Author Archive

image_pdfimage_print

Ch-Ch-Ch Changes: Endings & New Beginnings by Consultant Bob Cooper

Managing Change by Bob Cooper

As we pass Labor Day I find myself thinking about the transition from summer to fall, even though the fall season doesn’t officially begin for a few more weeks. It seems as if the pace starts to pick up again. Vacations come to an end, students return to school, and business tends to accelerate.

Change is a constant. Why do some people embrace change and others struggle?

After all, we know that the seasons change, one ends and a new one begins. In business, projects come to an end, and new ones begin. Changes in expectations, new technologies, increased competition, reduced margins are just a few examples of the changes businesses face today.

As a leader, it is very important that you take a good look in the mirror and reflect on how you embrace change.  As a model for others, you set the tone for how your team will be able to demonstrate resilience when facing the business headwinds.

In order for you to assist others to move through the changing seasons, you need to understand what happens to others when facing change. Change is external to the individual. A new boss, revised policy, or a new role become understood once explained to staff.  However, individuals react to changes differently.  The reason for this is some team members psychologically struggle to come to terms with the change.  They find it difficult to make the internal transition.  In my experience, the number one reason for this is fear. Perhaps they are not confident in their ability to deliver on the change.  They may be hesitant to take a risk due to a fear of failure. They don’t feel as safe or secure.

Questions you should ask yourself during times of change.

What do my team members need to let go of?

What do they feel they are losing?

Transitions require endings. Great leaders understand that certain changes have a big impact on individuals. Some individual’s self-esteem is tied to the old process. They may have felt an enormous sense of pride in what they had accomplished.  Great leaders effectively assist others to work through these endings, and become comfortable with transition.

The following are a few suggestions to assist others through change and transition:

  1. Explain what is changing and why it is changing. Let others know what is not changing.
  2. Allow staff to express concern, and show empathy for anyone struggling to embrace the change. Be tolerant of mistakes. Mentor others to turn mistakes into opportunities for learning and growth.
  3. Maintain ongoing two-way communication throughout the change process.
  4. Engage others in making the change work.  Listen to staff ideas and incorporate suggestions that are beneficial for the business.
  5. Be positive and promote a feeling of optimism.

Great leaders assist team members to come to terms with their endings, and work hard to help others to find new beginnings. Things will not be the same, but as a leader you can help staff to develop the competence and confidence to move forward.

You will be able to assist most team members to move through the changing seasons and find comfort in new beginnings, if you move through the transition yourself.  If you are stuck in the summer, as we embark on the fall, how can you expect your team to turn the page?

Great leaders treat each and every team member as a unique individual who experiences change in their own way. Without judgment, great leaders meet staff wherever they need to be met.  Some staff become the champions of certain changes, and others need a lot more attention.

One of the most important lessons in leadership (and in life) is to treat every person you meet with total respect regardless of how they deal with the seasons of change. Not everyone can be the “A” student, but they all deserve to be in the classroom.  An individual may ultimately need to leave the room, but this should be handled with complete respect, understanding and compassion.

Bob Cooper: We are very pleased to announce that in collaboration with Consulting For A Cause, we will be providing another one day “Discovery Session” on Thursday, October 17 in Chappaqua, NY.  You will be provided with the opportunity to capture in your personal journal the following – how to turn talents into sustainable strengths, lead a life with purpose and passion, achieve quantum leaps in performance, brand yourself for future success, achieve a sense of work-life balance, and how to effectively execute your business strategies. Space is limited. To register, please go towww.consultingforacause.com

For a complete listing of our services, including our books “Huddle Up”, “Leadership Tips to Enhance Staff Satisfaction and Retention”, and “Heart and Soul in the Boardroom” please visit us at www.rlcooperassoc.com or call (845) 639-1741.

Bowie Photo Credit: Tim Yates via Compfightcc

If you would like to receive Manage My Practice article updates via email, click here to subscribe.

Posted in: Day-to-Day Operations, Human Resources, Leadership

Leave a Comment (3) →

Are Patients Lost in Translation? An Interview With Dr. Charles Lee of Polyglot

Universal Medication Schedule (UMS)
Sometimes you find the most amazing things in your own backyard. In Research Triangle Park, NC, I found the wonderful Dr. Chuck Lee, President and Founder of Polyglot. I was bemoaning the lack of good translation software for healthcare and Sims Preston, CEO of Polyglot, contacted me on LinkedIn and invited me to see their product Meducation. I was fascinated by Dr. Lee’s story and I think you will be too.

Mary Pat: Dr. Lee, you had a very personal reason for starting a healthcare company that focuses on communication in different languages, didn’t you?

Dr. Lee: First, as a clinician, I’ve always believed that we need to help all our patients understand their health information so that they can make better health decisions.  To me, it’s just common sense that better health outcomes starts with better informed patients.  The challenge is that much health information is not usually written with the patient in mind.  It’s often written in high grade reading levels using medical jargon, and often only available in English.  If it is available in another language, it’s usually only in Spanish.

