April 17, 2014

Questions to Ask Before Signing an EMR/EHR Agreement

1. Have you defined your needs?

You will need to complete a needs assessment or an evaluation of what exact goals you will need the EHR product to meet.  In that assessment you need to consider who will be doing the bulk of the work? How will the workflow be changed as a result of that answer is next.

2. Does the EMR system function appropriately for your practice?

Are there limitations with the new software that affect your practice? Does it have the functionality that you need for you daily practice operations?  Are there excessive features and bells and whistles that you will not use? Will your vendor offer customization options and, if so, exactly how micro are those customizations?

3. How will the new software and technology interface with key systems you use regularly?

Will your existing radiology, laboratory and Practice Management systems interface with the EHR?  Is there other cost associated with building the interfaces? Is it a onetime cost or ongoing? What if there are problems with the interface? Be sure to have that all covered in your agreement with the vendor.  Current costs for an interface can range from $5,000 to $15,000 or higher.  Be sure to find out if your practice will require multiple interfaces.

4. How will your data populate in the new system(s)?

Not only how will it populate, but what is considered data by your vendor? Will your existing progress notes, and nurses notes now become PDF or some other readable file that you cannot extract data from?  Did your vendor present you with a plan for converting all the existing data and are they doing that conversion or is it going to be put on your staff to convert that data?   What about your patient financial information and vital information such as DOB, marital status, preferred language… Be sure that your discreet data that you have already collected will be transferred over to your new system.

5. Will you have the opportunity to test the software?

Will you and your staff be able to test the software and put it through its paces and have your questions answered.  Will it cost extra to have a test version? Will you be able to test it in an environment that reflects your current workflow?

April 16, 2014

Hospital self-disclosure results in 8.5 million dollar settlement

ProMedica Memorial Hospital in Fremont will pay $8.5 million to settle claims that it engaged in improper financial relationships with referring physicians, according to a news release from the U.S. Department of Justice.

http://www.justice.gov/opa/pr/2014/March/14-civ-270.html

Details on the allegations and settlement were sparse. The justice department said the settlement covers activities related to a joint venture the hospital had with a pain management doctor and a separate arrangement with an ophthalmologist who purchased intraocular lenses — eye implants that correct vision — and then resold them to Memorial Hospital at higher prices. The hospital voluntarily disclosed these issues to the government, according to the release.

“Physician referrals should be made exclusively based on what’s best for the patient, not on financial relationships,” said U.S. Attorney for the Northern District of Ohio Steven M. Dettelbach. “We hope that this settlement will once again help drive that message home.”

In response to questions from The News-Messenger, ProMedica, the regional nonprofit hospital chain that took over Memorial Hospital on the first of the year, provided a statement indicating that the hospital discovered the discrepancies in a 2012 internal audit, prior to joining ProMedica. The alleged compliance failures were operational and did not cross over into patient care, according to the statement.

“All of the services provided to patients were reasonable and necessary,” the ProMedica statement reads.

The allegations would have violated the False Claims Act, which involves defrauding the federal government, the Anti-Kickback Statute and the Stark Statute, both of which restrict the financial relationships that hospitals may have with doctors who refer patients to them, according to the justice department. The claims will remain only allegations, however, as the investigation will be closed and the hospital will not be required to admit culpability.

The state of Ohio will receive about $600,000 in the settlement because some of the claims included Medicaid patients, and the state covers some of those costs.

 

April 08, 2014

AMA Issues Grace Period Guide to Assist Physicians

The American Medical Association (AMA) announced new resources to guide physicians on navigating a little known rule in the Affordable Care Act (ACA) that could pose a significant financial risk for medical practices. The rule published by Centers for Medicare & Medicaid Services (CMS) provides individuals that purchase subsidized coverage through the state insurance exchanges a 90-day grace period before their coverage is cancelled for non-payment.

