By David Doyle from Physicians Practice
Roughly 27 percent of Americans on Medicare are enrolled in a Medicare Advantage plan. Federal funding for this Medicare alternative has already been cut by 6.5 percent this year, and additional cuts are planned. Preliminary 2015 rates for Medicare Advantage will be announced in February and finalized in April.
Hospitals are responding to existing and upcoming Medicare cuts by trimming staff. Lawrence + Memorial Hospital in New London, Conn., reduced its workforce by 33 positions in September 2013. In its press release, the hospital specifically blamed a predicted “$260 billion reduction in Medicare outlays between 2013 and 2022.” Other hospitals are also cutting staff and will continue to do so if Medicare cuts become too cumbersome — bad news for the thousands of doctors who recently sold their practices to healthcare systems.
Cuts to Medicare reimbursement rates and Medicare Advantage are impacting private practices as well. Last November the nation’s largest provider of Medicare Advantage Plans, UnitedHealth Group, sent termination letters to physicians in 10 states. According to an article in The Wall Street Journal, these letters cited “significant changes and pressures in the health care environment.” UnitedHealth Group hopes to trim the program to between 85 and 90 percent of its current size by the end of 2014.
These sudden, drastic cuts threaten patient care and will even force many patients to stop visiting specific physicians midtreatment. However, some practices are fighting back. Judge Stefan R. Underhill, the United States District Judge for the District of Connecticut, issued a temporary injunction in December that prohibits UnitedHealth Group’s planned dismissals in Fairfield and Hartford Counties. Another lawsuit in the state of New York is still pending. The American Medical Association even weighed in when it recently joined with 30 medical associations and physician advocacy groups to oppose “wide-spread terminations in the Medicare Advantage program.”
Additional debates over the future of Medicare cuts will likely ensue over the next few months, but what can practices do in the meantime?
As cuts to Medicare and Medicare Advantage reimbursement rates go into effect, practices that serve Medicare patients must ensure that it’s still profitable for them to do so.
Begin by calculating the amount of time a physician can spend with a Medicare patient before the practice loses money. Next, consult your patient records from the last three months to determine whether physicians are exceeding this mark. If the practice loses money every time it sees a Medicare patient, you must set a strict time limit for physician consultations and monitor any changes over the next three months. If at the end of this time you discover that treating Medicare patients is still a net loss for the practice, then it might be time to reconsider your patient base.
Practices that are removed from Medicare Advantage networks will also need to adjust. If your practice is one of these, and you haven’t already done so, you must inform your affected patients as soon as possible. According to The Washington Post, many patients don’t understand that these terminations were not their physicians’ fault. Help your patients by either referring them to physicians within their network whom you trust, or recommending alternative Medicare Advantage networks that your practice still belongs to.
Taking precautionary measure now will help protect your practice’s long-term viability and reputation without leaving your patients out in the cold.
Courtesy of Physicians Practice http://www.physicianspractice.com/blog/physicians-should-prepare-now-medicare-cuts?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=11022014
Showing posts with label practice management. Show all posts
Showing posts with label practice management. Show all posts
Tuesday, March 11, 2014
How to Implement Open Access Scheduling at Your Medical Practice
By Carol Stryker from Physicians Practice
It may be time for your medical practice to implement open access, also referred to as advanced access or same day scheduling. It certainly deserves serious consideration.
Here's how open access scheduling works, and why your practice may want to consider it. Defining open access
Open access covers a variety of scheduling approaches, including completely unscheduled (a la an ED or urgent care center), open blocks of time on certain days, and a specific number of appointments kept open in each clinic session. A practice could utilize more than one of these options, as well as traditionally scheduled appointments. The imperative is to do what makes sense for the patients and the providers.
For instance, it might make sense for an OB to block out Tuesday mornings for first and second trimester appointments and let patients come in at their convenience for these typically quick appointments. The methodology could also support scheduled group meetings at the beginning or end of the open access period to disseminate general information and answer typical questions. Another alternative is to reserve the last appointment time in each clinic session for same-day appointments, and be willing to work through lunch or after the regular workday until all patients have been seen.
Making open access work
Open access requires an explicit service promise from the practice to the patient. The purpose of a service promise is to manage patients' expectations and provide something against which to hold the practice accountable.
Solutions to common open access concerns
• How does a practice avoid empty appointment slots on some days and being overwhelmed on other days?
The solution is not necessarily easy, but it is simple: Ease into open access based upon a good understanding of your current operations. Monday mornings are probably a busy time for the phones, as patients call in about problems encountered during the weekend. Does that mean that the practice needs more open time on Monday morning, or does Monday afternoon make more sense?
Based upon the specialty and the patient population, some types of appointments will create natural opportunities for open access and they don't have to be every week or every month. A pediatrics practice, for example, might run an immunization or sports exam clinic for parts of several days just before school starts. • What about insurance verification?
The best answer is to have an effective way to quickly verify insurance coverage. Supplement that process by asking patients to provide a credit card to be billed in the event the office cannot verify insurance coverage. If the patient subsequently provides adequate, current insurance information, the practice can file the claim and have the payment sent to the patient.
Authorizing a charge in lieu of insurance is more palatable to patients when the practice is accommodating them with promptly provided care. Benefits of at least partial open access
The two primary benefits are increased patient satisfaction and improved practice productivity. Patients are happier because they can be seen more quickly. They are also happier because they can be seen in their regular setting with all of their records available, instead of in an urgent care center they know nothing about.
Waiting room time, within reasonable bounds, is not as aggravating when there is not a set appointment time. Practice productivity should increase for several reasons. No shows and cancellations drop because less time elapses between the appointment and its scheduling. Average visit lengths tend to be shorter because the visit is more focused on the precipitating issue. Open access visits require no appointment reminders.
Courtesy of: Physicians Practice http://www.physicianspractice.com/blog/how-implement-open-access-scheduling-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=07032014#sthash.0TQZoIZi.dpuf
It may be time for your medical practice to implement open access, also referred to as advanced access or same day scheduling. It certainly deserves serious consideration.
Open access covers a variety of scheduling approaches, including completely unscheduled (a la an ED or urgent care center), open blocks of time on certain days, and a specific number of appointments kept open in each clinic session. A practice could utilize more than one of these options, as well as traditionally scheduled appointments. The imperative is to do what makes sense for the patients and the providers.
For instance, it might make sense for an OB to block out Tuesday mornings for first and second trimester appointments and let patients come in at their convenience for these typically quick appointments. The methodology could also support scheduled group meetings at the beginning or end of the open access period to disseminate general information and answer typical questions. Another alternative is to reserve the last appointment time in each clinic session for same-day appointments, and be willing to work through lunch or after the regular workday until all patients have been seen.
Making open access work
Open access requires an explicit service promise from the practice to the patient. The purpose of a service promise is to manage patients' expectations and provide something against which to hold the practice accountable.
Here's an example of a service promise related to open access:
- If you call our office before 9 a.m. and want to be seen the same day, someone in the practice will see you before the end of the day.
- If you call our office after 9 a.m. and want to be seen the same day, you may have to wait until the next business day to be seen.
- The provider you see (if it is not your primary physician) may ask you to make a follow-up appointment with your regular physician.
Solutions to common open access concerns
• How does a practice avoid empty appointment slots on some days and being overwhelmed on other days?
The solution is not necessarily easy, but it is simple: Ease into open access based upon a good understanding of your current operations. Monday mornings are probably a busy time for the phones, as patients call in about problems encountered during the weekend. Does that mean that the practice needs more open time on Monday morning, or does Monday afternoon make more sense?
Based upon the specialty and the patient population, some types of appointments will create natural opportunities for open access and they don't have to be every week or every month. A pediatrics practice, for example, might run an immunization or sports exam clinic for parts of several days just before school starts. • What about insurance verification?
The best answer is to have an effective way to quickly verify insurance coverage. Supplement that process by asking patients to provide a credit card to be billed in the event the office cannot verify insurance coverage. If the patient subsequently provides adequate, current insurance information, the practice can file the claim and have the payment sent to the patient.
Authorizing a charge in lieu of insurance is more palatable to patients when the practice is accommodating them with promptly provided care. Benefits of at least partial open access
The two primary benefits are increased patient satisfaction and improved practice productivity. Patients are happier because they can be seen more quickly. They are also happier because they can be seen in their regular setting with all of their records available, instead of in an urgent care center they know nothing about.
Waiting room time, within reasonable bounds, is not as aggravating when there is not a set appointment time. Practice productivity should increase for several reasons. No shows and cancellations drop because less time elapses between the appointment and its scheduling. Average visit lengths tend to be shorter because the visit is more focused on the precipitating issue. Open access visits require no appointment reminders.
Courtesy of: Physicians Practice http://www.physicianspractice.com/blog/how-implement-open-access-scheduling-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=07032014#sthash.0TQZoIZi.dpuf
Wednesday, March 5, 2014
Road to 10: The Small Physician Practice's Route to ICD-10 From CMS
CMS has created “Road to 10” to help you jump start the transition to ICD-10.
Built with the help of small practice physicians, “Road to 10” is a no-cost tool that will help you:
- Get an overview of ICD-10
- Explore Specialty References by selecting a specialty
- Click the BUILD YOUR ACTION PLAN box to create your personal action plan
http://www.roadto10.org/
Specialties include: Family Practice, Pediatrics, OB/GYN, Cardiology, Orthopedics, Internal Medicine and other.
Eight Easy Ways to Boost Medical Practice Efficiency
In this presentation, family ph
ysician L. Gordon Moore, who is often credited with pioneering the micropractice model, in which physicians employ no or very few staff members and rely heavily on technology, shares his top eight efficiency improvement tips.
ysician L. Gordon Moore, who is often credited with pioneering the micropractice model, in which physicians employ no or very few staff members and rely heavily on technology, shares his top eight efficiency improvement tips. Follow this link to view the presentation:
http://www.physicianspractice.com/articles/eight-easy-ways-boost-medical-practice-efficiency?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=14022014
Improve Your Medical Practice Billing Process in a Few Simple Steps
By P.j. Cloud-moulds from Physicians Practice
My old primary-care physician was a really great physician. She spent enough time with me, asked great questions, was always available, and took very good care of me.
So then why is she no longer my physician after fifteen years? Because of the back-office billing staff. They were rude, unorganized, didn't know how to post payments for the life of them, and continuously billed me in error. This is a very, very common problem in most physician practices. Have you read your Yelp or Healthgrades reviews? They may say something like: “My doctor's care was great, but the billing office experience was awful.” If this is the case in your practice, fear not. I have cracked the code on customer service in the billing department. At my practice, I started testing this new process after an outstanding brainstorming session with my staff. They were very eager to change the flawed billing process, and we fumbled through a few revisions before we finally got it right. Here's what we do:
Make strides towards providing a good billing experience for your patients. We have and it has made all of the difference in the world. Remember, “That's just the way it is” is a crutch and an excuse for not being brave enough to change what needs changing.
Article from physicians Practice: http://www.physicianspractice.com/blog/improve-your-medical-practice-billing-process-few-simple-steps?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=04032014
My old primary-care physician was a really great physician. She spent enough time with me, asked great questions, was always available, and took very good care of me.
So then why is she no longer my physician after fifteen years? Because of the back-office billing staff. They were rude, unorganized, didn't know how to post payments for the life of them, and continuously billed me in error. This is a very, very common problem in most physician practices. Have you read your Yelp or Healthgrades reviews? They may say something like: “My doctor's care was great, but the billing office experience was awful.” If this is the case in your practice, fear not. I have cracked the code on customer service in the billing department. At my practice, I started testing this new process after an outstanding brainstorming session with my staff. They were very eager to change the flawed billing process, and we fumbled through a few revisions before we finally got it right. Here's what we do:
- Once we close the month for processing, statements are run.
