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19 posts from August 2005

August 30, 2005

Aetna gives patients pricing in advance

In a move to to educate its patients and tame medical spending, Aetna said it will disclose prices in advance for doctors' visits, according to an August 19 story in the Ventura County (California) Star.

The new test program, which began August 18, will help patients calculate their out-of-pocket medical expenses before they are incurred, Aetna said. As many as 1 million Americans are enrolled in health plans with deductibles of more than $1,000 for an individual and $2,100 for a family.

“As there's more transparency, then there will be an impact on cost and on quality,” Robin Downey, Aetna’s head of product development, told the Star. Patients with deductibles may use Aetna’s program to compare prices for an office visit and choose a cheaper one, Downey said.

WellPoint and UnitedHealth Group say they have taken steps toward price transparency as well.

The program now targets Aetna's 200,000 customers in southwestern Ohio, including Cincinnati, Dayton, and Springfield as well as neighboring parts of Indiana and Kentucky. Patients there will be able to check the cost of the most common procedures done by 5,000 general practitioners and specialists.

The database includes prices for 600 procedures.

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August 29, 2005

CMS Stark Law Advisory Opinion No. CMS-AO-2005-08-01

On August 22, 2005, the Centers for Medicare and Medicaid Services (CMS) released its most recent advisory opinion concerning the application of the Stark Law. In it, CMS stated that physicians' stock ownership in the not-for-profit, tax-exempt medical practice corporation for which they worked did not constitute an ownership or investment financial relationship under the Stark Law, 42 U.S.C. § 1395nn.

The corporation in question employed more than seven hundred physicians in various specialties, many of whom also owned stock in the corporation. The incorporating state's law permitted individual physicians to own stock in the not-for-profit corporation. Consistent with the corporation's not-for-profit, tax-exempt status however, the stockholders had no claim to the corporation's assets, received no dividends on their investments either directly or in the guise of salary, and could realize no appreciation or depreciation of stock value upon resale of the stock.

August 24, 2005

A thought About Managed Care Negotiation

Simply put, you need to start a program of trying to renegotiate all of your managed care contracts (I suggest doing them all at once). My viewpoint has always been the same on this issue:
1. You never know about success in managed care negotiation until you try;
2. The negotiation process allows you to see payer attitudes towards your practice;
3. The negotiation process will provide you with details about what you need to do to position your practice for contracting success in the future.

August 23, 2005

Stark Law Update

The following was recently published in Vinson Elkins' (www.velaw.com) electronic healthcare newsletter:

STATUS OF NEW STARK RULE-On August 17, 2005, the Office of Management and Budget received a proposed rule from CMS (CMS -1303-P), entitled "Physician Referrals to Health Care Entities with Which They Have Financial Relationships, Exception for Certain Electronic Prescribing and Electronic Health Records Arrangements." Reporter, Larry Oday, Washington, 202.639.6792 or loday@velaw.com.

August 22, 2005

Posting & Reconciling Payments

The following is an excellent policy for daily posting reconciliation; this was posted on one of the MGMA listservs last week:

Mail payments are sorted as commercial, Medicare, Medicaid, BCBS, and personal.  Posting employees must:

1.       Make sure their payments balance to the mail log

2.       Note on the mail log the control posting group and date posted

3.       Person posting personal payments must also balance to the money paid at the receptionist window.

A separate employee prepares the bank deposit of all these payments and it must match the total posted into the system for the day.  She must also notate on the log the date the checks were deposited and the amount of the deposit.   A runner takes the deposits to the bank.

We do have 5 clinics as well - the receptionists from the clinic must balance out with a B.O. staff member.  Both sign a log book indicating the amount of money turned in for the day.  These funds then go to the individual that post personal payments.

August 18, 2005

IRS Announcement regarding S Corporations

If your medical practice corporation has elected S status, this is for you:


IRS officials have announced the launch of a study to assess the reporting compliance of S corporations. The study, carried out under the National Research Program (NRP), will examine 5,000 randomly selected S corporation returns from tax years 2003 and 2004. “The use of S corporations has exploded,” said IRS Commissioner Mark Everson. “The IRS needs a better understanding of what this means for tax compliance. This research is critical for achieving a strategic goal of ensuring that corporations and high income individuals are paying their fair share.” The study will include audits of officers receiving $10,000 in compensation, provided the corporation had $50,000 in profits."

Courtesy of the NSA.

August 17, 2005

Deducting Unreimbursed Expenses by Physician S Corp Shareholder

Many physician shareholders in S corporations incur expenses out of their own pocket that do not get or have not yet been reimbursed by the corporation. If "ordinary and necessary" to the corporation's business, the corporation deducts these expenses on its tax return.

A recent tax case addressed this issue:

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August 16, 2005

Book for Physician ASCs

Master the art of managed care contracting and reap the revenue rewards with this book!

Managed Care & Ambulatory Surgery: Strategies for Contract Negotiation and Reimbursement gives ASC administrators, physician-owners, and office managers the how-to advice they need on the tricky art of managed care contracting. Complete with helpful sample policies and forms, this resource is the only book available that deals specifically with managed care contracting for ASCs.

To order, call 800/650-6787 and mention Source Code EB36268A or visit HCPro's Healthcare Marketplace.

August 15, 2005

Take decisive steps away from mediocrity

Customer service excellence will make your practice stand out in a competitive marketplace. To achieve maximum patient satisfaction, take the four following steps to move away from mediocrity and toward improvement:

1. Start with yourself. You wouldn’t dream of short-changing your patients medically. Apply that same diligence to the “stuff” that goes with it: being on time, keeping charts current, returning phone calls quickly, etc.

2. Expect excellence. Make sure your staff understand your commitment to excellence. Encourage and reward employees for zero-error work.

3. Apologize and fix it. Don’t be afraid to admit your own mistakes, and instruct employees to handle patient problems with similar humility. Give your staffers appropriate authority to fix errors and satisfy your patients, referrers, and payers.

4. Prevent repeats. Analyze mistakes to see whether you can fine-tune policies or procedures to prevent a recurrence. Enlist staffers in your troubleshooting efforts, and reward them for creative solutions.

This nugget was adapted from Customer Service for Successful Medical Practice, from Advisory Publications, a division of HCPro, Inc. Go to http://www.hcmarketplace.com/Prod.cfm?id=2089

August 12, 2005

Physician Office Manager v. Administrator

There was a thread in a recent MGMA listserv regarding salaries for an office manager versus one for an office administrator. It got me to thinking the differences between the two, since the position of office manager and administrator are often considered interchangeable.

To me, the real difference is the following based on my experience working with physician medical practices: An office manager basically "babysits" the daily operations of the office while a true administrator is making the practice grow. To me, it's that simple.

Continue reading "Physician Office Manager v. Administrator" »