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15 posts from August 2011

August 30, 2011

Physician coding reviews - increasing payments & reducing audit risk

Physicians with little enthusiasm for coding reviews of their practice become even less motivated when their perception is that the process does not always equate, due to a heavy managed care environment, to more income. This perception is not only unfounded, but dangerous. In fact, the higher the percentage of managed care billings, the greater the real need for a complete coding review. Not only can the process dramatically improve reimbursement and strengthen negotiating leverage, the practice also benefits by reducing the inherent risk of third party post-payment audits with properly priced, coded, and documented claim submissions. 

Amidst today’s climate of zealous fraud and abuse enforcement, the reality is that a medical practice must undertake a coding review, if for no other reason than to provide peace of mind should OIG auditors come to call. That prospect is all the more likely when you consider the OIG is hiring more agents for audits on as many as one-third of all physician practices. E&M services are now better clinically defined, and the E&M Documentation Guidelines give Medicare and other payers the ability to reduce or deny payments through post-payment audits.

August 26, 2011

The Modern Physician Practice Administrator in a Dynamic Healthcare Environment

There was a recent post on the LinkedIn Healthcare Executive Network discussion group entitled “The Modern Practice Administrator in a Dynamic Healthcare Environment.” The originator of the post asked “What new skillsets are you all discovering that we all need to keep up with healthcare changes?, what drives you professionally?” Well Jonathan Cohen replied with an absolutely fabulous post that I just have to show you; it will make you think.

I may change the word Dynamic to "Turbulent". Our healthcare system is off balance yet changing faster than we can adapt. Every healthcare provider from the individual practitioner to the major hospitals are working with only half of the healthcare puzzle while making "best guesses" at potential scenarios. The primary risk is making important policy decisions from a "fight or flight" mode. This process would be similar to working a business from a cash poor position, shading all business decisions and potential outcomes.

How to remain on the cutting edge is simple. It is important to impose the trend rather than react to it.

To survive it is often about bottom line, but new generations of consumers have an even higher expectation on quality of care and being a part of the decision process. I listened to a speaker once that talked about the consumer wanting it "ALL"; the access to the greatest number and the best services. On the other hand, we have insurance companies, federal government and consumers wanting to pay less for the "ALL" package.

Trend is simple, taking into account both sides of the coin by improve efficiency and eliminating waste. This is accomplished by the following: Focusing effort on proven modes of intervention that have solid quantitative numbers to prove its efficacy and outcome.

Utilize standard and efficient processes throughout a system.

Eliminate waste by converting to an EMR methodology of documentation and communication.

Fully utilize technology that has already been purchased and implemented.

Improve communication both to internal and external customer through secure modes of technology.

Fulfill a needed niche, not a perceived niche.

I hope this helps and gives you some food for thought. I do not know why I took the time and elaborated so much, definitely can go into much more detail, but your question seemed to be important for our current times. I wish you well in your talk. I hope people listen. [emphasis added]

August 25, 2011

Physician practice employee recognition idea - a good one or a bad one?

I recently ran across the following website:


They sell sets of pre-printed sticky notes for the busy practice administrator to use to give positive feedback to employees. You just sign and deliver according to the ad on the website. Let's face it. What employee doesn't get a boost out of getting a pre-printed sticky note from the boss saying "You Nailed it" or "You Rock"?

What makes these even more of a value is that they come in sets of four in a binder that has inside the cover several  reasons why you might "reward" someone with a sticky. If you are a negative person, it is probably good to have the handy reminders that you might award a sticky for "keeping focused" or "being persistent." But I hope this comes with a warning label to keep it hidden within the desk. If the boss is out, seeing the locked and loaded stickies combined with the reminder list of why a subordinate might deserve such a reward open on the desk of the boss might generate many Facebook postings, if not outright laughter.

There is a point here, which I hope is obvious. if you are so bad about giving your employees feedback that buying pre-printed stickies to give out kudos is tempting to you, that siutation probably merits some more time and consideration. Medical practices are busy places and competency is just assumed every day. But people like to hear when they are doing a good job, even if a pre-printed sticky note doesn't seem like the right tool for most physician offices.

But if you want to try passing out a few notes to employees for positive feedback, I do have an idea for you. Always include a GIFT CARD with them!!

August 24, 2011

Only 132 More Days Until the HIPAA 5010 Compliance Date!

Register for the 5010 National Testing Week, August 22–26, 2011. Is your practice ready for 5010 implementation? I'm finding most will be waiting to the last minute, which could be disatrous.

Note: The outbound 835 remittance advice will also be supported during the National Testing Week. ERA receivers can register their ERA receiver number along with their 837 claim submission information. 