- Immediately, we review each and every statement. It took us about three months to clean up the riff raff that was plaguing accounts receivable
- During the statement review, we consider four important questions:
- Did our system post the monies properly, and is this a true patient balance?
- Has this patient been on the A/R list for more than 90 days? If yes, we send them a pre-collections letter. If they then don't pay within 15 days, we send them to collections.
- If the patient is showing a balance, is it because it was not processed by the insurance per the original verification?
- If the patient is showing a balance, is it because it was not collected up front or posted properly in the system? We also identify the exact date of service a payment is missing.
- Once we have reviewed all of the statements and we have identified true statement balances, we check in with the front-office staff to see if they have receipts for those specific dates of service. If they have receipts, we post them and remove the statement from the list going out.
- We document this information in an easy to access spreadsheet-type format so that when patients call in, we have already identified the problem and can quickly, and efficiently answer their question with full confidence.
Make strides towards providing a good billing experience for your patients. We have and it has made all of the difference in the world. Remember, “That's just the way it is” is a crutch and an excuse for not being brave enough to change what needs changing.
Article from physicians Practice: http://www.physicianspractice.com/blog/improve-your-medical-practice-billing-process-few-simple-steps?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=04032014
Wednesday, February 12, 2014
Medicare Redeterminations: Top Five Requested Codes and Tips
Redeterminations: Top Five Requested Codes and Tips
Noridian conducted data analysis on the top procedure codes from redetermination requests submitted since October 2013. Below are the top five CPT/HCPCS codes, resources and tips to assist your office when submitting such requests.
CPT 88305 - Pathology Examination of Tissue Using a Microscope
CPT 88305 - Pathology Examination of Tissue Using a Microscope
- These appeals were denied because the requesting party failed to provide the following:
- Indicate requirement of a valid order/intent to order.
- Documentation must be signed and dated by the performing provider.
- Pathology Reports - Include surgery/procedure notes when biopsies taken.
- These appeals were denied because the requesting party failed to provide the following:
- Evaluation and Management (E/M) outpatient/office notes must be dated and signed by the performing provider. Medical necessity is required for this level of service. Services must meet requirements of this code, including two of the three components:
- Detailed history
- Detailed exam
- Medical decision making of moderate complexity located in CPT book
- For further clarification:
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 23, Section 30
- CMS IOM Publication100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.7
- CMS 1995 Documentation Guidelines for Evaluation and Management Services
- CMS 1997 Documentation Guidelines for Evaluation and Management Services
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 23, Section 30
- Evaluation and Management (E/M) outpatient/office notes must be dated and signed by the performing provider. Medical necessity is required for this level of service. Services must meet requirements of this code, including two of the three components:
- These appeals were denied because the requesting party failed to provide the following:
- 99232 should only be billed once per day by providers of the same group/specialty. Exception: Multiple visits in same the day for unrelated issues. Medical necessity is required for this level of service. Documentation must support additional services.
- Documentation submitted with the redetermination request must be signed and dated by the performing provider and must meet two of the three key components
- Expanded problem focused history
- Expanded problem focused exam or
- Medical decision making of moderate complexity
- For further clarification:
- These appeals were denied because the requesting party failed to provide the following:
- Provides the same instructions as those for 99232 with the following exception:
- 99233 should meet two of the three components:
- Detailed interval history
- Detailed exam
- Medical decision making of high complexity
- Medical necessity is required for this level of service.
- For further clarification:
- 99233 should only be billed once per day by providers of the same group/specialty. Exception: Multiple visits in the same day for unrelated issues. Documentation must support additional services.
- For further clarification:
- These appeals were denied because the requesting party failed to provide the following:
- Include the following documentation in the request:
- Trip report which must be signed and dated by a crew member.
- Discharge notes
- Progress notes that support the necessity of the ambulance trip
- Certification for medical necessity of the ambulance transport
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 10
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 15
- Include the following documentation in the request:
Last Updated Jan 30, 2014
Wednesday, January 29, 2014
Five Tips to Reduce Patient Dissatisfaction with Wait Times
By David Doyle from Physicians Practice
According to a recent study released by Software Advice, 97 percent of patients are frustrated by wait times at the doctor’s office. Fortunately there are some low-cost and even cost-free ways for physicians to reduce overall patient dissatisfaction with wait times.
1. Keep Patients Occupied
Idle time tends to feel longer; so one way to make a long wait more bearable is to keep your patients occupied. Many practices accomplish this by having patients fill out paperwork, but too much busy work creates additional frustrations. The recent widespread implementation of electronic health records (EHRs) makes this a short-term solution at best.
One tried-and-true method for keeping patients occupied is to stock the waiting room with a wide selection of current magazines, newspapers, and other reading materials. For a more modern approach, consider adding complimentary Wi-Fi service so patients can use their smartphones, tablets, or laptops while they wait. Software Advice reported that 60 percent of their study respondents believed that access to free Wi-Fi would minimize their level of frustration in the waiting room.
2. Set Expectations
Unclear wait times have also been shown to contribute to patient frustration, and the same holds true outside of your practice. Thus, wait times are now provided for everything from pizza delivery to standing in line for a theme park ride. Yet some practices still fail to provide an estimated wait time for their patients. Offering a rough estimate lets patients know they have time to open a magazine or load a website on their smart phones instead of anxiously eyeing the clock and wondering what’s taking the doctor so long.
3. Explain the Wait Time and Provide Updates
One reason why long waits are so agitating is because patients feel as though their time isn’t being respected by the practice. Instead of letting patients assume the worst, whenever possible your staff should provide an explanation for the wait and ease patients’ concerns. Patients will often flip from feeling frustrated to forgiving upon learning that the physician was called into an emergency surgery or that the office’s EHR system is temporarily down. After informing patients about the reason for a delay or long wait, provide periodic updates so they don’t feel forgotten.
4. Break Up the Wait
Breaking up the wait by moving patients to different locations in the office will help patients feel like their appointments are starting on time. Have an assistant or nurse begin the appointment at the scheduled start time by bringing the patient into an exam room. Even if a patient has to wait to be seen by the doctor, the delay feels shorter in the exam room than out in the waiting room. Software Advice found that females are more likely than males (40 percent versus 33 percent) to prefer waiting in a private exam room.
5. Ask for Patient Feedback
Everyone likes to feel heard. So in many instances, simply asking patients for feedback after their appointments will minimize dissatisfaction. Strauss & Seidel found that dissatisfied customers whose complaints are taken care of are more likely to recommend the business to others than are satisfied customers. Consider administering a brief survey to gauge patient attitudes about your practice’s wait time. Your patients will appreciate the opportunity to voice any frustrations and that you care enough about their waiting room experience to look for ways to improve it.
Sometimes you cannot avoid long wait times, but taking these five steps to ensure a positive experience for your patients will keep them from negatively affecting your practice’s reputation.
According to a recent study released by Software Advice, 97 percent of patients are frustrated by wait times at the doctor’s office. Fortunately there are some low-cost and even cost-free ways for physicians to reduce overall patient dissatisfaction with wait times.
1. Keep Patients Occupied
Idle time tends to feel longer; so one way to make a long wait more bearable is to keep your patients occupied. Many practices accomplish this by having patients fill out paperwork, but too much busy work creates additional frustrations. The recent widespread implementation of electronic health records (EHRs) makes this a short-term solution at best.
One tried-and-true method for keeping patients occupied is to stock the waiting room with a wide selection of current magazines, newspapers, and other reading materials. For a more modern approach, consider adding complimentary Wi-Fi service so patients can use their smartphones, tablets, or laptops while they wait. Software Advice reported that 60 percent of their study respondents believed that access to free Wi-Fi would minimize their level of frustration in the waiting room.
2. Set Expectations
Unclear wait times have also been shown to contribute to patient frustration, and the same holds true outside of your practice. Thus, wait times are now provided for everything from pizza delivery to standing in line for a theme park ride. Yet some practices still fail to provide an estimated wait time for their patients. Offering a rough estimate lets patients know they have time to open a magazine or load a website on their smart phones instead of anxiously eyeing the clock and wondering what’s taking the doctor so long.
3. Explain the Wait Time and Provide Updates
One reason why long waits are so agitating is because patients feel as though their time isn’t being respected by the practice. Instead of letting patients assume the worst, whenever possible your staff should provide an explanation for the wait and ease patients’ concerns. Patients will often flip from feeling frustrated to forgiving upon learning that the physician was called into an emergency surgery or that the office’s EHR system is temporarily down. After informing patients about the reason for a delay or long wait, provide periodic updates so they don’t feel forgotten.
4. Break Up the Wait
Breaking up the wait by moving patients to different locations in the office will help patients feel like their appointments are starting on time. Have an assistant or nurse begin the appointment at the scheduled start time by bringing the patient into an exam room. Even if a patient has to wait to be seen by the doctor, the delay feels shorter in the exam room than out in the waiting room. Software Advice found that females are more likely than males (40 percent versus 33 percent) to prefer waiting in a private exam room.
5. Ask for Patient Feedback
Everyone likes to feel heard. So in many instances, simply asking patients for feedback after their appointments will minimize dissatisfaction. Strauss & Seidel found that dissatisfied customers whose complaints are taken care of are more likely to recommend the business to others than are satisfied customers. Consider administering a brief survey to gauge patient attitudes about your practice’s wait time. Your patients will appreciate the opportunity to voice any frustrations and that you care enough about their waiting room experience to look for ways to improve it.
Sometimes you cannot avoid long wait times, but taking these five steps to ensure a positive experience for your patients will keep them from negatively affecting your practice’s reputation.
Obamacare's Big Changes Change Little for Physicians
By James Doulgeris and Nicholas Bonvicino, MD taken from Physicians Practice
"It starts with complete command of the fundamentals," Jesse Owens explained about his dominance in the Olympics. Athletes know that. Engineers know that. Plumbers and tradesmen know that.
Congress and the Obama administration could learn a lot from these working folk. Their single-minded conviction that mandating massive changes to healthcare's banking system will somehow fix a fundamentally broken healthcare-delivery system is like trying to fix government bureaucracy by changing the tax code.
With one-sixth of the U.S. economy in the balance, politics and egos have to move aside in both parties to face reality instead of reelection.
American medicine, with all of its technological, training, and fiscal prowess, has lost its way. This is the place to be if you have a complex trauma or disease. We invent and have an overabundance of the most sophisticated diagnostics, pharmacology, and facilities in the world.
But if you have a chronic condition like diabetes, COPD, or CHF, where 80 percent of our overall healthcare dollars go and 96 percent of Medicare dollars go, you are better off in 45 other countries, many of which are in what we consider the “third world.”
As our costs have gone up, our relative standing in many key metrics of population health have fallen far behind. An argument for socialized medicine and more primitive technology? Hardly.
An argument for more attention to prevention, personalized care, and integration of medical care with social institutions, you bet!
Our system has come to treat symptoms instead of people, and Obamacare reinforces the problem fiscally and philosophically. Case in point: Providing a diabetic with insurance that doesn’t pay to motivate, teach, or provide the support for what needs to be done between doctor visits is worse than wasteful. Further, applying high individual deductibles that discourage frequent and regular office and home care visits that can improve compliance and health status are a drop in the bucket compared to the costs of an amputation or blindness.
Since we are talking policy, what are the fundamentals on a policy basis?
