooga, Tennessee, says, “From a productivity standpoint, we measure new and established office visits, skin tests and intradermal tests, units of extract and number of allergy shots including clusters. From a financial standpoint, we review the profit and loss to analyze costs, accounts receivable, payer mix, etc. When possible, we compare our data to the Medical Group Management Association’s benchmarks.”

Benjamin Franklin famously said, “By failing to prepare, you are preparing to fail.” Don’t let your allergy practice suffer from lack of preparation in 2019. Invest time in these important tasks and set your practice up to succeed.