Exclusive Partnership with TherapyNotes

GreenpointMed is excited to announce an exclusive partnership with TherapyNotes, a leading EHR for mental health providers. As part of this partnership, GreenpointMed is one of a select group of medical billing companies which TherapyNotes customers have access to. The combined partnership of the leading technology platform for notes, billing, scheduling and other important features, with the service excellence of the GreenpointMed billing team makes this a win-win for providers.

“We are extremely proud that GreenpointMed has been selected as an exclusive partner of TherapyNotes,” remarked Justin Gaines, President of GreenpointMed. “Clients will have the combined power and ease of use of the great TherapyNotes platform with the precision and service excellence of the GreenpointMed billing process. I’m looking forward to a long, successful partnership which delivers value for providers and helps their practices run more efficiently.”

GreenpointMed was founded in 2016 with the goal of helping providers run their practices more efficiently. Offering both billing & credentialing services, GreenpointMed delivers a high-quality product which allows providers to spend more time focusing on their patients and practice. Clients enjoy a level of service excellence not often found with billing companies, large and small. To learn more about GreenpointMed, visit www.greenpointmed.com.

To learn more about TherapyNotes, visit www.therapynotes.com.

Take advantage of two months free when using referral code GP and by clicking this link.

Beware of the "Unspecified" Diagnosis Code

ICD-10 was introduced to the medical billing world in October, 2015. ICD-10 codes became key to the success of any medical billing platform, whether you bill yourself or outsource your billing almost immediately. The key difference when billing ICD-10 codes vs ICD-9 is that the ICD-10 codes begin with a letter, such as F or G. ICD-9 codes did not follow this format. 

The medical billing world was in some ways turned upside-down by ICD-10. When introduced, there were now 70,000 codes for a medical biller to know and understand! This was quite an increase over the 14,000 or so codes that medical billers needed to worry about with ICD-9. Nevertheless, we must adapt and ICD-10 is here to stay. 

In many ways, ICD-10 is an important introduction into the world of insurance billing. The codes provide more specificity than ICD-9, and allow a healthcare provider to properly define the diagnosis of a patient. At the same time, certain codes were designated as "unbillable" because they were deemed not specific enough. For example, if you are a behavioral health provider (a field that GreenpointMed specializes in), and you tried to use the DX code F33, Major Depressive Disorder, recurrent, your claim would be rejected. Here's an important distinction: rejection vs denial. A rejection is a claim that did not make it to the insurer for processing, and bad DX codes are a common reason why. Other reasons a claim would be rejected is a bad member ID or bad DOB entered on the claim. A denial on the other hand is a claim that was processed by the insurer where payment was refused. Name your reason why a claim is denied; often it can be as simple as human error on the part of the insurer (nobody is perfect).

Medicare has developed a comprehensive Coverage Database which analyzes all claims submitted at a local level through a Local Coverage Determination (LCD) database. One denial we are beginning to see as a medical billing service that processes thousand's of claims per month are claims with billable DX codes. What do I mean? If your code ends with a ".9" there is a  chance that it will be denied. The reason: codes ending in ".9" are by definition unspecified. Medicare does not like this, and so they are being denied  as a result. Looking at two examples, F80.9, Developmental disorder of speech and language, unspecified; F33.9, major depressive disorder, recurrent, unspecified.

Even if you are not a Medicare provider, this still could affect you. Commercial insurers typically follow Medicare guidelines on reimbursement, coding and other policies. If Medicare is providing guidance on a specific policy, such as which DX code is acceptable and which is not, there is a chance that your commercial insurer like UnitedHealthcare, Aetna or the Blues will follow. Medicare is the leader, and the commercials are the followers. 

These are not hard and fast rules, and there will be exceptions (like everything in billing insurance). At GreenpointMed, we have a great search engine that is available to our clients which helps define billable vs. non-billable codes. The difference between submitting a billable code can drastically speed up your reimbursement and lead to fewer headaches for you (and your biller). 

