2010-2009 RBRVS side by side comparison

Frank Cohen is like the Energizer Bunny – he just keeps going, and going, and going. He has now created a workbook that does a side-by-side comparison of the 2009 to 2010 RBRVS data by procedure code.  It’s filtered such that, in order to be included, the procedure code needs to have both 2009 and 2010 RVU data.  He also calculated the variance for each component as a convenience.

To get a copy, go to www.mitsi.org and click on the download tab.  Don't forget, you can go to the bottom of the page and click on the No Thanks button to bypass the initial page.

Frank is one of our best consulting resources and his website is rich with information. Be sure to visit it.

Business associates -- who are you?

It’s never too late to learn the actual definition of a business associate (BA) when it comes to HIPAA.

A BA, as defined in HIPAA, means a person who “performs functions or activities on behalf of, or certain services for, a covered entity that involve the use or disclosure of individually identifiable health information,” according to HHS.

Examples of business associates include:

• Third party administrators
• Pharmacy benefit managers for health plans
• Claims processing or billing companies
• Transcription companies
• Persons who perform legal, actuarial, accounting, management, or administrative services for covered entities and who require access to protected health information

Reproduced from [name of publication] © 2008 HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945. 781/639-1872. www.hcpro.com. Used with permission.

 

Best front desk sign I've ever seen so far

I was in a primary care physician’s office recently (not a client) where this sign was on the receptionist window:

 

“We regret, but in order to see you, your insurance company requires us to collect your co-payment at the time of service.”  

 

My reaction? Brilliant! Outstanding! This office follows this sign up with a strong front desk policy that requires patients to reschedule if they do not have their co-payments. I found out their co-payment collection ratio for managed care patients was near 100%. For those patients coming to this office who are in acute crisis and must be seen, they are triaged for acuity and the self addressed stamped envelope for the copayment is sent home with the patient. Yes it is tough times for many people but I continue to stress that in any “service industry”, and yes, healthcare is a service industry, goods and services are not delivered without payment received. It’s that black and white.

Crosswalk from consultations to other visit codes

Frank Cohen (www.cpahealth.com) provided us with the table below; this will be important for predicting future utilization and revenue (cash flow) since CMS is doing away with consult code billing.  This is the official crosswalk table from CMS.

  

 

OFFICE CONSULTATION CODES				INPATIENT CONSULTATION CODES
SOURCE	DESTINATION	MAPPING		SOURCE	DESTINATION	MAPPING
99241	99201	50%		99251	99221	70%
	99211	50%			99304	30%
99242	99202	50%		99252	99221	35%
	99212	50%			99222	35%
99243	99203	50%			99304	15%
	99213	50%			99305	15%
99244	99204	50%		99253	99222	70%
	99214	50%			99305	30%
99245	99205	50%		99254	99222	35%
	99215	50%			99223	35%
					99305	15%
					99306	15%
				99255	99223	70%
					99306	30%

More sources for employee background checks

Looking for websites to run pre-employment background screens through? Here is what my clients are using:

 

www.publicdataworks.com
www.ceoinfosolutions.com
www.allisontaylor.com

I shouldn’t have to state the obvious but you need to conduct backgrounds checks on every hire you make. It’ll save you and prevent a lot of grief in the future.

How to analyze a resume

Whether a job applicant is a physician, an administrator/office manager or a medical technician, reviewing the resume is your first step in the selection process. Ostensibly, that resume provides the candidate's objective history, but it's really meant to convince you that he or she is the best person to hire.

Therefore, properly analyzing a resume calls for some detective skills: You need to search for hidden clues, reading between the lines to determine whether you and your manager want to spend the valuable time interviewing that particular job candidate. Resumes and CVs are often created by professional firms specializing in their preparation. Don't get hooked by wishful thinking based on the format and language. Take the facts, consider them critically and don't wander beyond them.

