Medical Billing Disputes: Finding Peace between Patients and Billers : Don't Be This Billing Service!

Your front-office staff is great. They check patients in, smile, schedule, and do everything right. The doctor or nurse sees the patient, listening intently for any clue that might help them solve whatever the problem. The patient leaves happy.

Then the bill arrives. The patient has a coinsurance they need to pay, and are very willing to do so, but it appears something has gone wrong with the insurance payment amount. They call the number on the statement to pay the bill, and get a not-so-friendly customer service representative. Things go downhill from there. A month later, the patient comes back into the office beside themselves, acting like a lunatic waving a bill around. Once you bring them into a private room away from the rest of your patients, you find out the problem: The patient has been fighting with your billing company for over a month to get a better understanding of what has happened.

This scenario happens far too many times. The office provides excellent service and the billing department — not so much. What is a practice manager to do? First, try to identify the actual problem and go from there.

Here are some tips on conflict resolution between your practice, the patient, and the billing department.

1. Identify the person in the billing department who the patient has been dealing with. Find out the rest of the story, as it could be the patient only had one interaction with the billing department, and the employee could have been trying to explain that the bill was part of the patient deductible and coinsurance. When patients don't want to hear what they don't understand, they start to argue.

2. Once you have a clear understanding of the problem, find out where the customer service portion of the patient experience failed. If it was lack of follow up with the patient or if the representative was indeed rude, that should be addressed with the billing department's manager.

3. Take this opportunity to create a plan with the billing manager to address overall customer service opportunities within the department and how you would like a very specific level of customer service to your patients.

This should include:

• Friendly customer service representatives for your patients.
• If the patient is not satisfied with the level of service, they should be allowed to speak with the manager immediately.
• Follow up with patients. If the representative says, "Let me call you back on that," a phone call best be made within a specific time frame; in most cases 24 hours in a good rule of thumb.
• • If your office is unsure how an insurance is going to pay a claim and the patient needs to be seen multiple times for similar treatments, it is reasonable to ask the billing department to follow a claim from beginning to end. They can then call and let your office know if the insurance is imposing a copay, coinsurance, or deductible for the patient to pay. Your office can then inform the patient. Good billing departments can get most claims through to the major payers in less than two weeks.

Overall, the billing department is part of your team. They need to be on-board with your requests and policies. If you find there is a lack in this area, it's time to set up a meeting and set some standards for them. You are their customer and should be treated as such.

Article By P.j. Cloud-moulds of Physicians Practice http://www.physicianspractice.com/blog/medical-billing-disputes-finding-peace-between-patients-and-billers?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=24092013

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The Affordable Care Act's Effect on Medical Billers

Article By Marsha Sosebee from Physicians Practice

The staunch proponents of Obamacare are joyously dancing in the streets amid a tickertape parade while those who vehemently oppose its inception are hunkered down in a fury of nail-biting anger. I think the vast majority of the population though are in a fog of miscommunication, false hope, and maybe some unnecessary worry.

What does Obamacare really mean to someone like me, an “in the trenches” medical biller? First of all it means that people will be looking to me to answer questions about their insurance now that Obamacare is here. But I have as many questions as they do. The one thing Obamacare has done is put everyone in the same boat, a boat called limbo. We don’t really know how it’s all going to work.

For example, I want to know how reliable eligibility verifications will be. I have claims on my desk right now for which I am fighting retro-termination denials. The day services were rendered, coverage was verified. When the claim was processed, the insurance denied saying the coverage was retro-terminated because the employer didn’t send in notification that the employee had been laid off. In the past, I’ve had denials because the insurance company said the Cobra premiums were not paid. The patient had cancelled checks showing that they did pay the premiums. That fight took me six months to finally receive payment for those outstanding claims. I feel justified in my level of concern for eligibility verification for these government-regulated exchange insurance plans.

Another area of concern for me is precertification. Considering the difficulty regular insurance companies exhibit on occasion, I can’t help but wonder how the governmental connection will affect the precertification process. Just last week, I spent four hours on the phone getting shuffled back and forth between the pre-certification and claims departments of a certain major insurer. The precertification department had told me prior to surgery that no precert was required. I documented the name, date, and time related to this call. Last week the surgery claim was denied because there was no pre-certification. I gave the claims department my documented information and was told that didn’t matter to them because in their system it said precert was required. They said they couldn’t help that the precert department had given me wrong information. I asked if they could get the precert department on the line with us so we could resolve this issue. The response was, “No, we don’t make outgoing calls to other departments.”

So I called the precert department back. They said they were correct, no precert was required and that I should just tell the claims department to pay the claim. I asked if they would please call the claims department for me to verify. That request was met with a prompt, “Once the service is rendered, we are out of the picture.

”Ultimately the issue was resolved, but only because I finally found someone who actually cared about solving the problem and didn’t just pass the buck. I look at instances like this which occur with more regularity that I am comfortable with and I can’t help but think it will there will be worse headaches than this with plans that are overseen by governmental agencies. Maybe we billers should stock up now on aspirin.

My take on the whole Obamacare plan is that making healthcare affordable is a great thing. And if that’s what the Obamacare plan was really doing, I would be more supportive of it. But I think it will do more harm than good. I can very easily see that small businesses will convert employees to part-time status to avoid the penalty. What will that do to families already finding it nearly impossible to stay afloat financially?

I have strong reservations about the government forcing anyone to get health insurance. So many people think that Obamacare is offering free insurance. This is not true. They are forcing you to pay for insurance and the cost of the insurance plans are not readily available. I was just on the healthcare.gov website and I consider myself semi-tech savy. The only way I could find to be able to compare the cost and benefits of the different plans was to actually do your application first. Applying for something before you know the cost is what my dearly departed father would have called "buying a pig in a poke".

"It has been my experience in life that people who are trying to manipulate a situation for their own benefit will create a diversion to get your attention off the truth of what they are doing. I think Obamacare has created a diversion with false concern for the health and well-being of the Amercian people. What is its real agenda? It could be simply to rake in more money for the government or it could be something much more sinister. Whatever the case may be, the next several months are going to be very interesting to say the least.

Article Courtesy of: http://www.physicianspractice.com/blog/The-Affordable-Care-Acts-Effect-on-Medical-Billers?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=01112013

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Medical Practices: Think Twice Before Waiving Copays

Historically, family practices and many other physicians groups have routinely waived insurance copays as a gesture of goodwill to patients in a tight economy. After all, who wants to hound sick patients for their portion of the charges?

There was a time when insurance companies turned a blind eye to these routine waivers of copays. Not anymore.

The AMA's Code of Medical Ethics Opinion 6.12 explains why routine waivers are unethical, particularly when a clinic advertises a willingness to waive copayments.

Further, the Office of Inspector General (OIG) has long taken the position that routine waiver of copayments constitutes an illegal kickback, which is a felony. 

The routine waiver of copayments also constitutes a violation of the terms of private insurance company plans. This contractual violation serves as a basis for a recoupment audit, during which insurance companies request proof of collection of copayments for five randomly selected patients. If the clinic cannot prove it collected, or at least exhausted all reasonable means of collection, then the carrier may demand a refund for any benefits paid across a large patient population.