Medicare FFS Implementation of HIPAA Version 5010 and D.0 Transactions – National Provider Call August 31, 2011

August 22, 2011

Getting physician buy-in when purchasing an EMR system

No matter how robust, no matter how many bells and whistles an EMR system has, efficient implementation and execution will not occur without a high degree of physician buy in. The problem then becomes “How do we attain physician buy-in?” 

With apologies for an admittedly broad generalization, physicians tend to be creatures of habit. They are protective of their routine and often quite set in their current modes of operation. The probability of failure increases with the amount of change a physician is required to make in his or her own daily practice style. Physicians – like the rest of us - can feel threatened by new technology and their perceived loss of control can have deleterious effects on productivity and employee morale. 

One approach to avoid the problem and gain acceptance of a new information system is to integrate the physician’s practice style with the new tool so that when implementation occurs, the physician has a choice of how he or she will interact with it. As the fruits of implementation such as productivity and efficiency begin to ripen, and if the physician has not had to alter his or her practice style dramatically, acceptance should fall into place. 

A second approach to achieving physician acceptance is to identify a physician champion or visionary, at the outset, who serves to set the parameters by which implementation occurs. This person is integral in the sense that they identify the decision making committee, solicit structured feedback and create rules such as the extent of customization. This person serves as the point of contact for the practice and both organizes and evaluates the implementation process. Without a champion, the drive for completion diminishes. Without drive, invested dollars are likely to see little in the way of return.

August 19, 2011

Are your medical practice employees put in a position to succeed?

 Employees, who don't feel connected to their work, engaged by their management or loyal to their organization are approximately 53% less productive than their engaged counterparts. Employee engagement is hugely important in the healthcare industry. With loads of paperwork, EMR transitions, industry overhauls, an endless stream of patients, new emphasis on customer service and a daily influence on matters of life or death, it is vital that healthcare workers be passionately plugged into their work.

Research published in a 1999 Harvard Business Review demonstrated that people excel at jobs that interest them deeply, more than at jobs that their education, skills or experience might suggest are perfect fits for them.

Employees who are highly engaged are excited, enthusiastic, focused on their work, emotionally and mentally involved with their company, highly productive, not easily distracted. That energy and momentum is critical for optimum business success. This is why you should review your organizational chart to make sure your employees are in the right job role.  If an employee is not engaged, it may not be that they are a bad employee, they're just not a fit for that particular job position. If they are put in a position where they can be passionate about their work, it will benefit them and you as their employer.

August 18, 2011

Questions every physician should ask before entering a practice merger

As the consolidation trend sweeps over the healthcare industry, many medical groups are considering strategic mergers with other groups in their region and/or specialty. In our experience, many physicians do not want their organizations to grow into larger entities (because of the increase in complexity, loss of autonomy, etc.). However, more and more groups recognize that in today's marketplace, bigger is often better in terms of providing cost-effective care and creating negotiating clout with managed care companies. 

Typically merger efforts begin with friendly and general discussions about shared interests and possibilities. Unfortunately, the merger effort often bogs down because either the groups do not know what to do next, or because of the lack of an organized effort. 

In order to be successful, physicians that embark on a merger effort should always make sure they get the answers to the following questions: 

  • Why should we consider a merger?
  • What are the costs and risks associated with merging?
  • How does a merger process typically work?
  • What are the key issues usually addressed in a merger process?
  • Who participates in the merger process?
  • How do we get started?

August 17, 2011

Why every physician needs a CPA and healthcare consultant

During my years in consulting, I have found that the successful medical practices out there are the ones that surround themselves with excellent advisors. Not only do they surround themselves with excellent advisors, they utilize them at every turn. I think it’s important to have people on the outside looking in, willing to offer advice when needed. I have never seen the “perfect” medical practice – it does not exist. Why? Because we are human and as humans, we make mistakes - It’s not a perfect world we live and practice in. However by surrounding yourself with a solid team of advisors, I think you can minimize these mistakes and maintain a healthy bottom line. 

Every medical practice has a variety of specialized team members that handle patient intake, billing, collections, office management, and, of course, the delivery of the actual medical care itself. In the best medical practices this system is continually refined and each member is carefully selected and trained to ensure that the practice runs as safely and efficiently as possible. 