Look ahead to your office’s future

Besides considering how the office affects your current practice, think about how the facility fits into your future. Offices often hinder doctors' ability to change the way they practice. Don't, for instance, let your office impede these four growth strategies:

• Adding physicians or merging practices. Carefully project your future office needs early in the planning process. Real estate issues sometimes completely derail a merger or make new-doctor recruiting grind to a halt. "Squeezing in" a new physician is at best a very short-term alternative to acquiring needed space.
• Building patient-management teams. Moving to a team-management patient care approach, many physicians discover that office limitations prevent them from being on the staff, like mid-level providers and patient educators, they need to make the approach work.
• Adding in-office procedures. Technological advances continue to move medical and diagnostic procedures into the office. Many payers prefer practices able to provide more services, so don't let yourself lose out simply because you lack the additional work space.
• Bringing in new revenue. Colleagues around the country are breaking new ground with expanded lines of service, like optical shops, physical therapy, new diagnostic tests, executive physicals, and even medically related retail. Ideas like these require expanding or redesigning your office.

Charging a re-billing fee

I ran across a physician practice that has begun charging a "rebilling fee" beginning at 90 days. They clearly state on their patient statements that the rebilling fee will be charged on balances over 90 days. According to the administrator, this has been really effective in getting patients to pay earlier rather than watching their balance role across until it reaches the 120 day box.  It has also helped with balancing out what they might receive in the future when we finally do send a patient to collections (they include the rebilling fees along with the balance). Is anyone else doing this?

Again, remember my mantra – one statement only to the patient, then out goes the 10-day letter, and if the patient does not respond to the 10-day letter, then off to the collection agency.

Communicate effectively with referring physicians

When it comes to ensuring your referral sources last, spend time giving your referrers what they most want-timely and effective communication. When a new referrer enters your market, make contact. If possible, personally call or visit the physician and introduce yourself, as well as your personal or practice subspecialties. Your administrator or designated employee should also make contact with his or her peer at the referrer's office to discuss communication and referral particulars. Drop off information about your practice, your physicians, office hours, and driving directions to your practice.

Further, have your manager handle the specifics of how to make the referring office's job easier. That doctor may prefer reports delivered in a particular manner or may express specific concerns about scheduling patients in short turnaround. While you use this first meeting as a time to discuss the clinical side of patient referral, your manager can assess specific needs concerning patient scheduling, flow, and paperwork.

Physician Fee Schedule Promises Significant Reimbursement Changes in the Coming Year

by Julie E. Kass and Mark A. Stanley, Ober Kaler, www.ober.com

CMS has released its Calendar Year (CY) 2010 Final Rule with Comment Period for practitioners who are paid under the Physician Fee Schedule (PFS). Some specialists can expect to see a substantial drop in Medicare payment rates under changes made in the final rule. The rule may be viewed here [PDF].

Among other changes, the rule:

• Eliminates billing codes for consultation services except for telehealth services;
• Ties reimbursement under the PFS to the Physician Practice Information Survey (PPIS);
• Establishes a system for accreditation with respect to suppliers of the technical component (TC) of advanced diagnostic imaging services;
• Clarifies the definition for "stand in the shoes" under the physician self-referral rules;
• Revises the utilization estimates for certain high cost, non-therapeutic equipment; and
• Solicits comments regarding whether CMS should define the meaning of "performed the DHS" in the context of the self-referral rules, and which factors to consider if it adopts such a definition.

Elimination of Consultation Codes

Consultation codes are used for evaluation and management services that are provided by physicians, based on a request by another physician or appropriate source. The final rule eliminates consultation codes in the context of everything but initial visits for telehealth services. Any other services that are currently billed using consultation codes must now be billed as new or established office visits, initial hospital visits, or initial nursing facility visits. CMS will increase the relative value units (RVUs) associated with new and established office visits, and with initial facility visits for hospitals and nursing homes in order to offset the reimbursement effect of eliminating consultation codes. Physicians may notice that, while the proposed rule anticipated a 2% increase in RVUs for hospital and nursing facility visits, the final rule provides for only a 0.3% increase. The final rule offers no explanation for this significant discrepancy, but a CMS representative responded to an inquiry on the subject by indicating that a correction notice will be forthcoming "that will look more like" the proposed rule. Click to continue...