About one of every three US adults has some difficulty understanding health information and almost 30 million struggle with the English language – almost 10 percent.  Because I am a first generation Korean immigrant – I came to the US when I was 7 years old – I saw how my grandmother struggled to understand how to take her medications.  This is one of the reasons I became interested in this issue.

Mary Pat: How did your own experiences drive your vision for your company ‘Polyglot”?

Dr. Lee: It became very apparent that other HIT companies had little interest in serving the needs of minority populations – they said that there’s not much money in it.  They said it was too difficult, too costly, and that the market wasn’t big enough.  If you look just at the numbers, yes it may not make sense – but how do we continue to ignore almost 10 percent of the population – thirty percent if you count low health literacy! That’s when I decided to form Polyglot Systems to show that creating technology to support language and cultural needs of underserved populations doesn’t have to be hard or costly.  If our small company can do it, the big guys will have no excuse.

Mary Pat: Can you talk about the state of healthcare communication for non-English speakers in the United States today?

Dr. Lee: Just think about what it would be like for you if you were in another country and they didn’t speak English.  If you got sick and needed medical care, would you know how to read the signs? Know where to go? Know what forms you are signing? Know what the doctors were saying? What your treatment choices are? Or how to take your medicine if the bottle didn’t have English instructions?  That gives you a glimpse into what it’s like for non-English speakers in the US.

After I saw my grandmother’s pill bottles with instructions written in English that she couldn’t read, I became aware that this was not an isolated incident.  So I asked myself this: How many medication errors are caused by language barriers? Last year there were about 4 billion prescription written – that’s not including over-the-counter medications.  Just based on statistics, that would mean about 400 million prescription were given to patients who are limited English proficient.  The need was obvious.  If you include English-speaking patients who have difficulty understanding health information, this number approaches 1.5 billion prescriptions.  Have you seen some of instruction they give you at pharmacies? Even I can’t understand what much of it says.  Also, a lot of the instructions are printed in such small print that I had a hard time reading them.  So one of the features we built into Meducation was larger font support for elderly and visually impaired patients.

Mary Pat: It seems that the timing for Meducation is perfect based on the recent emphasis on patient engagement, eliminating waste in healthcare, and increasing medication compliance. How does Meducation address these?

Dr. Lee: For me, it all comes down to common sense.  We submitted our first grant proposal to the NIH for Meducation almost 10 years ago – when all those issues you mentioned should still have been issues back then, they just weren’t popular things to talk about then.

Healthcare statistics usually say that a minority of the population utilizes the majority of our healthcare resources. This includes those with heart disease, diabetes, CHF, etc.  Do we ignore them because they are the minority? Of course not.  I bet you that a significant portion of the patients with heart disease, diabetes, CHF have low health literacy and/or language barriers.  If we can make even a few percent improvements in these populations, wouldn’t it be worth doing? This just made sense to me.

I sometimes like to compare our healthcare system to the cable industry.  The cable companies spend tremendous amount on research and expense for laying fiber-optic cables in streets in front our homes.  But unless we can connect the home to the corner – what they call “the last mile” – it means nothing.  It’s the same in healthcare. Unless patients understand and act to self-manage their own condition, all our advances in healthcare will have little effect.  Patient engagement is the last mile.

Mary Pat: How does Meducation interface with EMRs?

Dr. Lee: This is our biggest challenge now.  We’ve developed APIs to make it easy for EMRs to request and download our multi-language patient information.  The difficulty has been getting many of the EMR vendor’s attention.  They are so preoccupied with Meaningful Use and certifications that they have paid little attention to patient education and engagement.  But I predict that this will start to turn around as reimbursements will force them to do so.

Mary Pat: Meducation also has videos with demonstrations on medication techniques. What types of videos are available and how can patients view them at home?

Dr. Lee: The videos focus on techniques for taking complex medicines such as inhalers, eye drops, etc., so the patients are actually benefiting from the medicine and not wasting it by using it incorrectly.  We want to expand these to include other techniques such as wound care, port care, etc. in the future.  The demos are free to patients if their healthcare provider or pharmacies use Meducation. Patients receive a card with the website and video ID so they can view it as often as they like at home.

Mary Pat: Meducation uses a universal graphic that shows patients when to take medication which seems like a great idea for communication despite the language the patient speaks – can you talk about this?

Universal Medication Schedule (UMS)

Dr. Lee: Yes, this is called the Universal Medication Schedule (UMS).  It was developed by a group of health literacy researchers at Northwestern University and Emory University.  It breaks up medication times into four times of day: morning, noon, evening, and bedtime. Over 90% of all daily meds can fit into this schedule and make taking medicines much easier to follow.  The Institute of Medicine (IOM), the American College of Physicians (ACP), and most recently the National Council for Prescription Drug Programs (NCPDP) have recommended its use.  I really like it because it helps patients remember with pictures if they have difficulty understanding written instructions.

