Why I started GreenpointMed

Often times when I begin a conversation about why GreenpointMed's services are the right fit for a healthcare provider, I inevitably veer into the story of why I started GreenpointMed. It is not that I am eager to tell the story; I am not. By nature, I am a private person and shy at the opportunity to talk about myself. However, I find it instructive to detail the “why” because it ultimately is what the mission of GreenpointMed is built on – to make the business of healthcare simple & efficient for healthcare providers.

I am a big believer in process and have spent many hours studying the intricacies of process excellence from a variety of sources. These include Harvard Business Review, Six Sigma & Jack Welsh/GE. Any organization, no matter how big or small, will thrive or fail based on the internal processes it has. At GreenpointMed, our process is everything. It’s what allows us to create a streamlined system for claim submission and follow-up. Credentialing becomes less daunting and seems more of an opportunity instead of a liability. If we chat and you don’t hear me say the word "process" once during a conversation, I am probably having an off-day!

So why did I start GreenpointMed? I worked for some major financial corporations in New York City after I received a Master’s in Finance in 2011. You might have heard of some of the companies – American Express & Merrill Lynch. During my time working for these industry giants, I learned the importance of process and the need for it to be implemented, monitored and, when necessary, refined.

In the summer of 2015, my wife & I relocated to South Florida expecting our first son (who’s now two and climbing out of his crib!). After the move, I was fortunate enough to borrow office space from the best healthcare provider I know – my mother. One day she walked into my office and asked if I could help her with a few denied claims, because an insurer was stonewalling and not paying what she was owed. I reviewed the denied claims and said to myself what I imagine a lot of healthcare providers say upon receiving an EOB: “This looks like hieroglyphics!”

Now, I think I understand business, and I said to myself, “…if I can’t make sense of this insurance stuff, what does someone who has spent their life dedicated to the study of medicine and helping others do? My mom can’t be the only one experiencing these types of problems.” At that moment, GreenpointMed was born.

According to the Henry J. Kaiser Foundation, approximately 9 in 10 adult Americans had health insurance as of 2016. There are numerous money flows in healthcare between patients, insurers, doctors and governments totaling trillions of dollars and all running super inefficiently. According to the Center for Medicare & Medicaid services, healthcare spending accounted for nearly 18% of GDP, or over $3 trillion in 2015. The bottom line: healthcare is an enormous industry, controlled by a handful of dominant players and constantly kept in a state of limbo by politics. This combination creates complexities for every stakeholder in the industry, from a small solo practitioner to the Administrator of CMS (currently Seema Verma, and a strong candidate for Health and Human Services Secretary).

GreenpointMed’s goal is to make this complex world seem a little more orderly and a little more efficient. We are a small fish in a big pond, but I believe we make a difference. I am confident that the nearly 35 clients we bill for feel this way too, and I am beyond appreciative of the trust they have placed in GreenpointMed as an indispensable partner for their practice.

And yes, if you were wondering, those denied claims did get paid.

JG

5 Solid Practice Management Tips

Starting a practice is hard, but keeping a successful practice going is even harder. Much like any business, your “edge” is the key to success. I always like the reference to, “what’s your edge”? If you read any of Mark Cuban’s books or blogs, he always stresses that the differentiator between you and everybody else is your “edge”. Finding it, keeping it and building it is the key to maintaining a successful business.

Unfortunately, “edge” is somewhat intangible. The beauty however, is that each person can define “edge” their own way. Many may already know what it is, either through specialized study, area of focus or even location! For those who have not, below are 5 tips to try and master to build & sustain your practice/business:  

1.       Set Goals – seems simple, right? Setting the right goals can be not only a challenging task, but a demanding one as well. Your goals should be oriented from short-term to long-term, becoming progressively more challenging the further out you go. Along the way, make sure to always track progress towards your goals and adjust, if necessary.

2.       Use metrics & data – there is more data available than one could possibly ever need; leverage it to your advantage. Use data to help you become smarter in your specialty, or more knowledgeable about advancements in your field. Likewise, find a program that can deliver high-value metrics to help you evaluate quantitatively. Above all else, use these metrics to track progress towards your goals!

