Author: Jd Medlink

Medicare Changes for 2020 | How Will They Affect The Private Practice Owner

Posted on by Jd Medlink

Every January brings Medicare changes that ripple through private practice billing. Here is a breakdown of the most significant 2020 changes and their practical implications.

## 1. Medicare Beneficiary Identifier (MBI) — Full Transition Complete

CMS completed the transition from the legacy Health Insurance Claim Number (HICN) to the new Medicare Beneficiary Identifier (MBI). As of January 1, 2020:

– **All claims must use the MBI.** HICNs are no longer accepted.
– MBIs are unique, randomly generated 11-character codes (no Social Security Number embedded).
– Practices that had not updated their patient records faced claim rejections.

**Action taken:** MedLink clients completed full MBI updates in Q4 2019. If you had ongoing HICN-related rejections into 2020, your eligibility verification process needed revision.

## 2. Opioid Treatment Programs (OTP) Bundled Payments

CMS introduced a new bundled payment model for Medicare-enrolled Opioid Treatment Programs. Under this model, OTPs receive a single bundled payment covering:

– Counseling services
– Toxicology testing
– Medication administration
– Individual therapy

This is a significant structural change for practices involved in opioid treatment, moving away from fee-for-service toward a care-coordination model.

## 3. Part B Premium Changes

The 2020 Medicare Part B premium increased to **$144.60 per month**, up from $135.50 in 2019. While this is a patient-facing cost, it matters for practices because:

– Higher premiums correlate with higher deductibles
– Some patients defer care or reduce appointment frequency when premiums rise
– Patient balance management becomes more important

## 4. KX Modifier Thresholds for Therapy Services

For PT, OT, and speech-language pathology practices, the 2020 therapy cap thresholds were:

– **$2,080 for PT and SLP combined**
– **$2,080 for OT (separate)**

Once a patient’s allowed charges exceed these thresholds, the KX modifier must be appended to each claim to attest that the services are medically necessary beyond the cap. Missing the KX modifier results in automatic denial.

## 5. Therapist Assistant Modifiers

A major change for PT and OT practices: services provided by physical therapist assistants (PTAs) or occupational therapy assistants (OTAs) must now use specific modifiers:

– **CQ modifier** — Services provided in whole or part by a PTA
– **CO modifier** — Services provided in whole or part by an OTA

These services are reimbursed at **85% of the standard rate**. Practices that failed to apply these modifiers faced compliance risk and potential overpayment recovery.

## 6. MIPS Participation Requirements

For practices subject to MIPS (Merit-based Incentive Payment System) in 2020:

– **45 points required** to avoid a negative payment adjustment in 2022
– Reporting required across 2 of 4 categories: Quality, Promoting Interoperability, Improvement Activities, and Cost
– Small practices (≤15 clinicians or ≤$90K in Part B charges) had the option to submit at a reduced threshold

**If your practice is subject to MIPS, the payment adjustments from 2020 reporting apply to 2022 Medicare payments.** It is not too late to review your historical reporting.

## Final Thought

Medicare changes come every year, and each one requires action. The practices that stay ahead are the ones with billing partners who track these changes proactively. If you have questions about how any of these changes affected your practice, reach out to our team.

Nurse Practitioner Private Practice Income | Maximize It With These 5 Strategies

Posted on by Jd Medlink

Nurse practitioners entering private practice often face a gap between their clinical training and the business skills required to build a financially successful practice. Here are five strategies that consistently move the needle on income.

## Strategy 1: Prioritize Empathetic Bedside Manner

This might seem like an obvious clinical skill, but its financial impact is measurable. Practices where patients feel heard and respected have:

– Higher appointment completion rates (fewer no-shows and cancellations)
– Better patient retention and referral rates
– Lower risk of billing disputes and complaints

Patients who trust their provider are also more likely to comply with financial policies — including paying copays at time of service and settling balances promptly. The relational quality of your practice is the foundation of its economic health.

## Strategy 2: Build Communication Outside the Exam Room

The highest-performing independent NPs treat their practice like a publishing business. They communicate with patients and the community consistently through:

**Email Marketing**
An email list is one of the most valuable assets your practice can build. Industry data values a healthcare email address at approximately **$15.23 per address per year** in practice revenue. A list of 1,000 patients translates to roughly $15,000 in annual revenue retention.