Mary Pat: You use the word “affordable” as part of your mission for Polyglot. I am always seeking solutions that are affordable in healthcare. Can you talk about the cost of Meducation for a solo primary care physician?

Dr. Lee: You know, I wish I could give this away for free to everyone.  But we have to make this a sustainable effort.  I’ve seen so many good projects die because they didn’t have a plan to keep it funded and going beyond the grant or some other funding source.  This is one of the reasons I left academics to start our Polyglot.  That being said, our products need to be affordable for front line providers – safety nets and federally qualified health centers (FQHCs) – because they interact most often with underserved patients – and have the least financial resources.

For provider practices, the subscription list price is $50/mo for unlimited use.  That’s less than $2 day for the ability to print instructions for all your patients in 16 languages – including elderly English-speaking patients in larger fonts.  As a comparison, $2 is about what it cost to use a telephone interpreter for about 1 minute.  Mary Pat, we would be happy to provide your readers a discount on Meducation.  Just have them contact me at lee@pgsi.com.

Mary Pat: What other projects do you have planned for the future?

Dr. Lee: I think the opportunities to improve communication for patients are only limited by our imagination.  There is so much that we can do create quality literacy and language solutions and deliver it inexpensively to a wide audience.  We are currently working on a solution to reduce hospital readmission through simplified multi-language discharge instructions that can be individualized for each patient.  We are adapting this for use during home care visits as well.

Charles Lee, MD, President and Founder of Polyglot
Dr. Lee: Polyglot Systems was founded in 2001 to help our US medical community care for the 26 million Americans who are unable to communicate effectively in English. Our mission is to deliver solutions that eliminate communication barriers at every stage of the medical encounter – improving the experience of both the patient and health care provider.

For more information about Meducation, Dr. Lee invites you to visit the Polyglot websiteHe is extending a discount on Meducation to readers of this article – please contact him at lee@pgsi.com.

For another post on communicating with patients, read my post “Can Patient Safety Be Improved By Asking Three Questions?” here.

Posted in: Amazing Customer Service, Compliance, Day-to-Day Operations, Electronic Medical Records, Innovation, Quality

Leave a Comment (2) →

Introducing a New HIPAA Privacy Notice for Patients and Practices

HIPAA Notice of Privacy Practices

September 23, 2013 is the date that medical practices and other covered healthcare entities will roll out a new Notice of Privacy Practices to patients to be compliant with the HIPAA Omnibus rule enacted in March 2013.

What Does This Mean For Patients?

Patients should be aware that after September 23rd, their healthcare providers will have a new Notice of Privacy Practices (NPP) available. The new NPP should be posted in each office, on the website if one exists, and should be available as a handout for any patient requesting it.

The new notice will include:

    • Reasons that your Protected Health Information (PHI) can and cannot be disclosed to others.
    • Information for opting-out of communication related to fundraising activities, if your healthcare provider does any fundraising.
    • The ability to restrict your PHI from payer disclosure when you pay in cash instead of having the charges filed with your insurance plan.
    • Information about being contacted if there is a breach of your PHI due to unsecured records.

What Does This Mean For Practices?

    • A new Notice of Privacy Practices that is specialized to your practice must be developed.
    • The new NPP must be posted in your practice, on your website and available as a handout for any established patients who request them.
    • All new patients must be offered a copy of the new NPP and must sign an acknowledgement that they received it. (They may turn a copy of the NPP down, however.)
    • Policies that address the disclosure of information/records and notification of a breach, should one occur must be developed.
    • Old and new versions of the NPP should be on file in the practice, and patient acknowledgements should also be kept as long as the medical record is retained.

What else is required for compliance with HIPAA Omnibus?

One of our good friends, Steve Spearman at Health Security Solutions has posted great information on his site about the other requirements of the HIPAA Omnibus rule. His excellent posts help readers understand and comply with the new HIPAA guidelines in the following areas:

    • Business Associates Agreement (BAA) Update
    • Downstream Subcontractors Needing BAAs
    • New Breach Notification and Reporting Protocol
    • School Immunization Records Protocol
    • Electronic Fulfillment of PHI Request
    • Medical Record Protocols for Cash Payments

At Manage My Practice, we’ve offering a free sample Notice of Privacy Practices for your practice use. Please read the sample notice carefully, make changes specific to your practice and add your practice name. Note that language related to fundraising is NOT included, as it will not apply to most private practices. Insert fundraising language as follows if appropriate for your practice.

Fundraising Activities: We may use PHI to contact you to raise money. If  you wish to opt out these contacts, or if you wish to opt back in to these contacts, please contact our Privacy Officer.

Likewise, if your practice has a research function, insert relevant language:

Research: We may use and share your health information for certain kinds of research, however, all research projects are subject to a special approval process.

Check your state laws.