3.       Understand the insurance landscape – insurance is getting more complex. There isn’t a day which goes by where I don’t see this. What’s worse, I see how it impacts healthcare providers, creating a more stressful environment for reimbursement and payment. Did you know that Florida Blue is cutting rates for mental health providers by 30% in October? Did you also know that Florida Blue is one of the more profitable of the “Blues” organizations and is the most profitable insurer in the state of Florida? There is one school of thought that by lowering reimbursement rates or restricting access to provider networks, the ripple effect is more patients will go out-of-network for services or pay cash, thus reducing the burden on the payor.

The bottom line is that dealing with insurance can be a challenge, but also a tremendous asset. Take out-of-network (OON) benefits, for example. If done correctly, accepting OON benefits can be a tremendous asset to your practice. And guess what, these can be billed just like any in-network claim, regardless if you are using a billing company or billing yourself. Just knowing the nuances and how to leverage insurance to improve your practice can give you a tremendous edge.

4.       Simplify your business functions – stop using multiple systems to do your insurance billing. Don’t use an excel spreadsheet and QuickBooks together. Put down the pen & paper and just use an EHR. These are just a few examples of how to simplify the functions of your business to make your business lean, efficient and adaptable. Being adaptable might be the most important attribute listed, because the only constant in business is change.

5.       It’s all about relationships – it doesn’t matter if it’s with your clients, networking community, or external business vendors; maintaining relationships is so critical. And it’s so simple, almost as simple sometimes as picking up the phone or responding to an email. The foundation of that relationship will help you in unknown ways, but it will help you.

Any business, and especially a healthcare practice, can benefit from these 5 tips. I’ve tried to keep it general, because each person will interpret their own meaning and ways of accomplishing their goals. If any of my tips help, then my mission is accomplished.

- JG

Telehealth and Insurance – It’s Not Complicated!

Telehealth, telemedicine, e-health, online therapy is a major force in healthcare. As healthcare continues to evolve, one of the primary drivers of healthcare change is technology. Technology has helped cure diseases, increased life expectancy and countless other things. Today, one of the newest and up-coming ways in which technology is changing healthcare is through Telehealth.

According to the AMA, “telehealth has the power to transform health care…” for both providers and patients. In the comfort of one’s own home, a patient can speak to a doctor, receive a diagnosis and treatment at a fraction of the cost of a doctor visit. The cost does not include money; it also includes time, effort, sacrifice. Organizations such as the American Telehealth Association have grown in tremendous size to promote the use of and advance telehealth. From both a cost and efficiency standpoint, telehealth is a “win-win” for both providers and patients.

Telehealth will quickly evolve, and over time be embraced more as a standard practice. As that continues to happen, insurance companies, who today are lukewarm to telehealth will come to embrace it. Certain insurers already allow telehealth to be a “covered benefit” under a member’s plan. It’s important when checking benefits to specifically ask if telehealth is covered.

Telehealth is not a service performed over the phone. It is done through HIPAA compliant platforms that have been approved for its use. This is why insurers will specifically state that as part of their coverage of telehealth services, phone calls do not qualify. There are some great platforms out there, and if you are interested in pursuing telehealth you should make sure to find the best one or consult with someone who actively practices on a particular type of software. I’m not going to get into the specifics of telehealth platforms today; I’ll save that for another blog post.

Hurdles remain to accomplish the end-goal of telehealth being a viable alternative to a doctor’s visit, and one of those hurdles is insurance desire to cover only certain types of procedures. Fortunately, one of those procedures which is seeing more and more insurance coverage is mental health visits. There are numerous examples, including Blue Cross and Blue Shield of Alabama coming out in 2016 and declaring that mental health telehealth is a covered service. Additionally, UnitedHealthcare in the State of Florida covers telehealth, depending on a patient’s plan. More and more insurers over time will follow the lead of these two giants in ensuring that patients seeking mental health treatment have telehealth as an option.

If you are currently on an insurance panel like UnitedHealthcare in Florida and are considering the opportunity to perform telehealth type services, you are probably asking yourself how would you bill? The answer is simple: a modifier. A modifier is a specific code that goes on an insurance claim indicating something unique about the particular procedure that was performed. In the case of telehealth, the modifier is GT. This indicates to the insurer that the service was performed via telehealth, and also ensures that the provider is properly coding their claim when submitting for reimbursement. Why is it important to properly code? Because in the event of an audit, you want to make sure that you are following the policies and procedures of the insurance company. Additionally, improper coding could lead to clawbacks, suspension of payments or even termination from an insurance panel.

Partnering with GreenpointMed for billing telehealth services will guarantee that your claims are submitted properly to the insurance company. Telehealth is an exciting part of the future of healthcare and GreenpointMed will continue to find innovative ways to stay ahead of the curve.