Bottom line: avoid the unspecified diagnosis codes where you can.

Just for fun, let's take a deep dive into some other ICD-10 codes that exist which you may not be aware of:

  • W56.02XA: Struck by dolphin, initial encounter: (was there a second or even third encounter?). If you have ever swam with a dolphin or seen one at an aquarium, it definitely could hurt if you were to get struck by a dolphin. However if I were lost at sea, there is no mammal I would rather find myself with then the friendly porpoise. *We believe we have identified what this type of diagnosis might look like. Please visit our Twitter page, https://twitter.com/Greenpoint_Med, to evaluate.
  • V91.07XA: Burn due to water-skis on fire, initial encounter: First, I hope there is no subsequent encounter (there actually is no billable code for second encounter), and wouldn't a possible remedy for this affliction be to jump into the water?

I don't mean to make light of anybody's plight. However this should give you an idea of the extent of codes that are available under ICD-10. And if you were asking, yes, these codes are technically billable. 

GreenpointMed's Drive To Be More Efficient

I'm obsessed with efficiency. In my daily life, either personally or for GreenpointMed, it is a never ending quest. Our business' #1 goal is to make the billing process simple & efficient, and we accomplish that better than nearly all private billing companies on the market. It's an easy formula for us: pay attention to the details, always communicate and be precise. Almost sounds like a winning strategy for a football team, though never for my Miami Dolphins! 

Our billing process is simple & efficient and the numbers don't lie. Our "clean claims rate", the percentage of claims that pass through to the insurer without issue is 97%. The industry standard is around 92% and for specific fields in healthcare it's even worse. Payout times on claims we submit are also among the shortest periods for RCM vendors. We average about 7 days for commercial insurers and 10 business days for Medicare. It can be so precise, in fact, that I'm often able to predict when a payment will be made. 

I'm really proud of these results, because most importantly it shows that we are able to deliver a best in class service to our clients. The foundation for this success rests on two important factors: our technology and my team. I want to give a big shoutout to my team, for working to keep this engine running. Our billing process wouldn't be best in class without their tireless efforts!  

Over the years, I've spent a ton of hours researching, testing, demoing, etc. different types of technology that would help our process become more efficient. Where I landed was a combination of standard, basic communication tools with enhanced security features to comply with HIPAA. Those that bill with GreenpointMed know my emphasis on the use of secure email! We've also developed a more streamlined process to collect billing logs, check benefits, and send payment reports. 

As we evolve, the technology needs to evolve with us. Over the next several months, I'm really excited about a new client portal that could revolutionize the way our process is communicated to you. It's one thing for the process to work, but what good is it if you don't know it's working! Our client portal will be a standard for how we manage the flow of information between clients and our billing team. 

Just another step closer to (near)perfect efficiency!

Medicare ID Numbers Are Changing: 5 Things to Know

The long awaited change to Medicare ID numbers is here so now is a good time to take a moment to make sure you are prepared. New ID cards will start shipping and be distributed to Medicare beneficiaries in April 2018 and, fortunately, you have time to prepare. This doesn't mean you should wait until the very last few weeks before the old ID numbers are no longer active to have a plan in place; no, no. Create a plan now so that way when your patients came to you with their new ID cards you will be able to confidently tell them how seamless the transition will be. Why? Because you have a plan, and because you read this blog. 

Many people for a long time said it was so unlikely that Medicare would change ID numbers from the SSN that it would take an act of Congress for it to happen. Well, that every one-thousand-year event happened in 2015 with the passage of MACRA. Now MACRA affected many specific features of Medicare, including payment growth rates and payments to doctors, but this change is the most impactful. This will touch every single person who has Medicare, some 44 million people, so every provider should be prepared. 