Your state law may require authorizations for certain uses and disclosures of PHI beyond those outlined in the sample notice. Be sure to amend your NPP to reflect any state-specific laws (resource hererelated to release of medical records. Remember to post your new NPP on your website and in your practice, and begin giving it to new patients September 23, 2013.

The new Notice of Privacy Practices is not required until September 23rd, but you can start using it as soon as you have yours ready.

For more on HIPAA, read my post “Three Big HIPAA Myths.”




(Photo Credit: hyku via Compfightcc)

Posted in: General

Leave a Comment (0) →

How Are Physicians Returning to Private Practice?

Cresting Wave

The healthcare industry has gone through a lot of change very quickly in the past five years, with still more to come. Independent practices and smaller physician groups have a lot of reason to “seek higher ground” in mergers, partnerships, and buyouts by larger groups and hospitals that have the resources to better deal with lower reimbursement and increasing regulation. Still, just as we are seeing the crest of the wave of physicians selling their practices to hospitals, we are also beginning to see a lot of the reverse trend – physicians leaving hospital employment and starting their own practices.

We have a number of new solo physician practices among our clients and each of these practices can make the numbers work for the three reasons outlined below. Their new practices may look much different from the practices they once had, but they now can bypass the crushing financial burden of start-up costs and find ways to cut expensive overhead. As hospitals ratchet down physician salaries and present new hoops from them to jump through, more and more physicians will look to these new tools for independence and financial viability.

Free EMR

In 2008 I was living in Seattle and I attended a conference at Microsoft in Redmond, Washington. It was there that I met Dr. Bill Crounse, the Senior Director of Worldwide Health for Microsoft. He was kind enough to sit down for a few minutes and talk to me about the future of physician practices. He told me something at the time that I didn’t really understand. He said, “Something is about to happen that will be  game changer for physicians.” At the time I didn’t understand what he meant, but today I believe he was hinting of the pending launch of Practice Fusion, the first free electronic medical record (EMR.)

The free EMR has indeed been a game changer for physicians. The ability to e-prescribe and report PQRS to avoid Medicare financial penalties and to collect the EHR Stimulus money (aka Meaningful Use) without the typical $25 -$30K outlay per physician has been a boon for many practices. How can an EMR be free? With advertising and the agreement that they blind and sell your data to third parties. (Have EMR companies been doing this all along and not telling you? A topic for another post.)

Physicians still need a billing system to run their businesses, but today software vendors are bundling billing packages with practice management and/or EMR software. For anywhere from 2.9% – 5% of net revenue, physicians can use the software and receive insurance billing services as a package. The two largest vendors providing this service are Athena and eClinical Works.

Social Media

The second reason physicians can start a private practice is the replacement of traditional (quite expensive) traditional marketing with social media. For a fraction of the cost of a direct mail campaign, a physician can use social media to establish a digital presence via a website, blog, YouTube and Facebook. These mediums are not free, but they are long tail, meaning that they will continue to drive patients to the practice long after a direct mail postcard has been thrown in the trash.

New Practice Models

Physicians and other care providers have a choice of self-employed practice models today.  Here are a few choices they have:

    • Concierge – concierge can mean different things to different people, but I am using it to describe a practice that accepts insurance and also requires an additional fee from all patients on top of insurance payments.
    • Medicare Subscription – similar to concierge, but applies the additional fee for Medicare patients only to pay for additional services not covered by Medicare, particularly an annual physical examination.
    • Direct Pay – this is a primary care model where patients pay a monthly fee each month that covers unlimited primary care (sick and well visits) and some in-house laboratory services. This model also includes direct-contracting with employers.
    • Telemedicine – gaining popularity for more than just rural specialty care, telemedicine is seeing patients via a secure video connection.
    • House Calls – this model is coming back as a pure practice model because physicians and other care providers do not have to invest in a brick and mortar office. Coupled with the ability to accept payments via their smartphones and the influx of baby boomers, this model is gaining popularity quickly.
    • Nursing Home – Another “rounding” type of practice like the House Call practice, physicians spend 100% of their time in nursing homes seeing patients.
    • On Call Specialty Practice – specialty physicians, typically surgeons, see patients pre and post-surgery in the office of the referring physician and have no brick and mortar office.
    • Cash Practice – this is a 100% cash model with no insurance payments accepted. Typically, physicians will provide patients with what they need to be reimbursed from their insurance plan. Because insurance is not filed, the practice can afford to discount their prices.
    • Co-op Practice – this is a time-share-type practice where one practice or a non-physician owner leases space to physicians, providing everything for one fee except billing, EMR and a medical assistant.
    • Micropractice – an even skinnier form of the co-op practice, the physician works without any assistants and does everything him/herself with just a computer, utilizing one exam room. Micropractice physicians see on average 8 to 10 patients a day.

For more information on different practice models, see our posts Yes, You Can and Should Start a Solo Medical Practice in 2013!How Physicians Can Offer Direct Primary Care to Employers: An Interview with Dr. Samir Qamar of MedLion,  The Direct Pay Physician Practice Model: An Interview With Scott Borden and Physicians are Leaving Hospital Employment and Starting New Practices on Their Own Terms.