-  Justin   

The Business of Healthcare is Unavoidable

No matter what field you are in, there will always be a business element to it that is unavoidable. Some fields are simpler than others. For example, if you owned a store selling bolts, the business of running your store would be quite simple. Likewise in many other businesses; it's just simple & easy. Unfortunately, healthcare is not simple and easy. 

Over the years, there have been a multitude of factors introduced that have gotten us to this point in June, 2017 where the business of healthcare is so complex. One factor is the rise and power of insurance. The insurance companies have gotten bigger and more powerful while cutting reimbursement rates and making it more difficult for doctors to earn what they should earn. We could get into the reasons as to the "why" but let's save that for another discussions. 

Another reason is legislation. The amount of regulation that is in the healthcare market has caused the complexity of running a healthcare business to increase 10-fold. Ask any doctor how much time they would rather be spending on patientcare versus the time spent on running their practice, and it's not even close. Regardless of what happens in Washington with repeal of the Affordable Care Act, the fact remains that too many people in our nation are dependent on some type of government subsidized healthcare, and that will not change. 

Medical practices need to partner with a company that specializes in healthcare business; that company is GreenpointMed. Our company is the premier partner for dealing with all insurance matters. We know how to cut through the complexity, speak to the right individuals and save you time & money. It's not a secret, and we don't try to hide it. Our firm is dedicated to making sure that running a healthcare practice is simple & efficient, and when you partner with GreenpointMed you will understand why. 

We live by two values - simplicity & efficiency. We use technology to make healthcare business more efficient, and we always hold insurers to account. In a world where the largest insurance companies are getting bigger & stronger by the day, you shouldn't feel that you are alone. Know that you have a partner in GreenpointMed that will advocate for you day-in, and day-out. It's what we do, and it's what healthcare needs. 

Contact GreenpointMed today to find out how we can make your business simpler through our billing & credentialing solutions. You will not be disappointed. 

Justin 

The Republican Controlled House Passed the AHCA. Now What?

By a slim, 217-213 majority, the Republican controlled House of Representatives today passed the American Health Care Act, or AHCA. This is the same bill that failed to get a vote at the end of March, albeit with some minor tweaks. Many must be asking, what happens now? Is the bill law? How will everyone be impacted? I'll do my best to answer those questions below. 

The AHCA in it's original form attempted to do four things: 

  • Repeal the Affordable Care Act's individual mandate,
  • Scale back Medicaid expansion, 
  • Reduce and in some cases eliminate subsidies available to participants of the various state health exchanges,
  • Eliminate certain taxes in the ACA which helped subsidies the marketplace.

The bill in it's original form did not receive a vote because a block of ultra-conservatives in the House, also known as the House Freedom Caucus (HFC), withheld their support because they felt the bill did not go far enough. The HFC wanted further provisions in the bill which would, among other things, allow insurers to charge more for people with pre-existing conditions and eliminate the requirement that all insurance plans cover 10 essential health benefits, including maternity and mental health care. As a result of the lack of support from the HFC, the initial bill as written failed. 

However, continued pressure from the Trump administration caused lawmakers to revisit the original bill. A compromise was brokered between the leader of the HFC, Mark Meadows of North Carolina, and Tom MacArthur of New Jersey. The deal centered on an amendment proposed by MacArthur which would allow states to seek a waiver from the Department of Health & Human Services for certain "essential health benefits". States would be subject to various requirements, one of which would be to setup high-risk pools for the sickest people.

Initially, moderates in the Republican conference balked at this amendment because they feared states would use the waiver to eliminate the requirement that insurers cover pre-existing conditions. After a few days of back and forth, including intervention by Trump and his top deputies, an additional amendment was added that provided $8 billion in funding over five years to state high risk pools. This amendment was enough to win over moderates who had initially opposed the bill, and subsequently, the bill passed in a floor vote today. 

Where do we go from here? First, let's declare that the bill is not law and the Affordable Care Act aka Obamacare is still the law of the land. Now the legislation moves to the Senate, where there is a very unclear path for this particular bill. Numerous Republican senators from states such as Ohio, West Virginia, Pennsylvania and many others have expressed alarm at the Medicaid rollbacks, primarily because hundreds of thousands of people have obtained coverage in those states because of the Medicaid expansion (almost 700,00 in Ohio alone). It is highly unlikely the bill in the form that passed the House will see a vote in the Senate. 

