I am very pleased to be the speaker for a free webinar sponsored by Integrated Healthcare Systems. The webinar will be on one of my favorite topics – front-end patient collections – and will air live on Tuesday, May 11th, at 2:30 Eastern time.
Topics I will address include:
”¢ WHY would a practice move from a back-end collections strategy to a front-end strategy?
”¢ WHERE does patient education fit into the patient collections program?
”¢ WHAT can be collected at the time of service: co-pays, co-insurance, deductibles, estimates and deposits?
”¢ WHEN should a practice use technology to improve time-of-service collections?
”¢ HOW can managers train staff to overcome their fear of talking to patients about money?
Attendees will have the opportunity to purchase my book, “30 Days to a Front-End Patient Collection Program” for a special promotional price.
There are two types of electrocardiograms (abbreviated EKG or ECG) – screening and diagnostic. Medicare covers one screening EKG in the patient’s lifetime in conjunction with theInitial Preventive Physical Exam (IPPE), referred to as the “welcome-to-Medicare” exam, which the patient must have performed within 12 months of enrolling in Medicare for the first time. As of January 2009, the deductible does not apply to the IPPE or EKG. The patient will pay 20% of the Medicare-allowed amount.
Medicare will also cover EKGs performed as a diagnostic test, which means that the patient has symptoms which leads the provider to prescribe an EKG to diagnose the patient’s problem. For an EKG performed in a hospital outpatient department, Medicare Part B pays the full Medicare-approved amount, except for a patient co-payment. For an EKG in any other setting, Medicare Part B pays 80 percent of the Medicare-approved amount.
As of January 2009, the EKG was removed from the list of mandated services that must be included in the IPPE benefit and makes the EKG an educational, counseling, and referral service to be discussed with the patient and, if necessary, ordered by the physician. This change alleviates physician frustration of having to perform a screening ECG when the patient just had a diagnostic EKG/ECG.
Medicare will cover the screening ECG when the physician deems the screening is appropriate for the individual patient
Codes to be used for the EKG are:
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment
G0403 Electrocardiogram, routine ECG with at least 12 leads; performed as a screening test for the initial preventive examination with interpretation and report
G0404 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive examination
G0405 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only, performed as a screening for the initial preventive examination
NOTE: For information on using the Advance Beneficiary Notice (ABN) for EKGs that the patient requests but Medicare will not consider “medically necessary” go here.
In 2001, the Institute of Medicine (IOM) published Crossing the Quality Chasm: A New Health System for the 21st Century, which outlined fundamental changes that must be made in order to improve healthcare in the United States. Here is a quote from the book:
“The U.S. health care delivery system does not provide consistent, high-quality medical care to all people. Americans should be able to count on receiving care that meets their needs and is based on the best scientific knowledge–yet there is strong evidence that this frequently is not the case. Health care harms patients too frequently and routinely fails to deliver its potential benefits. Indeed, between the health care that we now have and the health care that we could have lies not just a gap, but a chasm.”
Although the concepts in the books have been widely implemented in the inpatient setting (100,000 Lives Campaign and now 5 Million Lives Campaign), not as much has been done in the outpatient setting, predominantly because inpatient safety has been (rightfully) highlighted by needless deaths and injury (The Josie King Story, The Dennis Quaid Story.) These same concepts must be applied in the outpatient setting to achieve improved patient care and patient satisfaction. Ultimately, patients will demand to know what medical practices are doing to provide safe, effective, patient-centered, timely, efficient and equitable care. This is a great book to read (you can read it online) and think about in preparation for the changes coming with healthcare reform, “Payment for Performance” (P4P) and electronic medical records promulgation.
Aim #1: Care should be SAFE: Patients should not be harmed by the care that is intended to help them. Current estimates from the Agency for Healthcare Research and Quality place medical errors as the eighth leading cause of death in this country. About 7,000 ”” people per year are estimated to die from medication errors alone ”” about 16 percent more deaths than the number attributable to work-related injuries.