If you would like to receive Manage My Practice articles via email, click here to subscribe.

 

(Photo Credit: nathangibbs via Compfightcc)

 

Posted in: General

Leave a Comment (11) →

Ten Golden Rules for Every Medical Practice – A Manage My Practice Classic

Important Rules for Employees

 

Although I originally created this list for medical practices in 2009 and republished it in 2011, I think it still stands true today and applies to all workplace situations.

Sometimes employees do not understand or follow the most basic workplace guidelines. Here is a simple but comprehensive list that you can tweak to make your own. It covers about 25 basics in a short list of ten “Golden Rules.” Make it part of each job description or personnel handbook and/or post it in strategic places.

Report to work on time daily.

Be ready at your desk to begin work at the designated time. Leave promptly for lunch and return to work when you should, unless you’ve made special arrangements with your supervisor. Take breaks on the honor system and do not abuse the privilege. Clock in and out faithfully.

Command respect…

….from the physicians, managers and employees of (your practice/business name here) by demonstrating total professionalism in the workplace with your dress, your demeanor and conversation. Represent the business/practice in a way that would make your Mother and your boss proud of you. Treat your co-workers as you would like to be treated.

Be economical…

…by not wasting time or supplies or doing sloppy work that must be re-done.

Give every customer/patient your total attention, patience and courtesy.

Do not assume you know what the customer/patient is going to say, but listen carefully to the patient (in-person or on the phone) so you can assist them to the best of your ability. Remember how good it feels to be the center of someone’s attention and give that gift to every single patient.

Keep your supervisor aware…

…of any problems in your workload, whether too much or too little. Do not expect your supervisor to know if you are falling behind or caught up.

Document…

…all interactions with customers/patients and other businesses/medical facilities to assist your co-workers in knowing what you have done, and document your resolution of the situation to the customer’s satisfaction.

Strive for a positive attitude every single day.

Don’t whine.

Be a team player.

This means both covering for your co-workers and knowing that they will cover you. This means supporting your co-workers to their faces and behind their backs. This means having (your business/practice name here) goals for your goals, and knowing that your success will be your team’s success, and ultimately, the success of the business/practice.

Clean up your own messes…

…and act as an adult acts in the workplace: responsibly, maturely, and with thought for others. Accept blame for your own mistakes, knowing that everyone makes them, and that if no one is making any mistakes, nothing is improving.

Contribute…

…to making (your business practice name here) a good place to work. Only you can create a place where everyone enjoys working. Only you can make this place a good place to be.

 

For more medical office rules, read 21 Common Sense Rules for Medical Offices.

If you would like to receive Manage My Practice articles via email, click here to subscribe.

(Photo Credit: Gord McKenna via Compfightcc)

Posted in: Amazing Customer Service, Day-to-Day Operations, Human Resources, Manage My Practice Classics

Leave a Comment (9) →

The Danger Signs of Picking the Wrong Medical Billing Company

Dangers Signs with your Medical Billing Service

 

Outsourcing your billing can be a great decision.

Practices typically outsource billing when they feel they don’t have the people, space, resources, bandwidth or finances to keep billing in-house. There is a strong difference of opinion as to which model is less expensive. Most billing companies will charge 4% – 8% of net revenue, which is medical revenue minus any payer and patient refunds. Most medical billing companies charge on the lower side of the range for surgical groups and other high-dollar specialties and on the higher side of the range for primary care and other medicine specialties. Some states require billing companies to charge on a flat fee as opposed to a percentage, as it is felt that paying a percentage of revenue incentivizes billing companies to “game” the system in trying to maximize revenue.

We work with many practices that either want to bring their billing back in-house again or want to outsource their billing again. For those wanting to outsource their billing, we offer a list of the danger signs to watch for when choosing a medical billing company you’ll be tied to in the years (contract are usually 3 years) to come.

Danger Sign #1: They have no existing clients in your specialty.

It’s true that most physician coders and biller are trained on all specialties, but coding and billing rules change annually, and if the billing company isn’t up to speed on the nuances of your specialty, how long will it take them to get there?

Danger Sign #2: They will not give you any references except the ones on their pre-printed list.

You know that saying – a company is not going to put any name on their reference list that won’t give them a glowing reference. Some companies give you their entire list of clients – they’re not afraid! If they only give you 10 names and you know they have 100 clients, you have to ask what’s wrong with the other 90?

Danger Sign #3: They do not give you access to their system to look up patient accounts.

This is where a system on the cloud makes everything so easy – the vendor assigns you a login and initial password and you can look at everything. Why wouldn’t you expect to have 100% access to your own data? Recently I heard of a billing company that would not give their practices access to their system because it was “proprietary.” What is proprietary about a billing system and what are they afraid you will see?

Danger Sign #4: They do not allow you to run your own reports.