What's more likely, in my opinion, is that Senate republicans write a new bill which includes some of the provisions from the recently passed House bill. Some examples would include refundable tax credits for insurance and the repeal of taxes & the individual mandate. Whether any bill that passes the Senate can also pass the House is unclear, and it's important to remember that both chambers must agree on the same bill before the President can sign into law. 

The impacts are unclear. The Congressional Budget Office did not have a chance to score the bill and estimate costs and number of people who would lose coverage. However, based on the score of the previous AHCA which failed in March, we know that 24 million people would potentially lose coverage through 2026 and premiums would rise above current ACA projections through 2020, until they began to fall. A new score should be available in the coming weeks. 

There is still a long road ahead, but certainly proponents of repeal are thrilled at the fact the AHCA made it out of the House. Celebrations took place in the Rose garden of the White House after the vote, with much backslapping, high-fiving and loud praises among the G.O.P conference for passing the bill. This may be premature, but for a conference that seemed to not be able to agree on anything, it certainly was a moment to savor. 

I will continue to post over the coming months to keep you informed, and as always you can reach out to us at GreenpointMed with any questions. 

**I do my best to present the facts and provide views on what is likely to happen in the legislative process. In most cases, I will attempt to limit my opinions regarding how I actually feel about the bill. For deeper analysis, please visit www.kkf.org, the Kaiser Family Foundation, which is world-class in their analysis of healthcare.**

Where do we stand on AHCA heading into tomorrow's vote?

As I wrote in my headline yesterday, the House punted the vote on AHCA to Friday. This should not have come as a surprise because the vote tally was way short, and the ultra-conservative House Freedom Caucus refused to back the bill. the HFC has anywhere from 30-40 members and if within the caucus 80% vote a certain way, then the full caucus will vote that way. At this point, the HFC is leaning no. 

This is a strict power play by the HFC. The group is demanding extreme rollbacks of provisions, popular provisions of ACA. For example, the group is demanding that "essential health benefits" are no longer required as part of all insurance plans. The belief is that requiring these 10 coverage areas in all plans drives up premiums. This may be partially true. My counter-argument is that over the long-term, the benefits of preventative, mental health and other coverages would lead to less overall cost, which tend to fall more on taxpayer shoulders instead of the individual. (Note: I am not talking a position on the morality of coverage in this post), 

At this point, there is a battle between HFC & Trump, and whoever wins will determine the fate of the vote on Friday. If the HFC wins, then the AHCA will drastically strip provisions from Obamacare and the House will pass the AHCA. If Trump wins, it will be because he held the line and didn't give in to the most hard-line demands. It appears, at least tonight, that Trump was leaning towards stripping "essential health benefits" but would not compromise preclusion of pre-existing conditions and the current age of 26 to remain on a parents plan. 

Side note - if the 21-26 age group were required to own individual policies, it would add more young, healthy people to insurance pools which would offset high-risk people and theoretically drive down costs. 

We'll see what happens tomorrow. This bill not passing would be a massive embarassment to Trump and potentially be the end of the Paul Ryan Speakership. Additionally, the rest of Trump's "agenda" including tax cuts, infrastructure spending would be in serious doubt. 

The House Votes on AHCA Tomorrow (Maybe). My Thoughts...

The Republican controlled House of Representatives, led by Speaker Paul Ryan, is set to vote on the American Health Care Act tomorrow. The American Health Care Act will repeal many of the provisions of the Affordable Care Act and fulfill the campaign promises of the last 7 years from Republicans of "repealing and replacing" Obamacare. The legislation still would need to be voted on in the Senate and signed by the President before becoming law.

This is a terrible bill. The initial draft of it raised premiums, dropped coverages and would send the health insurance market into a period of extraordinary uncertainty. The non-partisan CBO score estimated 24 million people would be without health insurance by 2026. Now, in order to appease a faction of hard-line G.O.P members, there is talk of stripping popular elements of the Affordable Care Act, including

  • Prohibition on denying coverage based on pre-existing conditions
  • End of Medicaid expansion anywhere between 2018 and 2020
  • Requirement that all plans cover 10 essential benefits, including mental health 
  • Lifetime limits and out of pocket caps

Effectively, this will be a boon to insurance companies who will be able to sell high priced plans to high risk people without regulation. Additionally, almost 10 million Medicaid recipients would lose coverage very quickly. 

