Reed Tinsley, CPA

Tips for hiring a biller for your physician medical practice

Know where to look. Staff can help recruit, too, so ask them for suggestions. A current staff member may have a friend who would fit in well with your operation. More employers are offering small incentives – for example, a $200 gas card – to employees who suggest a job candidate who turns into a hire. Managers and employees alike can network with colleagues at local medical billers’ associations. Many of these groups can also circulate the job posting. Turn to local training programs and community colleges when posting a position, as well as using advertisements in the local newspaper. Local community colleges and technical schools that train billing and office staff may be able to place interns. Internships can give you a view of how a potential candidate would fit with your team well before you ever need a replacement.
 
Get online. Online job listings like monster.com and careerbuilder.com can be expensive, but they will get the word out to a lot of people. Post the opening on your organization’s website and don’t forget about social networking. If your organization uses Facebook or Twitter, use them to spread the word about an opening. Staff might mention the opening to their online “friends” and “followers”, too.

Be patient. Yes, medical billing requires daily attention, but that doesn’t mean that you should hire the first candidate who walks in the door. Take your time, and find the right person. Consider employment like a marriage – the cost of a failed one comes at a very high price. Plan how to handle work on a short-term basis because you may need to wait to get the right candidate. If you’re hiring from another medical practice or billing service, the candidate may need to give two weeks’ notice. Don’t be put off by a top candidate’s desire to leave their previous employer on good terms – it’s a sign of respect. You’ll appreciate the same consideration when your employees leave.

Don’t overlook references. Research shows that Americans have a propensity to stretch the truth on their resumes. Check all references. Be on the lookout for anything appears sketchy (for example, all of the reference phone numbers are cell phones, or the voice of the “reference” sounds the same on every call). Look carefully at the company name of the reference, then call the main number directly and ask for that individual. If they’ve never heard of that person, you know the job candidate is trying to scam you. Speaking of scams, don’t skip the background check – essential in today’s recruiting world – particularly for someone hired to handle significant sums of money. Finally, verify credentials directly with the accrediting body – the American Academy of Professional Coders, for example, offers an on-line confirmation process to determine if a candidate actually is a certified professional coder (CPC).

DOJ and HHS Highlight Obama Administration Efforts, Health Reform Tools to Combat Medicare Fraud

At a Chicago summit highlighting a new high-tech war against health care fraud, Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder recently discussed how the Affordable Care Act and the Obama Administration’s Health Care Fraud Prevention and Enforcement Action Team (HEAT) are helping fight Medicare fraud.  The Chicago summit is the seventh regional health care fraud prevention summit hosted by the Department of Justice and HHS.

“This Administration continues to move aggressively in protecting patients and consumers and bringing health care fraud criminals to justice,” said Attorney General Holder.  “Through HEAT, we have achieved unprecedented, record-breaking successes in combating health care fraud and as a result of the Affordable Care Act, we have additional critical resources, tools and authorities to continue this great success.”

 “We have a simple message to criminals thinking about committing Medicare fraud: don’t even try,” said Secretary Sebelius.  “Thanks to health reform and our Administration’s work, we have new tools and resources to catch criminals and stop Medicare fraud before it happens.”

 New tools provided by the Affordable Care Act are strengthening the Obama Administration’s efforts to fight health care fraud.  As a result of Affordable Care Act provisions:

- Criminals face tougher sentences for health care fraud, 20-50 percent longer for crimes that involve more than $1 million in losses;

- Contractors that police the Medicare program for waste, fraud and abuse will expand their work to Medicaid, Medicare Advantage and Medicare Part D programs;

- Government entities, including states, the Centers for Medicare and Medicaid Services (CMS) and law enforcement partners at the Office of the Inspector General (OIG) and the Justice Department, have greater abilities to work together and share information so that CMS can prevent money from going to bad actors by using its authority to suspend providers and suppliers engaged in suspected fraudulent activity.
 
A fact sheet with additional details about the Obama Administration’s efforts to combat health care fraud can be found at www.healthcare.gov/news/factsheets/2012/02/medicare-fraud02142012a.html.

http://www.justice.gov/opa/pr/2012/April/12-ag-429.html

Tax Calendar for Small Businesses and Self-Employed

The IRS has created a great calendar to keep up with due dates and also to provide tax advice. The calendars come in online form, desktop form, and paper form.  To download, follow this link:

http://www.irs.gov/businesses/small/article/0,,id=176080,00.html

 

Apparently the ACO concept is spreading within the private payer community

Here's some proof from CIGNA I read yesterday:

Cigna partners with Houston doctors for collaborative accountable care

"Cigna has partnered with doctors affiliated with St. Luke’s Health System Clinically Integrated Providers and Renaissance Physicians Organization on collaborative accountable care initiatives. The goals of the program are the same as those of an accountable care organization, the Connecticut-based insurer said in a Wednesday statement. They focus on expanding patient access to health care, improve care coordination, improving health outcomes, lowering total medical costs and increasing patient satisfaction. They build on Cigna’s push to move the health care delivery system to an outcomes-based system."

Cigna Launches New ACO With Denver Physician Group

"Cigna and New West Physicians P.C., a Denver-based physicians group, have launched a collaborative accountable care initiative, Cigna's version of an accountable care organization. The collaborative will benefit nearly 7,800 people covered by a Cigna health plan who receive care from the 60 primary physicians and 20 mid-level providers with New West Physicians. The group has 16 locations through the Denver metro area."