Under the CMS rule, insurers in health exchanges are required to pay any claims incurred during the first 30-days of the grace period, but insurers are not required to pay claims incurred during the last 60-days for any patient whose coverage is terminated. Patients are considered to be covered for care during the entire grace period, but insurers are allowed to place all the claims during the last two-thirds of the period in a pending status and retroactively deny them when coverage is terminated at the end of the grace period.

As such, the grace period rule imposes a great risk for uncompensated care on physicians and their medical practices.

https://download.ama-assn.org/resources/doc/washington/x-pub/grace-period-step-by-step.pdf

https://download.ama-assn.org/resources/doc/washington/x-pub/grace-period-collection-policies.pdf

https://download.ama-assn.org/resources/doc/washington/x-pub/grace-period-model-financial-agreement.pdf

https://download.ama-assn.org/resources/doc/washington/x-pub/grace-period-notice-to-patients.docx

 

April 04, 2014

Implement Credit Card on File Program to Increase Collections, Reduce A/R

We know patients are bearing more of the financial burden for healthcare, particularly in the form of High Deductible Health Plans (HDHPs), so it falls to the provider to collect the deductibles. How can you collect deductibles, co-pays and co-insurance, as well as electronically manage patient payment plans while reducing the associated labor and resource expense? Implement a credit card on file program is how.

A Credit Card on File Program facilitates the collection of a credit or debit card from each patient and requires this card to be used for co-pays, co-insurance and deductibles. You have the option of collecting an estimate of what is due at time of service, and/or charging the credit card when the payer pays the claim. Here are the benefits to your physician practice by implenting such a Program:

  • Reduced days in accounts receivable.
  • Improved cash flow.
  • Elimination of statements.
  • Electronic management of payment plans.
  • Elimination of bounced checks.
  • Elimination of the manual refund process and refund check expense.
  • Reduced labor in daily reconciliation process.
  • Elimination of cash drawers and change issues.
  • Reduction or elimination of deposits.
  • Facilitate faster check-in and check-out.
  • Elimination of paper receipts.
  • Elimination of collections expense.

April 03, 2014

The ABCs of Providing the Annual Wellness Visit Educational Tool — Revised

The “Quick Reference Information: The ABCs of Providing the Annual Wellness Visit” Educational Tool has been revised by CMS and is now available in downloadable format. This educational tool is designed to provide education on the Annual Wellness Visit (AWV). It includes a list of the required elements in the initial and subsequent AWVs, as well as coverage and coding information.

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/AWV_Chart_ICN905706.pdf

April 02, 2014

Physician practice patient retention strategies

Attracting new patients to your practice is one thing, but keeping them can be an entirely different issue. The days when you got to treat all members in a family from the cradle to the grave are long over, and regular attrition is an ongoing concern. You may not be able to avoid losing patients who move from their current location to another city or state, but you can try to avoid losing patients to other medical practices.

From primary care physicians through optometrists and gynecologists, patient retention is an important factor in the success of the practice. Here are 7 tactics you can use to keep your patients coming back for more.

Tactic #1: Think of Your Patients as Clients

Let’s face it, your patients need you probably more than you need them. Far too often, however, medical professionals treat patients as if they are doing them a favor by seeing and treating them. Even if it isn’t true about your practice, how certain are you that your patients feel as if you value them? By thinking of them as clients and fostering a customer service attitude among your practice staff, you can ensure that your patients feel important and cherished. The customer doesn’t always have to be right – he just always has to be king!

Tactic #2: Live Up to Your Promises

Personalized health care? 24/7 Accessibility? No waiting for appointments? Make sure you live up to your claims if you want patients to stay with your practice. No matter how much your patients love you, they’re going to get fed up if you’re constantly overbooked or late for appointments and they have to spend 30 minutes or more waiting for you to see them. The best marketing strategy in the world can’t overcome poor service, so keep the promises you make when you come up with your unique differentiators.

