Overwhelming nurse phone call volume
Many physician offices have hard time dealing with the continual increase in nurse phone call volume. In most cases, the vast majority of total call volume is for the nurse. However, many nurse calls require physician involvement before the call can be returned. To compound the situation, many times patients call back several times per day to find the status of their issue, which just serves to clog the phones further. Are there any options other than just hiring more nurses to man the phones??
"Triage" phone traffic is a constant struggle. I heard a speaker identify this problem as a leftover from the HMO/capitation days. As such it becomes a matter of re-education for patients, staff, and physicians. Basically, the goal is to turn those calls into income producing office visits, as well as better patient care.
The resistance to change in this area comes from all players:
· Patients want free medical care
· Staff wants to maintain an important role, and job security
· Physicians don't want to work more by seeing those patients in office
Consider an attempt to change this paradigm by:
1. Convincing the physicians that medical care should not be given away - oath, liability, reputation, income. Educate the nurses that their skills and time are better used for actual triage situations.
2. Creating physician-nurse-developed protocols for telephone receptionists that quickly identify problems where the response is "The doctor must see you for that. There is an appointment . . . ." The call never gets to the nurse who interrupts the physician mid-office visit.
3. Short stop all prescription "refill" calls, not renewals, at the auto-attendant, pharmacy, website, and telephone receptionist.
4. Outsource lab results to a patient call-in service.
December 10, 2009 | Permalink | Comments (0) | TrackBack (0)
IRS Tax Publication Update
The IRS released updated Publication 17 (Your Federal Income Tax) used to aid in the preparation of 2009 returns. There are more than 30 law changes that took effect in 2009 that are discussed along with changes taking effect in 2010 that may impact estimated payments. The online version available at www.irs.gov/pub/irs-pdf/p17.pdf contains interactive links to quickly navigate through questions and answers.
December 9, 2009 in Taxes | Permalink | Comments (0) | TrackBack (0)
Deduction for Nurse's MBA
The Tax Court held in a summary opinion that a registered nurse could deduct expenses paid in 2005 in attaining an MBA with a specialization in Health Care Management (MBA/HCM) in 2008. From 1984 to 2008, taxpayer worked in various capacities for multiple facilities, including director of nursing for a 150-bed long-term care facility. While the MBA/HCM "may have improved [her] preexisting skill set . . . she was already performing the tasks and activities of her trade or business before commencing the MBA." Therefore, her MBA/HCM did not qualify her for a new trade or business, and she could deduct her education expenses for 2005. Lori Singleton-Clarke , TC Summ. Op. 2009-182 (Tax Ct.).
December 8, 2009 in Taxes | Permalink | Comments (0) | TrackBack (0)
IRS announces 2010 standard mileage rates
Beginning on Jan. 1, 2010, the standard mileage rates for the use of a car (also vans, pickups or panel trucks) will be:
* 50 cents per mile for business miles driven
* 16.5 cents per mile driven for medical or moving purposes
* 14 cents per mile driven in service of charitable organizations
For details go to:
http://www.irs.gov/newsroom/article/0,,id=216048,00.html
December 7, 2009 in Taxes | Permalink | Comments (0) | TrackBack (0)
Holiday Parties: 12 Tips for liability free events
Make no mistake about it, physicians and their employees can “party down” with the best of them. However, every year around this time, the Ghost of Christmas Parties Past comes clanking down the hallway, dragging in its wake a chain of dread for employers and employees alike—drunken exploits, gag gifts gone wrong, ill-advised sexual overtures and the ever-present threat of bad dancing.
Here are 12 tips from the HR Specialist (http://www.thehrspecialist.com/) to ensure that what's supposed to be the best of times doesn't turn into the worst of times.
1. Make sure invitations stress that attendance is voluntary. Avoid conducting business, such as awards ceremonies, during the party.
2. Keep the festivities culturally inclusive. Avoid religious references and symbols and try to choose a time that does not conflict with employees’ religious observances.
3. Invite families. People tend to behave more responsibly in a family setting.
4. Follow up with a reminder to all employees that your company’s alcohol and drug abuse, sexual harassment and professional-conduct policies apply during the party. Word the reminder positively, noting that responsible behavior will ensure that all employees can fully enjoy the party, but also state that violations will result in discipline, just as they do during working hours.
5. Issue a “gag” order. Lawsuits are frequently spawned by offensive gifts, games and pranks. Include in your professional-conduct notice a reminder that off-color jokes and games are strictly off-limits.
6. Consider an alcohol-free party. Nobody says you can’t offer punch, fancy coffee bars or smoothies instead of cocktails.
7. If you do serve alcohol, consider serving beer and wine instead of liquor. Daytime parties also tend to discourage excessive drinking. Issue tickets rather than holding an open bar, which is an invitation to overindulge. Close the bar at least one hour before the end of the party, and take precautions to ensure that no underage employees have access to alcohol.
8. Hedge your bets: If you serve alcohol, provide transportation. Don’t just offer to call a cab. Hire taxis or private drivers and have them waiting to give rides.
9. Serve food, and plenty of it. Emphasize eating over drinking.
10. Ask supervisors and managers to help ensure that employees behave professionally. Designate one manager as the person to approach during the party if problems arise.
11. Treat complaints arising out of the party just as you would any other workplace complaints.
12. Plan activities to ensure that guests have something to do besides drink and chat and—heaven forbid—dance.
Final note: The U.S. Department of Labor offers more tips for safe workplace celebrations.
December 3, 2009 in Human Resources | Permalink | Comments (0) | TrackBack (0)
Stark and personally performed services
The physician self-referral prohibition (Stark) regulations exempt from the definition of referral "any designated health service personally performed or provided by the referring physician. A designated health service is not personally performed or provided by the referring physician if it is performed or provided by the referring physician ifit is performed or provided by any other person, including, but not limited to, the referring physician's employees, independent contractors, or group practice members." 42 CFR 411.351.
The rule makes no distinction between the professional component and the technical component of designated health services. However, you should note that the rule does emphasize that the service does need to be personally performed by the physician in order for it to fall outside of the definition of referral. In the commentary to Phase I of the Stark II rule, the agency explicitly discussed the issue of designated health services provided incident-to a physician's services and declined to include incident-to services as personally performed services for the purpose of the Stark regulation. This decision has not been changed by Phase II or Phase III. The commentary, located at 66 FR871, explains:
Services performed by others are reasonably considered to be performed as a result of a "request." Moreover, the statutory language in section 1877(h)(4)(B)(i) of the Act indicates that the Congress considered there to be a difference between personally performed services and services performed by others. On balance, we have chosen to include services performed by others, including a physician's employees in the definition of referral. We are concerned that a blanket rule exempting services performed by a physician's employees from the definition of "referral" could, in some circumstances, undermine the intent of section 1877 of the Act.
December 1, 2009 in Regulatory | Permalink | Comments (0) | TrackBack (0)
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.
November 30, 2009 in Medicare | Permalink | Comments (0) | TrackBack (0)
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.
November 28, 2009 in HIPAA | Permalink | Comments (0) | TrackBack (0)
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.
November 25, 2009 in Practice Management | Permalink | Comments (1) | TrackBack (0)
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% | |||||
November 24, 2009 in Medicare | Permalink | Comments (0) | TrackBack (0)
