October 24, 2014

Continual improvement a must for physician practices

Physician practices are under pressure to cut costs, improve delivery, focus on patient satisfaction, comply with regulations, use EHR’s expertly and make money.  Not to mention treat patients on a daily basis in a way that improves their quality of life.  The office staff must be friendly and helpful, the nurses prompt and efficient, the physicians all-knowing and take time to listen to patients.

Our expectations of physician practices are really quite amazing.  They must deal with emergencies and routine visits, know all the current medications and treatment options and be experts on a computer. Keeping up with technology, compliance, clinical advances and federal and state laws becomes part of a practice daily routine.  The complexity of billing and carrier rules is a daily challenge to minimally paid front end receptionists.

The successful practices take all this in stride as they continuously look for opportunities to improve the patients experience at their practice. Organizational effectiveness, service excellence and high performance become the driving forces behind successful practices.  It’s not finding a secret to success that boosts practices from good to great…….it’s the consistent review and refocus of practices in a seemingly relentless and unending pursuit of excellence that’s the real secret.

There are no magic keys to success; indeed, as the targets keep changing, so do the “keys”.  It’s not so much about what practices do as it is about how consistently they look to improve that really counts….that brings real excellence to a practice.

The critical issue in any physician practice is how to sustain continual improvement efforts. How to continually motivate staff to look for opportunities to positively change work flow, become effective and efficient, and provide excellent care to patients is the function of leadership. Driving cost cutting in innovative and new ways is a function of management.  Expecting excellence has to be the focus and refocus of every practice…..every day

October 20, 2014

Compliance auditing tips for physician practices

Ever wonder which physicians should be audited to make sure your physician practice is and stays in compliance with the myriad of billing and coding rules out there today? Here are a few examples of identifying and auditing physicians with the following patterns (this includes solo-practicing physicians):

  • Routinely billing high level E/M codes
  • Billing high level codes for follow up visits
  • Always using the same E/M code
  • High overall work relative value units (RVUs)
  • Physicians with a high number of services per day
  • Billing for procedures that others of the same specialty are not billing
  • High volume of certain modifiers billed, such as modifiers -25 and -59
  • High denial rates
  • Attempts to unbundle or bill services that may not be medically necessary

October 16, 2014

Helping managers lead others in your physician medical practice

Managing for the first time can be a massive undertaking for most people, especially when the transition is external rather than internal.  Being the new guy or gal on the block can already be intimidating enough and on top of that, you are expected to lead those sizing you up?!  When it comes to breaking down barriers and becoming a great leader, there are a few steps you can take to minimize the discomfort and increase the ease of the transition to become an effective leader.  Here are some of the ways first-time leaders can boost their confidence and gain the trust of others.


From the beginning, being transparent as a manager can show those you will be working with that you are open to learning more about them and their operations.  Along with this effort to show transparency, be sure to inform your team what you will be looking for and what you expect from them.  Putting these items out in the open from the beginning will help increase buy in from employees and remove the stress of uncertainty.

Ask Questions

Be sure to communicate with your team that you are willing to answer questions and are open to them.  Even suggesting everyone come up with as many questions as they want to get to know you can be a great way to increase comfort levels as a team. 

Figure Out What Your Team Members Really Want to Do

The bottom line is you should get to know your team members.  In most cases, employees are being underutilized or in a position that doesn’t fully compliment their skill sets.  Gaining a better understanding of each employee’s background, goals and strengths can be a quick way to get your team on track and improve morale as roles are adjusted.

Get Your Hands Dirty

You’ve probably heard this one before, lead by example.  Don’t be shy; follow your team members around and get to know their duties and responsibilities.  Also, don’t accept the mindset that just because you are the manager you cannot perform simple, small tasks to help take the workload off others in a tough spot.

Be Decisive

When you have built rapport with your team and have had the time to create your plan and vision; be sure to share this with your team.  Be certain to move forward in a confident manner and enter this conversation with an action plan.  Employees will see you taking charge and most likely will be eager to follow.

Leadership isn’t for everyone; in fact, only about one-third of workers (34%) surveyed by CareerBuilder said they aspire to leadership positions.  For those that do aspire for these roles, the learning curve can be difficult, but using these tips first time managers are bound to find their way quickly.

October 14, 2014

Poor customer service at a physician office

I really get pissed at poor customer service in a physican medical practice like the following post on Facebook- thank goodness he or she didn't call out the actual practice and doctor name:

Really sucks when you are on time for your dr appointment. You wait 30 minutes before they call you back, then you sit in the room now going on hour waiting for the doctor. Then you have to pay for parking. The longer wait the more I pay to park.

October 08, 2014

2014 Report on U.S. Physicians' Financial Preparedness: Employed Physicians

A new, in-depth report from AMA Insurance shows that employed physicians — now comprising 59 percent of all American physicians — have their own set of personal financial challenges, in part due to their employment status.


• Only 8 percent of employed physicians surveyed consider themselves 'ahead of schedule' in retirement savings. 42 percent consider themselves "behind where they'd like to be." And 44 percent report they have less than $500,000 saved for retirement.

• Funding long-term care has emerged as a top financial concern. Sixty-five percent (65%) are concerned about funding long-term care expenses; and one-third of all employed physicians are unsure how they will pay these expenses.

