Reed Tinsley, CPA

Balancing Life, Work, and Relationships

As many know, I have used this blog as a recepticle for ideas, observations, recommendations, and insights about physician medical practices. In other words, I want one place everyone can go to review and discuss medical practice business issues. But every now and then it's nice to get off the subject when something comes across your desk that you feel everyone needs to hear about. I think everyone should subscribe to BALANCING ACT: BLENDING LIFE, WORK, AND RELATIONSHIPS. This is a free monthly newsletter about balancing life, work, and relationships based on the books and popular workshops conducted by Alan Weiss, Ph.D. Here is a little something from his most recent newsletter:

Interludes on balance:

- If you don't treat yourself well, why would you expect others to treat you well?

- When everything is a priority, nothing is a priority. Most things can simply wait a while.

- The constant feeling that you should be doing something; is usually an indicator that you feel you don't deserve to simply be idle and think.

- Always leave others wanting more of you. There's nothing more pathetic than the eternally needy who never want to surrender the spotlight, stop bathing in attention, or simply go home.

- It may just be me, but I'm not familiar with anyone who ever learned much while speaking.

- I've never seen an organization with unhappy employees and happy customers.

- Moving to the next level" means being defeated at times by people who are better than you, and not continually beating those whom you've always beaten in the past.

- Don't look now, but those things you were always going to get around to achieving are still there, but the time horizon is much shorter than it used to be.

- I'm told that most people who die on Mt. Everest die on the way DOWN, not on the ascent.

- Listen to reason. Go with your gut. They sound antithetical. But perhaps the best decisions are those where logic sets the parameters and passion guides the alternatives.

- If you've planned your vacation down to the last detail, you're not really on vacation, you're on some kind of maneuver.

Pretty good advice I say..............To subscribe to this newsletter, send an email to: join-balancingact@summitconsulting.com

Why wave scheduling may improve on-time performance

Despite the clear benefits of customizing patients' appointment time slots, many doctors still operate on a so-called “stream” approach, simply scheduling patients in equal intervals throughout each office session. Thus, a doctor may be committed to see patients at 9 a.m., 9:10 a.m., 9:20 a.m., 9:30 a.m., and so on, regardless of the variations among those patients. Little wonder, then, that the late arrivals and time-consuming patient problems compound themselves as the day progresses.

Wave scheduling takes a different appointment approach, scheduling a number of patients at one time (hence, a “wave”) and none in the succeeding time slots, in the expectation that visits will average out in time usage. Thus you might bring in an hour’s worth of patients at the top of the hour, and see each in turn. Modified wave scheduling books smaller groups at intervals throughout the hour.

Both methods keep a ready supply of patients on hand while minimizing physician down time caused by no-shows and late arrivals. Although we still encounter some physicians and staff members who resist the approach, saying we have seen it applied successfully by a variety of practices.

What to do if member fraud is suspected

A patient comes into your clinic for treatment and presents a plan identification (ID) card identifying her as the dependent spouse under her husband's managed care plan. But you overhear her telling an employee that they aren’t really married. The ID card is in her correct name but a different last name from the "husband's." If you suspect that she isn’t a covered plan member, can you simply refuse to accept the ID card outright and insist that she pay in cash, as if she wasn't covered? Here is what you should do:

Follow your regular procedures for verifying a patient's plan coverage before taking the position that the patient isn't covered. If you don't, you run the risk of wrongly accusing a member of fraud and violating your plan contract for demanding cash payments from a covered member, warns Atlanta consultant Karen M. Beard.

Remember that an increasing number of employers are allowing employees to add domestic partners as dependents to their health insurance coverage, even if they aren't married. So you can't assume that a patient is committing fraud and summarily treat him or her as noncovered.

If the plan ID card is in the patient's correct name, "then it's less likely that fraud is involved," Beard notes.

To protect yourself, follow your regular procedures for verifying coverage with the plan. If the plan verifies coverage and the patient's information matches what the plan has, including the date of birth, Social Security number, and other important information, it's reasonable to assume that the ID card is valid, says Beard.

Compare the information on the ID card with the patient's other identification, such as a driver's license or similar photo ID. If you still can't verify that the ID card is valid or you suspect that the patient isn't really a covered plan member, ask for cash up-front.

"If you can show a plan that you tried to verify coverage before treating the patient as noncovered, then even if it later turns out that you were wrong, the plan will be much less likely to accuse you of violating your contract," Beard explains.

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

Health Savings Accounts for Physician Employees

While many physician offices have not implemented health savings accounts as an employee benefit, there is a prediction that many more will do so in the future. I thought you might be interested in this commentary by one medical practice that has implemented HSAs for its employees:

We switched 1/1/06.  Our employer was paying 100% of healthcare coverage for all employees and families.  We went to HSA/HDHP.  The employer is contributing the same set amount to each employee’s plan and the employees have the option to contribute enough to fully fund the deductible through payroll deduction if the physician contribution doesn’t cover it.  And we are STILL ahead!  We are covering 16 people, including physicians.  Naturally the family coverage group is not entirely thrilled as they potentially have a good amount of out-of-pocket expenses but we still have on of the best benefit packages in the area.

FTC Settles Price Fixing Charges with Texas Physician IPA

On February 13, 2006, subject to final approval, the Federal Trade Commission (FTC) entered into a consent order (Order) with Health Care Alliance of Laredo, L.C. (HAL). HAL is a physicians' independent practice association (IPA). The Order settles the FTC's allegations that HAL had negotiated and implemented agreements among competing physicians to fix prices and other contract terms, engaged in collective negotiations regarding those terms, and refused to deal with third-party payors except on the collectively-set terms. The FTC had charged that HAL was neither clinically, nor economically, integrated, and that its actions had increased the cost of healthcare in the Laredo, Texas area.