This is similar to #3, but I have had billing companies provide me with reports that are not system-generated. In other words, they took the data from the system reports and entered it into a spreadsheet. So I don’t know if the numbers are real or not. I insist that all reports given me by a billing company be system-generated. They can give me a snapshot report that simplifies the information, but I want the system-generated reports as well.

Danger Sign #5: They do not allow you to have an interview with the lead biller on your account.

I want to know who will have this crucial role in my client’s financial wellbeing and who the staff will be communicating with over the coming years. I also want to know if the biller is a data-entry person or a real thinker.

Danger Sign #6: You’ve never heard of the billing software they use.

There are hundreds of billing systems out there and I am sure I haven’t heard of all of them. If I’ve never heard of this billing software, I’d like to know more about it. How long has it been around? How often is it updated? How many practices are using the software? What do you mean the billing company owner’s wife wrote the software and you are the only ones using it? Is the company big enough to put enough resources into ICD-10 or will they be one that will fall by the wayside before the big switchover?

Danger Sign #7: They will not give you a daily report of their work completed.

You need a daily report on charges, adjustments and payments. If you have access to their system, or they are working on your system, you’ll be able to generate this report yourself, but otherwise, you don’t know what they are doing until month-end. Think of what could potentially happen (or not happen) in four weeks.

Danger Sign #8: They do not give service turnaround guarantees (charges entered 24 hours after receipt, claims processed daily, etc.)

A service guarantee is one of the biggest reasons you outsource your billing. If they don’t have the bench-depth to cover staff losses or unexpected staff shortages, why are you even considering them?

Danger Sign #9: They will not agree to do your billing on your software – they insist on using theirs.

A lot of billing companies will only use one brand of billing software. Take it or leave it. Their profit is dependent on the efficiency and duplication of the same process over and over again. I understand that. But what if you have a system you like, and it is loaded with years of data, but for whatever reason you want someone else to staff it? You can outsource your billing, but don’t commit to losing your system when you’re happy with it.

Danger Sign #10: They cannot integrate electronically and accept your charges from your EMR.

Providers are taking the place of superbills (encounter forms, charge slips, etc.) by having their EMR orders translated into CPT codes. If you are doing this in your EMR (and you should if you’re not!) and you can’t feed that info into a billing system, you’ll have to go back to a paper system such as a superbill. Ask the billing company if you will have to print out anything on your side for them to do their work and use the answer to gauge the additional work outsourcing billing might be for your practice.

The Contract

If you do sign a contract with a billing company, make sure the contract language is very clear on how problems will be resolved. What happens if they don’t meet the service guarantee? What happens if they don’t have adequate backup and your claims aren’t sent for a week while someone is on vacation? The most dangerous time is in the early days when you are in transition from one system to another. Have a timeline for the switchover with very specific goals and penalties if the goals are not met. It’s always good to have a line of credit or a little padding to draw on during a billing switchover – you never know how smoothly things will go. Make sure the termination clause or end of contract term has language on when and how you will receive your data if the billing company is not using your software, and what the cost will be.

If you would like to receive Manage My Practice articles via email click here to subscribe.

Posted in: Collections, Billing & Coding, Day-to-Day Operations, Finance

Leave a Comment (3) →

Your Practice Management Software Is Only As Good As Your Practice Management

The Robot Practice Manager

 

A colleague of mine has been part of a well-known PM/EMR company’s software support team for 10 years. She often tries to steer people to me when she cannot solve a client’s problems with a software solution. Even though she was once a practice administrator herself, she is a software support person now and the problems she sends to me cannot be solved with software. “Mary Pat,” she asks me, “Why do they think I can solve their practice management issues? All I am empowered to do is to help them use the software.”

Earlier in my career (before EMR) I heard someone call “Practice Management” software “Billing” software and I remember being offended for some reason. I thought “Billing” was such a narrow description of what PM software did – but they were right. That software is meant to deal with everything billing. It all comes down to billing – whether it is the actual billing/claims management itself, running reports to diagnose billing problems, or capturing recalls so patients get reminded to come in for a service and…get billed. Before you unload on me in the comments let me be clear that I am not saying that healthcare is all about billing, I am only saying that Practice Management software was developed to handle the financial side of the house.

Practice Management software cannot “do” practice management. It cannot figure out your workflow so you capture data in the most efficient way, and it cannot analyze your reports and tell you what to change to increase efficiency or decrease overhead. It certainly cannot tell you the best way to schedule, or how much to charge your self-pay patients. It is only a billing tool.

I have worked in healthcare long enough to have helped practices go from manual billing (you typed or hand-wrote claim information on a 1500 form and mailed it in) to their first practice management system. I did a lot of practice management consulting even though that’s not what I was there to do. I had to get them in shape on paper so they could handle the software. I had to get their workflow optimized so the software would make things better – not worse.