Aim #2: Care should be EFFECTIVE: providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit. Estimates are that about half of all physicians rely on clinical experience rather than evidence to make decisions. But should they? Experts say that physicians in most practices do not see enough patients with the same conditions over long enough time to draw scientifically valid conclusions about their treatment.
Aim #3: Care should be PATIENT-CENTERED, respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. One study of physician-patient interactions showed that physicians listen to patients’ concerns for an average of 18 seconds before interrupting. Medical schools are beginning to place greater emphasis on the development of good patient-interaction skills.
Aim #4: Care should be TIMELY: reducing waits and sometimes harmful delays for both those who receive care and those who give care. Many hospital Emergency Departments (EDs) are symptomatic of a system that cannot reliably give timely care. One recent survey revealed the average wait at “crowded” EDs was one hour. One third of U.S. EDs report they must periodically divert ambulances to other facilities.
Aim #5: Care should be EFFICIENT: avoiding waste, including waste of equipment, supplies, ideas and energy. Some experts estimate that most physicians are productive only 50% of their time, in part because the system works against them. Working smarter, not harder, can reduce non-clinical work and increase “face time” with patients.
Aim #6: Care should be EQUITABLE: care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status. There is a growing number of studies showing disparities in care and treatment for some population groups. The implications can be dramatic: for example, the life expectancy of a black child is seven years shorter than that of a white child in Baltimore, Maryland, USA.
You can download a PowerPoint program from the Institute for Healthcare Improvement (IHI) that cover the concepts in the book for free here. Registration is required, but it is free and gives you access to lots of tools and resources.
You can also read the book for free online by clicking on the “READ” icon below. No registration is required.
What books, websites, blogs, organizations or people would you add to the list of resources to prepare us for the changes of the future?
Every health organization has a standard fee schedule that it discounts for volume health services payers such as Blue Cross or Aetna. When one agrees to accept a discounted fee schedule, it is not legal to bill the patient the difference between your standard fee schedule and the discounted fee schedule. This practice is called balance billing and is only allowable if you do not have a contract with the payer.
The slight exception to this rule is Medicare, which regulates the amount above the Medicare allowable that you may bill the patient, but only if you are a non-participating provider. If you are a participating provider with Medicare, you may only bill the patient for their unmet deductible and for co-insurance which is 20% of the allowed amount.
A health care organization’s attempt to collect from the patient the difference between the standard charge amount and the allowed amount approved by a contracted carrier such as Medicare. Balanced billing is a contract violation and may be illegal. The practice should be avoided.
Bad debt is accounts receivable (money owed) that cannot be collected from the patient and is written off as uncollectable. If you turn a patient account over to a third-party collection agency, the account is considered bad debt and is written off. If money is received on the account in the future, the amount is returned to the A/R and the payment is posted.
Many practices write off the bad debt but do not turn the account over to collections. If the patient requests services from the practice in the future, the patient must pay off the bad debt balance first before being seen in the practice.
Capitation is a payment structure which is the opposite of traditional fee-for-service reimbursement. In fee-for-service (FFS), a practice receives a payment for every visit to the practice a covered patient makes. With capitation, the practice is paid a certain amount per member, per month (PMPM) regardless of how many times the patient is seen at the practice. If a patient is seen 10 times during a month, the practice receives the same amount as if the patient is not seen at all at the practice during the month.
A carve-out is a group of services that are not covered under the primary contract, but are addressed under a separate agreement. For instance, a practice may have a contract with a payer whereby the all services will be reimbursed to the practice at a specific percentage of Medicare. There may also be a carve-out, whereby 10 procedures are paid at a contracted dollar rate, not a precentage of Medicare.
Case management is a department/program wherein registered nurses and licensed social workers coordinate care for patients who require additional services with the goal of attaining the best health outcomes at the most reasonable cost.
The Case Management Society of America can be found here. The part of their mission statement that I really liked was:
Care managers are advocates who help patients understand their current health status, what they can do about it and why those treatments are important.