January 13, 2015

Miscellaneous ACA health care tax subjects

Consumer-friendly Tools for the 2015 Tax Filing Season: Individuals with health coverage obtained through the Marketplace and those that chose not to enroll in health coverage will have additional steps to complete in filing their returns. Marketplace enrollees will receive Form 1095-A that they will use to reconcile their upfront financial assistance. Individuals who could afford coverage but chose not to purchase it will pay a fee. The Health and Human Services and Treasury Departments recently announced they are proving tax filers with information and other resources to answer questions regarding the changes to the 2014 Form 1040 . General resources are located at www.IRS.gov/ACA or https://www.healthcare.gov/taxes/ and more will be made available in the coming weeks.

New IRS Publication on Reporting Individual Health Care Coverage: Tax year 2014 is the first year individuals will be required to report whether they satisfied the Individual Shared Responsibility (ISR) provisions of the Affordable Care Act (ACA). The IRS issued a new publication on how individuals are to report their health care coverage on their tax returns. Publication 5187 (Health Care Law: What's New for Individuals and Families), covers some of the tax provisions of the ACA and explains how taxpayers satisfy the ISR provision by enrolling in minimum essential coverage. Additionally, the publication explains how individuals qualify for an exemption or how they are to make a shared responsibility payment, as well as information about the new premium tax credit. Publication 5187 is available at http://www.irs.gov/pub/irs-pdf/p5187.pdf .

January 09, 2015

How can a health care provider apply for and obtain a National Provider Identifier (NPI)?

A health care provider may apply for an NPI in one of three ways:

1. Apply through a web-based application process. The web address to the National Plan and Provider Enumeration System (NPPES) is https://nppes.cms.hhs.gov.

2. If requested, give permission to have an Electronic File Interchange Organization (EFIO) submit the application data on behalf of the health care provider (i.e., through a bulk enumeration process). If a health care provider agrees to permit an EFIO to apply for the NPI, the EFIO will provide instructions regarding the information that is required to complete the process.

3. Fill out and mail a paper application form to the NPI Enumerator.  Health care providers may wish to obtain a copy of the paper NPI Application/Update Form (CMS-10114) and mail the completed, signed application to the NPI Enumerator located in Fargo, ND, whereby staff at the NPI Enumerator will enter the application data into NPPES.  This form is now available for download from the CMS website (http://www.cms.gov/cmsforms/downloads/CMS10114.pdf) or by request from the NPI Enumerator.  Health care providers who wish to obtain a copy of this form from the NPI Enumerator may do so in any of these ways:

Phone:  1-800-465-3203 or TTY 1-800-692-2326
E-mail:  customerservice@npienumerator.com
Mail: NPI Enumerator
P.O. Box 6059  
Fargo, ND  58108-6059

January 08, 2015

A simple business model for a physician practice

Lest we forget............

1. Generate a charge;

2. Collect for services;

3. Manage cost (overhead); and most importantly

4. Live within your means!!

January 06, 2015

Begin the new year with focus on employees

The physician medical practices are focused on reducing turnover costs, but more importantly, they are focused on keeping top performers - They accomplish this goal by taking positive steps to engage their employees.

According to the Gallup organization, employers have three types of employees:

Engaged employees work with passion and feel a profound connection to their employer. They drive innovation and move the organization forward.

Not-Engaged employees are essentially "checked-out." They're sleepwalking through their workday, putting in time - but not energy and passion - into their work.

Actively Disengaged employees aren't just unhappy at work - they're busy acting out their unhappiness. Every day, these workers undermine waht their engaged co-workers accomplish.

I have observed that leaders in many physician medical practices fail to implement initiatives that go a long way in supporting and retaining their engaged employees (top talent). Many physician practices also lack the commitment to outplace the actively disengaged employees. Remember this - your best performers EXPECT YOU to get your poor performers out of the way.

So as you start this new year as yourself: Does it make sense to get rid of the deadwood?

December 22, 2014

Payer insurance analysis report

Every physician practice should be looking at and analyzing the payer insurance analysis report each and every month. This report tracks collections, payments and CPTcodes from a practice’s top ten carriers. This lets practices compare reimbursement across carriers, an important way to monitor the financial health of a practice in terms of its top revenue sources. Also use this report to identify payments that do not agree with your contracted rate(s) with the payer. Next, this report can also be a useful tool in negotiating contracts with payers. I you identify a carrier that is paying significantly less than others for the same CPT codes, you may even choose to drop that carrier. Though this is option seems unattractive to many practices, experts suggest dropping under-paying carriers can save a practice as much as $50,000 per year.