Perhaps most frighteningly, routine copay waivers constitute ordinary financial fraud. If a patient is charged $100 and the insurance carrier is billed $80, the patient is supposed to pay $20. If you never attempt to collect the $20, this means the actual charge is $80, not $100.  Therefore, the insurance company should only pay $64 (80 percent of the $80
Fraud or dishonesty is a primary way to get in trouble with state medical boards.

There are provisions for waiving copayments in cases of financial hardship. At a minimum, you should document the financial hardship, and obtain a release from the patient to turn the financial document over to the insurance company, if requested.

The OIG states the following criteria for waiver on the basis of financial hardship:

• The waiver must be based on a good faith determination of the patient’s financial need. In other words, waivers must not be applied routinely. The government does not specify the financial status that would justify a waiver, so you should develop your own approach, apply it consistently, and document your efforts. For example, if your efforts to collect on a patient’s bill fail, or if it’s obvious that a patient is struggling to pay the amount owed, ask the beneficiary to fill out a form noting their employment status and average household income and expenses. Then make your determination based on the information provided.

• The waiver must not be based on the amount of the charges. Your decision about whether to waive what a patient owes should be based on the patient’s ability to pay without regard to what Medicare may have paid or the total charges for the service.

• The waiver must not be offered as part of an advertisement or solicitation.

State laws vary regarding waivers. Therefore, seek the advice of an experienced health lawyer in your state if you have questions about your practices.

Article By Martin Merritt from Physicians Practice
http://www.physicianspractice.com/blog/medical-practices-think-twice-before-waiving-copays?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=19112013

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Keeping Up with the Copay: Health Plan Changes Always Happen

By Melissa Young, MD from Physicians Practice

I’ll be the first to admit: I don’t know all the details of my own medical insurance plan. And I’m the one who chose it! I reviewed the benefits at the time. I looked at what the copays would be for office visits and meds, and I looked at what the out-of-network benefits would be. Thankfully, I have not really needed to use it much, so I have forgotten much of the details.

Many of my patients are no better. I doesn’t help that their employers change their plans from year to year. And even if they keep the same plan, the insurance companies change their formularies and their benefits all the time. It often comes as a complete surprise to patients.

For example, I have one patient for whom I prescribed a medication earlier this year. The cost to her at the time was minimal; her prescription plan paid for most of it. She is due for it again now, but now she has this big deductible and it is going to cost her hundreds of dollars. I also have a patient whose ultrasounds I used to do in the office …until her plan decided they didn’t cover it if it was done here, so now she has to get it done in radiology. Of course, neither of us knew that before the last ultrasound I did here. Drugs that didn’t need prior authorization six months ago need it now.

I am certain patients are informed one way or the other about changes in their copay (although many of them seem surprised when my staff asks them for $40 instead of $25 like they paid last time), and maybe they get notice about other changes, but I would not be surprised if they give any mail they get from their insurance company a quick glance and then toss it. I can’t say I blame them. We all get so much mail that looks like junk; it can be hard to figure out which ones are really important. And since things change from month to month, who can keep track of it all?

Courtesy of Physicians Practice: http://www.physicianspractice.com/blog/keeping-copay-health-plan-changes-always-happen?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=22112013

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Health Insurance Exchanges: Two Key Issues to Discuss with Patients

The American Academy of Family Physicians (AAFP) is encouraging its members to provide their patients with information regarding health insurance exchanges.

The AAFP website advises: "During patient visits, be prepared to discuss the insurance options available through the marketplaces and encourage patients to make coverage decisions that are appropriate for their health care needs. "But not all doctors are ready to get involved.

The majority of physician respondents to a recent Medscape survey said that they should either have a limited role or no role in providing health insurance and health insurance exchange information to patients.

Yet, spending a few minutes sharing some key information about health insurance exchanges with interested patients may benefit you and your practice in the long run.

Here's why: If your patients that are shopping on the health insurance exchanges don't make well-informed purchasing decisions, you may see them less frequently. In fact, you may not see them at all.

Many of the health plans offered in the exchanges appear to have narrower networks — meaning patients will likely have fewer physicians and health systems to choose from within the plans.

In addition, many of the health plans offered in the exchanges have higher deductibles — meaning patients may end up shouldering more of their healthcare costs.

"They are trying to funnel people into narrow networks overall, and simultaneously shift people into higher cost sharing that is higher deductible, higher copay kind of plans," Kip Piper, a healthcare consultant in Washington, D.C., recently told Physicians Practice.

If patients purchase those higher cost sharing plans, it's likely that they will put off or avoid visiting your practice due to cost concerns, said Piper. In addition, higher patient cost sharing will place more burdens on your collections staff, as they will need to step up patient payment collection efforts. 
For that reason, you might want to consider talking to your patients about the importance of finding a plan that does not require a lot of out of pocket costs. "Make sure that ... they're not enticed by a low premium to pick a plan that has a high cost sharing that then keeps them out of the doctor's office," said Piper.

The narrower networks offered by many of the plans may also pose problems for your practice.

If you are excluded from a plan or if you have decided to opt-out of a plan, you run the risk of losing your patients to providers who are participating in that plan. For that reason, you might want to share which plans you are participating in with patients.

"I'm afraid of a lot of people in January are going to start making an appointment and then they're going to find out they can't go to their doctor," said Piper.

Article By Aubrey Westgate from Physicians Practice http://www.physicianspractice.com/blog/health-insurance-exchanges-two-key-issues-discuss-patients?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=03122013

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Presentations to Physicians: Don't just Share Data, Provide Direction

Knowledge is power when it directs action. When someone is presenting a case or clinical research to a physician, both the presenter and the physician understand how the information can help the physician successfully address similar clinical circumstances in the future.

The purpose is the same in presentations of non-clinical information, but the implicit call for physician action is neither universally recognized nor understood. As a consequence, physicians are often left feeling helpless in the face of what is clearly bad news.

Consider some information recently shared during a Grand Rounds presentation to a group of orthopedic surgeons:

• In 2011, healthcare spending in the U.S. amounted to almost 19 percent of GDP. The inescapable conclusion is that we have reached the limit of funds available for healthcare, if we have not surpassed it.  Physicians cannot rely upon new money coming into the healthcare system

• The payment system is opaque, particularly to patients. Most hospitals in a recent survey were either unable or unwilling to hazard even an estimate of the costs for a total hip replacement for a patient with no co morbidities. Other studies have shown that there is no relationship between hospital charges and what they actually get paid for services.  Patients surveyed thought physicians' Medicare reimbursement for the surgery was five times what it is, and the patients thought it ought to be about four times the current rate.

• There is a mismatch between supply and demand. The population is aging, and the obesity epidemic puts unsustainable demands on lower extremity joints. Physicians are opting to limit their Medicare participation or retire early, rather than accept prospectively lower levels of reimbursement. Concurrent with a potential shortage of surgeons, hospitals have a lot of unused beds and are continuing to expand their physical plants.

