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14 posts from January 2006

January 31, 2006

Healthcare Losses High Amid Antifraud Efforts

Blue Cross and Blue Shield Plans say that their anti-fraud efforts delivered savings and recoveries of nearly $228 million in 2004. Overall, government and law enforcement officials estimate that healthcare fraud at as high as $90 billion a year, the companies reported. More information can be found at http://releases.usnewswire.com.

The News section of the Coalition Against Insurance Fraud Web site provides updates on recent insurance fraud cases and trends. It can be found at http://www.insurancefraud.org/stats_set.html.

January 30, 2006

Who Pays for Physician Employee Malpractice Tail Coverage

Here is my belief: a physician practice should pay the malpractice tail for a departing physician employee and a physician owner should always pay for his or her own malpractice tail.

Remember that the physician employee is "relying" on the medical practice's reasons for needing to recruit another doctor. Sometimes these reasons just don't work out. However this does not excuse the need for due diligence on the part of the physician employee candidate. In other words, the medical practice should bear the risk of the recruitment - if it doesn't work out, it should bear the tail responsibility.

January 26, 2006

Why Can't Physicians Get Along?

I just finished up a 5 day trial as an expert witness in case involving two local physicians. They were office sharing and when one doctor left, the other demanded that he pay up the shared overhead that was still unpaid at the time of departure. Of course a lawsuit resulted. The doctor that left countersued saying that the office screwed up his billing and collections during the shared office period and as such, he was due damages.

A special master was appointed by the court and his report showed that the departing doctor owed approximately $133,000 in shared overhead and the doctor in the office owed the departing doctor approximately $60,000 related to the billing and collection issues.

The case goes to the jury today..........

Keep this in mind - the doctor remaining in the office to date HAS SPENT $330,000 in legal fees so far on this case; the departing doctor HAS SPENT $429,000 in legal fees on this case to date. THREE QUARTER OF A MILLION DOLLARS on this little case?????????????  I was flabbergasted when I heard this testimony in court!!!


1. Why didn't these guys settle this case?  Even when tensions are running high, somebody has to have a little common sense.

2. Why can't physicians get along? It just proves my long standing point - money disputes almost always leads to something like this and it's the lawyers and professinals like me that win out in the end.

January 23, 2006

Four guidelines to obtain timely physician payment from ERISA plans

It’s important to write a convincing letter when you want to receive timely payment from ERISA plans. Your letter to the plan should

  • tell the plan that the claim is unpaid and overdue--and that you're entitled to notice about it. Tell the plan that it has been more than 30 days since you filed the claim and that you want payment immediately. Also point out that you have either authorization to act as the member's representative or an appropriate assignment of benefits and therefore the right to be notified of any decision directly. Include a copy of that authorization or assignment with your letter

  • refer to regulation. Tell the plan that you believe that the plan's failure to pay may be in violation of the regulation. Be specific. Specifically reference the regulation and quote some of it in the letter. If you have additional ammunition, use it. For example, if the plan is also in violation of a deadline imposed by your plan contract, point that out. And some plans are subject to state prompt-pay law, even if they tell you that they're not, says South Carolina attorney Lawrence Laddaga. “It depends on whether a plan is insured or self-funded,” he explains.

  • ask for--or demand--payment. Tell the plan that you want the claim decided and paid immediately

  • copy the member. “The member should be informed of the status of the claim,” says reimbursement specialist Tammy Tipton. “And if the member has more information than you do, this puts him on notice to share it with you.”

    Author's note: This week's tip was excerpted from HCPro's monthly newsletter, Managed Care Contracting & Reimbursement Advisor. For more information, click here.

  • January 19, 2006

    Adjust income division for physician underproducers

    Even under the current productivity crunch, many medical groups divide some or all of their income equally. After all, physicians still share many fairly equal responsibilities. Often, however, one partner lags behind the others in pulling his or her weight. Before that happens, have good data available. And create clear performance expectations so the underproducer knows the penalties for not meeting specific goals.

    Define minimum performance expectations and maintain a “scorecard.” Emphasize the need for numbers to back up compensation decisions. When partners fail to meet agreed-upon standards—as shown by good data—they can less easily argue their contribution to the good of the group.