Below are 5 things to know heading into the transition:

1) Existing Medicare ID numbers are valid until December 31, 2019 - While the new Medicare ID cards will start being shipped in April 2018, the old ID numbers will be valid until December 31, 2019. That means there is a full 21 months to make sure every healthcare practice is ready to accept this change without any bumps to Medicare payments. This also means that Medicare Administrative Contractors (MAC) will continue to process and pay claims using the old ID numbers through the end of the transition period. This is good news for providers and will provide ample time to create a plan for transitioning to the new ID numbers.

2) The new Medicare number will be referred to as the "Medicare Beneficiary Identifier", or MBI - In all documentation you receive from CMS regarding this change, this will officially be how the new Medicare ID number is referred to. Additionally, it will most likely appear in any letters or correspondence sent to beneficiaries. Starting in June 2018, providers will have the opportunity to look up a patient's MBI on each MAC's website. This will be accessed through SPOT, so if you don't have access to SPOT now would be a good time to get registered. 

3) Start having the conversation with your patients now - This is important because beneficiaries will want to make sure their address is updated with CMS. If not, the new card could go to the wrong place. Also, this will be a good opportunity for the patient to make sure CMS has their most current supplemental insurance on-file for crossover purposes. 

4) Have a conversation with your billing provider or clearinghouse about the transition - It's important that whoever does your billing has a process in place to make a seamless transition to the new ID numbers. If you are using a billing company, how will they ensure there are no disruptions in your Medicare payments? At GreenpointMed, we have our process ready to go.   

5) Railroad Medicare Beneficiaries will have an MBI identical to everyone else - No longer will there be 1-3 letters in front of a RRB Medicare beneficiary's ID number. The MBI will be the same as all other Medicare beneficiary's, except the card will have a (hopefully well designed) RRB logo on it. 

This will be an easy transition and I promise we will get through it. The most important thing though: Be prepared!


Happy 2018! New year; new benefits

Happy New Years to all! Let's all have a happy & prosperous year. Part of making sure that the year starts off in the right direction is to make sure you know your patients' benefits. Remember, benefits reset at the beginning of each calendar year, so everyone starts at square one with a deductible to meet. It's important to know the details so you can A) make sure you are collecting the maximum allowable amount, and B) communicate with your patients about their responsibility until their insurance kicks in. 

First, let's start with the basics: what is a deductible? According to Healthcare.gov, a deductible is "an amount you pay for covered health services before your insurance plan starts to pay." Each patient has a different deductible that is determined based on their plan type. Once the deductible is satisfied, meaning the patient has paid the deductible amount, the insurance portion kicks in. This insurance payment to your practice will either be in the form of co-insurance or co-payment, and it's important to know what your patient has. 

Almost every insurance plan has a deductible, and understanding the math is a key to success. As an example, let's say your patient has a $1000 deductible, and 20% co-insurance. The allowed rate for the service you perform is $100. In this scenario, it would take 10 sessions for your patient's deductible to be satisfied, and on the 11th session the 20% co-insurance kicks in. For our example, the patient would owe $20 starting on the 11th session. The deductible could be met quicker if the patient is seeing other in-network healthcare providers and uses their insurance. 

If your patient has Medicare, there is a deductible also. That deductible is $183. Sometimes, the patient will have a supplemental policy that will pay for the Medicare deductible. In other cases, the supplemental policy will have its own deductible to meet. 

What should you do? Simple. Check the benefits and create a plan to discuss with your patients. For your patients who have commercial insurance, they will be responsible for the full amount "allowed" for the service you perform. It is safe to go off of last year's rates to determine how much will be owed per commercial plan, unless you received a letter or some type of correspondence indicating the rate has changed.

At GreenpointMed, we are offering customized reports for your practice. This report will go into great detail around the patient insurance details for 2018: deductible, patient responsibilities, maximum out-of-pocket, etc.. This customized report is available to any healthcare provider, practice or group and will deliver great transparency into your insurance landscape in 2018. We are also here to explain the trickier details and help you create a plan, so contact any member of our team to find out more details.



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.


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. 


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


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. 


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.