• Physicians have not been effective in preserving their reimbursement rates. Reimbursement levels for hip surgery have declined by as much as 50 percent, in non-inflation adjusted dollars, in the last 30 years. At the same time, hospitals and implant manufacturers have seen their reimbursements more than double.

• The very high volume of total hip replacements performed in the US makes the procedure an obvious target for cost containment and cost reduction.

A lot of knowledge was shared, but it did not indicate a clear path forward. What can and should a physician do with the information?

As in a clinical presentation, the answers were implicit. The difference is that they were not obvious to the audience:

• There will be winners. The current system is unsustainable; and disruptive, systemic change is inevitable. The imperative is either to be one of the people who figures out how to thrive in the new environment, or to align with them.

• Patients are on their doctors' sides. Physicians can leverage that by being more transparent about the reimbursement levels and the problems they present. To be effective, this requires talking actual dollars. "The reimbursements don't cover my costs," sounds like sour grapes. Patients can be moved to contact their representatives in support of physicians, especially if their access to care is a potential casualty of the status quo.

• Given that the pie is not growing, physicians need to get a bigger piece of it. This may be the best news about bundled reimbursements. Hospitals and device manufacturers have done a good job of maintaining healthy margins. Physicians should be able to argue for and achieve a more appropriate piece of the total cost of a procedure for two reasons:

1. The physicians are the ones who are doing the actual work that drives all hospital and implant revenue.
2. Patients tend to choose physicians, as opposed to hospitals or specific devices.
The redistribution will not happen automatically. If physicians are not aggressive and effective in advocating for themselves in the allocation of bundled payments, they will encounter a reprise of the Medicare fee-for-service situation.

The critical question for any presenter is "What do you want me to do with that information?"  Each presenter has a duty to provide the answer, either in the course of the presentation or in response to audience questions,

Article By Carol Stryker from Physicians Practice http://www.physicianspractice.com/blog/presentations-physicians-dont-just-share-data-provide-direction?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=06122013

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Maximizing Physician Compensation at Your Medical Practice

The financial pressure is on for physicians to get compensated not just fairly, but well, at their practices, and Shawn Harkey's medical group is no different.

"We definitely keep a close eye on both fixed and variable components," says Harkey, the financial services director of Texas Retina, an ophthalmology practice with 13 locations in the Dallas-Fort Worth area. "Medicare payments aren't necessarily increasing and we're fighting that battle because the high majority of our patients are over [the age of] 60. That's forcing us to become leaner, more efficient in providing patient care.

" Harkey's practice, which has been using its NextGen EHR for six years and its accompanying practice management system for three years, has already seen improved efficiency (physicians can see patients in a more timely manner) and a reduction in overhead costs, such as paper, storage, and staff time spent manually pulling charts.

Today, the practice is also using its Navicure claims clearinghouse technology to verify patient insurance in advance of appointments to avoid a cash-flow slowdown.

"We see a high volume of patients every day so we make sure we have everything checked, such as benefits and referrals, and we use a number of high-cost drugs so we can make sure there's no issues in place with payers," says Harkey.  The state of physician pay is not only changing, but it is also challenging, as Harkey and our annual Physician Compensation Survey respondents would attest. But by taking a proactive approach — taking stock of the trends and seeking new ways to maximize compensation — physicians can not only stay alive, but they can also thrive, financially.

 * (To see the data, check out the details of our 2013 Physicians Compensation Survey here.)

The state of physician compensation

Today's physicians are under increasing pressure to make money and see more patients.

While more than two-thirds of the 1,474 physicians who answered our survey told us their income is, to some degree or entirely, tied to productivity, just one-third of physicians said their income is tied, at least in part, to value-based metrics. Twenty-four percent of physicians told us their income relies in part on patient satisfaction.

"[Value-based reimbursement] is growing at a small level, and the reason is that there is not funding available for it," says Kenneth Hertz, a Medical Group Management Association healthcare consultant. "If you're earning $250,000 per year and your practice wants to put in place this value-based reimbursement, quality metrics, and other performance metrics, the practice will need to secure additional funds to pay you. Right now, the payers are not providing additional significant dollars to do this. In most cases, practices are having to carve out a pool of money from the current funds available to pay physicians, and then pay those that meet the quality metrics out of that pool."
Regardless of the basis of their payment, more than half of docs in this year's survey — 53 percent — said they were either "slightly" or "highly" disappointed with their income.

"I think there are financial pressures [such as] the changing payment models, the increase in expenses, the reduction in reimbursement in practices," says Hertz. "If you're in private practice you're seeing your expenses go up, and you're seeing reimbursements go down."
Today, many specialists are making more while primary-care physicians are staying flat, income-wise, adds Tommy Bohannon, divisional vice president of recruiting at Merritt Hawkins, a physician staffing agency.

Article By Marisa Torrieri Courtesy of:
 http://www.physicianspractice.com/physician-compensation-survey/maximizing-physician-compensation-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=06122013

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You Need to Adapt in Order to Survive: How Your Medical Billing Service Can Prosper During the Healthcare Industry Chaos

How Your Company Can Prosper During the
Healthcare Industry Chaos

By Patrick Phillips

The healthcare industry is facing a state of complete disorder and confusion: Uncertainty surrounding the implementation of the Affordable Care Act, the looming switch to ICD-10, EHR and "meaningful use" deadlines, hospital acquisitions of physician practices, new HIPAA rules, and Health Insurance Exchanges... the list goes on. It seems like a challenging time for medical billing companies – and it is.

 

The good news is that not only can you prosper, you can bring hope and financial stability to struggling practices and salvage some that would otherwise collapse and shut down (or get swallowed up by a hospital or other acquisition entity). How can you assure your and your clients' continued prosperity and growth?

 

Focus on becoming a full-service revenue cycle management company.
In today's dynamic marketplace, billing companies that do not keep up with the constant changes will be left in the dust by companies that do. You must not only stay current with what is happening in the industry, you need to make alliances with other companies that can provide services to your clients that will help them solve cash-flow challenges beyond just their medical billing. The more services you can offer to your clients, the more you will be perceived as "the expert" who can solve their cash flow problems.

A brief review of the latest issue of Billing will introduce you to vendors that can be valuable to you in assisting your clients with medical coding questions, HIPAA compliance, EHR Meaningful Use attestation, online document management, patient portals, integrated payment channels, patient collections, and other revenue cycle issues. Do not forget that HBMA conferences will introduce you to technology partners that can help you keep up with changes in this dynamic industry.

Make sure you are using a billing system that is fully integrated with an EHR system.
Many outdated, server-based billing systems are trying to patch together a practice management system with one of the new electronic health record systems designed by a different company or on a different platform. The company that developed the practice management (PM) system creates an interface with an EHR system developed by another company. Chaos generally ensues.

