A new year brings new beginnings – and an opportunity to set your practice up for success in the year ahead. The Practice Management Committee has outlined 10 key things every allergy and immunology practice should do to be profitable, safe, prepared and in compliance for 2024.
- 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! Read our five tips.
- 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 to evaluate productivity and revenue. - Review and evaluate vendor contracts.
Check vendor contract expiration dates and fee increases, and evaluate potential vendor changes. Consider getting bids for new vendors/suppliers where appropriate. - Review coding changes for 2024.
- Beginning in 2024, Medicare will reimburse for HCPCS code G2211, which is an add-on code used in conjunction with E&M services. This code describes “medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition.” Note HCPCS code G2211 cannot be reported with payment modifier 25. The Advocacy Council will provide more information on this code as soon as it becomes available from CMS.
- CMS established a new stand-alone code, HCPCS code G0136, to describe the administration of a standardized, evidence-based Social Determinants of Health (SDOH) Risk Assessment. G0136 can be billed no more than once every six months, with a duration of 5-15 minutes.
- Review 2024 Merit Based Incentive Payment System (MIPS) requirements and determine if you must participate.
Check the Quality Payment Program website to see if you’re required to participate in MIPS in 2024. Penalties are steep if you’re required to participate but choose not to do so — you’ll get a 9% reduction on all Medicare payments in 2026. - Plan annual HIPAA, OSHA, extract mixing and other clinical staff training.
Physicians and staff should participate in annual HIPAA and OSHA training. See the College’s Risk and Compliance Toolkit for details. Additionally, clinical staff should have annual clinical training for CPR, proper documentation and administration of allergy shots, spirometry use, etc. Use the College’s Allergen Extract Mixing Toolkit to access all the resources you need for personnel training requirements related to allergen extract mixing. Additionally, if you chose to implement an ISO Class 5 PEC (rather than an AECA) to meet USP 797 allergen extract mixing requirements, create a plan to have the PEC certified every six months. - Plan annual emergency training.
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 and drills for natural disasters specific to your geographic area. Read the College’s article “Is your practice prepared for emergencies?” - 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 to guide you through the process. The risk assessment includes planning for cyber security events, electronic health record outages and HIPAA breaches. Tom Derrico, advisor to the Practice Management Committee, 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. - Review financial and operational metrics for 2023.
Charlie Furr, MHA, practice administrator of Carolina Asthma & Allergy Center in Charlotte, NC, says, “From a productivity standpoint, we measure new and established office visits per provider and location, average number of skin pricks and intradermals per provider, immunotherapy retention for departed providers, immunotherapy conversion rates (% of patients who start immunotherapy following provider recommendation), units of extract and number of allergy shots by provider and location including clusters, appointment fill rates by provider, and percentage of visits conducted via telehealth. From a financial standpoint, we review profit and loss to analyze costs, balance sheet, statement of cash flows, accounts receivable, payer mix, charges and receipts by business type per location, a graphical three-year monthly comparison trend of key financial metrics, etc. When possible, we compare our data to Medical Group Management Association (MGMA) benchmarks.” - Make sure you’re compliant with the No Surprises Act and Information Blocking Rule requirements.
The No Surprises Act requires allergy practices to provide Good Faith Estimates to self-pay and uninsured patients. See details on the rule requirements in our Advocacy Insider article. Information Blocking Rule requirements became effective in April of 2021 and are outlined in the College’s Risk and Compliance Toolkit.
Don’t let your allergy practice suffer from lack of preparation in 2024! Invest time in these important tasks and set your practice up to succeed.