An implementation of Practice Management software is not intended to do anything but set-up the system and train you to use it. Sometimes that perfectly rosy future the salesperson paints is nothing like the painful first steps (and cash flow jam) of a new system. An implementation will not fix the issues that are existing in your practice that have nothing to do with the functionality of your billing system.

 

Your Practice Management Software can:

    • Automate your registration process so patients can register and check-in online, or at a kiosk in the practice.

But your Practice Management Software cannot:

    • Train staff to greet patients and make them welcome in the practice.

 

Your Practice Management Software can:

    • Check the patient’s eligibility for active insurance coverage.

But your Practice Management Software cannot:

    • Automatically choose the correct insurance company/payer to attach to each patient account (one of the biggest problems I hear about in the field!)

 

Your Practice Management Software can:

    • Calculate the days since the patient’s last physical, the days left in a global period or visits left in annual cap. 

But your Practice Management Software cannot:

    • Help the patient understand their benefit plans and understand their financial responsibility.

 

Good practice management has a lot to do with attracting, training, coaching and retaining the right staff, as well as providing them with the tools to do the job you hired them to do. Getting the software right is a must, but don’t expect your software trainers to be able to solve any of your staffing, communication, workflow or cultural problems. That’s up to you, the Practice Manager!

(Photo Credit: baboon™ via Compfight cc)

Posted in: A Career in Practice Management, Collections, Billing & Coding, Day-to-Day Operations, Finance

Leave a Comment (0) →

Medicare to Providers “Tell Us More”

What's In Your Brain?

 

 

Medicare recently started denying an increased number of claims because documentation submitted for diagnostic tests does not include signed test orders or evidence of intent (MD progress notes listing tests needed) and evidence of medical necessity (description of clinical conditions and treatment showing the need for the testing.)

Most of us who have gone through the implementation of a EMR realize that electronic medical records (EMRs) do not always “tell the story” of a visit in the way that paper records used to. Encounters are documented without the glue that allows an auditor to understand what went on during the visit. Here are three ways to make sure that your documentation meets requirement for Medicare and other payers.

 

Establish Medical Necessity: Make sure the test is attached to the right diagnosis

Some providers attach all diagnoses assigned to a visit to any/every test ordered and performed. This is incorrect. All diagnoses can be attached to the Evaluation & Management (E/M) code, since all were addressed during the visit. Don’t list any diagnoses from previous visits that were not addressed at the current visit unless you note their impact on your decisions for care at the current visit.

Remember that screening tests and diagnostic tests are two different things. A screening test is ordered when you are looking for something with no provocation. Wikipedia states that a screening test “may be performed to monitor disease prevalence, manage epidemiology, aid in prevention, or strictly for statistical purposes.”

A diagnostic test is ordered when there is a sign or symptom that prompts the provider to look for the cause. Wikipedia defines a diagnostic test as “a procedure performed to confirm, or determine the presence of disease in an individual suspected of having the disease, usually following the report of symptoms, or based on the results of other medical tests.”

According to Medscape, the 5 main reasons for any test are as follows:

      • Screening: Screen for disease in asymptomatic patients. For example, a prostate-specific antigen (PSA) test in men older than 50 years.
      • Screening: A test may be performed to confirm that a person is free from a disease or condition. For example, a pregnancy test to exclude the diagnosis of ectopic pregnancy.
      • Diagnostic: Establish a diagnosis in symptomatic patients. For example, an ECG to diagnose ST-elevation myocardial infarction (STEMI) in patients with chest pain.
      • Diagnostic: Provide prognostic information in patients with established disease. For example, a CD4 count in patients with HIV.
      • Diagnostic: Monitor therapy by either benefits or side effects. For example, measuring the international normalized ratio (INR) in patients taking warfarin.

 

Reveal your decision making in the record

      • Need add’l tests to est. xxxxxx. Plan to…
      • Return in 3 wks and repeat test to establish…
      • DM worsening – will….
      • Consider d/c xxxxxx medication if fatigue persists.
      • Hypothyroidism vs. anemia?
      • Fatigue most likely sec. to HTN meds – r/o electrolyte abn.
      • DM stable, continue current regimen, recheck in 3 months.

 

Don’t forget the signatures!

A signature log can be as simple as entries on a document such as:

Provider Name (printed): ______________________

Full signature (written by provider): ______________

Initials (written by provider): ___________________

(Photo Credit: deadstar 2.1 via Compfight cc)

Posted in: Collections, Billing & Coding, Compliance, General, Medical Coding Education, Medicare & Reimbursement, Medicare This Week

Leave a Comment (0) →

The New Age of Managed Care Contracting: Talking with Maria Todd of The Healthcare Business Institute

Managed Care Contracting

 

 

Dr. Maria Todd has been in healthcare since 1979 and has been the nation’s leading managed care trainer and consultant since 1989. She’s trained more than 70,000 healthcare professionals via more than 2500 road show seminars presented through McGraw Hill Healthcare Education Group, HFMA, MGMA, Heritage Professional Education and Business Network. Her iconic Managed Care Contracting Handbook sold more copies than any other managed care professional handbook in history, and is now in 2nd edition. No other industry professional has contributed more to the art of managed care contracting and managed care professional skills education than Dr. Todd. Manage My Practice recently sat down with her to learn more about “the new age of contracting.”