If this is the case with your PM system, you are only asking for headaches and a possible loss of clientele. EHR companies are dropping by the wayside every day. Some of them are also server-based. Trying to get them to work together with billing software is like using "bubble gum and bailing wire" and will only lead to ongoing issues in your company. Two different companies, with two groups of programmers, trying to keep all the different parts of both systems running smoothly is almost impossible and can lead to turmoil in your company.

As painful as it may seem now, it may be a good idea to begin looking for a billing system that is totally integrated with an EHR system. That means that it was designed from the ground up by the same programmers in the same company. There are such systems available, and most of them are cloud-based (accessed securely 24/7 through a browser via the Internet).

Anything less than total integration of the two systems could be a disaster waiting to happen. Start your research now and find a system that will take you into the future, especially with any new clients you bring on. And, as part of your due diligence, make sure there is a way to import the data from your current system into the new system (at least the patient demographics). Then, begin to educate your current clients on why they need to start using an EHR, if they are not already, and why they might need to use a system that is fully integrated with your billing system.

Look for a system that has a way to electronically communicate with insurance company databases. You need one that checks for eligibility and automatically imports the patient data directly from the insurance company's database to create new patient charts. This will save you hours of data input and will help you keep employee costs under control. It will also prevent you from submitting claims that are sure to be rejected because the patient was not eligible for the service and it will keep the practice from spending time seeing patients that insurances will not cover. This will increase your revenue for that practice and will eliminate a large number of claim rejections as well.

 

Keep up with changes in the industry.
I can predict the success you are going to have in your business – and in life in general – if you will tell me just two things: the people you associate with and the books (and periodicals) that you read. Do not get bogged down in the details of your billing business. You need to set aside time to attend industry conferences at least once a year and to read industry newsletters and books.

The person who does not read is no better off than the person who cannot read, so set aside time each week to read about our industry and keep up with the constant changes. Change is what life itself is based on, and if you are willing to change along with the industry, you and your clients will prosper.

Do not assume you will have your current clients forever.
You won't. Things change in medical practices: staff turnover, new policies and procedures, new government rules and regulations, competition, updated technology, and the marketplace itself. All these things can cause you to lose a client from time to time. You must always be marketing.

Whether you realize it or not, your competition in this industry is not just other medical billing companies. The practice itself is your biggest competition. All it would take is for a new office manager to come into one of your practices and decide that they would rather not outsource their billing: they think they can do it themselves more efficiently and more economically. You must keep reselling your clients on your efficiencies and on your cost savings versus doing the billing themselves internally. Provide them with revenue reports that delineate what percentage of billed dollars (expected) are actually being collected. Show them you are the expert in this industry by producing and providing to them a professional newsletter with articles that show that you keep up with the changes in the industry. HBMA has a newsletter you can purchase and tailor with your company logo (www.hbma.org). 

Take the practice administrator (or the doctor) to lunch from time to time and show them printed reports that illustrate the revenue collections from both insurance providers and patients. Hold "Lunch 'n Learns" on a regular basis with your clients to bring them up to date on what is happening in the medical industry. Position yourself as the expert. People want to do business with "the expert" in every field.

When you buy a home, you do not want the new real estate agent: you want the guy or gal who has sold 100+ homes. When you look for a CPA, you do not want one who just hung out his or her shingle: you search for one who pays less than double digits of their own taxes and has a number of clients who they service. The same is true of a doctor's office. They want to feel that they are dealing with the company that can bring in every last dime that is due to the practice.

Continue to network with other business people in the community and join your local BNI group or chamber of commerce. Get out once a week and let people know you can solve the cash crunch for doctors and help them build their practices through your contacts.

Set up an automated way of keeping in touch with everyone you come in contact with who is a prospective client. Let them know that you are the only company that they should do business with. When it comes time for them to decide to outsource their billing, you are the only choice that makes sense. People do not buy when you are ready to sell – they buy when they are feeling the pain. Be at the top of their list when they decide it is time for change.

Remind your current doctors and office administrators that you are looking to build your business. Assuming you have done a good job for them, ask them for a referral. You would be surprised as to how many billing company owners never ask their clients for referrals. Do not just ask for the name of someone. Ask your client to pick up the phone and call the other doctor or office administrator and tell them how pleased they are with your billing service and that they think it would be in their interest to meet with you.

You can shrivel up and die in this ever-changing industry, or you can make the choice to grow and prosper, starting right now!

 

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Physicians Dropped by Health Plans for Overutilization

By Averel B. Snyder, MD from Physicians Practice

After United Healthcare dropped 15 percent of its provider panel, I was not surprised. I actually thought something like that would occur sooner. It is clear that for Medicare to survive and to decrease healthcare costs in this country, healthcare delivery needs to change. Most believe that fee-for-service reimbursement is no longer an option and there seems to be a shift toward pay for performance. Clearly, increasing quality, decreasing costs, and increasing patient satisfaction are goals both payer and provider would strive for.

There are certain services in place to help meet these goals. One such example is the Medicare Annual Wellness Visit (AWV). The AWV, by delivering evidence-based preventive services, helps keep patients healthier and prevents over-utilization of services. The visit also helps satisfy quality measures for PQRS reporting. Despite all these advantages only approximately 12 percent of Medicare beneficiaries have had their AWV.

Another way to increase quality and decrease costs is to identify those patients that are at increased risk of overutilization. The current methodology to identify risk is the CMS HCC method. In addition to identifying risk by assigning a risk score to each patient, the codes are necessary for Medicare Advantage (MA) plans to get paid from CMS. The majority of physicians do an incomplete job of coding, making it necessary for MA plans to use third-party providers for risk assessments and retrospective chart reviews. There are now automated software solutions that provide all the components of the AWV and calculate the CMS HCC risk score real time.

The point is that fee-for-service overutilization, no coding, and not providing quality measures will not be and should not be tolerated. Those plans with strong executive leadership will identify those top 15 percent physician over-utilizers and not allow them to participate in the MA plan. If I was one of those executives I would make the same decision. It is time to make the paradigm shift and provide the highest quality care as cost efficiently as possible. It is to the providers' advantage to provide wellness visits for all their Medicare patients, and to understand the nuances of HCC coding.

Article By Averel B. Snyder, MD from Physicians Practice

http://www.physicianspractice.com/blog/physicians-dropped-health-plans-overutilization?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=19112013

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Physicians and the Financial Challenge of Providing an Interpreter

By Melissa Young, MD from Physicians Practice

I’ve written before about unexpected expenses, and we recently ran into another one.

Practices are required to provide access to care to patients regardless of their ability to speak the same language as the physician, and the practice must provide a reliable way to communicate with the patient. That means for patients who do not speak English (and in our practice, instead speak Filipino or Urdu), a translating service must be available.  Patients may decline and use a family member, but the service must be available. There are different options for such a service. If there is a staff member who speaks the same language as the patient, the staff member can do it. Or the practice can contract with a translator service. As a less-expensive alternative, there is software that can translate, although that doesn’t always work as well. There are also telephone-based translating services. Well, it isn't just the non-English speakers who need a translator. We recently had a patient come in who is hearing-impaired. When his appointment was confirmed, he reminded us (through a representative) that it is our responsibility to provide a sign-language interpreter.
We had never needed the services of a signer before.  Fortunately, he provided us with the number of someone we could call. It turns out, such services cost between $150-200 in our area. At least, that was the quote we got.