What many physicians and practice managers often overlook however is the importance of the “outside” staff that supports the operations of the medical business. These outside professionals are just as vital to the success of a practice as any internal employee and must be chosen with the same degree of care. In my last post, I talked about the need for an insurance agent and financial planner. A physician also needs a CPA and healthcare consultant as key outside advisors you should surround yourself with: 

CPA  Some will disagree but there is not much separating “tax preparers” these days. Any CPA worth their salt can prepare a good tax return. They should – it’s their job! This is a necessary skill set but in today’s economic conditions and reimbursement rates, you require more. You need a real “tax planner” — someone who is BOTH technically proficient at the paperwork and who is proactive about spotting and suggesting ways for you to pay the minimum amount legally possible. Which category does your current CPA fall into? Make sure they are working as hard to save you money as you worked to earn it. 

Healthcare consultant  If your CPA does not already provide healthcare consulting services, then seek to engage such a person. What can an outside consultant do for you? First, this person acts as a resource to your practice. This person can advise you and your team on any area/issue related to daily practice management. Working in unison, there should be no practice problem that can’t be addressed and resolved. A consultant can be that set of eyes from the outside looking in to the practice. This kind of oversight is vital in today’s ever changing marketplace. Finally, working together, you and the consultant can strategize and implement ideas that will increase your bottom line. Remember there is only one financial benchmark that should matter to you – did I make more money this year than last year?

These advisors form the absolute core of any well-crafted external support team. My advice is to use them. These people are not “overhead,” but an investment in your practice. Engaging a successful team of outside advisors will make you money in the long run.

August 15, 2011

Why every physician needs a good insurance agent and financial planner

Insurance agent(s)  Insurance is your indispensible first line of defense against a variety of exposures from malpractice to data breach and even traditional life and health. In many cases these needs are served by two different agents, one who handles life insurance planning for the staff and principals and another who is a property and casualty or “P&C” professional to help with liability coverage and health insurance. There are certainly many agencies that do both, but my experience with thousands of doctors leads me to believe that most are better at one or the other. I also prefer multi-line agents that have the entire universe of products available to suit my client’s needs at competitive pricing, not just one insurance carrier’s line.

Financial planner  As corny as it sounds, People don’t plan to fail, they just fail to plan. I typically find that most physicians pay more attention to their business finances than their personal finances. However, the two should go hand in hand. Want an example? You would not believe how many doctors practicing today HAVE TO WORK – they can’t retire and simply live off their retirement savings. 

A good financial planner will address these areas:

  • Are you adequately insured
  • Are you planning for retirement
  • Are you saving
  • Are you planning for college education
  • Do you have an estate plan
  • Working with legal counsel, are your assets protected
  • Do you even have a written financial plan in place
  • Is there diversity in your investment portfolio

A financial planner should also work with your CPA to identify opportunities to reduce taxes and allow to safely and predictably keep more of everything you earn by examining the costs and benefits of things like retirement plans and other legal tax deferment strategies.

August 12, 2011

2010 Medicare Electronic Prescribing (eRx) Incentive Program Payment Update

The Centers for Medicare & Medicaid Services (CMS) announced that incentive payments for the 2010 Medicare Electronic Prescribing (eRx) Incentive Program has begun for eligible professionals who met the criteria for successful reporting. Distribution of 2010 payments Medicare Electronic Prescribing (eRx) Incentive is scheduled to be completed by August 31, 2011. If you are not on this program, you're missing out - I just had a client receive $52,000 for eRX!!

Effective January 2010, CMS revised the manner in which incentive payment information is communicated to eligible professionals receiving electronic remittance advices. CMS has instructed Medicare contractors to use a new indicator of LE to indicate incentive payments instead of LS. LE will appear on the electronic remit. In an effort to further clarify the type of incentive payment issued (either PQRI or eRx incentive), CMS created a 4-digit code to indicate the type of incentive and reporting year. For the 2010 eRx incentive payments, the 4-digit code is RX10. This code will be displayed on the electronic remittance advice along with the LE indicator. For example, eligible professionals will see LE to indicate an incentive payment, along with RX10 to identify that payment as the 2010 eRx incentive payment. Additionally, the paper remittance advice will read, “This is an eRx incentive payment.” The year will not be included in the paper remittance. 

Who to Contact for Questions? 

If you have questions about the status of your eRx incentive payment (during the distribution timeframe), please contact your Provider Contact Center. The Contact Center Directory is available at:

http://www.cms.gov/MLNProducts/Downloads/CallCenterTollNumDirectory.zip, on the CMS website. 

The QualityNet Help Desk is available Monday through Friday from 7:00 a.m. – 7:00 p.m. CST at 1-866-288-8912 or via qnetsupport@sdps.org. The help desk can also assist with program and measure-specific questions. 

The following CMS resource is available to help eligible professionals understand the 2010 eRx Incentive Payments, view A Guide for Understanding the 2010 eRx Incentive Payment [PDF 57 KB], on the CMS website.