1. Technology reform. Obamacare’s $16 billion program encouraging and funding stand-alone electronic medical records systems back fired. They boost compensation instead of collaboration, increasing costs while doing nothing to increase efficiency or effectiveness. EHR systems were created to maximize reimbursement by exploiting the inherent flaws in fee-for-service reimbursement by boosting up-coding and high-cost service production. Supporting common, interoperable platforms that transform EHR data into actionable information to manage population health and cost, removing regulatory stonewalls, and requiring EHR providers to allow access to their data platforms to make common platforms work fixes the problem.
2. Reimbursement reform. Get serious about paying for results instead of tasks. Encourage physician-owned and -led networks financially and with regulatory and tort relief, and eliminate the Rube Goldberg gain-sharing schemes. Make it simple: premium less actual cost = savings. Then split them. Value versus volume. Reimbursement for results. Pay for performance. They all mean savings, and not the few percent from tweaking the status quo, but hundreds of billions from allowing the free market to perform.
3. Reform reform. Get hospitals out of the accountable care business. Savings come from keeping patients OUT of the hospital, and successful accountable care organizations are a fiscal disaster for them. Instead of enabling regional hospital monopolies that eliminate competition, particularly lower-cost community hospitals, enable primary-care physicians to become "purchasing agents" for their patients. This will foster competition on price, quality, and safety through price transparency in the marketplace. Remove the shackles and allow them to do what is right instead of complying with what is regulated.Managing safety, fair play, and honest competition and preventing and dealing with abuses quickly and firmly are the government's job. Central management is not.
4. Tort reform. Instead of holding physicians liable for not using the best technology, indemnify them when they use best practices.These things are not liberal or conservative, political or progressive — they are practical. And, way overdue.
Courtesy of Physicians Practice
"It starts with complete command of the fundamentals," Jesse Owens explained about his dominance in the Olympics. Athletes know that. Engineers know that. Plumbers and tradesmen know that.
Congress and the Obama administration could learn a lot from these working folk. Their single-minded conviction that mandating massive changes to healthcare's banking system will somehow fix a fundamentally broken healthcare-delivery system is like trying to fix government bureaucracy by changing the tax code.
With one-sixth of the U.S. economy in the balance, politics and egos have to move aside in both parties to face reality instead of reelection.
American medicine, with all of its technological, training, and fiscal prowess, has lost its way. This is the place to be if you have a complex trauma or disease. We invent and have an overabundance of the most sophisticated diagnostics, pharmacology, and facilities in the world.
But if you have a chronic condition like diabetes, COPD, or CHF, where 80 percent of our overall healthcare dollars go and 96 percent of Medicare dollars go, you are better off in 45 other countries, many of which are in what we consider the “third world.”
As our costs have gone up, our relative standing in many key metrics of population health have fallen far behind. An argument for socialized medicine and more primitive technology? Hardly.
An argument for more attention to prevention, personalized care, and integration of medical care with social institutions, you bet!
Our system has come to treat symptoms instead of people, and Obamacare reinforces the problem fiscally and philosophically. Case in point: Providing a diabetic with insurance that doesn’t pay to motivate, teach, or provide the support for what needs to be done between doctor visits is worse than wasteful. Further, applying high individual deductibles that discourage frequent and regular office and home care visits that can improve compliance and health status are a drop in the bucket compared to the costs of an amputation or blindness.
Since we are talking policy, what are the fundamentals on a policy basis?
1. Technology reform. Obamacare’s $16 billion program encouraging and funding stand-alone electronic medical records systems back fired. They boost compensation instead of collaboration, increasing costs while doing nothing to increase efficiency or effectiveness. EHR systems were created to maximize reimbursement by exploiting the inherent flaws in fee-for-service reimbursement by boosting up-coding and high-cost service production. Supporting common, interoperable platforms that transform EHR data into actionable information to manage population health and cost, removing regulatory stonewalls, and requiring EHR providers to allow access to their data platforms to make common platforms work fixes the problem.
2. Reimbursement reform. Get serious about paying for results instead of tasks. Encourage physician-owned and -led networks financially and with regulatory and tort relief, and eliminate the Rube Goldberg gain-sharing schemes. Make it simple: premium less actual cost = savings. Then split them. Value versus volume. Reimbursement for results. Pay for performance. They all mean savings, and not the few percent from tweaking the status quo, but hundreds of billions from allowing the free market to perform.
3. Reform reform. Get hospitals out of the accountable care business. Savings come from keeping patients OUT of the hospital, and successful accountable care organizations are a fiscal disaster for them. Instead of enabling regional hospital monopolies that eliminate competition, particularly lower-cost community hospitals, enable primary-care physicians to become "purchasing agents" for their patients. This will foster competition on price, quality, and safety through price transparency in the marketplace. Remove the shackles and allow them to do what is right instead of complying with what is regulated.Managing safety, fair play, and honest competition and preventing and dealing with abuses quickly and firmly are the government's job. Central management is not.
4. Tort reform. Instead of holding physicians liable for not using the best technology, indemnify them when they use best practices.These things are not liberal or conservative, political or progressive — they are practical. And, way overdue.
Courtesy of Physicians Practice
Wednesday, January 15, 2014
Top Ten Tech Tools for Your Medical Practice
By Rosemarie Nelson taken from Physicians Practice
It doesn't matter how busy the other guy tells you he is; you know you are even busier. While you can fit more in a day than the average person and usually accomplish this before they even wake up, that doesn't mean you can't use a little help. Here are 10 time-saving apps and technology tips that can make your personal and professional life easier.
1. Epocrates. It's likely that you know about this mobile drug-reference resource. It's free and as many as 50 percent of U.S. physicians rely on Epocrates to help improve patient safety and increase practice efficiency. For an annual subscription fee, you can also have access to ICD-9 and CPT billing codes, lab tests and panels with reference ranges, and more.
2. Quick response codes. By scanning a QR code (similar to a bar code) using a smartphone camera, you can access data that links your phone directly to a webpage. For example, if you add QR codes to patient statements, patients can easily link to your payment page online. There are multiple, free QR code generation websites: Qrstuff.com, Zxing.appspot.com/generator, Quikqr.com. Create the code, print it, and you're ready to go.
3. Patient education apps. There are plenty of apps to help patients keep track of and understand their health, but two that are particularly useful are:
• DrawMD (free in Apple app store) — physicians can sketch, stamp, or type on detailed anatomic images and then save them to the EHR and/or share images with patients.
• NumeraNET (free in Apple app store) — patients can share information such as weight, blood pressure, and pedometer results with physicians, who can then send the information to their EHR.
4. Telecommuting. Telecommuting is not just for your transcriptionist — think coding and billing staff and even phone operations. www.telecommute.org
5. Back up data. Not just your practice management system, but your entire PC network so that all those documents and forms and accounts payable records are all safely stored and retrievable if a problem occurs. Investigate Internet-based services for data backup such as HP Live Vault or OffSite Backup.
6. Doximity. This app provides access to a social network for physicians and healthcare professionals across the United States — similar to "LinkedIn." Features include a free digital fax, ability to upload your CV, and earn honoraria. Free.
7. Password management. Passwords, while they can be troublesome, are a necessity. Be sure that you force a password change for all users on your network at least once per quarter. Do not allow staff to post their passwords anywhere. Change all passwords for all staff and providers whenever an employee resigns or is terminated. Check out RoboForm. It provides a master password and inserts a toolbar into your browser to auto-logon for up to 10 applications for free ($29.95 for more).
8. Patient surveys. Survey on the Spot, a free app in Apple's online store, allows you to gather instant feedback on your practice with custom surveys; see compiled survey results in your account and get software alerts when a patient rates your service as poor.
9. Kiosks. Let your patients check-in and make their copayment at a kiosk in your reception area. Some kiosks will even verify insurance eligibility! A few of the vendors you might consider are: OTech Group, ClearWave, SeePoint, and Phreesia.
10. Get in shape. Feeling great can help you be even more productive. Try these two apps for your smartphone:
• Crossfit Daily. Get your daily workout with how-to details, including video. Each workout will provide the benchmark for you and feedback from others attempting these serious exercises. Free.
• LoseIt. Enter your daily calorie budget and throughout the day you can add the food you take in and the exercise you complete. Voila! Are you under (weight loss) or over (weight gain) your budget? The app is easy to use, allowing you to create "My Foods" lists, custom recipes, and brand name food lists. Free.
The approach to effective use of technology tools is incremental. If you wait until the next version comes out, or the next upgrade, or the complete interface, or … you will miss many opportunities to reap incremental benefits. "All or nothing" is a losing proposition. Take small steps down the path of technology and you will gain big returns for yourself and for your practice.
Courtesy of: http://www.physicianspractice.com/technology/top-ten-tech-tools-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=19122013
It doesn't matter how busy the other guy tells you he is; you know you are even busier. While you can fit more in a day than the average person and usually accomplish this before they even wake up, that doesn't mean you can't use a little help. Here are 10 time-saving apps and technology tips that can make your personal and professional life easier.
1. Epocrates. It's likely that you know about this mobile drug-reference resource. It's free and as many as 50 percent of U.S. physicians rely on Epocrates to help improve patient safety and increase practice efficiency. For an annual subscription fee, you can also have access to ICD-9 and CPT billing codes, lab tests and panels with reference ranges, and more.
2. Quick response codes. By scanning a QR code (similar to a bar code) using a smartphone camera, you can access data that links your phone directly to a webpage. For example, if you add QR codes to patient statements, patients can easily link to your payment page online. There are multiple, free QR code generation websites: Qrstuff.com, Zxing.appspot.com/generator, Quikqr.com. Create the code, print it, and you're ready to go.
3. Patient education apps. There are plenty of apps to help patients keep track of and understand their health, but two that are particularly useful are:
• DrawMD (free in Apple app store) — physicians can sketch, stamp, or type on detailed anatomic images and then save them to the EHR and/or share images with patients.
• NumeraNET (free in Apple app store) — patients can share information such as weight, blood pressure, and pedometer results with physicians, who can then send the information to their EHR.
4. Telecommuting. Telecommuting is not just for your transcriptionist — think coding and billing staff and even phone operations. www.telecommute.org
5. Back up data. Not just your practice management system, but your entire PC network so that all those documents and forms and accounts payable records are all safely stored and retrievable if a problem occurs. Investigate Internet-based services for data backup such as HP Live Vault or OffSite Backup.
6. Doximity. This app provides access to a social network for physicians and healthcare professionals across the United States — similar to "LinkedIn." Features include a free digital fax, ability to upload your CV, and earn honoraria. Free.
7. Password management. Passwords, while they can be troublesome, are a necessity. Be sure that you force a password change for all users on your network at least once per quarter. Do not allow staff to post their passwords anywhere. Change all passwords for all staff and providers whenever an employee resigns or is terminated. Check out RoboForm. It provides a master password and inserts a toolbar into your browser to auto-logon for up to 10 applications for free ($29.95 for more).
8. Patient surveys. Survey on the Spot, a free app in Apple's online store, allows you to gather instant feedback on your practice with custom surveys; see compiled survey results in your account and get software alerts when a patient rates your service as poor.
9. Kiosks. Let your patients check-in and make their copayment at a kiosk in your reception area. Some kiosks will even verify insurance eligibility! A few of the vendors you might consider are: OTech Group, ClearWave, SeePoint, and Phreesia.
10. Get in shape. Feeling great can help you be even more productive. Try these two apps for your smartphone:
• Crossfit Daily. Get your daily workout with how-to details, including video. Each workout will provide the benchmark for you and feedback from others attempting these serious exercises. Free.