Willl the ACO concept move in to the private payer arena?

Will the ACO concept move in to the private payer arena? Seems likely. Many private insurance companies are embracing the same concepts that underscore the Medicare ACO initiatives and in so doing, are encouraging their participating providers to join them in adopting new payment methodologies that will reduce costs while improving quality of care. For example, UnitedHealthcare, one of the nation's largest managed care organizations, has posted the following statement on its website:

"UnitedHealthcare is evaluating a variety of value-based contracting strategies to increase quality, reduce medical costs, improve patient outcomes and share risk as well as responsibility for controlling medical cost trend.

UnitedHealthcare considers Accountable Care Organizations (ACOs) to be an important element of its value-based contracting strategy. The goal of value-based contracting is to move the delivery system toward increased collaboration between the health care community and greater emphasis on shared risk accountability for improved outcomes. The transformation of industry-wide payment models is evolving and will require a variety of strategies to suit the needs and diversity of consumers and health care providers in individual communities across the country. UnitedHealthcare is currently pursuing a variety of value-based contracting models from performance based contracting incentives to full capitation."

As a private physician practice, this is a continuing trend you need to stay on top of. If the trend does continue, you can bet it has the potential to impact the econcomics of your medical practice.

UPDATE: After I wrote this blog post, CIGNA announced new ACO agreements with providers.

http://www.modernhealthcare.com/article/20120718/NEWS/307189960?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMVGJVL3dKRWxiNUtpQzMyWmVzNW5RWUpicWg=&utm_source=link-20120718-NEWS-307189960&utm_medium=email&utm_campaign=mpdaily#

Top 10 Challenges Facing Medical Practices in year 2012 and beyond

The Medical Group Management Association (www.mgma.com) recently published results of its annual member survey and listed the top challenges facing physician practices today. They are listed below. Take a look at them closely and ask yourself "Are these my same practice issues?" If so, what are you proactively doing to address them? Sitting on your hands and doing "nothing" is a recipe for disaster!

1. Managing finances with the uncertainty of Medicare reimbursement rates.

2. Preparing for reimbursement models that place a greater share of financial risk on the practice.

3. Preparing for the transition to ICD-10 diagnosis coding.

4. Dealing with rising operating costs.

5. Participating in the CMS EHR meaningful use incentive program.

6. Understanding the total cost of an episode of care from the payer's perspective.

7. Collecting from self-pay, high-deductible health plan and/or health savings account patients.

8. Maintaining physician compensation models.

9. Managing finances.

10. Recruiting physicians.

Narrow HMO networks

According to an article in the Arizona Republic posted on AZcentral.com, Health Net of Arizona has begun offering a new "narrow network" HMO product to employers in conjunction with Banner Health, a health system offering healthcare services in seven western states.  Under the new plan, employers will receive premium discounts for limiting their network of providers to the newly formed "Banner Health Network".  Presumably based on an ability to better manage care within an integrated network, Health Net believes the should offer a 20% savings over its traditional PPO products.

The emergence of narrow network HMO products is a trend worth watching for several reasons: first, it demonstrates that third party payers are aggressively seeking to better manage health care costs and are looking for innovative ways to do so; and, second, it is apparent that as new products are developed, those providers who are integrated (both horizontally and vertically) are most likely to be the players of choice, as they will presumably have a greater ability to control costs across the delivery continuum.  Physicians and other providers should take these developments to heart when developing their strategic plans for the coming year(s).

http://www.azcentral.com/business/articles/2011/11/01/20111101health-net-offer-discounted-insurance.html

The number of ACOs are on the rise

The number of accountable care organizations (ACOs) has increased by 38 percent in the past six months, with 221 models identified in 45 states, according to a study by Leavitt Partners. http://leavittpartners.com/wp-content/uploads/2012/06/Growth-and-Dispersion-of-ACOs-June-2012-Update.pdf

Out of the 221 ACOs, 148 are single-provider ACOs, 67 percent, followed by 43 multiple-provider ACOs, 19 percent, according to the report. The other models included 17 insurer ACOs and 13 insurer-provider ACOs.

The number of hospital-sponsored ACOs has continued to increase, from 99 in late 2011 to 118, while ACOs sponsored by physician groups has almost doubled, from 38 to 70, the report found.

The week, 89 new ACOs were announced:

http://www.hhs.gov/news/press/2012pres/07/20120709a.html

Large medical practices and The Family Medical Leave Act

The Department of Labor posted a new publication called The Employee's Guide to the Family and Medical Leave Act on its website (www.dol.gov/whd/fmla/employeeguide.htm). The Family Medical Leave Act (FMLA) requires employers with at least 50 employees to provide up to 12 weeks of unpaid leave to an employee for births, adoption, foster care placement, or serious health conditions involving the employee, employee's spouse, child or parent. The new guide helps employees understand (1) who can use FMLA leave, (2) medical certification, (3) when the leave can be used, (4) FMLA benefits, (5) requesting leave, and (6) returning to work. Employees must have worked for the employer for at least 12 months, but it does not have to be 12 months in a row. Airline flight attendants and flight crew members are subject to special eligibility requirements.

Dear Physician-Do your due diligence if considering selling to a hospital

Here is an article from the recent electronic version of Medical Economics that was produced from a persentation I gave at the annual meeting of the National Society of Certified Healthcare Business Consultants (www.nschbc.org) in Las Vegas.

http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=780200&cid=PRAC