Tactic #3: Be Personal

For truly personalized attention, maintain records about your previous consultations so you can refer to former discussions during appointments. You can never remember the dozen patient conversations you have every day, but your patients can remember every discussion they have with you. Use whatever tools you have to in order to make patients feel like you have a personal interest in them. Also, go the extra mile to be pleasant and train your staff to do the same – people prefer to do business with service providers they like.

Tactic #4: Stay in Touch

Include regular communications in your medical marketing strategy. If the only time your patients ever hear from you is when they are sick or you need them to pay a bill, there’s little reason for them to stay with you. Stay top of mind by sending them quarterly newsletters, birthday and holiday greeting cards and reminders about vaccinations or annual checkups. A basic patient relationship management program will provide all the tools you need to automate much of the process, but your patients don’t need to know that fact. Remind patients the day before their appointment with a telephone call, email message or text to their mobile phone.

Tactic #5: Be a Resource

Stats show that 85% of people use search engines to look for information on medical conditions and healthcare issues. Much of the time, the material they find is inaccurate and misleading, which makes your job harder because they come to you with preconceived ideas and beliefs. You can both prevent this and cultivate loyalty by creating resources for your patients by:

Blogging regularly

Publishing educational materials such as eBooks and white papers

Providing links to authoritative websites

Offering an online forum for discussion and questions

Setting up virtual support groups for various patient categories

Tactic #6: Manage Your Team

You may be fabulous, but if your employees aren’t then your team will let you down. How often have you heard of patients leaving a practice because of the rude receptionist or the unfriendly nurse practitioner? It happens more than you think, because your staff have good days and bad days and to them it’s a job – not their professional reputation that’s on the line. Conduct regular training sessions to create awareness among your employees of specific issues. Start a recognition program to reward random acts of kindness, or let patients vote for the team member of the month and present the winner with a small gift.

Tactic #7: Get Reviews and Testimonials

Testimonials and reviews are a hugely important aspect of a comprehensive medical marketing strategy, so ask your patients to tell you what you’re doing right. Get feedback by means of online and email surveys, your social media profiles, in-practice feedback forms and personal requests. Publish positive testimonials anonymously so others can read them – on a board above your front desk, on your website, in your email signature and on your regular newsletters. Address any negative reviews individually and manage your online reputation by setting up alerts and responding to anything you find.

Include these patient retention tactics in your medical marketing strategy to improve the success of your practice.

March 31, 2014

Communicate with patients to improve patient satisfaction

Last year Consumer Reports started ranking physicians and other healthcare providers in recent issues.  Although most patients generally rated their physicians highly, they were less pleased with their interactions with staff. Overall, 87 percent of respondents said their doctor always showed respect for what they said, and 84 percent said their doctor always explained things in a way that was easy to understand. But only 57 percent said that front-office employees were always as helpful as they should be--a survey result that should capture the attention of practice leaderships.

But the really bad news is that most physicians didn't realize exactly what was going on between staff and patients. And the staff knew they didn't know. Practices are inherently very busy places and the Physician rarely has time to really know what's going on at the front desk, but they need to find out.  And one way is to simply ask patients.

1.  Online Survey and Polls. Use your web site to ask patients about what they do and do not like about your practice.  The web site is the perfect way to poll patients and ask them how your practice can do better at providing services both at the front-desk and in the exam room.  Of course, be prepared to act on that survey.

2.  Shorten wait times. Long wait times continue to be in the top 5 on the list of patient complaints.  And when you really think about it, why is the real reason for long wait times?  Apart from a bone fide emergency, there is no other excuse that passes muster.  Careful planning of appt times, start times of physicians, and staff training on proper work flow should solve long wait times.  Most patients asked said they would rather wait an extra day for an appointment than sit in an office for a couple of hours.  It is disrespectful of patients and simply should not be tolerated.  Find the problem and fix it.