• LoseIt. Enter your daily calorie budget and throughout the day you can add the food you take in and the exercise you complete. Voila! Are you under (weight loss) or over (weight gain) your budget? The app is easy to use, allowing you to create "My Foods" lists, custom recipes, and brand name food lists. Free.
The approach to effective use of technology tools is incremental. If you wait until the next version comes out, or the next upgrade, or the complete interface, or … you will miss many opportunities to reap incremental benefits. "All or nothing" is a losing proposition. Take small steps down the path of technology and you will gain big returns for yourself and for your practice.
Courtesy of: http://www.physicianspractice.com/technology/top-ten-tech-tools-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=19122013
Monday, January 13, 2014
Seven Simple Strategies to Market Your Medical Practice
Getting in the habit of actively marketing your practice shouldn't have to wait until your New Year's Resolutions. Get started today with these seven simple strategies to market your medical practice:
1. Have a blog connected to your practice website. Blog often and about a variety of topics. And make sure people can subscribe to your blog by e-mail (which is more beneficial for your marketing efforts than RSS feeds). 2. Turn your existing patients into raving fans. It is easier to maintain an existing patient base then it is to find new prospective patients and convert them into patients. Make sure you and your staff over deliver and takes excellent care of the patients who love you already. Those patients will become raving fans and carry the load of some of your marketing for you. 3. Gather testimonials. If you have ancillary products or services and they have worked for you personally or for your staff and your services, save them and use them on your website, for social media, or for other marketing efforts. This builds credibility and social proof that you are amazing. 4. Stay in touch. Take those e-mail addresses that you gathered in the first strategy and stay in touch with your patients, at least monthly. Make sure you include a note from a provider or staff member, a recommendation of a product/service/event, and a short article of helpful content. 5. Be open. Make sure your marketing message conveys what patients, disease processes, or diagnoses you are passionate about (market to your ideal patients). By showing up and showing who you are and what you have, you will invite the type of patients that will make your practice both successful and joyful for you. 6. Participate in the media. Seek out and take opportunities to be featured in the media as an expert and share those appearances in your marketing efforts. You could be featured nationally or locally, in print or online, or even on television or the radio. It is often as simple as sending an e-mail or making a call. 7. Get offline too. It would make all of our lives easier if we could only use online or offline-marketing strategies to market practices. The fact of the matter is that with a "brick-and-mortar" business (which is what a medical practice is), you must be involved and present in your local community. Both online and offline marketing works together in synergy to get the desired effect of bringing in more patients to grow your practice.
Pick a few of the strategies that you can begin immediately with the goal being to implement all of them by the end of January 2014. Once you get in the marketing groove, you will find that marketing is fun and even a joyful experience. Rome wasn't built in a day; it takes 21 days to form a habit and in the case of marketing, six to 12 months to be great at it, but stick with it … it will pay off.
From Physicians Practice, By Audrey "Christie" Mclaughlin, RN: http://www.physicianspractice.com/blog/seven-simple-strategies-market-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=17122013
1. Have a blog connected to your practice website. Blog often and about a variety of topics. And make sure people can subscribe to your blog by e-mail (which is more beneficial for your marketing efforts than RSS feeds). 2. Turn your existing patients into raving fans. It is easier to maintain an existing patient base then it is to find new prospective patients and convert them into patients. Make sure you and your staff over deliver and takes excellent care of the patients who love you already. Those patients will become raving fans and carry the load of some of your marketing for you. 3. Gather testimonials. If you have ancillary products or services and they have worked for you personally or for your staff and your services, save them and use them on your website, for social media, or for other marketing efforts. This builds credibility and social proof that you are amazing. 4. Stay in touch. Take those e-mail addresses that you gathered in the first strategy and stay in touch with your patients, at least monthly. Make sure you include a note from a provider or staff member, a recommendation of a product/service/event, and a short article of helpful content. 5. Be open. Make sure your marketing message conveys what patients, disease processes, or diagnoses you are passionate about (market to your ideal patients). By showing up and showing who you are and what you have, you will invite the type of patients that will make your practice both successful and joyful for you. 6. Participate in the media. Seek out and take opportunities to be featured in the media as an expert and share those appearances in your marketing efforts. You could be featured nationally or locally, in print or online, or even on television or the radio. It is often as simple as sending an e-mail or making a call. 7. Get offline too. It would make all of our lives easier if we could only use online or offline-marketing strategies to market practices. The fact of the matter is that with a "brick-and-mortar" business (which is what a medical practice is), you must be involved and present in your local community. Both online and offline marketing works together in synergy to get the desired effect of bringing in more patients to grow your practice.
Pick a few of the strategies that you can begin immediately with the goal being to implement all of them by the end of January 2014. Once you get in the marketing groove, you will find that marketing is fun and even a joyful experience. Rome wasn't built in a day; it takes 21 days to form a habit and in the case of marketing, six to 12 months to be great at it, but stick with it … it will pay off.
From Physicians Practice, By Audrey "Christie" Mclaughlin, RN: http://www.physicianspractice.com/blog/seven-simple-strategies-market-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=17122013
Forgiving Patient Copays Can Lead to Unforgiving Consequences
At one time in America, there was no such thing as "health insurance." Patients negotiated directly with hospitals and doctors, and paid what they could, often on a sliding scale, according to ability. Eventually, health insurance entered the market, easing the burden of healthcare costs.
It didn't take long to realize the ordinary rules of supply and demand would not apply, if the insurance company, not the patient, was responsible for the bill. Copayments, deductibles, and coinsurance developed as a check against overutilization. If the patient had some "skin" in the game, this would provide some disincentive, though not absolute, but some hedge against over-use. This protective requirement, though necessary, is at times at odds with AMA Code of Ethics Opinion 8.03, which holds: "The primary objective of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration.
"In the current economy, as available dollars are becoming scarce, insurance carriers have begun checking up on the collection of copayments, deductibles, and coinsurance. With greater regularity, physicians and hospitals are receiving letters requesting proof, in perhaps five randomly selected cases, that the provider has collected, or sufficiently attempted to collect the portion of fees which is the patient's responsibility. This comes as a shock to many providers, who in keeping with Opinion 8.03, and the historical tradition of sliding scales, based upon ability to pay, have subordinated financial ability to pay in favor of the higher duty to care for the patient's need.
It is important to understand, however, forgiveness of copayments could land you in hot water. Therefore, doctors must understand the rules regarding waiver of copayments. AMA Opinion 6.12 addresses the ethical considerations:
Opinion 6.12 - Forgiveness or Waiver of Insurance Copayments
Under the terms of many health insurance policies or programs, patients are made more conscious of the cost of their medical care through copayments. By imposing copayments for office visits and other medical services, insurers hope to discourage unnecessary healthcare. In some cases, financial hardship may deter patients from seeking necessary care if they would be responsible for a copayment for the care. Physicians commonly forgive or waive copayments to facilitate patient access to needed medical care. When a copayment is a barrier to needed care because of financial hardship, physicians should forgive or waive the copayment.
A number of clinics have advertised their willingness to provide detailed medical evaluations and accept the insurer's payment but waive the copayment for all patients.
Physicians should be aware that forgiveness or waiver of copayments may violate the policies of some insurers, both public and private; other insurers may permit forgiveness or waiver if they are aware of the reasons for the forgiveness or waiver. Routine forgiveness or waiver of copayments may constitute fraud under state and federal law. Physicians should ensure that their policies on copayments are consistent with applicable law and with the requirements of their agreements with insurers.
Where the insurance contract requires a doctor to make reasonable attempts to collect the patient's portion, an open question surrounds the definition of "reasonable attempts to collect the debt." Historically, doctors could satisfy the requirement by sending at least three letters attempting to collect the debt. However, the Office of Inspector General (OIG) has taken the position that the routine waiver of copayments could constitute a criminal kickback in Medicare cases.
This has emboldened private insurers, who are relying upon this contractual provision as a basis for a post-payment recoupment audit. If a provider cannot demonstrate efforts to collect from the patient, the carrier may demand a refund for any benefits paid across a large patient population.
Providers should be aware of this new emphasis upon patient responsibility. My advice would be to proactively get ahead of the problem. Contact your insurance representative to find out what is expected of you and document the response. By all means, if you are a physician and you receive a letter from an insurance carrier requesting proof of attempts to collect, do not ignore it. A failure to cooperate could constitute grounds for termination of the contract with the payer.
Because this emphasis upon collection of copayments is a fairly recent phenomenon, even if you have been deficient in the past, you may be able to satisfy the carrier by demonstrating a corrective plan of action going forward.
Courtesy of Physicians Practice, By Martin Merritt http://www.physicianspractice.com/blog/forgiving-patient-copays-can-lead-unforgiving-consequences?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=17122013
It didn't take long to realize the ordinary rules of supply and demand would not apply, if the insurance company, not the patient, was responsible for the bill. Copayments, deductibles, and coinsurance developed as a check against overutilization. If the patient had some "skin" in the game, this would provide some disincentive, though not absolute, but some hedge against over-use. This protective requirement, though necessary, is at times at odds with AMA Code of Ethics Opinion 8.03, which holds: "The primary objective of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration.
"In the current economy, as available dollars are becoming scarce, insurance carriers have begun checking up on the collection of copayments, deductibles, and coinsurance. With greater regularity, physicians and hospitals are receiving letters requesting proof, in perhaps five randomly selected cases, that the provider has collected, or sufficiently attempted to collect the portion of fees which is the patient's responsibility. This comes as a shock to many providers, who in keeping with Opinion 8.03, and the historical tradition of sliding scales, based upon ability to pay, have subordinated financial ability to pay in favor of the higher duty to care for the patient's need.
It is important to understand, however, forgiveness of copayments could land you in hot water. Therefore, doctors must understand the rules regarding waiver of copayments. AMA Opinion 6.12 addresses the ethical considerations:
Opinion 6.12 - Forgiveness or Waiver of Insurance Copayments
Under the terms of many health insurance policies or programs, patients are made more conscious of the cost of their medical care through copayments. By imposing copayments for office visits and other medical services, insurers hope to discourage unnecessary healthcare. In some cases, financial hardship may deter patients from seeking necessary care if they would be responsible for a copayment for the care. Physicians commonly forgive or waive copayments to facilitate patient access to needed medical care. When a copayment is a barrier to needed care because of financial hardship, physicians should forgive or waive the copayment.
A number of clinics have advertised their willingness to provide detailed medical evaluations and accept the insurer's payment but waive the copayment for all patients.
Physicians should be aware that forgiveness or waiver of copayments may violate the policies of some insurers, both public and private; other insurers may permit forgiveness or waiver if they are aware of the reasons for the forgiveness or waiver. Routine forgiveness or waiver of copayments may constitute fraud under state and federal law. Physicians should ensure that their policies on copayments are consistent with applicable law and with the requirements of their agreements with insurers.
Where the insurance contract requires a doctor to make reasonable attempts to collect the patient's portion, an open question surrounds the definition of "reasonable attempts to collect the debt." Historically, doctors could satisfy the requirement by sending at least three letters attempting to collect the debt. However, the Office of Inspector General (OIG) has taken the position that the routine waiver of copayments could constitute a criminal kickback in Medicare cases.
This has emboldened private insurers, who are relying upon this contractual provision as a basis for a post-payment recoupment audit. If a provider cannot demonstrate efforts to collect from the patient, the carrier may demand a refund for any benefits paid across a large patient population.
