June 18, 2014

Physician reimbursement analysis

Have you checked your managed care reimbursement lately? If not, you may be losing revenues!!

Please do the following:

  1. Prepare a spreadsheet for your top 8 managed care payers. On this spreadsheet, write down for each payer the current allowables for your top 20 CPT codes. Be sure to take these allowables off of most recent EOBs.
  2. Next, add a column listing the current Medicare allowable for each of the 20 CPT codes.
  3. For each CPT code, then record what percentage of current Medicare rates you are getting reimbursed (You might be surprised here).
  4. Finally, compare the allowables to the managed care contracts for each of the 8 payers. Is this the reimbursement rate you are suppose to be getting?

If reimbursement is low or unacceptable, RENEGOTIATE your contract! If reimbursement is incorrect, submit a sample of EOBs to the payer so they can investigate the reimbursement - You may be due some refunds.

June 16, 2014

Employers Cannot Reimburse Individual Health Care Policies on a Pretax Basis

In recently posted employer healthcare arrangement FAQs, the IRS warns employers about using employer payment plans to reimburse employees on a pretax basis for health insurance premiums the employee pays on an individual policy (either through a qualified health plan in the Marketplace or outside the Marketplace). As explained in Notice 2013-54, these employer payment plans are considered to be group health plans subject to the market reforms, including the prohibition on annual limits for essential health benefits and the requirement to provide certain preventive care without cost sharing. Notice 2013-54 clarifies that such arrangements cannot be integrated with individual policies to satisfy the market reforms. Consequently, such an arrangement fails to satisfy the market reforms and may be subject to a $100/day excise tax per applicable employee (which is $36,500 per year, per employee). (The term employer payment plan generally does not include an arrangement under which an employee has the option of receiving an after-tax premium reimbursement or taking that amount in cash compensation. Thus, employers can reimburse employees for individual policies on an after-tax basis without violating market reforms.)

The IRS FAQs can be found at


June 04, 2014

Another reminder about physician practice embezzlement

I was working on an independent embezzlement review that resulted from a medical practice employee going to the bank and trying to cash SEVEN insurance checks. Luckily the bank called the practice first before cashing them. To date, we have found her to have taken numerous patient copays and pocketing the money.

Embezzlement seems to be rampant these days in medical practices. It's easy for an employee to cover his or her tracks if (1) controls are not in place as best as they can be (mainly in small medical practices where it is hard to separate certain duties) and/or (2) when people aren't watching. It is the latter that gets medical practices in trouble. Management just does not take the time to "spot check" for embezzlement. The person above got caught but I wonder how many people out there ARE NOT getting caught............

June 02, 2014

Important financial planning issues for physicians

Have you recently considered/looked at these important financial planning issues?

Investment Strategies. Since the passage of the American Taxpayer Relief Act and the enactment of the net investment income tax last year, physicians are faced with a significantly higher income tax rate on investment income. It is causing many to step back, look at their investment strategies and analyze the tax implications.

Asset Placement. Asset placement issues are a critical piece of your overall planning picture. I think it’s particularly important to do two things: 1) decide whether fixed income that generates a lot of taxable income should be in retirement accounts, Roth IRAs or regular accounts; and 2) determine whether higher growth equities that are taxed at a lower rate belong outside of the retirement account.

Harvesting Gains. Harvesting gains can be part of a physician's overall strategy – even in this environment with higher tax rates on capital gains. Trying to plan that around your income year by year, over a multi-year period, is the best way to identify where to incorporate capital gains. I believe that harvesting gains can make sense in the right scenarios – especially for physicians with low incomes due to business losses in a particular year.

Planning for retirement. To me this is the big one. Are you doing any retirement planning? Will you even be able to retire when you WANT TO. To be effective, look at an asset’s efficiency and do projections on an asset basis. Determine whether it will last through your lifetime and then look at where that income stream is going to come from (such as an IRA, a pension or from a regular account) when you retire.

May 28, 2014

Some more ideas for improving front desk collections

What has become clearer and clearer to the healthcare community is that point of service collection must be included in the metrics for a practice to achieve financial success.  Healthcare plans with higher deductibles and co-pays are a reality in the roll out of new insurance plans.  Some patients will only opt for high deductible hospital plans and pay for physician visits out of their pocket. What are the steps your practice can take to ensure collection of the right amounts at time of service?

1. Investigate co-pay/deductible amounts prior to appointment.  For first time patients, this means collecting insurance information when they call for the appointment.  Many practices with web sites have on-line forms to complete with both clinical and insurance information.  Verifying the insurance information either on-line or by phone with carriers will ensure shorter time at check-in windows.  For return patients, verifying insurance should also be done to ensure accuracy.

2. Use your appointment reminder system to prompt patients about payments due at time of service.  Having clear communication with patients about the practice collection policies will eliminate doubt and patients will come prepared if they understand the expectation.

