Archive for General


How to Ask for Advice

A question I recently answered on Quora was:

How would you go about asking a business professional that you admire, for advice on starting up a business?

My answer could just as easily apply to asking someone to mentor you.

Here’s what I said:

Asking someone for advice means you have to adhere to their timeline – meet or talk when they can meet or talk. Offer them email questions as an alternative.

Treat them, if they are willing, to a meal or beverage – breakfast, coffee, lunch, drinks, or dinner and don’t be cheap about it if you pick the place.

If you want to stand out, write them a letter to ask for their time to give you advice. When meeting, take notes. After the meeting, call or email or write to them to thank them for their time.

Don’t make the meeting or call all about you. Ask questions about them, not just what they can share about your situation.

Don’t think of this connection as a one-time thing. It could potentially grow into a professional relationship that benefits both parties. You are just starting our and willing to learn, they are willing to share – how can you help each other?

Posted in: A Career in Practice Management, General, Leadership, Starting a New Practice

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Heart Failure Patient Innovation Leads to New Service Line

Transitional Care for Heart Failure Patients

Setting up new practices and healthcare businesses gives me the opportunity to meet some very creative and dedicated people. An exceptional case in point – Elizabeth Blanchard-Hills, the founder of CareConnext. She and I met several years ago while she was piloting a Transitional Care Management program for Heart Failure patients and she wanted a business model to match the care model.

Fast forward several years,and Elizabeth has taken her experience and her success and made it available to organizations who are looking for a proven way to improve care to patients, reduce healthcare costs by preventing hospital readmissions, and improve patient satisfaction.

Elizabeth agreed to an interview to update me on CareConnext.

Mary Pat: What is CareConnext?

Elizabeth: CareConnext is a care transition service giving heart failure patients renewed hope and a sense of personal control over their emotional well-being and physical health. Patients meet weekly for one month in a small group; they are coached by a multidisciplinary team and encouraged by their peers.

Mary Pat: Why would CareConnext be of interest to hospitals, physician practices or home health agencies?

Elizabeth:Hospitals interested in lowering their heart failure readmissions and improving their HCAHPS scores would benefit from CareConnext. Nurse practitioners and doctors who want to increase revenue by saving time would also benefit from CareConnext, as Medicare and private insurers will pay for this model of care. Home health agencies tell us CareConnext offers them a unique marketing edge over their competitors.

Mary Pat: What is the science behind CareConnext?

Elizabeth: CareConnext is the result of a randomized clinical trial (then called SMAC-HF) which followed more than 200 patients for five years. The results were recently published in Circulation, an American Heart Association journal for cardiologists.

Mary Pat: What is the business rationale for CareConnext?

Elizabeth: My company currently has the privilege of “transitioning” the results of the randomized clinical trial into practice.  We have been conducting an on-going pilot project with The University of Kansas Hospital since November 2013, and our results are corroborating the results of the randomized clinical trial. Happily, we also discovered that Medicare and private insurers are willing to pay us for the work we do. This is an important benefit when attempting to persuade executive leadership to implement CareConnext.

There are dozens of very good interventions for heart failure, such as software solutions or post-discharge case management tools. Very few are able to pay for themselves; fewer still have the rigor of a randomized clinical trial behind their results.

Mary Pat: What are the main findings of the study?

Elizabeth: That we could, in fact, significantly lower hospital readmissions among heart failure patients.

Mary Pat: What was most surprising about the results?

Elizabeth: We have found several surprises:

  • The importance of managing emotions when managing a chronic disease such as heart failure;
  • The randomized clinical trial showed depression puts heart failure patients at risk for readmission; this mirrors what we are now finding in the literature; helping patients feel emotionally and spiritually better is now a signature piece of CareConnext. We screen for depression using the PHQ9, and watch our patients rebuild hope by regaining a sense of control. We do so by talking frankly and directly about sensitive issues that are often time-consuming to address: end-of- life planning, the loss of independence, or asking family members to participate in a change of diet.
  • The value of peer-to- peer coaching; because of the time constraints we as health care professionals face, we too often resort to “lecturing” our patients, leaving us little time to validate our patients’ understanding, or their ability to take positive action. For example, it is easy to “tell” someone to limit their sodium intake to 2 grams a day. But does the patient even understand how to read a food label? If not, would he or she feel comfortable revealing that? CareConnext provides a safe environment for patients to recognize and overcome knowledge gaps, as they rely on one another for real-life strategies and emotional support. Our providers are mostly on “standby,” available to address specific questions or misconceptions that specifically require the expertise of an advanced practice nurse or physician.
  •  Our data holds across varying patient populations; patients who struggle with literacy or language benefit from our intervention as do patients who are affluent, well-educated and compliant. Only the “sickest of the sick” (Heart Failure Class III and IV) were included in the randomized clinical trial.
  • Our physicians and nurse practitioners enjoy the CareConnext model, too. Our team is quite talented, and therefore much in demand at The University of Kansas Hospital. They are often recruited for interesting projects always in play at a large academic medical center. They tell us CareConnext is professionally rewarding, and a welcome change from the standard, one-on- one office visit.