Providers should be aware of this new emphasis upon patient responsibility. My advice would be to proactively get ahead of the problem. Contact your insurance representative to find out what is expected of you and document the response. By all means, if you are a physician and you receive a letter from an insurance carrier requesting proof of attempts to collect, do not ignore it. A failure to cooperate could constitute grounds for termination of the contract with the payer.
Because this emphasis upon collection of copayments is a fairly recent phenomenon, even if you have been deficient in the past, you may be able to satisfy the carrier by demonstrating a corrective plan of action going forward.
Courtesy of Physicians Practice, By Martin Merritt http://www.physicianspractice.com/blog/forgiving-patient-copays-can-lead-unforgiving-consequences?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=17122013
Why Cloud Services are Ready for Prime Time in Healthcare
Chances are, you've heard about cloud computing but may not know much about it and how it relates to HIPAA. Here, we answer a few key questions about cloud services.
Cloud hosting — what is it?Cloud hosting has many variants and goes by many names, but it generally refers to the IT model where a medical practice uses computer servers and data-storage systems located in a service provider's data center rather than onsite at the practice. Some people think that since the word "cloud" is used, there is somehow magically no more hardware issues to worry about. On the contrary, a typical cloud-hosting facility has massive amounts of hardware and software systems. Cloud is so new, is it right for healthcare?Cloud hosting is actually not a new concept. In fact, versions of cloud hosting under different names have been around for nearly 30 years. In the early days of massive mainframes, such companies as Boeing Computer Services and Computer Science Corporation offered these services under the terms "timeshare" and "service bureau." Over the years many other labels have been used, including application service provider (ASP), software-as-a-service (SaaS),infrastructure as a service (IaaS), utility computing, and hosting. Finally about five years ago, the label "cloud" finally took hold, and although some of the terms above are still relevant in specialized circumstances, cloud hosting covers the overall concept.
What has made it an attractive solution for healthcare? Recent advances in several areas, including server and storage virtualization, and increased bandwidth of broadband services, have made cloud hosting much more attractive. In addition, server architecture — including both processing horsepower and processing (CPUs) — have become massively scalable. And improvements in management software have significantly added to both performance and reliability. These advances in technology have prompted significant changes in the way cloud services can be configured and delivered. What about the cloud and HIPAA?Cloud services are not automatically HPAA compliant. In fact,not only are many cloud providers not HIPAA compliant, they are wholly ignorant of HIPAA principles. The new HIPAA Omnibus rule released earlier in 2013 required all service providers to undergo a HIPAA compliance and remediation program by September 23, 2013.
(If you are using a cloud provider, you should contact them and request a copy of their HIPAA compliance program documents, and also request that they sign a Business Associate Agreement. If they cannot produce them, or they are reluctant to execute a BAA, you have a major problem.)
Cloud-hosting services can be made HIPAA compliant, provided proper HIPAA security is built into the platform, along with HIPAA-compliant processes and procedures for its operation. Note: There are some common "cloud services" that you may be familiar with or are already using that are definitely not HIPAA compliant. These include common web mail services from many Internet Service Providers (ISPs) such as AOL, Gmail, Hotmail, etc. These are not — nor can they be made to be — HIPAA compliant. In addition, most of them specifically prohibit any kind of business use, so in using them in conjunction with a medical practice typically violates their "Terms of Use" policies.
What are the big advantages of cloud over onsite servers, storage, etc.? Perhaps the biggest advantages are in the ability to grow as the practice’s needs grow, and to avoid the costly and disruptive effects of repeated computer upgrades every few years. Most people understand that new computer systems are obsolete within a few months after they are installed. So system designers have to anticipate future needs and buy more capacity than they really need, based on anticipated requirements of a few years down the road. Eventually the needs increase and even the "new" equipment becomes underpowered. So in a computer system "lifecycle," for the first few years there is too much capacity, and for the last few years there is too little capacity. Therefore for most of the time, the system is either too big or too small. Cloud services allow the computing horsepower — CPU, memory and hard drive space — to be "dialed-up" as needs increase, so it can keep pace with the needs of the practice. And generally that upgrade can be done without the downtime typically associated with a computer system "forklift upgrade."
And a good cloud provider is generally able to offer access to hardware and software tools that would be unaffordable to a typical practice.
What about support?This is critical, and it is important to make sure you understand what is being provided to the practice by a cloud provider. With onsite servers and other infrastructure, you have to have staff (or contract with an IT provider) to maintain your servers and take care of things like data backups, operating system patches, etc. With cloud hosting, those services are still necessary, and in most cases they can be provided more efficiently than with an onsite model. However not all cloud providers deliver those services automatically, so you need to check and make sure. Are cloud services foolproof?No, since there is still hardware, software — and people — involved, there is still the potential for outages and downtime, so you need to do your homework and make sure you understand the risks as well as the advantages
My EHR is hosted —does that mean I’m good to go as far as HIPAA is concerned?
Not at all. There has never been a reported HIPAA breach from an EHR — either hosted or onsite. The main culprits have been e-mail, files stored locally, and the theft of portable devices like laptops and USB drives. So you need to consider your non-EHR applications, and make sure they are properly secured. This is true whether those applications are running locally or with a cloud provider. One advantage of properly designed cloud services is that they tend to not allow healthcare data to be stored on local devices.
Courtesy of Physicians Practice http://www.physicianspractice.com/blog/why-cloud-services-are-ready-prime-time-healthcare?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=12122013
Monday, December 9, 2013
Keeping Up with the Copay: Health Plan Changes Always Happen
By Melissa Young, MD from Physicians Practice
I’ll be the first to admit: I don’t know all the details of my own medical insurance plan. And I’m the one who chose it! I reviewed the benefits at the time. I looked at what the copays would be for office visits and meds, and I looked at what the out-of-network benefits would be. Thankfully, I have not really needed to use it much, so I have forgotten much of the details.
Many of my patients are no better. I doesn’t help that their employers change their plans from year to year. And even if they keep the same plan, the insurance companies change their formularies and their benefits all the time. It often comes as a complete surprise to patients.
For example, I have one patient for whom I prescribed a medication earlier this year. The cost to her at the time was minimal; her prescription plan paid for most of it. She is due for it again now, but now she has this big deductible and it is going to cost her hundreds of dollars. I also have a patient whose ultrasounds I used to do in the office …until her plan decided they didn’t cover it if it was done here, so now she has to get it done in radiology. Of course, neither of us knew that before the last ultrasound I did here. Drugs that didn’t need prior authorization six months ago need it now.
I am certain patients are informed one way or the other about changes in their copay (although many of them seem surprised when my staff asks them for $40 instead of $25 like they paid last time), and maybe they get notice about other changes, but I would not be surprised if they give any mail they get from their insurance company a quick glance and then toss it. I can’t say I blame them. We all get so much mail that looks like junk; it can be hard to figure out which ones are really important. And since things change from month to month, who can keep track of it all?
Courtesy of Physicians Practice: http://www.physicianspractice.com/blog/keeping-copay-health-plan-changes-always-happen?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=22112013
I’ll be the first to admit: I don’t know all the details of my own medical insurance plan. And I’m the one who chose it! I reviewed the benefits at the time. I looked at what the copays would be for office visits and meds, and I looked at what the out-of-network benefits would be. Thankfully, I have not really needed to use it much, so I have forgotten much of the details.
Many of my patients are no better. I doesn’t help that their employers change their plans from year to year. And even if they keep the same plan, the insurance companies change their formularies and their benefits all the time. It often comes as a complete surprise to patients.
For example, I have one patient for whom I prescribed a medication earlier this year. The cost to her at the time was minimal; her prescription plan paid for most of it. She is due for it again now, but now she has this big deductible and it is going to cost her hundreds of dollars. I also have a patient whose ultrasounds I used to do in the office …until her plan decided they didn’t cover it if it was done here, so now she has to get it done in radiology. Of course, neither of us knew that before the last ultrasound I did here. Drugs that didn’t need prior authorization six months ago need it now.
I am certain patients are informed one way or the other about changes in their copay (although many of them seem surprised when my staff asks them for $40 instead of $25 like they paid last time), and maybe they get notice about other changes, but I would not be surprised if they give any mail they get from their insurance company a quick glance and then toss it. I can’t say I blame them. We all get so much mail that looks like junk; it can be hard to figure out which ones are really important. And since things change from month to month, who can keep track of it all?
Courtesy of Physicians Practice: http://www.physicianspractice.com/blog/keeping-copay-health-plan-changes-always-happen?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=22112013
Health Insurance Exchanges: Two Key Issues to Discuss with Patients
The American Academy of Family Physicians (AAFP) is encouraging its members to provide their patients with information regarding health insurance exchanges.
The AAFP website advises: "During patient visits, be prepared to discuss the insurance options available through the marketplaces and encourage patients to make coverage decisions that are appropriate for their health care needs. "But not all doctors are ready to get involved.
The majority of physician respondents to a recent Medscape survey said that they should either have a limited role or no role in providing health insurance and health insurance exchange information to patients.
Yet, spending a few minutes sharing some key information about health insurance exchanges with interested patients may benefit you and your practice in the long run.
Here's why: If your patients that are shopping on the health insurance exchanges don't make well-informed purchasing decisions, you may see them less frequently. In fact, you may not see them at all.
Many of the health plans offered in the exchanges appear to have narrower networks — meaning patients will likely have fewer physicians and health systems to choose from within the plans.
In addition, many of the health plans offered in the exchanges have higher deductibles — meaning patients may end up shouldering more of their healthcare costs.
"They are trying to funnel people into narrow networks overall, and simultaneously shift people into higher cost sharing that is higher deductible, higher copay kind of plans," Kip Piper, a healthcare consultant in Washington, D.C., recently told Physicians Practice.
If patients purchase those higher cost sharing plans, it's likely that they will put off or avoid visiting your practice due to cost concerns, said Piper. In addition, higher patient cost sharing will place more burdens on your collections staff, as they will need to step up patient payment collection efforts.
For that reason, you might want to consider talking to your patients about the importance of finding a plan that does not require a lot of out of pocket costs. "Make sure that ... they're not enticed by a low premium to pick a plan that has a high cost sharing that then keeps them out of the doctor's office," said Piper.
The narrower networks offered by many of the plans may also pose problems for your practice.
If you are excluded from a plan or if you have decided to opt-out of a plan, you run the risk of losing your patients to providers who are participating in that plan. For that reason, you might want to share which plans you are participating in with patients.
"I'm afraid of a lot of people in January are going to start making an appointment and then they're going to find out they can't go to their doctor," said Piper.
Article By Aubrey Westgate from Physicians Practice http://www.physicianspractice.com/blog/health-insurance-exchanges-two-key-issues-discuss-patients?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=03122013
The AAFP website advises: "During patient visits, be prepared to discuss the insurance options available through the marketplaces and encourage patients to make coverage decisions that are appropriate for their health care needs. "But not all doctors are ready to get involved.
The majority of physician respondents to a recent Medscape survey said that they should either have a limited role or no role in providing health insurance and health insurance exchange information to patients.
Yet, spending a few minutes sharing some key information about health insurance exchanges with interested patients may benefit you and your practice in the long run.
Here's why: If your patients that are shopping on the health insurance exchanges don't make well-informed purchasing decisions, you may see them less frequently. In fact, you may not see them at all.
Many of the health plans offered in the exchanges appear to have narrower networks — meaning patients will likely have fewer physicians and health systems to choose from within the plans.
In addition, many of the health plans offered in the exchanges have higher deductibles — meaning patients may end up shouldering more of their healthcare costs.