    By setting a “fail-safe point” you maintain an agreed-upon productivity level. Any shareholder performing to the fail-safe level receives an equal portion of the group’s shared income. Below that level, underproducers receive only their percentage of the productivity income and the remaining partners divide the rest of the income equally.

    Many practices believe they’ll never have this problem. They end up calling in a consultant (i.e. ME!) or attorney to resolve an issue with grayer lines than a fail-safe point affords. Save your group both consultant and legal fees down the road by setting clear production and performance thresholds up front.

    Continue reading "Adjust income division for physician underproducers " »

    January 17, 2006

    Physican Median Days in A/R

    The following are selected single specialty median days of gross charges in A/R from the 2005 MGMA Cost Survey:

    Anesthesiology - 52.1

    Cardiology - 40.02

    Family Practice - 39.0

    Internal Medicine - 37.7

    Orthopedic Surgery - 54.2

    Pediatrics - 35.6

    General Surgery - 42.4

    January 16, 2006

    Select the appropriate staff to answer your phones

    Clearly, you can’t have just anyone answering the phone. First determine whether your receptionist can effectively field telephone inquiries or whether you need a special patient coordinator to handle callers with extensive questions. Deciding factors include the type and size of your practice, call volume, and the need for privacy.

    For example, larger practices or those specializing in multiple services may do better with a patient coordinator simply because the receptionist won’t have the time or the expertise to field all types of inquiries. Similarly, if your phone rings constantly, the receptionist won’t be able to handle all of the calls effectively without putting inquirers on hold—a big no-no when dealing with first-time callers.

    Finally, consider a patient coordinator to field phone inquiries when privacy is an issue. For example, if your practice treats patients with potentially embarrassing conditions, such as impotence or incontinence, your staff will be better able to converse discreetly with the caller behind closed doors. Moreover, patients in the waiting room don’t want to overhear the receptionist covering personal details with callers.

    This nugget was adapted from The Profitable Front Desk, from Advisory Publications, a division of HCPro, Inc. To order click here or call their Customer Service Department at 800/650-6787 for more information.

    January 13, 2006

    A financial counselor serves you and your patients

    In the world of professional collections, medical billing is unique. So be creative in your approach to securing payment: Appoint a financial counselor to help you minimize adversarial dialogues both between collectors and patients and between patients and their insurance companies. Most of all, your financial counselor can save staff time and improve collections without irritating or confusing patients.

    In larger practices, a financial counselor’s job can be quite narrow. You’ll want patients to see your financial counselor as an advocate, so—aside from excellent payer knowledge—look for a person with outstanding communication skills. Then go beyond awarding the title; equip and empower this person to do the job right. The counselor’s job duties include:

    1. Remain well versed on the rules and nuances of your managed care, worker's comp, and other payer plans.

    2. Learn about referrers, payers, and hospitals. Develop key relationships and contacts.

    3. Work with patients early on to coordinate benefits.

    4. Act as an advocate and liaison for patients with billing and insurance hassles.

    January 12, 2006

    Hospital Employment of Physicians

    The following is an article you might be interested in reading:

    The ?Hire? Road: Physician Employment Makes a Comeback By Preston Gee, for HealthLeaders News - Jan 3, 2006


    January 11, 2006

    When an Employee needs another W-2

    From The American Institute of Professional Bookkeepers – www.aipb.org

    To reduce phone calls and avoid sending a duplicate to the wrong person (e.g., an ex-spouse), develop a policy and procedure, such as the following:

    1.      Take requests for duplicate W-2s only in writing.

    2.      When issuing a duplicate W-2.

    Type "REISSUED STATEMENT” in the upper right-hand corner on all copies of the W-2. It is acceptable to use a copy of the employer’s copy.

    If you are mailing W-2s to former employees, make a copy of the envelope showing the address that you used and put the date you mailed the duplicate on the photocopy.

    If a W-2 is returned, keep it in the envelope. If you hear from the employee, put this envelope in another envelope and mail it to the corrected address. If not, keep it for at least 4 years as proof that it was mailed by the deadline.

    Best policy: Create a "W-2 Request Form." But what employee data should go on the form? Is there any company data you should include? How can you make sure this form will provide proof that you met your legal obligations if the IRS gets involved?