There are some positives, such as premiums decreasing by 2026 and savings of greater than $300B over 10 years. 

I am against this bill. I am not necessarily for the Affordable Care Act, but I do believe that the law should be improved, without repeal. We'll see what happens Thursday, and then in the months beyond. 

 

GreenpointMed Opening New Office in Deerfield Beach, FL

FOR IMMEDIATE RELEASE: March 6th, 2017

Deerfield Beach, FL: Today, GreenpointMed, Inc., a leading provider of medical billing and credentialing services to healthcare providers, announced the opening of a new office in Deerfield Beach, FL which will serve as the company's headquarters. Since it's founding in early 2016, GreenpointMed has enjoyed tremendous growth which necessitated the move to a more permanent home. The new corporate headquarters is conveniently located in the southwest corporate plaza off of I-95 & SW 10th Street at 1350 East Newport Center Drive. 

Of the company's move, Founder & CEO Justin Gaines remarked, "This is a very exciting time for our business as we continue to innovate and bring value to healthcare providers on billing, credentialing and other insurance needs. Our new corporate offices will uniquely position GreenpointMed to better serve existing clientele, while expanding service offerings to a larger group of healthcare providers throughout the state of Florida." 

About GreenpointMed, Inc: GreenpointMed is a medical billing & credentialing company based in Deerfield Beach, Fl. GreenpointMed currently serves healthcare providers across the mental & behavioral health spectrum, including Clinical Psychologists, Licensed Clinical Social Workers, Licensed Marriage & Family Therapists, and Licensed Mental Health Counselors. Utilizing the latest technology and implementing simple processes, we partner with healthcare providers to make healthcare business simple & efficient.  

MACRA Exemptions

There's been a lot of focus on what MACRA is. I'll leave that to the millions of other articles out there describing it. I'm going to focus on a less covered, but equally important topic: exemptions. 

You are exempt if you see less than 100 Medicare patients OR collect less than $30,000 in Medicare payments in a calendar year. The key word is OR - a provider only has to be below one threshold to qualify for an exemption. This will impact sole practitioners the most, and fields such as mental and behavior health. 

This gets tricky if you bill under a group NPI and the group does not qualify for an exemption. In this case, the group would have to adhere to MACRA standards starting in '17, as would the rendering providers. Individual providers under either threshold, however, are exempt for 2017. 

I like the exemption being one-year vs multi-year and applaud CMS for adopting the rule this way. The MACRA standards will continue to drag healthcare more into technology, which is badly needed.  

If you'd like to learn more, please email me at justin@greenpointmed.com. 

Justin

The Future Of Health Insurance in a Trump world

Tuesday, November 8th delivered a shocking result in the presidential race which will impact the healthcare landscape almost immediately after January 20th, 2017. While the healthcare industry has spent the last 6 years adjusting and implementing the Affordable Care Act (aka Obamacare), it's almost guaranteed that one of the first priorities of the Trump administration will be to repeal ACA. With a Republican controlled House & Senate, it is highly likely that large portions of the law will be rolled back, with the entire law repealed not entirely out of the questions. What this means for healthcare providers though is relatively unknown at this point.

Since Obamacare was passed, the mantra of the GOP has been "repeal and replace", but what will replace look like? There are currently 20 million additional people with health insurance as a result of ACA and a full repeal would strip all these people of their plans. At the very least, it is expected that subsidies to purchase health insurance on the exchanges will be rolled back, This will limit the ability of new people to obtain insurance or existing subscribers to maintain current plans. Another likely outcome is a reduction in Medicaid distributions to the states, which will have an impact on social service organizations and lower income households.

The Trump team has not yet outlined what healthcare policy may look like, however we can look to previous statements by the candidate and his VP for clues. Trump has stated that core provisions of the law, such as the prohibition against pre-existing condition restrictions will remain in place. We can also expect that overnight 20m people will not lose health insurance. A better idea of what healthcare policy in 2017 may look like could come from the House Republicans "Better Way" plan, which encourages the use of Medicaid block grants, self-funded health savings accounts and the promotion of Medicare Advantage plans. It is not guaranteed that any of these will become law, but they are good starting points for providers to prepare.  

Over the next 58 days, we will begin to get further clues of what healthcare policy may look like. One clue will come from whom is appointed Secretary of HHS. Another clue might be early collaboration with Speaker Ryan on "Better Way". Regardless, there is change coming and healthcare providers need to be prepared.