"They are trying to funnel people into narrow networks overall, and simultaneously shift people into higher cost sharing that is higher deductible, higher copay kind of plans," Kip Piper, a healthcare consultant in Washington, D.C., recently told Physicians Practice.
If patients purchase those higher cost sharing plans, it's likely that they will put off or avoid visiting your practice due to cost concerns, said Piper. In addition, higher patient cost sharing will place more burdens on your collections staff, as they will need to step up patient payment collection efforts.
For that reason, you might want to consider talking to your patients about the importance of finding a plan that does not require a lot of out of pocket costs. "Make sure that ... they're not enticed by a low premium to pick a plan that has a high cost sharing that then keeps them out of the doctor's office," said Piper.
The narrower networks offered by many of the plans may also pose problems for your practice.
If you are excluded from a plan or if you have decided to opt-out of a plan, you run the risk of losing your patients to providers who are participating in that plan. For that reason, you might want to share which plans you are participating in with patients.
"I'm afraid of a lot of people in January are going to start making an appointment and then they're going to find out they can't go to their doctor," said Piper.
Article By Aubrey Westgate from Physicians Practice http://www.physicianspractice.com/blog/health-insurance-exchanges-two-key-issues-discuss-patients?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=03122013
Presentations to Physicians: Don't just Share Data, Provide Direction
Knowledge is power when it directs action. When someone is presenting a case or clinical research to a physician, both the presenter and the physician understand how the information can help the physician successfully address similar clinical circumstances in the future.
The purpose is the same in presentations of non-clinical information, but the implicit call for physician action is neither universally recognized nor understood. As a consequence, physicians are often left feeling helpless in the face of what is clearly bad news.
Consider some information recently shared during a Grand Rounds presentation to a group of orthopedic surgeons:
• In 2011, healthcare spending in the U.S. amounted to almost 19 percent of GDP. The inescapable conclusion is that we have reached the limit of funds available for healthcare, if we have not surpassed it. Physicians cannot rely upon new money coming into the healthcare system
• The payment system is opaque, particularly to patients. Most hospitals in a recent survey were either unable or unwilling to hazard even an estimate of the costs for a total hip replacement for a patient with no co morbidities. Other studies have shown that there is no relationship between hospital charges and what they actually get paid for services. Patients surveyed thought physicians' Medicare reimbursement for the surgery was five times what it is, and the patients thought it ought to be about four times the current rate.
• There is a mismatch between supply and demand. The population is aging, and the obesity epidemic puts unsustainable demands on lower extremity joints. Physicians are opting to limit their Medicare participation or retire early, rather than accept prospectively lower levels of reimbursement. Concurrent with a potential shortage of surgeons, hospitals have a lot of unused beds and are continuing to expand their physical plants.
• Physicians have not been effective in preserving their reimbursement rates. Reimbursement levels for hip surgery have declined by as much as 50 percent, in non-inflation adjusted dollars, in the last 30 years. At the same time, hospitals and implant manufacturers have seen their reimbursements more than double.
• The very high volume of total hip replacements performed in the US makes the procedure an obvious target for cost containment and cost reduction.
A lot of knowledge was shared, but it did not indicate a clear path forward. What can and should a physician do with the information?
As in a clinical presentation, the answers were implicit. The difference is that they were not obvious to the audience:
• There will be winners. The current system is unsustainable; and disruptive, systemic change is inevitable. The imperative is either to be one of the people who figures out how to thrive in the new environment, or to align with them.
• Patients are on their doctors' sides. Physicians can leverage that by being more transparent about the reimbursement levels and the problems they present. To be effective, this requires talking actual dollars. "The reimbursements don't cover my costs," sounds like sour grapes. Patients can be moved to contact their representatives in support of physicians, especially if their access to care is a potential casualty of the status quo.
• Given that the pie is not growing, physicians need to get a bigger piece of it. This may be the best news about bundled reimbursements. Hospitals and device manufacturers have done a good job of maintaining healthy margins. Physicians should be able to argue for and achieve a more appropriate piece of the total cost of a procedure for two reasons:
1. The physicians are the ones who are doing the actual work that drives all hospital and implant revenue.
2. Patients tend to choose physicians, as opposed to hospitals or specific devices.
The redistribution will not happen automatically. If physicians are not aggressive and effective in advocating for themselves in the allocation of bundled payments, they will encounter a reprise of the Medicare fee-for-service situation.
The critical question for any presenter is "What do you want me to do with that information?" Each presenter has a duty to provide the answer, either in the course of the presentation or in response to audience questions,
Article By Carol Stryker from Physicians Practice http://www.physicianspractice.com/blog/presentations-physicians-dont-just-share-data-provide-direction?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=06122013
The purpose is the same in presentations of non-clinical information, but the implicit call for physician action is neither universally recognized nor understood. As a consequence, physicians are often left feeling helpless in the face of what is clearly bad news.
Consider some information recently shared during a Grand Rounds presentation to a group of orthopedic surgeons:
• In 2011, healthcare spending in the U.S. amounted to almost 19 percent of GDP. The inescapable conclusion is that we have reached the limit of funds available for healthcare, if we have not surpassed it. Physicians cannot rely upon new money coming into the healthcare system
• The payment system is opaque, particularly to patients. Most hospitals in a recent survey were either unable or unwilling to hazard even an estimate of the costs for a total hip replacement for a patient with no co morbidities. Other studies have shown that there is no relationship between hospital charges and what they actually get paid for services. Patients surveyed thought physicians' Medicare reimbursement for the surgery was five times what it is, and the patients thought it ought to be about four times the current rate.
• There is a mismatch between supply and demand. The population is aging, and the obesity epidemic puts unsustainable demands on lower extremity joints. Physicians are opting to limit their Medicare participation or retire early, rather than accept prospectively lower levels of reimbursement. Concurrent with a potential shortage of surgeons, hospitals have a lot of unused beds and are continuing to expand their physical plants.
• Physicians have not been effective in preserving their reimbursement rates. Reimbursement levels for hip surgery have declined by as much as 50 percent, in non-inflation adjusted dollars, in the last 30 years. At the same time, hospitals and implant manufacturers have seen their reimbursements more than double.
• The very high volume of total hip replacements performed in the US makes the procedure an obvious target for cost containment and cost reduction.
A lot of knowledge was shared, but it did not indicate a clear path forward. What can and should a physician do with the information?
As in a clinical presentation, the answers were implicit. The difference is that they were not obvious to the audience:
• There will be winners. The current system is unsustainable; and disruptive, systemic change is inevitable. The imperative is either to be one of the people who figures out how to thrive in the new environment, or to align with them.
• Patients are on their doctors' sides. Physicians can leverage that by being more transparent about the reimbursement levels and the problems they present. To be effective, this requires talking actual dollars. "The reimbursements don't cover my costs," sounds like sour grapes. Patients can be moved to contact their representatives in support of physicians, especially if their access to care is a potential casualty of the status quo.
• Given that the pie is not growing, physicians need to get a bigger piece of it. This may be the best news about bundled reimbursements. Hospitals and device manufacturers have done a good job of maintaining healthy margins. Physicians should be able to argue for and achieve a more appropriate piece of the total cost of a procedure for two reasons:
1. The physicians are the ones who are doing the actual work that drives all hospital and implant revenue.
2. Patients tend to choose physicians, as opposed to hospitals or specific devices.
The redistribution will not happen automatically. If physicians are not aggressive and effective in advocating for themselves in the allocation of bundled payments, they will encounter a reprise of the Medicare fee-for-service situation.
The critical question for any presenter is "What do you want me to do with that information?" Each presenter has a duty to provide the answer, either in the course of the presentation or in response to audience questions,
Article By Carol Stryker from Physicians Practice http://www.physicianspractice.com/blog/presentations-physicians-dont-just-share-data-provide-direction?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=06122013
Maximizing Physician Compensation at Your Medical Practice
The financial pressure is on for physicians to get compensated not just fairly, but well, at their practices, and Shawn Harkey's medical group is no different.
"We definitely keep a close eye on both fixed and variable components," says Harkey, the financial services director of Texas Retina, an ophthalmology practice with 13 locations in the Dallas-Fort Worth area. "Medicare payments aren't necessarily increasing and we're fighting that battle because the high majority of our patients are over [the age of] 60. That's forcing us to become leaner, more efficient in providing patient care.
" Harkey's practice, which has been using its NextGen EHR for six years and its accompanying practice management system for three years, has already seen improved efficiency (physicians can see patients in a more timely manner) and a reduction in overhead costs, such as paper, storage, and staff time spent manually pulling charts.
Today, the practice is also using its Navicure claims clearinghouse technology to verify patient insurance in advance of appointments to avoid a cash-flow slowdown.
"We see a high volume of patients every day so we make sure we have everything checked, such as benefits and referrals, and we use a number of high-cost drugs so we can make sure there's no issues in place with payers," says Harkey. The state of physician pay is not only changing, but it is also challenging, as Harkey and our annual Physician Compensation Survey respondents would attest. But by taking a proactive approach — taking stock of the trends and seeking new ways to maximize compensation — physicians can not only stay alive, but they can also thrive, financially.
* (To see the data, check out the details of our 2013 Physicians Compensation Survey here.)
The state of physician compensation
Today's physicians are under increasing pressure to make money and see more patients.
While more than two-thirds of the 1,474 physicians who answered our survey told us their income is, to some degree or entirely, tied to productivity, just one-third of physicians said their income is tied, at least in part, to value-based metrics. Twenty-four percent of physicians told us their income relies in part on patient satisfaction.
"[Value-based reimbursement] is growing at a small level, and the reason is that there is not funding available for it," says Kenneth Hertz, a Medical Group Management Association healthcare consultant. "If you're earning $250,000 per year and your practice wants to put in place this value-based reimbursement, quality metrics, and other performance metrics, the practice will need to secure additional funds to pay you. Right now, the payers are not providing additional significant dollars to do this. In most cases, practices are having to carve out a pool of money from the current funds available to pay physicians, and then pay those that meet the quality metrics out of that pool."
Regardless of the basis of their payment, more than half of docs in this year's survey — 53 percent — said they were either "slightly" or "highly" disappointed with their income.
"I think there are financial pressures [such as] the changing payment models, the increase in expenses, the reduction in reimbursement in practices," says Hertz. "If you're in private practice you're seeing your expenses go up, and you're seeing reimbursements go down."
Today, many specialists are making more while primary-care physicians are staying flat, income-wise, adds Tommy Bohannon, divisional vice president of recruiting at Merritt Hawkins, a physician staffing agency.
Article By Marisa Torrieri Courtesy of:
http://www.physicianspractice.com/physician-compensation-survey/maximizing-physician-compensation-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=06122013
"We definitely keep a close eye on both fixed and variable components," says Harkey, the financial services director of Texas Retina, an ophthalmology practice with 13 locations in the Dallas-Fort Worth area. "Medicare payments aren't necessarily increasing and we're fighting that battle because the high majority of our patients are over [the age of] 60. That's forcing us to become leaner, more efficient in providing patient care.
" Harkey's practice, which has been using its NextGen EHR for six years and its accompanying practice management system for three years, has already seen improved efficiency (physicians can see patients in a more timely manner) and a reduction in overhead costs, such as paper, storage, and staff time spent manually pulling charts.
Today, the practice is also using its Navicure claims clearinghouse technology to verify patient insurance in advance of appointments to avoid a cash-flow slowdown.