3. For larger practices, consider investment in front-end verification software.  There are more and more software options to verify and document insurance specifics. Leveraging technology saves time and as it can be done in batch, can control personnel costs.  Practices should explore their practice management options for verification of insurance options and implement what makes sense for their practice.

4. Ask for the payment.  It's really that simple.  If patients know the collection policy, understand what is owed at time of service, are regularly told what will be collected.....then all that is left is to ask for the payment.  Multiple options for accepting payment need to be offered and patients will usually comply with request.  For those who cannot comply, offer a financial counselor who can establish with patients a payment arrangement or referral to an agency for federal aid.

The most important  part of your efforts is to develop a plan.  Develop a logical system that includes insurance carriers, technology and patients to ensure the collection of owed monies at time of service.

May 27, 2014

Are your physician practice accounting records running behind?

I constantly see physician practices (especially the smaller ones) continually running behind on their monthly bookkeeping and practice management system close out. I wonder sometimes if physicians really care about getting timely financial information. 

I believe it is super important to have the records up to date and the inability to produce any type of reports is an alert that records are not being properly maintained. Accounting records that are not up to date could be a signal of other issues within the medical practice.  This could indicate the tardy deposit of funds, payment of bills, or simply not knowing the check book balance. In today’s digital universe, bank account statements can be viewed online and reconciled long before statements are received in the mail. Bank accounts that are not reconciled promptly are danger signals that should not be ignored.  The reconciliations and procedures should be reviewed periodically by management.

The lack of timely numbers thwarts any type of financal and practice management analysis. The best information weeks late cannot provide effective help to management or the people charged with overseeing an organization’s operations. Irrespective of when financial data is provided, a routine of periodic reviews or internal audits of the information should be established. Finally, KPIs are another tool frequently used by management that provide benchmarks of activity and can cause immediate reaction to unusual activity or deviations from what is expected. 

Always remember the old saying: "You can't manage what you don't measure!"

May 22, 2014

Physician sentenced for taking kickbacks from MRI center

A doctor practicing internal medicine in Orange, N.J., was sentenced last week to five months in prison and five months of home confinement for taking cash kickbacks for making referrals to a diagnostic testing lab in Orange, the DOJ announced. Mahesh Patel, 64, of Florham Park, N.J., a board-certified physician, previously pleaded guilty before U.S. District Judge Claire C. Cecchi in Newark federal court to an information charging him with soliciting and receiving more than $6,000 in illegal cash kickbacks for patient referrals in violation of the federal health care anti-kickback statute.

Including Patel, 17 defendants – including 15 doctors – have been convicted in connection with the government’s ongoing investigation of illegal payments made by Orange Community MRI LLC (Orange MRI), a diagnostic testing facility.

According to documents filed in this case and statements made in court:

Patel operated his own medical practice in Orange. From 2010 through November 2011, Patel agreed to take cash payments from Orange MRI in exchange for MRI scans he referred to the diagnostic testing facility. Patel admitted to receiving cash on a per-patient basis for nearly two years, and that on one of the occasions on which he received cash, Oct. 13, 2011, he received $375 in exchange for his prior referral of Medicare and Medicaid patients.       

Ashokkumar Babaria, 64, of Moorestown, N.J., Orange MRI’s former medical director, has been ordered to forfeit more than $2 million in revenue from corrupt referrals. Chirag Patel, 38, of Warren, N.J., Orange MRI’s former executive director, awaits sentencing and has agreed to forfeit $89,180 in corrupt gains. In addition, 13 health care providers, including Mahesh Patel, have agreed to forfeit a total of $460,140 in illegal cash kickbacks. Two health care providers were convicted at trial and forfeiture has yet to be determined.

Here is a related article from 2011:


May 16, 2014

Are You Aware of Medicare Penalties of not Participating in Meaningful Use

There are incentives to participating in MU as many physicians are aware. There are also penalties for not participating as well.   The question is “Can you afford the long term penalties and continue to sustain a successful practice?” This is an eight sided coin problem, as one of my mentors used to tell me, which means you can look at this from two different angles and still have six others that have not crossed your mind.

It’s not as simple as if you don’t participate then you don’t receive incentive dollars and will receive a penalty.  It is much more complex, let’s look at this and break down just based on the simplicity of not performing MU with a certified EHR and how the penalties will affect you and your practice. Physicians who have not adopted or refuse to use a certified EHR/EMR system by the deadline in 2015, can expect to see a reduction in Medicare reimbursement by 1%. That increases in the following years by an additional 1%.

So you’re looking at a possible total of 5% Medicare reduction in reimbursement over the next 5 years.