I will expand on this consent order in further detail in the next issue of my newsletter. If you would like to sign up for the newsletter, go to www.rtacpa.com.

Final HIPAA Enforcement Rule Published

From the American Health Lawyer's Association (www.healthlawyers.org):

The Department of Health and Human Services (DHHS) published in the February 16 Federal Register (71 Fed. Reg. 8390) the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Enforcement final rule. The rule extends the enforcement provisions currently applicable to the HIPAA privacy standards to apply to all HIPAA Administrative Simplification rules.

The final rule adopts most of the provisions of the proposed rule (70 Fed. Reg. 20225) with some changes made in response to the forty-nine comments received by DHHS.

For instance, in the proposed rule, variables were listed to count the number of violations of an identical requirement or prohibition, whereas the final rule “clarifies that the method for determining the number of such violations is grounded in the substantive requirement or prohibition violated.”

In addition, the provision for joint and several liability of the members of an affiliated covered entity is retained, unless it is established that another member of the affiliated covered entity was responsible for the violation.

The final rule also extends the number of days in which a respondent may file its request for a hearing to ninety days rather than sixty days.

Providing Fringe Benefits to Spousal Employees

A self-employed proprietor can deduct annual health insurance premiums under IRC Sec. 162(l) for income tax purposes. By employing his or her spouse and paying medical insurance premiums and possibly other medical costs of the spouse (and family members, including the proprietor) as a tax-free fringe benefit, the proprietor can achieve 100% deductibility for income tax and self-employment tax purposes. However, a key consideration in proving the benefits are provided on account of an employer-employee relationship rather than the family relationship is whether the spouse is a bona fide employee of the business. This issue was the subject of a recent Tax Court summary opinion, where the court held that the proprietor's husband was an employee of his wife's daycare business. Payments under the business's medical benefits plan were excludable from his income, and her business could deduct his medical benefits. Peter Speltz , TC Summ. Op. 2006-25 (Tax Ct.).

Upcoming Managed Care Contracting Seminar for Physician Offices

Thought you might be interested in this upcoming seminar:

Managed Care Contracting
Brokering the Best Deal Using a Value Plan Presentation
A 90-minute audioconference on March 7, 2006
Visit HCPro's Healthcare Marketplace to register today!

Gain the upper hand in managed care contracting
Whether you are in the process of obtaining new payer contracts or simply fighting for better rates, you owe it to your organization to attend Managed Care Contracting: Brokering the Best Deal Using a Value Plan Presentation on Tuesday, March 7, 2006. It will provide you with the knowledge and tools needed to promote your organization's distinctive value in an extremely competitive healthcare services and managed care market.

Yes! I want to register. How do I sign up?

During this valuable 90-minute audioconference, expert Vickie Axsom-Brown, CDC, will describe in detail the benefits, the development, and the effective use of a value plan presentation. This audioconference will explain how collecting and presenting information and data can demonstrate your organization's market impact and value. Earn the respect of your payers and convince them that they need you in their network.

Register today to learn how developing a value plan presentation can help you shift the power in managed care negotiations, and help you get the contracts and the rates you deserve. Plus, you’ll receive the following tools:

TOOLS:

1. Think outside the box challenge to develop a memorable value plan/presentation.
2. Value plan/presentation process description and development guidelines.
3. Data collection checklist
4. Resources reference list
5. Practical presentation template

CORRECT PHYSICIAN APPLICATION OF ICD-9-CM CODES SUBMITTED

As a reminder when filing Medicare and other third party payer claims, Item 21 is the appropriate area on the CMS-1500 claim form to provide the ICD-9 codes applicable to the patient's condition. The diagnosis codes should be entered in priority order (primary, secondary condition, etc.). The codes should be provided in the appropriate fields within Item 21. Incorrect placement of these codes may cause rejections due to the claim being processed through the Medicare Optical Character Recognition (OCR) scanner.

Example:
Two diagnoses provided:
Place in fields 1 and 2 within Item 21, which are above and below each other.
Do not place in fields 1 and 3 within Item 21, which are across from each other.

Marketing Idea for Primary Care Physicians

A recent email on one of the physician listservs asked the following question:

Does anyone have any good ideas on how/what a physician can do to help build their practice outside of the office?  She already goes to schools, daycares, etc and does medical presentations, etc.  Any innovative ideas would be greatly appreciated. 

Here was a response to the question on the listserv:

Have you tried the local newspapers – possibly doing a Q& A section where people could send questions and she could respond.  It’s free – good coverage – and you could probably get her picture put in. Community Service – Get involved with the local area Chamber of Commerce. Practice could do the welcome wagon – if your area is experiencing a lot of growth  although this gets pricey.

These are some basis good ideas for a marketing start. But remember this - if you practice in a heavy managed care marketplace, you must market directly to the employers.  Go to the human resource director of each of the large employers in your service area and ask them how you can get in front of their employees - write for the company newsletter, give brown bag luncheon talks on a medical subject, have a flu shot day, etc.

Remember how patients usually select a doctor: (1) Ask a family member or friend, (2) ask a coworker, or (3) pick up the provider booklet and select a physician who is either close to home or close to work. Develop a marketing plan that will eliminate all three of these - a plan that markets directly to the employees of the major employers in your service area.