At $150-200 a visit, that pretty much means that, at best, we break even for the visit, and more likely, we lose money each time we see him. Since it is a requirement, I thought, "maybe there is a CPT code for 'use of a translator.'" Maybe we could get reimbursed for hiring someone. Alas, there is no such code, at least not that I could find.  Now, this patient legitimately needed to see an endocrinologist. He wasn’t one of those people who just think they have an endocrine disorder because they are tired. He needed to be seen, and he will need follow up. And every time he comes, he needs an interpreter. Unless (according to the regulation) there will not be a significant amount of communication involved. What kind of doctor visit doesn’t entail communication? My biller/husband said we should be able to say we can't see him, but (aside form it being the right thing to do) we have to, otherwise it violates a whole bunch of regulations. The exception to the rule is if it places "undue strain" on the practice. And according to previously filed lawsuits, one patient doesn’t break the bank. So, we will continue to see him and provide him with an interpreter and take a loss each time. I was curious to know what the experience has been in other practices.

Article from Physicians Practice By Melissa Young, MD
http://www.physicianspractice.com/blog/physicians-and-financial-challenge-providing-interpreter?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=19112013

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Pleasing Patients Best Marketing Strategy for Medical Practices

Making your medical practice easy to do business with will differentiate it from others, establish a competitive advantage, and make it highly appealing to patients. Here are some of the many ways that physicians can make it happen.

1. Create convenient hours

Many people have workloads or requirements that limit their availability for doctors' appointments during the traditional 9 a.m. to 5 p.m. work day. To accommodate this population, many physicians have office hours beginning at 6 a.m. or 6:30 a.m. to accommodate "early risers" on their way to work, or those coming off night. Others have evening hours ending at 8 p.m., 9 p.m., or 10 p.m. to accommodate commuters and others for whom daytime appointments are inconvenient or impossible.

There are also pediatric practices that are open from 5p.m. to 5a.m. The premise is that the need for healthcare services often occurs after doctors' offices are closed —necessitating a costly trip to the emergency room or a night of worry waiting until doctor's office reopens.

"Availability" for a target population that needs the convenience of extended hours, is a strategy that works.

2. Increase phone availability

Many practices have telephone access only from 9 a.m. to 5 p.m. and are "closed" for lunch. This makes no sense if early morning callers are working men and women who do not want, or are unable, to call from work. Others prefer not to have their coworkers overhear their medical problems (or birth date when asked for it) or may not have access to a phone at work. For similar reasons, some patients may prefer to call you during their lunch break or at the end of their workday after 5 p.m. New-patient callers (with any of the above restrictions) are not likely to call back.

Recommendation: Have an employee available to answer the phones approximately one hour before the office opens, one hour after it closes, and during the hour your office might be closed for lunch. The calls that you might otherwise miss (and the goodwill you'll generate by being available) will be worth it.

3. Use electronic health records

Utilize EHRs to reduce the need for patients to fill out the same forms at each office visit, provide electronic referrals allowing easier access to follow-up care with specialists, and have the convenience of e-prescriptions electronically sent to patients' pharmacies, among other benefits.

4. Establish a Web portal

Provide an easy-to-use Web portal so patients can schedule, reschedule, or if necessary, cancel appointments, and access and print health history forms that can be filled out prior to coming to the office. A portal will also allow your practice to view and update patients' contact, insurance, and other personal information. Patients can also make electronic payments, request prescription refills, receive test results, and exchange secure messages with doctors about lab-test results (eliminating telephone tag).

To make these interactions even more convenient, give patients the freedom to connect to your practice from their smartphones via a mobile app.

Recommendation: Make sure your website is HIPAA compliant and as secure as possible.

5. Provide Wi-Fi

Provide Wi-Fi, it's a nice extra. Patients can then use their smartphones, iPads, laptops, etc., while waiting. It doesn't eliminate the inconvenience of long waits but it does make them more tolerable.

The great jazz pianist and composer Fats Waller knew about being easy to do business with. He said, "Find out what people want, and how they want it, and then give it to them just that way." He was spot on.

Courtesy of Physician Practice By Bob Levoy, the author of seven books and hundreds of articles on human resource and practice management topics. His newest book is "222 Secrets of Hiring, Managing and Retaining Great Employees in Healthcare Practices" published by Jones & Bartlett. He can be reached at blevoy@verizon.net.


http://www.physicianspractice.com/patient-relations/pleasing-patients-best-marketing-strategy-medical-practices?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=21112013

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Improve Patient Education to Improve Medical Practice Collections

Often patients misinterpret how, and how much, they will be billed for their visits.

Take for example, the copay. When patients pay a copay at time of service, they sometimes believe this is all they will owe. So when they receive a bill in the mail a few weeks later, they complain.  They call and say something like, "I was told I only had a $10 copay, and that's ALL I am paying!”
Addressing a patient concern like this one takes up staff time and hinders the collection process. Staff may feel so bad when speaking with a patient that they may even adjust off the patient's balance.

Problems due to payment misinterpretations, however, are avoidable if your front-office staff spends a few minutes prior to a patient's appointment explaining how the billing process works. 
A front-office person should come out to the lobby, sit with the patient, and explain each policy the patient will need to sign, including your practice's privacy policy, payment policy, and cancellation policy. This will indicate to the patient that he is valued and cared for.

Explaining the payment policy and how benefits work in a calm and professional manner will provide the patient with a much greater understanding of how his policy works. Over the years I have seen firsthand how many patients have a poor understanding of these important elements.   Although this one-on-one patient explanation might seem like a concierge-type service, it's a sound investment to make in your practice. 
Patients will no longer misunderstand how payment works, and they will have a greater understanding of insurance. That of course, will translate to more streamlined patient collections.

Patients will also have a better understanding of their benefits, which means they will  understand when billing questions and complaints should be directed to insurers, rather than to your practice. With all of the insurance exchanges marketing to patients; and the print, electronic, and television ads touting “affordable plans” to your patient population, it is more imperative than ever to spend the time explaining patient benefits clearly.
Consider the time spent explaining payment and benefits to your patients as part of your customer service package. Train your front-office staff to step out from behind the desk, sit with the patient, answer any question, and build rapport. You won't be sorry.

Article  By P.j. Cloud-moulds of Physicians Practice
http://www.physicianspractice.com/blog/improve-patient-education-improve-medical-practice-collections?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=01112013

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Ten No-cost Ways to Improve Patient Satisfaction

Patient satisfaction is a big deal. It boosts patient attraction and retention, and it reduces the likelihood a patient will file a malpractice lawsuit. It also saves a practice time: Happy patients do not take up physician and staff time complaining. Finally, it is beginning to affect reimbursement. Already for hospitals, and soon for all physicians accepting Medicare, patient satisfaction scores will determine bonuses and penalties.

