What are the hallmarks of a well-managed practice? There are many, but here are 10 basics.
- The practice has foundation documents appropriate to the corporate structure and written agreements describing how income and expenses are shared by physicians and/or other providers and how partners enter and exit the practice. The owners of the practice and management meet monthly.
- The practice has documents that set the guidelines for operations such as a compliance plan, disaster plan, personnel handbook, job descriptions and requirements for annual evaluations, raises, bonuses and progressive discipline. Management and staff meet monthly.
- The net collection percentage is 95% or more. This means that of the expected collectible dollars, 95% is collected.
- The practice has a budget and variances are addressed.
- The unfilled appointment percentage is 5% or less. This is in retrospect, so it includes no-shows. The practice has a marketing budget and a written marketing plan.
- The practice has a line of credit or other means to draw upon in the case of unexpected cash flow drop.
- A single commercial payer comprises no more than 50% of the practice business.
- Employee turnover rate is 10% or less. New employees are onboarded with training, coaching and competency testing.
- The practice has the ability to produce management reports to track and trend production, payments, adjustments, and denials. Process Improvement (PI) is used to address negative trends.
- Patient satisfaction is prioritized and measured, and improvement is valued.
What other hallmarks would you add?
Alcohol Misuse Screening and Depression Screening
On July 19th, the Centers for Medicare & Medicaid Services (CMS) proposed to add alcohol screening and behavioral counseling, and screening for depression, to the comprehensive package of preventive services now covered by Medicare. These proposed national coverage determinations (NCDs) are issued under authority granted by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which allows CMS to add coverage of new preventive benefits that are recommended by the U.S. Preventive Services Task Force and are appropriate for Medicare beneficiaries.
Image via Wikipedia
If you are a physician, non-physician practitioner or Independent Diagnostic Testing Facility (IDTF) who supplies imaging services and submits claims for the Technical Component (TC) of Advanced Diagnostic Imaging (ADI) procedures to Medicare contractors (carriers and A/B Medicare Administrative Contractors (MACs)), you should know that you must be accredited by Sunday, January 1, 2012. If your facility uses an accredited mobile facility, and you bill for the TC of ADI, you must also be accredited. The accreditation requirement is attached to the biller of the services.
Those not accredited by that deadline will not be able to bill Medicare until they become accredited.
For those planning on seeking accreditation to continue performing the technical component of ADI services, know that accreditation is dependent on the demonstration of quality standards, including (but not limited to):
- Qualifications and responsibilities of medical directors and supervising physicians;
- Qualifications of medical personnel who are not physicians;
- Procedures to ensure that equipment used meets performance specifications;
- Procedures to ensure the safety of beneficiaries;
- Procedures to ensure the safety of person who furnish the imaging; and
- Establishment and maintenance of a quality assurance and quality control program to ensure the reliability, clarity and accuracy of the technical quality of the image.
Additionally, the accreditation process may include:
Voice broadcasting is sending a pre-recorded voice message to a large set of phone numbers at the time same. Can either be a voice call (meaning the recipient must answer the call for the message to play) or voice mail (meaning the message will play only if the recipient doesn’t answer.)
A widget is a small graphical device that does a highly focused, often single, specific task. Web widgets can be embedded in web pages or run on the desktop of a PC (Windows or Mac) using software such as Apple’s Dashboard software or Yahoo! Widgets Engine.
Today’s CMS call reviewed the guidelines for the IPPE (Initial Preventive Physical Exam) and the AWV (Annual Wellness Visit), what they include and how to code for them.
What is the IPPE (also called the “Welcome to Medicare Visit”)?
The IPPE is a one-time visit, covered within 12 months after the effective date of Part B coverage and including:
- Review of medical and social history.
- Review of risk factors for depression.
- Review of functional ability and level of safety.
- Measurement of height, weight, body mass index, blood pressure, visual acuity, and other factors deemed appropriate.
- Discussion of end-of-life planning, if agreed upon by the patient.
- Education, counseling and referrals based on results of review and evaluation services performed during the visit, including a brief written plan such as a checklist, and if appropriate, education, counseling and referral for obtaining an electrocardiogram (a/k/a EKG, ECG).
- Note that although the IPPE has the word “exam” in it, there is NO physical exam associated with it. Most practices attempt to call it the Welcome to Medicare Visit and try never to use the word “exam” in association with it.
Who can provide the IPPE?
- Physician (doctor of medicine or osteopathy)
- Qualified non-physician practitioner including nurse practitioner physician assistant or Clinical nurse specialist
How is the IPPE Billed?
The medical record is a set of electronic or paper documentation relating to the care of a patient. The electronic record may also be called an Electronic Medical Record (EMR) and the paper medical record may also be called a patient chart.
American Nurses Credentialing Center (ANCC) is the world’s largest and most prestigious nurse credentialing organization, and is a subsidiary of the American Nurses Association (ANA). ANCC certification exams validate nurses’ skills, knowledge, and abilities and more than 80,000 advanced practice nurses are currently certified by ANCC. Before nurses can sit for a certification examination, they must demonstrate that they hold active RN licenses, have the appropriate education, and, for all but nurse practitioners and clinical nurse specialists, have experience in the specialty field. Those who have met the eligibility requirements can then register to take the certification examination. Each exam is designed by certified nurses in the specialty under the guidance of a professional psychometrician who ensures that all tests are psychometrically sound and legally defensible. Tests are based on the scope and standards of practice approved by the American Nurses Association Congress of Nursing Practice and Economics. The paper-and-pencil tests generally are given twice each year at many locations around the United States and at military installations abroad. Most Clinical Nurse Specialist and all Nurse Practitioner, Informatics Nursing, Cardiac/Vascular, and Gerontological examinations can be taken at the candidate’s convenience because they are computer-based.
The Magnet Recognition Program was created by the American Nurses Credentialing Center (ANCC) to recognize healthcare organizations that provide nursing excellence. Institutions designated as “magnet” hospitals are recognized for their ability to attract and retain professional nurses.