June 27, 2014

Thoughts on physician practice employee retention

Competition and quality. Both of these words define key elements that management personnel within the medical industry must remain focused on in order to be successful. Management teams are responsible for identifying and considering all stakeholders, whether primary or secondary, and incorporating their interests and goals into operational decisions and goal-setting.  Stakeholders of a healthcare facility are primarily viewed to be patients, but staff are stakeholders too. In order to be productive and effective in providing quality healthcare, management teams must develop and nurture their relationship with their staff. Establishing a foundation of trust and reliability will greatly influence a healthcare team’s ability to efficiently operate and effectively communicate. Management must feel confident and secure with their team dynamic and, oppositely, staff must feel confident and secure in their management team’s direction and ability.

According to a survey published by the Society of Human Resource Management, the fourth and fifth top contributing factors to employee satisfaction for 2012 were “communication between employees and senior management” and “relationship with immediate supervisor”, respectively. In some instances, a healthcare team may have several years, or decades, of working together cohesively; therefore, assigning a new manager may be delicate procedure. Responsibility falls to senior administrators to be able to identify key personality traits and potential areas of conflict prior to introducing a new manager to a department. Once that manager has been introduced, responsibility then falls to the manager to integrate themselves into that work environment and establish positive, productive relationships. Both staff and management must have a mutual understanding and respect for their individual roles in their department, as well as, their niche in an organization as a whole. When employees feel their manager has their best interest at heart, staff are more satisfied with their jobs, which directly contributes to increased performance.

Conversely, when a manager interviews for a potential new employee for placement into an established work environment, considerations must be made to ensure an appropriate selection. Staff’s positive reception to a new employee or position will be paramount to successfully onboarding and integrating a newly hired employee. Again, having a basis of trust and reliability between staff and management will allow for more streamlined and seamless transitions when staffing or workflow changes must be implemented. Even in the initial stages of interviewing, potential candidates are projecting potential job satisfaction if they accepted an offer. If managers convey a high interest in a candidates’ success and well being, a new hire may become more driven to perform highly and, thus, improving overall departmental productivity.

Employees and managers alike want to feel comfortable and supported by their co-workers and corporate structure. Developing and nurturing a mutually-respected relationship between managers and their staff should remain highly visible on a management team’s operational radar. New employees must be integrated appropriately and with management’s support to establish a positive foundation; whereas, established working relationships need to be continuously nurtured throughout their development. Improving these critical relationships will, undoubtedly, increase job satisfaction amongst all involved and directly improve productivity by reducing intra-departmental conflict between management and staff. Well-functioning and cohesive teams play an important factor in providing quality healthcare, as well as, creating a successful practice and management personnel should be mindful of prioritizing the concept appropriately.  

June 24, 2014

Common Medicare billing errors per EOBs

Medicare Benefits Message #96 Non-covered charge/s.  Prior to performing or billing a service, ensure that the service is covered under Medicare. Please refer to the Centers for Medicare & Medicaid Services Internet Only Manual, 100-02, Chapter 16.  

Medicare Benefits Message #18 Duplicate claim/service.  Please check claim status through the IVR to see if another claim was paid or is currently being processed. To prevent duplicate denials, allow us sufficient time to process a claim before submitting a second.

Medicare Benefits Message #46 Charges exceeds fee schedule/maximum allowable amount or contracted/registered fee arrangement.  Please check your Medicare Summary Notice for the additional remark codes as to why your claim has been adjusted.

Medicare Benefits Message #109 Claim not covered by this payer/contractor.  This denial indicates that the service is one that is processed or paid by another contractor. Examples of these types of services are: Durable Medical Equipment, hospice related services or Medicare Advantage. You must send the claim to the correct payer/contractor.

Medicare Benefits Message #B7 This provider was not covered by Medicare when you received this service.  This provider was not certified/eligible to be paid for this procedure/service on the date of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110) Service Payment Information REF), if present.

Medicare Benefits Message #183 The referring provider is not eligible to refer the service billed. Note: Refer to the 834 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.  This item or service is not covered when performed, referred or ordered by this provider.

Medicare Benefits Message #246 This non-payable code is for required reporting only.  This code is for information/reporting purposes only.

June 23, 2014

Have you updated your personnel manual?