"We see a high volume of patients every day so we make sure we have everything checked, such as benefits and referrals, and we use a number of high-cost drugs so we can make sure there's no issues in place with payers," says Harkey. The state of physician pay is not only changing, but it is also challenging, as Harkey and our annual Physician Compensation Survey respondents would attest. But by taking a proactive approach — taking stock of the trends and seeking new ways to maximize compensation — physicians can not only stay alive, but they can also thrive, financially.
* (To see the data, check out the details of our 2013 Physicians Compensation Survey here.)
The state of physician compensation
Today's physicians are under increasing pressure to make money and see more patients.
While more than two-thirds of the 1,474 physicians who answered our survey told us their income is, to some degree or entirely, tied to productivity, just one-third of physicians said their income is tied, at least in part, to value-based metrics. Twenty-four percent of physicians told us their income relies in part on patient satisfaction.
"[Value-based reimbursement] is growing at a small level, and the reason is that there is not funding available for it," says Kenneth Hertz, a Medical Group Management Association healthcare consultant. "If you're earning $250,000 per year and your practice wants to put in place this value-based reimbursement, quality metrics, and other performance metrics, the practice will need to secure additional funds to pay you. Right now, the payers are not providing additional significant dollars to do this. In most cases, practices are having to carve out a pool of money from the current funds available to pay physicians, and then pay those that meet the quality metrics out of that pool."
Regardless of the basis of their payment, more than half of docs in this year's survey — 53 percent — said they were either "slightly" or "highly" disappointed with their income.
"I think there are financial pressures [such as] the changing payment models, the increase in expenses, the reduction in reimbursement in practices," says Hertz. "If you're in private practice you're seeing your expenses go up, and you're seeing reimbursements go down."
Today, many specialists are making more while primary-care physicians are staying flat, income-wise, adds Tommy Bohannon, divisional vice president of recruiting at Merritt Hawkins, a physician staffing agency.
Article By Marisa Torrieri Courtesy of:
http://www.physicianspractice.com/physician-compensation-survey/maximizing-physician-compensation-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=06122013
You Need to Adapt in Order to Survive: How Your Medical Billing Service Can Prosper During the Healthcare Industry Chaos
How Your Company Can Prosper During the
Healthcare Industry Chaos
By Patrick Phillips
The healthcare industry is facing a state of complete disorder and confusion: Uncertainty surrounding the implementation of the Affordable Care Act, the looming switch to ICD-10, EHR and "meaningful use" deadlines, hospital acquisitions of physician practices, new HIPAA rules, and Health Insurance Exchanges... the list goes on. It seems like a challenging time for medical billing companies – and it is.
The good news is that not only can you prosper, you can bring hope and financial stability to struggling practices and salvage some that would otherwise collapse and shut down (or get swallowed up by a hospital or other acquisition entity). How can you assure your and your clients' continued prosperity and growth?
Focus on becoming a full-service revenue cycle management company.
In today's dynamic marketplace, billing companies that do not keep up with the constant changes will be left in the dust by companies that do. You must not only stay current with what is happening in the industry, you need to make alliances with other companies that can provide services to your clients that will help them solve cash-flow challenges beyond just their medical billing. The more services you can offer to your clients, the more you will be perceived as "the expert" who can solve their cash flow problems.
A brief review of the latest issue of Billing will introduce you to vendors that can be valuable to you in assisting your clients with medical coding questions, HIPAA compliance, EHR Meaningful Use attestation, online document management, patient portals, integrated payment channels, patient collections, and other revenue cycle issues. Do not forget that HBMA conferences will introduce you to technology partners that can help you keep up with changes in this dynamic industry.
In today's dynamic marketplace, billing companies that do not keep up with the constant changes will be left in the dust by companies that do. You must not only stay current with what is happening in the industry, you need to make alliances with other companies that can provide services to your clients that will help them solve cash-flow challenges beyond just their medical billing. The more services you can offer to your clients, the more you will be perceived as "the expert" who can solve their cash flow problems.
A brief review of the latest issue of Billing will introduce you to vendors that can be valuable to you in assisting your clients with medical coding questions, HIPAA compliance, EHR Meaningful Use attestation, online document management, patient portals, integrated payment channels, patient collections, and other revenue cycle issues. Do not forget that HBMA conferences will introduce you to technology partners that can help you keep up with changes in this dynamic industry.
Make sure you are using a billing system that is fully integrated with an EHR system.
Many outdated, server-based billing systems are trying to patch together a practice management system with one of the new electronic health record systems designed by a different company or on a different platform. The company that developed the practice management (PM) system creates an interface with an EHR system developed by another company. Chaos generally ensues.
If this is the case with your PM system, you are only asking for headaches and a possible loss of clientele. EHR companies are dropping by the wayside every day. Some of them are also server-based. Trying to get them to work together with billing software is like using "bubble gum and bailing wire" and will only lead to ongoing issues in your company. Two different companies, with two groups of programmers, trying to keep all the different parts of both systems running smoothly is almost impossible and can lead to turmoil in your company.
As painful as it may seem now, it may be a good idea to begin looking for a billing system that is totally integrated with an EHR system. That means that it was designed from the ground up by the same programmers in the same company. There are such systems available, and most of them are cloud-based (accessed securely 24/7 through a browser via the Internet).
Anything less than total integration of the two systems could be a disaster waiting to happen. Start your research now and find a system that will take you into the future, especially with any new clients you bring on. And, as part of your due diligence, make sure there is a way to import the data from your current system into the new system (at least the patient demographics). Then, begin to educate your current clients on why they need to start using an EHR, if they are not already, and why they might need to use a system that is fully integrated with your billing system.
Look for a system that has a way to electronically communicate with insurance company databases. You need one that checks for eligibility and automatically imports the patient data directly from the insurance company's database to create new patient charts. This will save you hours of data input and will help you keep employee costs under control. It will also prevent you from submitting claims that are sure to be rejected because the patient was not eligible for the service and it will keep the practice from spending time seeing patients that insurances will not cover. This will increase your revenue for that practice and will eliminate a large number of claim rejections as well.
Many outdated, server-based billing systems are trying to patch together a practice management system with one of the new electronic health record systems designed by a different company or on a different platform. The company that developed the practice management (PM) system creates an interface with an EHR system developed by another company. Chaos generally ensues.
If this is the case with your PM system, you are only asking for headaches and a possible loss of clientele. EHR companies are dropping by the wayside every day. Some of them are also server-based. Trying to get them to work together with billing software is like using "bubble gum and bailing wire" and will only lead to ongoing issues in your company. Two different companies, with two groups of programmers, trying to keep all the different parts of both systems running smoothly is almost impossible and can lead to turmoil in your company.
As painful as it may seem now, it may be a good idea to begin looking for a billing system that is totally integrated with an EHR system. That means that it was designed from the ground up by the same programmers in the same company. There are such systems available, and most of them are cloud-based (accessed securely 24/7 through a browser via the Internet).
Anything less than total integration of the two systems could be a disaster waiting to happen. Start your research now and find a system that will take you into the future, especially with any new clients you bring on. And, as part of your due diligence, make sure there is a way to import the data from your current system into the new system (at least the patient demographics). Then, begin to educate your current clients on why they need to start using an EHR, if they are not already, and why they might need to use a system that is fully integrated with your billing system.
Look for a system that has a way to electronically communicate with insurance company databases. You need one that checks for eligibility and automatically imports the patient data directly from the insurance company's database to create new patient charts. This will save you hours of data input and will help you keep employee costs under control. It will also prevent you from submitting claims that are sure to be rejected because the patient was not eligible for the service and it will keep the practice from spending time seeing patients that insurances will not cover. This will increase your revenue for that practice and will eliminate a large number of claim rejections as well.
I can predict the success you are going to have in your business – and in life in general – if you will tell me just two things: the people you associate with and the books (and periodicals) that you read. Do not get bogged down in the details of your billing business. You need to set aside time to attend industry conferences at least once a year and to read industry newsletters and books.
The person who does not read is no better off than the person who cannot read, so set aside time each week to read about our industry and keep up with the constant changes. Change is what life itself is based on, and if you are willing to change along with the industry, you and your clients will prosper.
Do not assume you will have your current clients forever.
You won't. Things change in medical practices: staff turnover, new policies and procedures, new government rules and regulations, competition, updated technology, and the marketplace itself. All these things can cause you to lose a client from time to time. You must always be marketing.
Whether you realize it or not, your competition in this industry is not just other medical billing companies. The practice itself is your biggest competition. All it would take is for a new office manager to come into one of your practices and decide that they would rather not outsource their billing: they think they can do it themselves more efficiently and more economically. You must keep reselling your clients on your efficiencies and on your cost savings versus doing the billing themselves internally. Provide them with revenue reports that delineate what percentage of billed dollars (expected) are actually being collected. Show them you are the expert in this industry by producing and providing to them a professional newsletter with articles that show that you keep up with the changes in the industry. HBMA has a newsletter you can purchase and tailor with your company logo (www.hbma.org).
Take the practice administrator (or the doctor) to lunch from time to time and show them printed reports that illustrate the revenue collections from both insurance providers and patients. Hold "Lunch 'n Learns" on a regular basis with your clients to bring them up to date on what is happening in the medical industry. Position yourself as the expert. People want to do business with "the expert" in every field.
When you buy a home, you do not want the new real estate agent: you want the guy or gal who has sold 100+ homes. When you look for a CPA, you do not want one who just hung out his or her shingle: you search for one who pays less than double digits of their own taxes and has a number of clients who they service. The same is true of a doctor's office. They want to feel that they are dealing with the company that can bring in every last dime that is due to the practice.
Continue to network with other business people in the community and join your local BNI group or chamber of commerce. Get out once a week and let people know you can solve the cash crunch for doctors and help them build their practices through your contacts.
Set up an automated way of keeping in touch with everyone you come in contact with who is a prospective client. Let them know that you are the only company that they should do business with. When it comes time for them to decide to outsource their billing, you are the only choice that makes sense. People do not buy when you are ready to sell – they buy when they are feeling the pain. Be at the top of their list when they decide it is time for change.
Remind your current doctors and office administrators that you are looking to build your business. Assuming you have done a good job for them, ask them for a referral. You would be surprised as to how many billing company owners never ask their clients for referrals. Do not just ask for the name of someone. Ask your client to pick up the phone and call the other doctor or office administrator and tell them how pleased they are with your billing service and that they think it would be in their interest to meet with you.
You can shrivel up and die in this ever-changing industry, or you can make the choice to grow and prosper, starting right now!
Friday, November 22, 2013
Physicians Dropped by Health Plans for Overutilization
By Averel B. Snyder, MD from Physicians Practice
After United Healthcare dropped 15 percent of its provider panel, I was not surprised. I actually thought something like that would occur sooner. It is clear that for Medicare to survive and to decrease healthcare costs in this country, healthcare delivery needs to change. Most believe that fee-for-service reimbursement is no longer an option and there seems to be a shift toward pay for performance. Clearly, increasing quality, decreasing costs, and increasing patient satisfaction are goals both payer and provider would strive for.
There are certain services in place to help meet these goals. One such example is the Medicare Annual Wellness Visit (AWV). The AWV, by delivering evidence-based preventive services, helps keep patients healthier and prevents over-utilization of services. The visit also helps satisfy quality measures for PQRS reporting. Despite all these advantages only approximately 12 percent of Medicare beneficiaries have had their AWV.
Another way to increase quality and decrease costs is to identify those patients that are at increased risk of overutilization. The current methodology to identify risk is the CMS HCC method. In addition to identifying risk by assigning a risk score to each patient, the codes are necessary for Medicare Advantage (MA) plans to get paid from CMS. The majority of physicians do an incomplete job of coding, making it necessary for MA plans to use third-party providers for risk assessments and retrospective chart reviews. There are now automated software solutions that provide all the components of the AWV and calculate the CMS HCC risk score real time.