Unfortunately, physicians do not always understand what satisfies, or even delights, patients. They tend to believe that the biggest component of patient satisfaction is quality of care.  What they miss is that patients have no way to effectively evaluate the quality of care. Instead, patients rely on proxies, and those proxies have everything to do with how the physician and staff make the patient feel — emotionally.
Here are 10 ways physicians and staff can significantly increase patient satisfaction:

 1. Use the patient's name. People love to hear their own name.

2. Use an honorific (Mr., Ms., etc.) to address a patient, particularly if you want to be addressed as "Dr. Jones."

3. Wear easy to read nametags just below your right shoulder. First name only is fine for staff. The objective is to give the patient something better to say than "Hey, you," if she needs something.

4. Make eye contact with the patient as often as is practical. This indicates you are paying attention and engaged with the patient.

5. Tell the patient what to expect. This applies to medical assistants bringing a patient back to an examining room, physicians making referrals to specialists, and check-out staff recapping the billing for visits.

6. Let the patient know what you expect of him. If you need to enter data during the visit, for instance, say, "I am entering your information, but I am listening," to indicate he should keep talking. Say, "I have to enter this information. I'll be done in just a minute," to indicate that you need silence.

7. Give written visit summaries, patient education materials, and instructions. Patients forget an incredible amount of what is said during the visit by the time they get to their car. The ability to reference a written record reassures them.

8. At the conclusion of the appointment, make eye contact with the patient and say, "Take care." This phrase resonates with patients more than, "Thank you," "Have a nice day," or "See you soon."

9. Run on time, or close to it. This may be the primary way patients evaluate the regard the practice has for them.

10. Return phone calls and fulfill requests according to your posted protocol. It is only reasonable for a patient to assume that a practice out of control in some areas is out of control in others.

Please note that I did not mention coffee and Wi-Fi in the waiting room or birthday cards for patients.  Some patients may appreciate amenities and remembrances, but none will identify them as indicating caring and concern.  Behavior, sincere and consistent, is what convinces patients that they are respected and well cared for.

Article  By Carol Stryker of Physicians Practice http://www.physicianspractice.com/blog/ten-no-cost-ways-to-improve-patient-satisfaction?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=29102013

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Improve Medical Practice Efficiency by Offering Group Visits

As reimbursement declines and overhead increases, many practices are struggling to keep up. But rather than attempting to squeeze more patient visits into each day, has your practice considered seeing more patients per visit?

Perhaps it should. The number of practices offering group visits has increased from about two percent to three percent just two years ago to about 10 percent this year, practice management consultant Owen Dahl recently told Physicians Practice.

Here's more on how a group visit works, what it entails, and why your practice may want to consider it.

How a group visit works. During a group visit, multiple patients with similar chronic conditions (such as diabetes, osteoporosis, congestive heart failure, or COPD) meet at the same time with their physician and other appropriate staff.  The visit is held in a private area in the practice, such as a conference room.
The visits may include the following components:

• The taking of vital signs;
• An educational piece, such as a 30-minute discussion with a nutritional counselor, dietician, exercise physiologist, podiatrist, or an ophthalmologist;
• A group discussion, during which patients talk with each other about their particular needs, struggles, challenges, lessons learned, and so on;
• And an individual assessment, during which the physician pulls patients out of the group individually for private exams.

"You see these 15 patients in an hour and half, so you're very efficient there," said Dahl. "The other thing that happens is you free up time slots on your schedule to see other patients."
How a group visit is reimbursed.  After the group visit, the practice bills the appropriate visit (99213 or 99214) for each patient that attends. "You don’t bill based on time, you bill based on the criteria for the level of visit they had," said Dahl, noting that documentation must support the level of code.

How a group visit benefits patients. Group visits provide patients with a support group facing similar issues, and they give patients an opportunity to receive more in-depth education about their condition. That often translates to better outcomes, said Dahl.

"You're actually improving patient care, and I say that with some conviction," he said. "The research that’s been done indicates clearly that there’s a positive outcome with patients being more compliant with their treatment plans ... seeking care, getting involved. There are all of these spinoff benefits that come together.

"How a practice can get involved. Assess your patient population to determine if you have enough patients with similar chronic conditions for which a group visit would be beneficial. Then, determine if enough of your patients would participate, said Dahl.

If you determine that a group visit is something you can and should offer, promote it to patients through one-on-one discussions, handouts, and if applicable, on your practice's website or patient portal.

Before the visit, require all participants to sign group-visit specific HIPAA forms noting that they understand that they will be talking about personal health information with other patients, and stating that they will keep the information shared during the group visit confidential.

Article By Aubrey Westgate of Physicians Practice

Do you offer group visits at your practice? What tips would you share with other physicians?

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Ethics on Ending the Patient-Physician Relationship

Once you accept a patient into your practice, you are under an ethical and legal obligation to provide services to the patient as long as the patient needs them.  There may be times, however, when you may no longer be able to provide care.  It may be that the patient is noncompliant, unreasonably demanding, threatening to you and/or your staff, or otherwise contributing to a breakdown in the patient-physician relationship. Regardless of the situation, you must avoid a claim of "patient abandonment."  Abandonment is a tort, similar to negligence, defined as the termination of a professional relationship between physician and patient at an unreasonable time and without giving the patient the chance to find an equally qualified replacement.
There must be some harm from the abandonment.  The plaintiff must prove that the physician ended the relationship at a critical stage of the patient's treatment without good reason or sufficient notice to allow the patient to find another physician, and the patient was injured as a result.  Usually, expert evidence is required to establish whether termination happened at a critical stage of treatment.
A physician who does not terminate the patient-physician relationship properly may also run afoul of ethical requirements, and find himself before the medical board.  According to the AMA's Council on Ethical and Judicial Affairs, a physician may not discontinue treatment of a patient as long as further treatment is medically indicated, without giving the patient reasonable notice and sufficient opportunity to make alternative arrangements for care.  Further, the patient's failure to pay a bill does not end the relationship, as the relationship is based on a fiduciary rather than a financial responsibility.

According to the AMA's Code of Medical Ethics, Opinion 8.115, you have the option of terminating the patient-physician relationship, but you must give sufficient notice of withdrawal to the patient, relatives, or responsible friends and guardians to allow another physician to be secured.

The Health Care District of Palm Beach County offers this advice regarding the appropriate steps to terminate the patient-physician relationship:

1. Giving the patient written notice, preferably by certified mail, return receipt requested;
2. Providing the patient with a brief explanation for terminating the relationship (this should be a valid reason, for instance non-compliance or failure to keep appointments);
3. Agreeing to continue to provide treatment and access to services for a reasonable period of time, such as 30 days, to allow a patient to secure care from another person (a physician may want to extend the period for emergency services);
4. Providing resources and/or recommendations to help a patient locate another physician of like specialty; and
5. Offering to transfer records to a newly-designated physician upon signed patient authorization to do so.