**Blog and Content**
A well-maintained blog builds search engine authority over time. For a primary care NP, a blog covering chronic disease management, prevention, and wellness can generate significant inbound traffic. Conservative estimates value a mature healthcare blog at **$100,000+ in equivalent traffic value**.

This is not marketing fluff. It is a systematic way to stay top-of-mind and ensure patients return to your practice rather than drifting to a competitor.

## Strategy 3: Monitor Your RVUs

If you are in a production-based compensation model (or considering one), understanding Relative Value Units (RVUs) is essential.

RVUs are the unit of measure CMS uses to price physician services. They factor in:
– Physician work (complexity of the service)
– Practice expense (overhead)
– Malpractice liability

Tracking your RVU production tells you:
– Whether your visit mix is appropriately complex for your payer contracts
– How your productivity compares to national benchmarks
– Whether you are being fairly compensated under any production incentive arrangement

NPs in production models who actively manage their RVU output consistently outperform those who simply see patients and hope for the best.

## Strategy 4: Master Correct E/M Code Selection

Evaluation and Management (E/M) coding is where more NP income is lost than perhaps any other single area. The 2021 E/M guideline changes simplified coding by focusing on Medical Decision Making (MDM) or Total Time — but many NPs are still under-coding.

Common under-coding patterns:
– Billing 99213 for visits that qualify as 99214
– Not documenting the full complexity of MDM
– Failing to capture time spent on care coordination and counseling

A single coding level difference across 20 patients per day represents thousands of dollars monthly in lost revenue. If you have not had a coding audit recently, invest in one.

## Strategy 5: Build a Robust Patient Payment Process

The timing of collection is everything. The data on patient payment behavior is clear:

– Collection rate at **time of service: ~95%**
– Collection rate **30 days post-visit: ~80%**
– Collection rate **90+ days post-visit: ~60%**
– Collection rate **after sending to collections: ~20%**

Every day you wait to collect is revenue at risk. A robust patient payment process includes:
1. Communicating expected patient responsibility at check-in
2. Collecting copays and known balances before the visit (not after)
3. Providing a clear patient-friendly statement with a quick payment option
4. Following up via text or email within 7 days of the visit for outstanding balances

NPs who implement this process see immediate and sustained improvement in their net collection rate.

## Summary

Building a financially strong NP practice requires intentional focus on both the clinical and business dimensions of your work. None of these strategies requires significant capital — they require systems, consistency, and the willingness to treat your practice like the business it is.

If you want help with the billing and collections side of this equation, MedLink Services works with independent NP practices across the country.

Medical Accounts Receivable Audit | 5 Metrics They Should Uncover In An Audit

Posted on by Jd Medlink

When practices come to us after switching billing companies or after a period of internal billing, an AR audit is always the first step. These are the five metrics we look for — and what they reveal about a practice’s billing health.

## Metric 1: 85% of AR Should Be Under 90 Days Old

This is the primary benchmark for a healthy practice. If more than 15% of your total AR sits beyond 90 days from the **date of service**, you have a systemic collection problem.

Common causes of excessive AR over 90 days:
– Claims not submitted timely
– Denial management is reactive rather than proactive
– Insufficient follow-up on aging balances

*Note: Always measure from date of service, not date of billing. Date of billing can be manipulated and does not reflect true payer performance.*

## Metric 2: 40% of Blue Cross Patient Balance Under 90 Days

Blue Cross (and other major commercial payers) moves quickly when claims are clean. If less than 40% of your Blue Cross patient balance is in the current bucket, investigate your claim submission quality for that payer.

Blue Cross typically processes clean claims in 7–14 days. If you are seeing 30+ day payment timelines on Blue Cross, there is likely a contract, credentialing, or claim quality issue to resolve.

## Metric 3: Reimbursement Comparison to Like Providers

An AR audit should benchmark your reimbursement rates against your peers — practitioners with the same specialty, in the same geographic market.

This comparison reveals:
– Whether your payer contracts are competitive
– Whether coding patterns are consistent with peers
– Whether there are payers systematically underpaying based on contract terms

If you are being paid 15–20% below your specialty peers for comparable services, you likely have a fee schedule or contract negotiation issue.