Mary Pat: What should clinicians and patients take away from your report?

Elizabeth: This particular patient population will remain engaged if they find something of value. Being “noncompliant” is a convenient label we often misuse with our patients. Heart Failure patients have logical reasons for being skeptical of what they perceive as “yet another doctor’s appointment,” such as a lack of energy.

We have been quite strategic in attempting to meet our patients’ emotional needs. The “clinical stuff” (monitoring fluid volume, especially overload) we offer as part of CareConnext are the ‘greens fees’ we pay so we can address and change patient behavior.  By making patients feel emotionally and spiritually empowered, we help them change the feelings they have and the choices they make.

Mary Pat: How does a reader get more information?

Elizabeth: Many organizations have approached us over the past couple of years about implementing CareConnext within their own institutions, using their own staff. We now have the experience, “lessons learned” and tools to help them be successful. Readers can email me directly to start the conversation at and can also visit our website:

Mary Pat: Anything else you’d like to say about CareConnext?

Elizabeth: Yes, I’d like to give you a special shout-out, Mary Pat. I first approached you with what I saw as an insurmountable problem several years ago: We had a unique care model that delivered outstanding outcomes for patients with Heart Failure, but no way to get paid for it. Using both common sense and a “roll up your shirt sleeves” approach, you helped us figure it out. Now I am excited to help others do the same, and I am grateful for your belief in me, my team and CareConnext.

Mary Pat: Thank you for the kind words, Elizabeth!


Elizabeth Blanchard Hills, BSN MSJ Founder of CareConnext for Heart Failure Patients

800-794-0118 (w)

913-485-0387 (m)


Posted in: Collections, Billing & Coding, General, Innovation, Medicare & Reimbursement

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Should You Outsource Your Chronic Care Management Program? An Interview With Flow Health

Outsourcing chronic care management could be a boon to your practice and your patientsWe recently caught up with Robert Rowley, MD, Co-Founder and Chief Medical Officer of Flow Health, The Operating System for Value-Based CareSM, to discuss practices outsourcing chronic care management services as well as the services that Flow Health offers to physician practices. Some of our readers may know Bob as the former Chief Medical Officer of Practice Fusion, the cloud-based electronic health record company.

Mary Pat: What is the Medicare Chronic Care Management (CCM) program?

Bob: In 2015, Medicare began a new program called Chronic Care Management (CCM) and established a new billing code for it – 99490. This is an initial step away from in-office, traditional care, and starts to promote (i.e., pay for) regular contact with patients in between office visits. A Medicare patient must first enroll in the service, since there is a charge for it – payable by Medicare just like any other service. Then, once a month, a CCM nurse will reach out to the patient, usually by phone, and review the patient’s treatment plan with them. Once 20 minutes each month has been spent addressing the patient’s case, a bill is generated. This service is unlike Case Management, or Home Health, which are intended for the 5% or so of Medicare enrollees who are very ill and need intensive support. Instead, the CCM service is intended for all Medicare enrollees with 2 or more chronic conditions – estimated to be about 80% of all Medicare members.

Mary Pat: Why have few physicians implemented CCM in their practices?

Bob: After a year of implementation, Medicare is discouraged at the low uptake of this new code by clinicians. According to CMS, CCM services have only been billed for 100,000 patients, out of 35 million enrollees – 0.029% of the potential. Why is that? There are a number of barriers:

  • The code is new, and physicians are just starting to become aware of it.
  • The service is burdensome, especially for smaller practices. It may involve hiring extra staff to do the CCM nurse calling. It involves extra billing – an extra bill for every enrolled Medicare member every month. The reimbursement from Medicare (about $40-44 per patient each month) may not cover the overhead of CCM nursing staff and billing.
  • Medicare wants a connected health platform, so that everyone taking care of the patient can see what is going on, and a consolidated care plan can be developed, understood by all. This is hard to achieve in a disaggregated, siloed environment

Mary Pat: What are the benefits of CCM to a small practice?

Bob: Medicare’s CCM service is like a non-physician health coach that reaches out from the practice to the patient and makes sure the care plan is understood, and “checks up” on the patient. If a patient does not want the service, after initially signing up for it, he or she can disenroll from the service at any time. In our experience, very few patients disenroll; most appreciate the extra outreach. The practice gets improved patient engagement and satisfaction, with fewer patients “falling through the cracks.”

Mary Pat: Tell me about Flow Health.