• 2015 - 1% • 2016 - 2% • 2017 - 3% • 2018 - 4% • 2019 - 5%

How does that affect your practice? According to many surveys an average Family Practice physician in private practice will have an annual income of $500,000 and is reimbursed 20% by Medicare. The penalties above would have an overall effect of a reduction in annual income in the amount of:

• 2015 - $1,000 • 2016 - $2,000 • 2017 - $3,000 • 2018 - $4,000 • 2019 - $5,000

Not a huge amount of money right off the top. The loss of income doesn’t stop there. You will lose referrals since you do not have an EHR and the other physicians in your area are using a certified EHR and trying to gain the incentive dollars, so they are sending those referrals to other certified EHR users.  You will possibly lose patients to another office, many people these days prefer technology and the ability to have information electronically.  That’s just one little piece of the big EHR puzzle.

May 14, 2014

EHR/EMR Implementation Issues You Need to be Aware of

There are so many challenges that come from any new organizational change.  Implementation of a new EHR/EMR has many diverse challenges. Here are what I consider three organizational challenges that practices have had to deal with.

Capital for purchase of a new EHR/EMR system

EHR/EMRs are not exactly on the low dollar side. Many single provider offices have trouble gaining the capital to purchase a fully functional system.  Yes, I know the incentive money is to help with offsetting the cost. However, this is an upfront cost. Many single and multi-practice offices have already scaled back the work force to a lean amount.  Also, any reduction in patient volume will hurt the bottom line and the ability to continue to make payments on any system.

Implementation of EHR/EMR

The reduction in the work force (from number one) plays a significant role in this challenge with the lack of support staff and time.  If you have already decreased your staffing, you are now understaffed to install and implement a successful EHR/EMR.  You have two choices at this point. You can negotiate that you will have the go-live support for your implementation and probably looking at another fee for that. Or you might want to consider hiring an EMR/EHR healthcare consultant.


This has always been one of the largest problems with any change, not just an EHR/EMR.  People in general do not like change.  Many would say I don’t like change for the sake of change. Agreed, changing something just to change it makes no sense at all.  This is not one of those times; this is a change for the better. How do you get that acceptance from the stakeholders, the physicians and the staff?  You need a marketing plan. You need a champion. You need believers in the change. You need your team from the president down to the check-in person to believe in this change. With proper training and workflow analysis you will gain that acceptance. Training is critical to acceptance. People want to know that a job can still be completed in the same amount of time if not faster with this change. After all, a real change represents a new or better way of conducting business. 

May 13, 2014

EHR/EMR implementation - Take the time to do it right

The decision to implement an EHR/EMR should not be looked at as a sprint to get just the incentive money.  It should be looked at like a marathon. A sprint is a short distance goal that helps you achieve the end goal of winning a marathon.  Way too many practices are trying to do a quick sprint and get an EHR in place to get the instant gratification of the quick money.  An EHR implamentation should be looked at as a marathon with goals to create an efficient, better health record for not only the patients but for the medical staff as well.

Decisions you make should be based on your goals and your current state of medical records and the EHR you currently own. You will need to choose and install the software and hardware components to help achieve that end goal. So your sprint is the startup of the implementation. You need to have an end goal of what you are really working towards.   What is the overall outcome you want to achieve with your EHR/EMR?

So many times I have heard a physician or even an administrator state “We will do this because its mandated, however we are still going to maintain paper charts.” Then they are very upset with those that made it mandatory and complaining that their staff has no time for entry of data and that the patient wait time has increased.  To point out the obvious, yes ,the staff really don’t have time to make all those entries since they are entering the data in two different places.  What a surprise the patient wait time has increased, you just doubled the amount of work your staff has to do a simple check in of a patient.   Do you plan to just use the EHR and still maintain paper charts?  Really, you want to make your employees do double the work.  How does that make any office more efficient?  In the long run your staff will become very agitated that they have to do double the work compared to an office that is probably right next door. That could lead to turnover of knowledgeable seasoned employees.    Or create an “Oh well attitude” of if they want me to do this much work, then they will have to pay overtime.

The following are some rookie mistakes to avoid that have been made with an EHR/EMR.

• Circumventing the system to use paper - cut down on one piece of paper once a week.

• Support – ensure there is an EHR user support program in place.

• Underestimation – do not underestimate yourself, your staff and their abilities.

• Double Bind situation – don’t create a conflicting message for your staff or yourself.

Keep this in mind as you are starting up your EHR, or training for your marathon. If it’s your first time you have very little experience to draw from.  For many, the goal is simply to finish. After finishing your first round and once you have established guidelines and goals, you can then set realistic long term goals for the next stage and consider your ultimate outcome of how the EHR works best for your organization.

As you gain experience, you can expect to see your pace and the pace of your staff gradually increase as you improve your overall level of efficiency.  Keep a journal of your workflow changes so you can see your overall improvements as you progress.