3.  Communicate, communicate, communicate. There is no such thing as over-communication between practices and patients.  If you want patients to comply with treatment protocols.....communicate.  Communicate is an interesting word....it requires listening as well as speaking.  We all know patients who want to tell you about their great aunt Bessie's experience, but those are not the normal patients.  Most patients are as busy as you are, have active lives and want to get back to them.  If you listen to their questions....give them web sites and reading material about their disease process or medications....offer them a warm smile, a listening ear and treat them with respect, you will have happy compliant patients who want to do the right thing.

Healthcare has many variables that requires most practices to have several balls in the air at one time.  There is no shortage of stress and confusion.  Practices are being asked to take on more and more complex equipment and spend more money while reimbursements are going down.

So, do simple things to make your patient's life easier. ..... and by the way, make your life easier too.  Pay attention, be kind, and know that everyone in the office is measuring up to your high standards.

March 28, 2014

Even with change, remember the simple things

It seems like change is everywhere these days and how to address these changes are at the forefront with physicians and their practice administrators. Sometimes however we need to remember the simple things. What will really drive the financial security of a physician practice now and in the future, whether aligned with a hospital, in a large multi-specialty practice or a lone physician practice is accounts receivables. Physicians have purchased sophisticated software that has touted we can manage accounts almost hands free and yet the biggest question every health care CEO is asking is where's the money?

Getting back to the basics of credits and debits.......managing accounts, not simply working claims in a queue is what is called for. We need to invest in training of competent persons to understand and think while looking at accounts and bringing them to a zero balance.  We need to actively work and analyze the hundreds of reports we now have access to and breakdown those numbers to a clear and straightforward strategic plan to predict and ensure cash flow.

"Change" is here to stay, and clearly more change is inevitable.  How we plan for and incorporate change will make or break many practices. Regardless of the changes coming, how we cost effectively and accurately produce charges and manage the denial/payment of those charges will continue to be the single most important dynamic on the business side of every health care practice. The business of health care has driven health care for many years and will continue to do so in the foreseeable future.

So get back to basics, control aging of AR, learn the carrier rules and live by them.  Analyze reports, trend denials, clean up AR and hire people who are passionate about accuracy and strategic thinking. Practice accountability at every level that compels excellence. Communicate with practices what's working and what's not working, treat patients like valued customers who will return not only because they have received excellent care, but also because the billing of their visits has been done accurately, timely and efficiently.

While technology provides us with great tools to use, we need people who understand AR and have the capacity to use technology to work smarter.

March 27, 2014

EHR Incentive Program: Medicare EPs Must Attest by March 31 to Receive 2013 Incentive

If you are an eligible professional (EP), the last day you can register and attest to demonstrating meaningful use for the 2013 Medicare Electronic Health Record (EHR) Incentive Program is March 31, 2014. You must successfully attest by 11:59pm ET on March 31, to receive an incentive payment for your 2013 participation. CMS extended the deadline for eligible professionals to attest to meaningful use for the Medicare EHR Incentive Program to allow more time for providers to submit their meaningful use data and receive an incentive payment for the 2013 program year.

Payment adjustments for EPs will be applied beginning January 1, 2015, to Medicare participants that have not successfully demonstrated meaningful use. For more information, visit the payment adjustment tipsheet for EPs. You must attest to demonstrating meaningful use every year to receive an incentive and avoid a payment adjustment.

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/PaymentAdj_HardshipExcepTipSheetforEP.pdf

March 26, 2014

Small Business Health Care Credit

In a news release, the IRS recommended that small businesses determine whether they can take the small business health care tax credit. The IRS website has a page devoted to the small business health care tax credit. The website includes a tax credit estimator, helpful examples, and a section with frequently asked questions (FAQs). The website is located at:

www.irs.gov/uac/Small-Business-Health-Care-Tax-Credit-for-Small-Employers

The credit is currently available to eligible employers from 2010û2013 and for two additional years beginning in 2014. Employers that filed previously and later learn that they are eligible for the credit can amend their returns within the three-year statute of limitations to request a refund. News Release IR-2014-27.