December 16, 2014

HIPAA and patient portals

I recently wrote an article about the importance of physician offices having a patient portal and how to implement such a portal. An attorney wrote me the following email reminding me about a HIPAA issue relating to patient portals; thought you might be interested in his reponse:

Just a quick note to compliment you on the patient portal item.  I’ve had recent communications with several health care attorneys and there is one HIPAA issue that I think you need to emphasize when your clients ask you about patient portals.  HIPAA requires a “security assessment” when a patient portal is implemented and, if that is not done and PHI is lost (even inadvertently), the feds could impose a hefty fine.

A recent case against an Anchorage provider reiterates the HHS position on updating training, security assessments and policies and procedures on a routine basis.

Scott Chase
Law Offices of J. Scott Chase
Board Certified, Health Law, Texas Board of Legal Specialization
Dallas, Texas
email:  schase@airmail.net

December 12, 2014

Coding for ICD-10-CM: More of the Basics

In this MLN Connects™ video on Coding for ICD-10-CM: More of the Basics, Sue Bowman from the American Health Information Management Association (AHIMA) and Nelly Leon-Chisen from the American Hospital Association (AHA) provide a basic introduction to ICD-10-CM coding. The objective of this video is to enhance viewers’ understanding of the characteristics and unique features of ICD-10-CM, as well as similarities and differences between ICD-9-CM and ICD-10-CM. Run time: 36 minutes.

  • How to assign a diagnosis code using ICD-10-CM
  • ICD-10-CM code structure
  • Coding process and examples: Combination codes, 7th character, placeholder “x,” excludes notes, unspecified codes, external cause codes
  • Resources for coders

Links to the slide presentation, audio recording, and written transcript are available on the video detail web page. Visit the Medicare Fee-For-Service Provider Resources web page for a complete list of MLN Connects videos on ICD-10.

December 11, 2014

Are you living your medical practice mission statement?

Many physician medical practices havve a mission statement. A mission statement will incorporate what your practice core values and goals are.  It doesn’t have to be long, doesn’t have to be profound…….it does have to be realistic and attainable.  A mission statement is more than a slogan, less than a strategic plan; but should incorporate both ideals and commitment.

Once you have mission statement, do you LIVE the mission statement? How you put that mission statement to work in your practice, how you incorporate both the ideals and values into every interaction, every transaction, every encounter defines your culture.

Sounds pretty simple doesn’t it? The problem however is that most physician practices I see do not live their mission statement. Want proof? It's very easy - all mission statements can be turned in to a questionnaire. You can create this questionnaire and give it all employees and providers to complete. For example, part of your mission statement may say "We treat all of our patients with compassion, empathy, and respect." This can be turned in to a simple question: Do we treat our patients with compassion, empathy, and respect on a daily basis?

If you  have a mission statement, I challenge you to turn it into a questionnaire and give it out to everyone to complete. Hopefully the answers won't surprise you.

December 10, 2014

Reminder about charitable contribution documentation

This is a reminder that individuals and businesses making year-end charitable contributions of several important tax law provisions and the substantiation requirements to deduct the contributions. Some of the reminders to consider include (1) obtaining a written acknowledgement from the charity for gifts worth $250 or more, (2) having a bank record or written statement from the charity, regardless of the amount, (3) ensuring that the charity is eligible, (4) mailing checks before year-end to deduct them in 2014 (credit card donations charged in 2014 but paid in 2015 are deductible in 2014, though), (5) for most donations of cars, boats, and airplanes valued at more than $500, limiting the deduction to the grossproceeds from their sale, and (6) filing Form 8283 with the tax return for all noncash ontributions over $500.

December 05, 2014

Medicare “Complying With Medical Record Documentation Requirements” Fact Sheet — Released

The “Complying With Medical Record Documentation Requirements” Fact Sheet (ICN 909160) was released by CMS and is now available in downloadable format. This fact sheet is designed to provide education on proper medical record documentation requirements. It includes information and resources to help Medicare providers understand how to provide accurate and supportive medical record documentation. This Medicare Learning Network publication was developed in conjunction with the Comprehensive Error Rate Testing (CERT) Part A and Part B and Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) Outreach & Education Task Forces in an effort to provide nationally-consistent education on topics of interest to health care professionals.