October 31, 2014

High deductibles and your physician practice's collection policy

One thing we are all seeing is the of high deductible insurance coverage.  High deductibles have always been around; the difference is this…..volume.  In most practices, the volume of high deductibles has been sparse as most patients are either covered by their employers or government in the form of Medicare or Medicaid.  This meant that practices could see patients with non-emergency visits and collect whatever the patient said they could pay without affecting the cash flow of the practice.  With the advent of the ACA and employer's continuing desire to reduce costs, the volume of patients with high deductibles will inevitably go up and that is a dilemma for many practices.

Each physician practice must take the time and thought needed to develop a policy that works for that practice.  Collection of payment at time of service is becoming the most popular and most followed practice.  The question with most high deductibles is how much to collect at one time?  Projecting cost of treatment at each visit and collecting the estimated amount is a practical solution.

There will always be patients who simply fail to pay for healthcare costs even as there will always be patients who feel the responsibility to pay for treatment and care received but who cannot afford the care and look for alternative payment options. How a practice determines to work with patients with high deductibles or no insurance for payment of services is probably the most needed policy at this moment of time in the business of healthcare discussion. A policy decision based on the values of the practice will be well received by patients if communicated in a straightforward way and applied consistently.  Communication to patients is always appreciated by patients.  Dealing with individual cases that fall outside the norm should be managed as that….outside the norm.

Take a look at your practices collection policy and determine if it is the right policy going forward. 

October 30, 2014

Is your physician practice using a portal to communicate with your patients?

Patient portals as a way of communicating with and to patients is now becoming more popular with patients and physicians.  While patient portals require no small amount of IT expertise and over-sight to build and maintain; once established, they provide a platform for patient/practice communication.  

The first step to success with patient portals is communication with patient on how to use and what they can expect from use.  This communication is vital.  How a patient perceives patient portals and their initial success in using will set the stage for a successful implementation and use of the patient portal.

Included in patient portal information should be medical history, visit summaries, access to lab results, appointment capabilities, and secure email from provider to patient.

A patient can at their convenience log into patient portal and receive follow-up information from provider on lab results, view those results, look at pending appointments, make appointments, ask routine questions via email, look at statements on line, make payments, and get other routine information that previously required a phone call.

Each time a patient calls the practice for information they could receive via the patient portal; the patient should be reminded that the information they have requested is available on the portal.  Of course, not all patients will or can utilize….but most patients will comply with expectations if initial experience successful.

Setting up the portal in a logical and easy to follow menu based way is a key to success.  This is true not only for the patient, but also for the provider.  If the providers experience with using the portal is logical and saves them time, they will use.  If they find it cumbersome, difficult and takes too much time, they will not use.  It’s that simple.  

Planning how the portal will look, how it will be populated, how implementation will be initiated and how both providers and patients will experience the value it will bring to practice is critical.  Poor planning always leads to a poor experience.

Here are some things you can do to create success with the patient portal:

  • Celebrate small wins – you won’t have full implementation overnight, so be aware when things go right and be positive about them with provider and patients.
  • Speak up about problems – while no one wants to be the one to point out problems or be seen as a nay sayer, not speaking up about issues will actually create more problems in the long run.  If you see something is not working…..talk about it.  Try to achieve resolution.  Don’t allow it to fester into something out of control.
  • Even though implementing technology, don’t forget to communicate – technology is a way to increase efficiency, cut costs and time and increase      revenue.  It will not replace, nor should it, communication. Communicate each day with staff, providers and patients on how patient portal working, how to make it better, what staff can do to keep a positive attitude with patients just learning to use.
  • Remember your primary mission – to deliver quality healthcare to patients who need it.  We often get sidetracked by technology and fail to keep in front of us the value that technology brings to our overall mission.

Technology is a tool….a useful And productive tool.  An efficient patient portal will bring value and resources to your practice and patients.  Design it well……implement it carefully, use it as a tool. Remember we now live in a technology savvy world and patients are beginning to expect this type of communication with their doctors!

October 28, 2014

CMS Launches $840 Million “Transforming Clinical Practice Initiative”

On October 23, 2014, CMS announced it would begin accepting  applications for its “Transforming Clinical Practice Initiative,” a four-year  initiative authorized by the Affordable Care Act.  The new Initiative is designed to support  clinician practices through collaborative and peer-based learning networks that  encourage transition from volume-driven systems to ones that are coordinated,  value-based, and patient-centered.   Through the Initiative, CMS will fund successful applicants who work to  rethink and redesign their practices to move towards becoming more focused on  patient outcomes rather than quantity of care.  Applications are due January 6,  2015, though CMS strongly encourages providers to submit applications or  nonbinding letters of intent by November 20, 2014.    

Through the Initiative, CMS will award cooperative funding for two  network systems: Practice Transformation Networks and Support and Alignment  Networks.  Practice Transformation  Networks are peer-based learning networks designed to facilitate collaboration  by coaching, mentoring, and assisting clinicians in developing core  competencies specific to practice transformation.  Successful applicants for this network would  have pre-existing relationships with multiple primary care and/or specialist  practices that include data sharing capabilities. 

Support and Alignment Networks are networks formed by national and  regional medical professional associations, public-private partnerships, and  others who would create an infrastructure to help identify evidence-based  practices and policies to support the Practice Transformation Networks.  Successful applicants for this network may  include eligible medical associations, specialty societies, or other organizations  involved in aligning their programs with the goals of the Initiative.  CMS  will hold webinars for potential applicants on November 6 and November 20.     

For more information on the Initiative, including application  information and upcoming webinars, please click here.  For a copy of the HHS Press Release, please  click here.  For a copy of the HHS Fact Sheet, please  click here

October 27, 2014

Is a physician's stamped signature acceptable?

No, stamped signatures are not acceptable. Medicare requires that services provided/ordered be authenticated by the author of the order or medical record entry. Only handwritten or electronic signatures are acceptable.

What specific verbiage is considered acceptable for electronic signatures?

The phrases listed below are acceptable for electronic signatures:

Accepted By” with provider’s name
“Electronically signed by” with provider’s name
“Verified by” with provider’s name
“Reviewed by” with provider’s name
“Signed by” with provider’s name
Signed: John Smith, M.D.” with provider’s name
This is an electronically verified report by John Smith, M.D.
Authenticated by John Smith, M.D
Authorized by: John Smith, M.D
Confirmed by with provider’s name
Electronically approved by with provider’s name

Please note Medicare would expect the phrase/signature to be dated.

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.