The point is that fee-for-service overutilization, no coding, and not providing quality measures will not be and should not be tolerated. Those plans with strong executive leadership will identify those top 15 percent physician over-utilizers and not allow them to participate in the MA plan. If I was one of those executives I would make the same decision. It is time to make the paradigm shift and provide the highest quality care as cost efficiently as possible. It is to the providers' advantage to provide wellness visits for all their Medicare patients, and to understand the nuances of HCC coding.
Article By Averel B. Snyder, MD from Physicians Practice
http://www.physicianspractice.com/blog/physicians-dropped-health-plans-overutilization?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=19112013
After United Healthcare dropped 15 percent of its provider panel, I was not surprised. I actually thought something like that would occur sooner. It is clear that for Medicare to survive and to decrease healthcare costs in this country, healthcare delivery needs to change. Most believe that fee-for-service reimbursement is no longer an option and there seems to be a shift toward pay for performance. Clearly, increasing quality, decreasing costs, and increasing patient satisfaction are goals both payer and provider would strive for.
There are certain services in place to help meet these goals. One such example is the Medicare Annual Wellness Visit (AWV). The AWV, by delivering evidence-based preventive services, helps keep patients healthier and prevents over-utilization of services. The visit also helps satisfy quality measures for PQRS reporting. Despite all these advantages only approximately 12 percent of Medicare beneficiaries have had their AWV.
Another way to increase quality and decrease costs is to identify those patients that are at increased risk of overutilization. The current methodology to identify risk is the CMS HCC method. In addition to identifying risk by assigning a risk score to each patient, the codes are necessary for Medicare Advantage (MA) plans to get paid from CMS. The majority of physicians do an incomplete job of coding, making it necessary for MA plans to use third-party providers for risk assessments and retrospective chart reviews. There are now automated software solutions that provide all the components of the AWV and calculate the CMS HCC risk score real time.
The point is that fee-for-service overutilization, no coding, and not providing quality measures will not be and should not be tolerated. Those plans with strong executive leadership will identify those top 15 percent physician over-utilizers and not allow them to participate in the MA plan. If I was one of those executives I would make the same decision. It is time to make the paradigm shift and provide the highest quality care as cost efficiently as possible. It is to the providers' advantage to provide wellness visits for all their Medicare patients, and to understand the nuances of HCC coding.
Article By Averel B. Snyder, MD from Physicians Practice
http://www.physicianspractice.com/blog/physicians-dropped-health-plans-overutilization?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=19112013
Medical Practices: Think Twice Before Waiving Copays
Historically, family practices and many other physicians groups have routinely waived insurance copays as a gesture of goodwill to patients in a tight economy. After all, who wants to hound sick patients for their portion of the charges?
There was a time when insurance companies turned a blind eye to these routine waivers of copays. Not anymore.
The AMA's Code of Medical Ethics Opinion 6.12 explains why routine waivers are unethical, particularly when a clinic advertises a willingness to waive copayments.
Further, the Office of Inspector General (OIG) has long taken the position that routine waiver of copayments constitutes an illegal kickback, which is a felony.
The routine waiver of copayments also constitutes a violation of the terms of private insurance company plans. This contractual violation serves as a basis for a recoupment audit, during which insurance companies request proof of collection of copayments for five randomly selected patients. If the clinic cannot prove it collected, or at least exhausted all reasonable means of collection, then the carrier may demand a refund for any benefits paid across a large patient population.
Perhaps most frighteningly, routine copay waivers constitute ordinary financial fraud. If a patient is charged $100 and the insurance carrier is billed $80, the patient is supposed to pay $20. If you never attempt to collect the $20, this means the actual charge is $80, not $100. Therefore, the insurance company should only pay $64 (80 percent of the $80
Fraud or dishonesty is a primary way to get in trouble with state medical boards.
There are provisions for waiving copayments in cases of financial hardship. At a minimum, you should document the financial hardship, and obtain a release from the patient to turn the financial document over to the insurance company, if requested.
The OIG states the following criteria for waiver on the basis of financial hardship:
• The waiver must be based on a good faith determination of the patient’s financial need. In other words, waivers must not be applied routinely. The government does not specify the financial status that would justify a waiver, so you should develop your own approach, apply it consistently, and document your efforts. For example, if your efforts to collect on a patient’s bill fail, or if it’s obvious that a patient is struggling to pay the amount owed, ask the beneficiary to fill out a form noting their employment status and average household income and expenses. Then make your determination based on the information provided.
• The waiver must not be based on the amount of the charges. Your decision about whether to waive what a patient owes should be based on the patient’s ability to pay without regard to what Medicare may have paid or the total charges for the service.
• The waiver must not be offered as part of an advertisement or solicitation.
State laws vary regarding waivers. Therefore, seek the advice of an experienced health lawyer in your state if you have questions about your practices.
Article By Martin Merritt from Physicians Practice
http://www.physicianspractice.com/blog/medical-practices-think-twice-before-waiving-copays?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=19112013
There was a time when insurance companies turned a blind eye to these routine waivers of copays. Not anymore.
The AMA's Code of Medical Ethics Opinion 6.12 explains why routine waivers are unethical, particularly when a clinic advertises a willingness to waive copayments.
Further, the Office of Inspector General (OIG) has long taken the position that routine waiver of copayments constitutes an illegal kickback, which is a felony.
The routine waiver of copayments also constitutes a violation of the terms of private insurance company plans. This contractual violation serves as a basis for a recoupment audit, during which insurance companies request proof of collection of copayments for five randomly selected patients. If the clinic cannot prove it collected, or at least exhausted all reasonable means of collection, then the carrier may demand a refund for any benefits paid across a large patient population.
Perhaps most frighteningly, routine copay waivers constitute ordinary financial fraud. If a patient is charged $100 and the insurance carrier is billed $80, the patient is supposed to pay $20. If you never attempt to collect the $20, this means the actual charge is $80, not $100. Therefore, the insurance company should only pay $64 (80 percent of the $80
Fraud or dishonesty is a primary way to get in trouble with state medical boards.
There are provisions for waiving copayments in cases of financial hardship. At a minimum, you should document the financial hardship, and obtain a release from the patient to turn the financial document over to the insurance company, if requested.
The OIG states the following criteria for waiver on the basis of financial hardship:
• The waiver must be based on a good faith determination of the patient’s financial need. In other words, waivers must not be applied routinely. The government does not specify the financial status that would justify a waiver, so you should develop your own approach, apply it consistently, and document your efforts. For example, if your efforts to collect on a patient’s bill fail, or if it’s obvious that a patient is struggling to pay the amount owed, ask the beneficiary to fill out a form noting their employment status and average household income and expenses. Then make your determination based on the information provided.
• The waiver must not be based on the amount of the charges. Your decision about whether to waive what a patient owes should be based on the patient’s ability to pay without regard to what Medicare may have paid or the total charges for the service.
• The waiver must not be offered as part of an advertisement or solicitation.
State laws vary regarding waivers. Therefore, seek the advice of an experienced health lawyer in your state if you have questions about your practices.
Article By Martin Merritt from Physicians Practice
http://www.physicianspractice.com/blog/medical-practices-think-twice-before-waiving-copays?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=19112013
Physicians and the Financial Challenge of Providing an Interpreter
By Melissa Young, MD from Physicians Practice
I’ve written before about unexpected expenses, and we recently ran into another one.
Practices are required to provide access to care to patients regardless of their ability to speak the same language as the physician, and the practice must provide a reliable way to communicate with the patient. That means for patients who do not speak English (and in our practice, instead speak Filipino or Urdu), a translating service must be available. Patients may decline and use a family member, but the service must be available. There are different options for such a service. If there is a staff member who speaks the same language as the patient, the staff member can do it. Or the practice can contract with a translator service. As a less-expensive alternative, there is software that can translate, although that doesn’t always work as well. There are also telephone-based translating services. Well, it isn't just the non-English speakers who need a translator. We recently had a patient come in who is hearing-impaired. When his appointment was confirmed, he reminded us (through a representative) that it is our responsibility to provide a sign-language interpreter.
We had never needed the services of a signer before. Fortunately, he provided us with the number of someone we could call. It turns out, such services cost between $150-200 in our area. At least, that was the quote we got.
At $150-200 a visit, that pretty much means that, at best, we break even for the visit, and more likely, we lose money each time we see him. Since it is a requirement, I thought, "maybe there is a CPT code for 'use of a translator.'" Maybe we could get reimbursed for hiring someone. Alas, there is no such code, at least not that I could find. Now, this patient legitimately needed to see an endocrinologist. He wasn’t one of those people who just think they have an endocrine disorder because they are tired. He needed to be seen, and he will need follow up. And every time he comes, he needs an interpreter. Unless (according to the regulation) there will not be a significant amount of communication involved. What kind of doctor visit doesn’t entail communication? My biller/husband said we should be able to say we can't see him, but (aside form it being the right thing to do) we have to, otherwise it violates a whole bunch of regulations. The exception to the rule is if it places "undue strain" on the practice. And according to previously filed lawsuits, one patient doesn’t break the bank. So, we will continue to see him and provide him with an interpreter and take a loss each time. I was curious to know what the experience has been in other practices.
Article from Physicians Practice By Melissa Young, MD
http://www.physicianspractice.com/blog/physicians-and-financial-challenge-providing-interpreter?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=19112013
I’ve written before about unexpected expenses, and we recently ran into another one.
Practices are required to provide access to care to patients regardless of their ability to speak the same language as the physician, and the practice must provide a reliable way to communicate with the patient. That means for patients who do not speak English (and in our practice, instead speak Filipino or Urdu), a translating service must be available. Patients may decline and use a family member, but the service must be available. There are different options for such a service. If there is a staff member who speaks the same language as the patient, the staff member can do it. Or the practice can contract with a translator service. As a less-expensive alternative, there is software that can translate, although that doesn’t always work as well. There are also telephone-based translating services. Well, it isn't just the non-English speakers who need a translator. We recently had a patient come in who is hearing-impaired. When his appointment was confirmed, he reminded us (through a representative) that it is our responsibility to provide a sign-language interpreter.
We had never needed the services of a signer before. Fortunately, he provided us with the number of someone we could call. It turns out, such services cost between $150-200 in our area. At least, that was the quote we got.
At $150-200 a visit, that pretty much means that, at best, we break even for the visit, and more likely, we lose money each time we see him. Since it is a requirement, I thought, "maybe there is a CPT code for 'use of a translator.'" Maybe we could get reimbursed for hiring someone. Alas, there is no such code, at least not that I could find. Now, this patient legitimately needed to see an endocrinologist. He wasn’t one of those people who just think they have an endocrine disorder because they are tired. He needed to be seen, and he will need follow up. And every time he comes, he needs an interpreter. Unless (according to the regulation) there will not be a significant amount of communication involved. What kind of doctor visit doesn’t entail communication? My biller/husband said we should be able to say we can't see him, but (aside form it being the right thing to do) we have to, otherwise it violates a whole bunch of regulations. The exception to the rule is if it places "undue strain" on the practice. And according to previously filed lawsuits, one patient doesn’t break the bank. So, we will continue to see him and provide him with an interpreter and take a loss each time. I was curious to know what the experience has been in other practices.
Article from Physicians Practice By Melissa Young, MD
http://www.physicianspractice.com/blog/physicians-and-financial-challenge-providing-interpreter?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=19112013
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