## Metric 4: Days in AR Calculation

Days in AR is one of the most important single-number metrics in medical billing. It measures how many days, on average, it takes to collect a dollar of charges.

**Formula:**
Days in AR = Total AR Balance ÷ (Average Daily Charges)

Where Average Daily Charges = Total Charges over 90 days ÷ 90

**Industry benchmarks:**
– Primary care: 30–40 days
– Specialty practice: 40–55 days
– Surgical specialties: 45–65 days

If your days in AR exceeds your specialty benchmark, billing lag and denial rates are the most common culprits.

## Metric 5: Healthy Aging Buckets Across All Payers

Beyond the 90-day metric, a full aging analysis should show:

| Bucket | Target % |
|——–|———-|
| 0–30 days | 50%+ |
| 31–60 days | 20–25% |
| 61–90 days | 10–15% |
| 90+ days | Under 15% |

Any payer where the 90+ day bucket exceeds 20% deserves immediate attention.

## The Date of Service vs. Date of Billing Issue

We see this frequently in audits: practices that measure aging from **date of billing** rather than **date of service**. This creates a false picture of AR health. If your billing team submits claims 10–15 days after service, your aging report will look better than it actually is.

Always measure from date of service. Always.

## What to Do With the Audit Results

Once you have these five metrics in hand, prioritize:
1. Fix the highest-value payers with the most aging over 90 days first
2. Address root causes (not just symptoms) — denial codes, credentialing issues, authorization failures
3. Establish a monthly cadence for reviewing all five metrics

An audit is only valuable if it leads to action. If you would like MedLink to conduct a complimentary AR audit for your practice, contact our team.

Asking for Payment At The Time of Service-Tips to Get Your Staff On Board

Posted on by Jd Medlink

Let’s face it, asking for payment at the time of service is a huge challenge in our day to day activities. This is the one task lots of people shy away from. And, in many cases this important part of the overall revenue piece is left to one of the lower-paid members of our staff. These team members and their collection efforts are crucial to the success or failure of the practice. But, why is there a lack of production in this part of the revenue cycle?

Setting priorities and sticking to them

Folks; your receptionist likely gets intimidated when asking for payment, and there are a lot of people in her distinguished company. Asking for money is about as popular to most people, as public speaking. You see, asking for a past due payment is confrontational, its requires an aire of bravado, and it takes doing a little research to make sure the debt is actually owed. Sometimes the billing system, if they even have access to it, can be unclear. Is it a billing debt? Or, has it already been written off to collections? Did the patient have a special verbal agreement with the provider where they would not collect payment after the insurance has paid? This is a minefield, the receptionist has to navigate through. So, not knowing the answers to these questions, makes not asking for payment at the time of service, well frankly- less uncomfortable. Its human nature for people to choose to do the things is their lives they find most comfortable. Then, when you have the variable that his or her pay is by no means affected by not asking, well then where’s the motivation? Incentives anyone?

So how do we help our receptionist get over this feeling of discomfort they likely feel day in and day out?

We at Medlink Services, do training seminars on the subject of Asking for Payment at the time of service. We role play, we teach our clients in this role, how to actually ask for payment (because there is a right way and a wrong way to ask for payment), and most importantly, we have a ‘real time’ billing system the receptionist can access and check accounts, thereby eliminating the ambiguity of whether or not they owe the debt. Some of our clients actually go as far as incentivizing their front desk staff to ask for payment. In the case of old balances, we have seen some of our clients pay as much as 15% of the actual dollar amount collected to the person who collects it. Our clients make a game of it; some hand out Starbucks, or movie theater gift certificates to the one person who collects the most in a given week. This is the kind of thing management should be introducing and managing. By doing so, it will have a positive ripple affect throughout the office, where people are talking about the competition and trying to outdo one another. Believe me, you throw in the opportunity for a weeks worth of Starbucks Iced Hazelnut Macchiato’s, and get ready to behold the off the charts production! Consider implementing an incentive program to motivate your staff to ask for payment at the time of service. It doesn’t always have to be a monetary incentive, it can be something like Comp Time, or flowers delivered to the office on Friday. What it really boils down to is being recognized and letting them know their true value. So, make sure they know they’re appreciated and you can look forward to taking more checks to the bank.