Following this protocol may be easier in some situations than others.  For example, if a physician has signed a covenant-not-to-compete, chances are the employer will not hand over the patient list upon notice of departure.  In instances such as these, you (in consultation with your attorney) may want to provide a model patient termination letter to the party withholding your patients' addresses, and request that the addresses and letter be merged for distribution to your patients. 
Ideally, you should not be in a contractual arrangement that makes contacting your patients difficult.  However, if you find yourself in this situation, work with an attorney to ensure that appropriate steps are taken.

Article  By Martin Merritt of Physicians Practice http://www.physicianspractice.com/blog/ethics-ending-patient-physician-relationship?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=29102013

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Boost Medical Practice Collections by Cutting Down Patient Statements

By P.j. Cloud-moulds from Physicians Practice

Do you know how many patient statements are sent out at your practice? Do you know how high that A/R class is? These are two very important questions you need to ask yourself today. The numbers might shock you.

If you do find that the number of patient statements is too high, you can then start asking why this is the case. Here are some of the common reasons:

Your front office staff did not collect the patient copay, coinsurance, or deductible. If you have an up-to-date fee schedule, calculating the patient coinsurance and deductible is easy, and should be done at the end of the appointment prior to the patient walking out the door. Copays are easy to collect and should be collected at the beginning of the appointment.

Your front-office staff did not collect according to plan details. When verifying an insurance plan, sometimes the insurance company will provide incorrect information. Your staff may also be calculating the patient portion incorrectly. Be sure your staff is well trained in this area. It's costing you a lot of money if they are not.


 Patients are paying at the time of service, but those payments are not getting posted properly. This results in a nasty call from the patient stating that, “I paid, and will not pay again!” This is the epitome of poor customer service. Institute checks and balances at the end of each day to ensure payments are posted.

Patient “forgot their checkbook or credit card.” This is a line that you hear too often, and it's full of hot air. If the patient “forgets,” let him know that he can call in his payment by the end of the day, or he will incur a late payment fee. Yes, this is legal. If the patient can't pay now, he certainly won't pay in a month when he gets the bill.

Staff adjusts off a patient deductible. Your front-office staff performs the insurance verification, and sees that the patient has a $5,000 deductible of which only $352 has been met. Once the deductible is met, the patient is responsible for 20 percent of the allowed charges. Your front-office staff is reluctant to charge the patient the deductible amount for fear of being yelled at by the patient (who should already know her plan limitations, but most often does not) so staff charges her the co-insurance instead. This results in the patient getting a bill for the remaining amount. The angry patient then calls and yells at the staff stating, “I paid at the time of service!” Another example of poor customer service. Remember, you cannot adjust off a patient deductible.

The patient has Medicare and a secondary insurance. Since we are not allowed to collect monies from Medicare patients until Medicare pays its portion, we bill the secondary. If the secondary does not pick up all of Medicare's 20 percent, then the patient gets a bill. It's really difficult when some Medicare patients do not understand their secondary insurance has a deductible, or will not cover the entire 20 percent.

Just sending out statement after statement is a very poor way of running a business. Have a time limit of how many statements you will allow a patient to receive. Three months is a good rule of thumb. If patients need to be put on a payment plan, that's great, but put a time limit on that, as well. Your practice is not a bank, credit union, or credit card. It is a business, and no other business would allow goods and services to walk out the door before payment. Stop allowing patients to take advantage of your good nature.

Article taken from Physicians Practice http://www.physicianspractice.com/blog/boost-medical-practice-collections-cutting-down-patient-statements?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=22102013

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How Practices Should Deal With Late Patients

By Marisa Torrieri from Physicians Practice

Even if practices have clear-cut policies on handling no-show patients, dealing with late patients — especially those who are chronically late to appointments — is another issue altogether.

Late patients can throw off a practice's schedule and affect the amount of time physicians can spend with patients, especially in a small practice. Therefore, dealing with them raises questions: Should you accommodate late patients right away? Can you show them the door?

Declining to see a patient isn't usually an option, as it can be downright unethical and could actually cause a legal problem.

"Turning patients away if they're arriving late — you must talk to your malpractice carrier about that," says Elizabeth Woodcock, an Atlanta-based healthcare consultant, trainer, and author of "Mastering Patient Flow to Improve Efficiency and Earnings." "And you need to understand any malpractice risks you're taking by implementing such a policy. Unfortunately, if they have a heart attack on your doorstep as they're walking away, it's going to be your problem."

It's important to try and get the patient in to see someone if possible, such as a nurse or another doctor, says Ericka L. Adler, a partner at the firm of Kamensky Rubinstein Hochman & Delott, LLP, and contributor to Practice Notes, PhysiciansPractice.com's blog. If a patient does not get required care that can come back to hurt the physician if something happens to the patient, she adds.
Practices do have some options, however.

The first thing a practice can do to diminish late patients is make sure it is generally running on time.

"Please, please make sure that your practice is running on time," says Woodcock. "The practices that yell the loudest about chronically late arrivers are the ones who run late themselves. If the doctor is always running an hour behind, I'm going to run an hour behind [as a patient]."


Only the doctor or another healthcare provider can determine how important it is to see a given patient quickly.

Woodcock suggests that if a patient is more than 20 minutes late, front-desk staff should contact the clinical team and see how soon a patient should be seen.

But for future appointments, chronic lateness may qualify as a valid reason to dismiss a patient entirely if they don't change their behavior.

At Performance Pediatrics in Plymouth, Mass., late patients — those who are more than five minutes late — are treated the same as no-show patients. On the first and second offenses, they're sent a warning letter. On the third offense, they're told they will be dismissed if the problem continues. And on the fourth offense, they are asked to find another provider.

"If you're five minutes late, everyone is five minutes late," says administrator Leann DiDomenico McAllister, adding that sometimes traffic can be bad on a particular day. "But we're talking about people who are a half-hour late. Or people who call an hour before their appointment because they forgot their kid had a baseball game."

Article By Marisa Torrieri from Physicians Practice
http://www.physicianspractice.com/blog/how-practices-should-deal-late-patients?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=15102013

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Physicians Need Business Training to Run their Practices Well

By Rebecca Fox, MD of Physicians Practice

Once physicians graduate medical school and complete the internship year, they can get unrestricted licensure in most states to practice medicine and surgery. However, I doubt that very few people would choose a doctor that had only these credentials and did not have extensive residency training and board certification in their specialty. As physicians, we spend an incredible amount of time and mental energy mastering the extensive body of knowledge that we need to practice medicine competently.

However, when we get out of our medical training, we are suddenly faced with the truth of the matter: We have no clue how to run a business! We are a really smart group of people that have not received the proper instruction for the business world.

If there is one thing I know about doctors, when we do not know something, we tend to disengage. We want to know what to do in order to help people. If we don’t know what to do, we retreat. We do it with patients and we do it with the business side of our practices, usually with poor results.