Mary Pat: Maria, you are teaching attendees at your contracting course what is new about payer contracting. What’s different in the current environment?

Maria: The managed care contracting scene is radically different under healthcare reform and the PPACA. Anyone who hasnt revisited their contracts in the past few years because they conveniently rolled overyear to year may find that they could be shut out of renegotiation, certain networks and other strategic updating that should have been done vigilantly since 2009.

Mary Pat: Do managers still need all the previous skills related to contracting with payers?

Maria: They need even more! For example, they will need to be able to safely configure bundled case rates without overlooking costly inclusions due to vague or ambiguous descriptions and accurately calculate the business opportunities and risks under capitated models.

Mary Pat: Contracting carries a lot of risk. How do you teach people about contract risk?

Maria: By showing them the ambiguities in every day contract language that doesnt look like legalese but can create loopholes for payment bundling, denials, foreclose appeals, and force the physician to refrain from billing.

Mary Pat: Many physicians have told me that there is no real negotiability in payer contracts anymore. I don’t believe that is true – what do you think?

Maria: I have always been able to negotiate some changes, perhaps not all that Id like to. The fact of the matter is that if there is nothing to negotiate, the contract is considered adhesiveand unfair and the courts can toss it out. Language can also be construed in interpretation against the drafter, if it is ambiguous. Also, the courts are not there to be paternalistic. If you negotiate some and leave others the courts put the onus on the physician or his/her manager for not finishing the job. You are not entitled to a fair contract unless you negotiate one. The class teaches participants how to spot problems and mitigate them, and provides more insight to defend a reason to say no thanks, Ive had enough!

Mary Pat: You say “Price is not the driver anymore.” What is?

Maria: New trends in contracting level the pricing field. That means that quality and service accountability, as well as adherence to evidence-based care protocols and guidelines will be measured, prescribing habits and patient engagementonly now, they will be contracted performance elements. The whole new ball game of pay for performance is now driven on different metrics. If one doesnt perform at a base level, one will have to find another ball field.

Mary Pat: Do managers and physicians need the help or review of a lawyer before they sign a payer contract?

Maria: Yes.. but for the right reasons. Too many attorneys are asked to assist on operational reviews. For most attorneys, those without practical experience in health administration and operations, (late entrants into law school after a career in healthcare, for example) the doctors and managers you mention are asking the attorneys to work outside their scope. Attorneys should, for the most part, review for enforceability and compliance, not fee schedules, operational practicability, and procedural matters that are purely at the discretion of the contracting parties to agree.

Mary Pat: In your course you discuss contracting with ACOs. Can you talk about what practices will need to learn to be able to contract appropriately with ACOs?

Maria: Which ones to align with, first. Second, how to get out if they make a bad decision, and third, what to look for and watch out for along the way. No one wants to miss the ACO with the successful management and operations and shared savings outcomes, and be left with the ACO that doesnt function well, isnt aligned and doesnt make any shared savings bonus at the end of the year.

Mary Pat: Many managers do not know how to handle ERISA (self-funded insurance plans where the employer acts as its own payer) claims. Do you teach skills to deal with ERISA claims?

Maria: I teach 3 ways to deal effectively with this problem. We know practices hear Were ERISA and we dont have to pay timely or accurately.We teach practices how to get paid faster and more accurately from ERISA payers and teach them exactly what to say to the “ERISA Excuse.”

Mary Pat: Do you talk about out-of-network strategies in your course?

Maria: Yes, because there will be times when the right strategy is to say no. Even them physicians and other healthcare providers may be able to attract market share in other ways, some that may even cost less in overhead and hassle factor – like, cash, for instance.

Mary Pat: What is the single most important thing (without giving away any trade secrets from your course!) that you wish managers and physicians would know about contracting?

Maria: How 150 words and phrases we use in everyday language like shalland other words like appropriate, adequate, reasonable, material, use best efforts, use reasonable commercial efforts, best, other, indemnify and hold harmless, can make life so miserable for physicians and their managers and collections staff because they didnt realize the implications.

Maria K. Todd, PhD

Maria has very graciously agreed to give Manage My Practice readers a 20% discount (code MMP2013) on her 3-day managed care contracting workshop which will be offered on August 14, 15 & 16, in Denver, Colorado. The Healthcare Business Institute, a new non-profit training and professional skills development institute in Denver, Colorado will host this hands-on workshop at the Grand Hyatt Denver Downtown. For more information and registration, call 800-209-7263 or register online here.

(Photo Credit: photos by blperk via Compfight cc)

Posted in: Compliance, Day-to-Day Operations, Finance

Leave a Comment (0) →
Page 5 of 70 «...34567...»