Bob: Flow Health is a universal patient-centered data platform that can draw from all separate sources of information and put it all in one place, unifying the data into a standard form. It can organize a patient’s data, and make it immediately and universally useful. Flow Health also has a suite of apps that sit on this data platform, and allow direct access to this data – a patient-facing app (called Guide), a provider-facing app, and a point-of-care app (Patient Check-In). Flow Health interfaces in the background with connected EHRs in physician offices, so that the data appears “native” to each EHR, and is updated whenever an event occurs in any connected care team member’s systems.

Mary Pat: How does Flow Health address CCM for practices?

Bob: Flow Health offers a full-service outsourced CCM service to medical practices. Flow Health hires the CCM nurses, who present themselves to patients as members of the medical practice, and have all the collected information about the patient and the care plans at their fingertips. Then, when the interaction has reached 20 minutes cumulatively over the month, a bill is sent on behalf of the practice for the CCM service. This allows smaller practices to participate in CCM without having to encumber the overhead required (staff, billing, connected platform).

Flow Health charges a portion of the bill as a fee to cover the cost of administering the service (CCM nurses, billing and platform), and the practice enjoys new revenue from Medicare without the down-side of out-of-pocket expenses to set up and run the new service.

Mary Pat: How much of the monthly Medicare reimbursement does the practice get?

The practice nets about $10-$15 per patient per month or approximately 25% of the Medicare allowable.

Mary Pat: What is the process for outsourcing CCM to FlowHealth?

A practice interested in participating in CCM and wanting the Flow Health outsourced solution simply contacts Flow Health, and an implementation process begins. Integration with the practice’s EHR is set up, which will vary depending on the EHR the practice uses. The Check-In app, deployed on iPads that Flow Health provides for office-lobby use, captures patient consent and on-boards patients into the system so that they can effectively use the patient-facing Guide app subsequently. The mechanism for billing Medicare for the service is set up.

Mary Pat: How does the Check-In app work?

Bob: Using the Check-In app facilitates enrollment in CCM for candidate patients. The authorization forms are embedded in the app, and appear when the patient is a Medicare enrollee with 2 or more chronic conditions. The Check-In app also collects numerous other data (pre-populated as much as possible), including the history of present illness, past medical history, and all the other things generally included on a paper check-in clipboard. It can be used for all of the practice’s patients, not just CCM patients, since its information is linked with the practice’s EHR

Mary Pat: Who supervises the CCM nurses?

Flow Health sets up teams of CCM nurses comprised of a mixture of Medical Assistants trained in CCM and supervising RNs. The notes from the CCM encounters are posted on the Flow Health platform, which the physician office staff can see using the provider-facing app. If there are suggestions and improvements that the clinician feels are important, these can be communicated using the provider app, or by phone. Every attempt is made to assign the same CCM nurse to the same patients, so that longitudinal relationships and trust can be built

For more information about Flow Health’s CCM program, Contact Flow Health.

Full Disclosure: I receive no compensation from Flow Health for this published interview, or for any business that Flow Health may garner due to this interview.

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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.”

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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.

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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): ___________________

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

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The Interview Question That Stumped Me

The Interview Question That Stumped Me

I’ve had many interviews over the course of my career, but one is particularly memorable because of the interview question that completely stumped me.

I was in the third and final phase of an interview, having already met with a team of potential peers and the person I would report to. The last interview was with the team that would report directly to me. I always think being interviewed by potential direct reports is the most difficult of all interviews, probably because while you think you know what peers and the boss are looking for, you have no idea what the staff is looking for.

Everything was rolling along well, and as that final hour was ending I could feel the relief of a runner being able to see the finish line. Then came the stumper: (more…)

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Three Big HIPAA Myths

Waiting Room



As a healthcare consultant, it is not unusual to be asked about HIPAA regulations on a weekly basis. Three questions come up regularly and seem to cause the most confusion when discussing HIPAA. I call them the Three Big HIPAA Myths – you can’t place medical charts on exam room doors, you can’t use sign-in sheets, and you can’t leave messages on patients’ voice mail or answering machines.

Here, then are the answers, straight from the Office for Civil Rights, which enforces:

  • the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information;
  • the HIPAA Security Rule, which sets national standards for the security of electronic protected health information;
  • the HIPAA Breach Notification Rule, which requires covered entities and business associates to provide notification following a breach of unsecured protected health information;
  • and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety.

#1 Question:  A clinic customarily places patient charts in the plastic box outside an exam room. It does not want the record left unattended with the patient, and physicians want the record close by for fast review right before they walk into the exam room. Does the HIPAA Privacy Rule allow the clinic to continue this practice? 