It is really hard as a physician to deal with a patient’s complaints if you don’t know what to do. It is easier to dismiss the topic and move on to something you feel competent with in order to help the patient. To give you an example, when I was faced with a very obese (72 pounds) two-year-old boy, my first reaction was to refer to pediatric endocrinology because I did not know how else to address the situation. However this little boy had no endocrine effects from his extreme obesity (yet!) so no endocrinologist would see him. Therefore, I was on my own to figure out what to do. Rather than to not address the problem, I sought to educate myself on pediatric obesity. I went to a continuing education course specifically to learn what to do for obese and overweight patients. I read further references and journals. I learned the proper approach and evaluation of these patients and now feel competent dealing with this subject; therefore I can help my patients.

But what about my practice? As I have written before, a medical practice needs the same level of care and attention as a patient in order to stay healthy and thrive. As long as everything is running well and the bills and payroll are met, it is easy to ignore or avoid the details. But when trouble arises, the physician owner(s) must be able to diagnose and treat their business. If they do not know how, then further education is necessary.

About four years ago, my practice went through a financial crisis after a year in which we had a "perfect storm" of events that drove us into red ink. My senior partner had a death in the family and the two junior partners had just attained this ownership level (and thus were inexperienced in all that is required of an owner). My office manager had been on the job for about two months at the point.  I had to deal with this looming disaster alone. I very quickly learned about financial analysis. The situation was so dire we considered having to lay off a provider. My office manager took an aggressive approach to cutting costs and it was my responsibility to increase revenue generated by the providers. Within 10 months, the practice had a complete financial turnaround and was back in the black. We have been solvent since that time.

So, how can physicians get the education they need to at least speak the language of office managers? They don’t have to go back to graduate school for an MBA. They can start slowly by reading journal articles about the business and management of medical offices as well as the multitude of business books on the market today. Many medical professional associates have resources as well.

One excellent source of education and information is Medical Group Management Association (MGMA). I have been attending the MGMA conference for the past three years. I have gained an incredible amount of education and knowledge that has improved my ability to guide the office manager and has given me skills to deal with financial matters and human resource challenges. I received education about management and feel that I am a better physician owner of my large pediatric practice. Additionally, the MGMA is very well versed in ongoing changes with government mandates and insurance company requirements.

Don’t get me wrong. I definitely want to leave management to the professionals and do what I am good at which is seeing patients (and generating revenue). But in order to create the kind of practice that my partners and I want, we have had to get more involved in the management issues; not to replace our office manager but to support her to do her job successfully. The combination of an effective office administrator along with the full support and understanding of the physician owners allows a seamless approach to our practice of 14 providers and over 40 employees.

By Rebecca Fox, MD of Physicians Practice
Courtesy of: http://www.physicianspractice.com/blog/physicians-need-business-training-run-their-practices-well?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=15102013

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The Unknown Impact of Health Reform on My Private Practice: An Honest Opinion From a Real Physician... "I honestly don't know."

By Melissa Young, MD, Courtesy of Physicians Practice

Patients have been asking me for the last few months, "So what do you think is going to happen to your practice with Obamacare?"  I told them what I assume most physicians are thinking, "I really don’t know. I’m apprehensive. But I guess I’ll find out."

There’s been talk about physicians being inundated with new patients because there will be an increase in demand for physicians without increasing the supply. In our case, we already have such a backlog, I don’t know what we’ll do if more patients call to make new patient appointments. I am concerned that we are going to have to close to new patients for a while if the wait for a new patient appointment gets any longer. As it is, patients are very dissatisfied with the wait. I can’t begin to imagine how primary-care physicians will handle this.

There is also the concern about increasing patient financial responsibility. That will put a greater strain on the patients, as well as on our staff who will have to collect more from patients. As many patients don’t understand when they have deductibles or how much their copays are, if their portion of the bill increases, it may become increasing difficult to get paid for services.

As a business owner and employer, there is also the question of providing health insurance to employees. We are a small enough practice that, as I understand it, I am not legally obligated to provide insurance coverage for the employees, but I have always done that anyway. I think it helps keep employees happy and instills some loyalty to the practice. Having said that, I was still obligated to print out and complete a form that I had to distribute to each employee, stating who is eligible for insurance, that we offer it, and that it is deemed affordable. They actually found it somewhat amusing that I had to inform them of something they already knew. Sigh. To think trees had to die for this paperwork.

So, what do I think will happen? Will Obamacare have a significant impact on the way our practice is run now? I honestly don’t know. But I guess I’ll find out.

Article Courtesy of: http://www.physicianspractice.com/blog/unknown-impact-health-reform-my-private-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=24092013

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How to Code, Negotiate After-Hours Reimbursement at Your Practice

There are codes in the CPT® code book to report services a physician provides during "nontraditional" hours. If you prove that it’s in the payer’s best interest, third-party insurers may allow additional reimbursement for after-hours services.

Medicare and payers that strictly follow CMS guidelines will not pay additional reimbursement for after-hours services. However, you might succeed with private payers in negotiating payment for after-hours codes as part of a contractual agreement, especially if you use savings potential as leverage. Have your negotiator make it clear to the insurer’s representative that you’ll willingly send patients to the emergency department (ED) instead of offering in-office after-hours services, but that ED services can cost as much as 10 times more than comparable physician services.

To further demonstrate cost savings, you could also start billing all applicable after-hours codes for your practice. Over time, you will have compiled an archive of claimed charges, which you can use to show the insurer how often you provide these services. In this report to the insurer, consider adding data on the much higher price of ED visits for the same services.

Know the Codes

Based on the CPT®/AMA guidelines, you may report 99050 — Services provided in the office at time other than regularly scheduled office hours, or days when the office is closed (e.g., holidays Saturday or Sunday), in addition to basic service — for any service provided in the office at a time when the practice would normally be closed (e.g., weekends or evenings). Code 99050 is reported in addition to the code for the basic service.

If your practice already maintains regular hours on evenings, weekends, or holidays, and you provide a service during those times, you should skip 99050 and use 99051 — Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service.

If a 24-hour facility requests that your physician provide a redeye or early-bird service, AMA guidelines allow you to claim 99053 — Service(s) provided between 10:00 p.m. and 8:00 a.m. at 24-hour facility, in addition to basic service, in addition to the basic service. Code 99053 can be used whether the provider is already at the facility, or if the physician has to make a special trip to care for the patient. The code 99053 can only be used if the service provided occurs at a 24-hour facility, such as an ambulatory surgical center (POS 24), urgent care facility (POS 20), or emergency department (POS 23).

Emergency department physicians may report 99053 for services rendered between the hours of 10 p.m. and 8 a.m. The American College of Emergency Physicians fully supports this use of 99053, stating that this code is appropriate for late-night services, "especially given the nighttime practitioner availability costs typically incurred by all medical practices, including emergency medicine."

G. John Verhovshek, MA, CPC, is the managing editor for AAPC's publications. He has written, co-written, and edited dozens of coding and compliance resource manuals, including the Part B Survival Guide (1st edition) and The Official CPC Certification Study Guide (1st edition). E-mail him here.

Article By G. John Verhovshek, MA, CPC http://www.physicianspractice.com/coding/how-code-negotiate-after-hours-reimbursement-your-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=03102013

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