When was the last time you updated your employee handbook and/or personnel policies. It is not uncommon for a handbook to reference policies or information that may change as needs arise. For instance, most handbooks will refer to benefits for full-time and part-time employees, but will not actually itemize the benefits in the handbook, instead referring to a separate schedule that may change. This allows the handbook to act as a stable source of information without having to alter it with every change in the practice. Here is are a few items to consider as you update your 2014 employee handbook or personnel policies.

General Compliance Statement

Do you have general compliance statement that speaks to the practice’s commitment to adhere to local, state and federal laws. If not, consider adding one. This, of course, includes HIPAA compliance.

At-Will State

All states recognize at-will employment but some states place limitations on it. Every practice’s handbook should have language about the at-will nature of employment. At-will means that an employer can terminate an employee at any time for any reason, except an illegal one, or for no reason without incurring legal liability.  Likewise, an employee is free to leave a job at any time for any or no reason with no adverse legal consequences. Check your state Department of Labor website for specific information.

What is Full-time Employment?

Did you change your definition of what “full-time” employment means? The Affordable Care Act defines full-time as 30 hours per week.

Lactation & Other Employee Breaks

Did you include or refer to lactation breaks for nursing mothers? According to the Department of Labor (DOL):

The Patient Protection and Affordable Care Act (P.L. 111-148, known as the “Affordable Care Act”) amended section 7 of the Fair Labor Standards Act (“FLSA”) to require employers to provide “reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child’s birth each time such employee has need to express the milk.” Employers are also required to provide “a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk.” See 29 U.S.C. 207(r). The break time requirement became effective when the Affordable Care Act was signed into law on March 23, 2010.

Do you adhere to your state’s requirement for employee breaks? http://www.dol.gov/whd/state/rest.htm

Paid Time Off (PTO) Use

Have you updated your information on how PTO may be used? Some states require that PTO be available for parent-teacher conferences. Check your state Department of Labor for more information. http://www.dol.gov/whd/contacts/state_of.htm

Drug & Alcohol Policy

If you have a drug and alcohol policy, does it need updated to reflect medical marijuana laws? Do you reserve the right to have any employee tested for drugs if their behavior warrants it? Check your state Department of Labor for more information.

Social Media Policy

Do you have a social media policy that guides not only personal use of social media in the workplace, but also guides who may speak on behalf of the practice on social media.

June 20, 2014

NSCHBC physician statistics are out

The National Society of Certified Healthcare Business Consultants (NSCHBC) (for which I have been a long standing member) has produced their annual Practice Statistics Report (2013).  This statistics report contains practice data from 2,492 professional practices representing 5,252 FTE doctors.  The aggregate data is reported on 60 dental and medical specialties.

Practices that utilize NSCHBC consultants are proven to produce more revenue and bottom line income, in most cases, than those practices that do not utilize expert professionals in assisting in the management and oversight of the business.  Additionally, practices included in the NSCHBC statistics report continually exceed revenue and profits of those practices contained in the MGMA annual practice surveys.  Here is a sampling of some of the 2013 report findings.

  • Family Medicine w/o Obstetrics
    • Average annual revenue per practice grew by about $45,000 or 3.6% and $33,000 or 5.1% per FTE Doctor
    • Avg income increased by 10.3% per practice and increased 13.4% per FTE Doctor
    • Avg OH decreased by2.6% per practice and decreased 2.7% per FTE Doctor
  • Family Medicine w/ Obstetrics
    • Average annual revenue per practice grew by about $120,000 or 10.2% and $120,000 or 18.4 % per FTE Doctor
    • Avg income dropped by 1.7% per practice and grew by 8.0% per FTE Doctor
    • Avg OH grew by 3% per practice and 2.3% per FTE Doctor
  • Internal Medicine
    • Average annual revenue per practice grew by about $75,000 or 6.6% and $72,000 or 12.4% per FTE Doctor
    • Avg income increase by 19.3% per practice and grew by 20.1% per FTE Doctor
    • Avg OH decreased by 6% per practice and decreased by 4.7% per FTE Doctor

Visit the NSCHBC website to find out more how your practice compares to like practices or contact a member consultant to assist you in benchmarking your practice today.

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!"