The existing Medicare gainsharing demonstration project, now extended for two years, was established to test and evaluate methodologies and arrangements between hospitals and physicians governing the use of inpatient hospital resources and physician work to improve the quality and efficiency of care provided to Medicare beneficiaries. The hospital under this arrangement provides payments to physicians that represent a share of savings attributed to collaborative efforts between the hospital and the physicians.
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The oft-repeated truism that you cannot change what you cannot measure has a less frequently repeated corollary: You get what you measure. This has been a hard-learned lesson for radiology practices, many of which—empowered with detailed information on radiologists' productivity—have linked some portion of compensation to work RVUs.
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The Centers for Medicare and Medicaid Innovation tests novel payment and service delivery models that have the potential to reduce program expenditures while maintaining or improving the quality of care for beneficiaries. Testing programs of alternative models for payment, including the Acute Care Episode and the Gainsharing Demonstration Projects (also known as the Bundled Payments for Care Improvement Initiative or BPCI) incentivize care redesign, engage and protect beneficiaries, and learn and diffuse best practices that might create changes to the Medicare fee-for-service program.
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Atlanta, Ga. – November 12, 2012 — Medical Management Professionals, Inc. (MMP), a national firm providing billing and practice management services to anesthesiologists and anesthesiology practices will deliver a complimentary webinar on achieving greater transparency in the anesthesiology billing process. The webinar will give anesthesiology groups strategies to improve billing and revenue cycle management operations and will analyze each step of the billing process for optimum transparency.
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CMS is currently testing programs of alternative models for payment, including gainsharing around bundled payments for episodes of care and accountable care organizations. Testing of these initiatives is meant to incentivize care redesign, engage and protect beneficiaries and diffuse best practices which might create changes to the Medicare fee-for-service program.
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Atlanta, Ga. – October 23, 2012 — Medical Management Professionals, Inc. (MMP), a national firm providing coding, billing and practice management services to emergency medicine practices and hospital-based physicians, announces that its Chief Compliance Officer, Edward R. Gaines III, JD, CCP has been awarded with honorary national membership in the American College of Emergency Physicians (ACEP).
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Neale Pashley, operations manager for Medical Management Professionals (MMP), found himself on the front lines of the CMS Acute Care Episode (ACE) Demonstration when a radiology practice with which he worked became a participant. "What the radiology industry should prepare for, more than anything else, is the impact this might have on utilization," Pashley says. "The goal is to cut down on unnecessary utilization of procedures, and while the initial impact might be limited, over time, that will change."
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Compliance risks for radiology practices have increased during the last decade, ranging from infrequent post-payment reviews, documentation requests, and occasional voluntary return of overpayments to formal investigations and audits based on data analysis, prosecution under the False Claims Act, and whistle-blower action.
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Atlanta, Ga. – October 4, 2012 – Medical Management Professionals, Inc. (MMP) today announced that it has acquired the assets of ProMedical, Inc.(ProMedical), an anesthesia billing company located in Ocala, Florida, effective October 1, 2012.

Founded in 1993, ProMedical is a full-service provider of medical billing and practice management services exclusively for hospital-based anesthesiology practices. ProMedical is expected to add 58 employees and approximately $4.9 million to MMP's annualized revenue.
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Regardless of one's loyalties, anyone who has attended or seen professional football games played in the last decade knows the image of Peyton Manning breaking a huddle, surveying the field in front of him and pointing vigorously, while calling out signals to the other players on his team. It is the image of a coach on the field. It is the image of a leader. Who will be the leaders in the new, emerging landscape of our healthcare system?
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As radiology practices deepen their investments in IT, a key stakeholder to consider is the patient, according to Anthony Brown, director of IT for Medical Management Professionals (MMP). "Nationwide, there is a movement to get people engaged in their health care," he notes. "Outcomes significantly improve when the patient is engaged in his or her whole care continuum. Taking that a step further, however, the question becomes how best to engage the patient efficiently."
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Transparency is a term that can be applied to almost any aspect of a business' operations, and while it is always a worthwhile goal, it is particularly important for radiology practices to embrace and achieve transparency when it comes to the billing cycle. A practice's financial health is significantly improved by an ongoing understanding of the fluctuations that make up the revenue cycle; further, this transparency enables the practice to take a proactive approach to addressing problems that stand to affect the bottom line.
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The threat of being taken over by a corporate entity is a relatively new—but increasingly real—concern in radiology. Corporate-owned outpatient imaging centers are directly competing with traditional practices for patient referrals and have gained considerable market share by promoting greater patient comfort, convenience, and procedure turnaround times. In a period of reduced reimbursement, their size and economies of scale can make them tough competition.Full Article

Medical Management Professionals, Inc. (MMP), a national firm providing billing and practice management services to emergency medicine physicians, announces a new partnership with Art of Healthcare (AoH). The partnership will benefit MMP's emergency medicine physician clients by offering AoH services such as clinical quality enhancements, patient call back programs, patient service improvements and scribe programs to the clients' current operating strategy.
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Looking back at the ANSI ASC x12 5010 (5010) implementation, we as an industry might ask ourselves what lessons were learned from the experience as we brace for more change. ICD-10-CM (ICD-10) has been mandated for adoption and implementation by all providers and health plans for dates of service effective Oct. 1, 2013, per the U.S. Department of Health and Human Services (DHHS) final rule published Jan. 15, 2009—or so we think.
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Benchmarking is a critical step when developing best practices for an imaging facility. Without knowing your facility's optimal output, reimbursements, and turnaround time, it becomes difficult to develop workflow and business strategies to achieve those goals. Medical Management Professionals Inc (MMP) recently undertook its 11th annual study aimed at collecting and analyzing these benchmarks for its clients.
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Thanks to the June 28 Supreme Court decision, one problem that radiology practices might not face for much longer is managing payment from uninsured patients—an issue that currently plagues hospital-based groups, in particular, according to Krista Pelensky, director of operations with Medical Management Professionals (MMP). "Many hospital-based groups have seen an uptick in uninsured business and an increase in emergency-department services," she says.
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Emergency department observation is defined as "use of a bed and periodic monitoring by the hospital's nursing or other ancillary staff, which are reasonable and necessary to evaluate an outpatient's condition or determine the need for possible inpatient admission," at least according to insurer Highmark. Observation represents a patient status, not a location, and the status provides a revenue opportunity for every emergency physician who is specifically determining if a patient needs to be admitted to the hospital. In essence, physicians are using time as a tool to assess results of treatment and evolution of clinical condition in order to determine the optimum final disposition for the patient.
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Atlanta, Ga. – July 9, 2012 — Medical Management Professionals, Inc. (MMP), a national firm providing coding, billing and practice management services to emergency medicine practices and hospital-based physicians, announces that its Chief Compliance Officer, Edward R. Gaines III, JD, CCP has been awarded with honorary national membership in the American College of Emergency Physicians (ACEP). Mr. Gaines will be formally presented with the honor during the 2012 Fellow Convocation and Awards Dinner at the 2012 ACEP Scientific Assembly in Denver, Colo.
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Atlanta, Ga. – July 2, 2012 — Medical Management Professionals, Inc. (MMP), a national firm providing billing and practice management services to emergency medicine practices and hospital-based physicians, announces that its Medical Director, Ronald Stunz, MD, FACEP has been named as a representative to the National ACEP Council from the Pennsylvania ACEP Chapter.
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Commoditization threatens the independence of the traditional radiology group, creating competitors on a local, national and, perhaps some day, global level. In the context of corporate takeover, it could be described as the biggest threat to radiologists in private practice.
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