• Many employed physicians have disability and life insurance through their employer; it can present implications from a personal financial standpoint. As an example, half of employed physicians reported that their employer pays their disability insurance premiums. It's important to understand that the benefits paid may be taxable income and could result in a shortfall.

• Over half of employed physicians surveyed use a professional financial advisor, and are more confident and on-track with their personal finances and retirement savings.

The report's findings were taken from a national survey, conducted by AMA Insurance, of employed physicians primarily working in group practices, hospitals and medical schools. Topics included: retirement planning and savings, financial concerns, personal financial acumen, use of professional financial advisors, family finances, and disability and other types of insurance protection.

View the full results of the 2014 Report on U.S. Physicians' Financial Preparedness: Focus on Employed Physicians released by AMA Insurance.


October 07, 2014

A few random HIPAA compliance tips for physician practices

Check EHR login information  Look at employee trails left in the computer logs to  get a feel for when employees are trying to access something they shouldn't. This goes for your practice management system too.

Recheck you breach notification policy as required by HIPAA  What will your practice do in thte event of a HIPAA breach?

Document everything your practice does to comply with HIPAA  Not only will this help you after a breach has occurred (shows you are and/or trying to be in compliance), this excersise will highlight where you are not in compliance with HIPAA.

October 06, 2014

ICD-10-CM Official Guidelines for Coding and Reporting Available

The 2015 ICD-10-CM Official Guidelines for Coding and Reporting is now available on the 2015 ICD-10-CM and GEMs web page and also on the Centers for Disease Control and Prevention website.

  • Narrative changes appear in bold text
  • Items underlined have been moved within the guidelines since the FY 2014 version
  • Italics are used to indicate revisions to heading changes

October 03, 2014

Cardiology group settles Stark Law complaint

On August 14, 2014, the Department of Justice (DOJ) announced the settlement with the New York Heart Center, which has nine physicians and serves central and northern New York.

Group practices have substantial flexibility to structure physician compensation in compliance with the Stark Law, particularly in comparison with hospitals and other healthcare providers.  Groups, however, are not allowed to pay their physicians in a manner that takes into account the volume or value of their referrals of Medicare designated health services (DHS) unless the payments satisfy a special rule permitting group practices to compensate physicians through productivity bonuses and profit shares that may indirectly relate to referrals, or that qualify as de minimis. The government determined that the group knew that the formula violated the Stark Law but adopted it anyway.

Until this case, Stark Law enforcement has traditionally focused on financial relationships other than internal compensation arrangements within a group practice. This settlement may be a harbinger of escalating Stark Law scrutiny for group practice compensation, and provides another reminder of the need for group practices to take care in structuring their compensation arrangements with physicians and other referral sources to comply with e Stark Law and the federal anti-kickback statute as well as state law, and to periodically review their financial arrangements for compliance.

You can read the DOJ's press release here:



October 02, 2014

Physician practice management - Are you proactive or reactive?

Proactive management means digging into the details of finances, processes and people to optimize resources and dollars.  It means planning….strategic planning.  Strategic planning involves not only the immediate future, but looking years down the road to lay foundations for practice expansion, IT growth, new building and alliances.  It also means a careful analysis of software and hardware needs as your practice grows and becomes more profitable.  It means management in place to over-see day to day process improvement to capitalize on new technology, better processes and more educated employee pools.

Daily, weekly, monthly analysis of processes and tools must accompany any proactive plan.  The culture of the physician or healthcare practice to be best in class must revolve around change management before a crisis confronts the practice.  The prospective look at accounts receivables means an ongoing look at the aging of accounts by financial class and determining the causes of aging;  then installing processes to prevent aging from occurring.  This always means collaboration between the practice frontend and the billing office.  About 50% of denials in most practices are due to frontend errors.  The right education, the right tools and the right people will become paramount if a practice is serious about proactively confronting that denial problem.

When problems and issues are allowed time, they only become worse.  Time alone has never turned a mess into profitable venture.  It always, always requires intervention.  Even before an issue is resolved, the practice should be asking the hard questions of what could have been done to anticipate and prevent the issue.

Unfortunately I see most physician managers are reactive instead of proactive. So what is your practice management style?  Do you arrive each day in reactive mode ready to tackle the problems of the day?  Or do you arrive in a proactive mode…..ready to change the practice culture from crisis management to profit management?

September 29, 2014

Key Individual and Medical Practice Tax Breaks that expired at end of 2013

• Option to deduct state and local sales taxes expired: Last year, you had the choice of claiming an itemized deduction for state and local sales taxes instead of an itemized deduction for state and local income taxes. This option was beneficial if you lived in a state with no personal income taxes or if you paid only a minimal state income tax bill.

• Super Section 179 has expired. As of right now 179 for 2014 is still limited to $25,000. Although several proposals have been made, nothing has passed to increase this.

• Bonus depreciation expired. No extensions have been made at this time.

• Charitable donations from IRAs: Last year, IRA owners who had reached age 70½ by Dec. 12, 2013 were allowed to make charitable donations of up to $100,000 directly out of their IRAs. The donations counted as IRA required minimum distributions. So well-off seniors could reduce their taxes by arranging for charitable donations from their IRAs to replace taxable IRA required minimum distributions.

• $500 credit for energy-efficient home improvements expired: Under this break, you could claim a tax credit of up to $500 for certain energy-saving improvements to your principal residence.