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Ending the Pain of Release of Medical Records: An Interview With Matt Cottrell of 5 O’Clock Records

Medical Records Release of Information RequestRelease of Protected Health Information (PHI) is strictly controlled by the Privacy Rule regulations of the Health Insurance Portability and Accountability Act (HIPAA).  Many practices struggle with a solid process to fulfill record requests in compliance with HIPAA, while achieving efficiency and minimizing expense. Because the logging, retrieval and fulfillment of the request for records is not a service covered by the patient’s insurance benefits, many organizations are unclear how to charge patients, payers and other organizations for this important service. I recently met Matt Cottrell, the founder of 5 O’Clock Records, a free service that helps practices and other healthcare organizations handle medical record requests.

Mary Pat: Tell us about the name of your company – 5 O’Clock Records.

Matt: The name is a reference to the ease of our solution for medical practices.  It improves medical record release so much that you leave at 5 o’clock!

Mary Pat: Over the years I’ve experienced all aspects of in-sourcing and outsourcing paper and electronic medical record requests and fulfillment. Tell us what makes your concept and your company unique.

Matt: For many years the only choices healthcare providers had for medical record release was to perform the functions in-house or hire a Release of Information (ROI) company.  ROI companies are medical record copy services and work with larger practices and hospitals.  They provide staff who copy and invoice medical records.  They also usually keep all the record request fulfillment revenue.

5 O’Clock Records, on the other hand, is a first-of-its-kind medical records request platform and works with practices of every size.  Our solution saves time and optimizes revenue for our provider customers. We help practices release paper or electronic records to requesters through an easy online platform that collects request information securely, handles customer IT support, charges, bills and collects all revenue from requesters BEFORE the record is released.  We make sure every request is billed and collected properly.  Nothing slips through the cracks.

Next, we significantly improve staff efficiency.  Calls for record requests drop from an average of 7 to 1 per request.

Finally, revenues to practices increase from hundreds of extra dollars per month to thousands.  We use our knowledge of state statutes and purchasing power of requester types.  Our software calculates rates based on both variables, thereby maximizing collections to your practice.

Mary Pat: We’ve come a long way with electronic medical records, but practices are at all different stages of EMR adoption, and not all practices are electronic. How does your system accommodate practices (and hospitals) regardless of their medical records platform?

Matt: We are platform agnostic.  If a practice still releases paper records (many do), our request platform does not require a change.  If the practice is electronic we release electronically.  In fact, we are in the process of integrating with several EMR and physician service vendors.  We meet you where you are.

Mary Pat: Traditionally, medical record requests have been problematic for medical practices. As rules change, it is unclear to most what medical records fulfillments are chargeable and which are not. How does 5 O’Clock simplify this?

Rules of medical record fulfillment change regularly.  If your practice is not up on the latest you could be releasing records without charging where you could be or charging where you shouldn’t.  All of this creates more work to correct issues that shouldn’t have happened.  5 O’Clock works with each practice to establish rules.  Here’s one of many examples: In some states, practices are required to provide patients with one free copy of their medical record per year.  Are you tracking this?  Additionally some practices elect not to charge patients for copies of records as a rule.  Does your practice charge patients?  It was very uncommon a few years ago, but now almost all practices do.  If you don’t wish to charge patients, our software won’t. If you do, we will.

5 O’Clock Records also tracks changes in chargeable rates nationwide and updates its software routinely to reflect these.  For example, many providers are still unaware that New York doubled its reimbursement rates last year.  Our customers automatically capture this revenue.

Mary Pat: Is there a standard release of medical records form that all practices should be using, regardless of whether they use help in medical record request fulfillment? 

Matt: Most HIPAA release forms are fairly standard.  Each practice decides which requirements its form should contain.

On our platform, requesters upload a signed release form or court order at the time of the request.  Practice staff review an image of the releasing document and either approves or denies it, maintaining control over the release process.

NOTE: Manage My Practice has a free Authorization for Release of Protected Health Information form available at the link below.

Mary Pat: I’ve had Medicare Replacement Plans request what I thought was an unreasonable number of records for their annual risk adjustment audits. How does a practice know when payer audits are unreasonable and when payers should reimburse the practice for resources to produce the records?

Matt: Medicare replacement plans and other major payers often budget fees for copies of records without communicating these to the practices.  They also commonly hire third-party record retrieval companies (e.g. EMSI, MediConnect) to obtain copies of records.  I should know – I founded and sold one! These third party firms routinely work to obtain free records as they’re reimbursed via a flat fee per request; paying copy fees to providers shrinks their margins.  Knowing when to push back on fees is an area where we routinely help practices.  Doing so increases revenue to your practice and helps you maintain a firm footing with payers.

Mary Pat: If a practice does not have an easy way to log disclosures per HIPAA requirements, does your software provide a log?

Matt: The 5 O’Clock Records platform makes and keeps a permanent log for Accounting of Disclosures purposes.  It tracks who is making the request, the purpose of the request, date and time of service, etc.  It even maintains a permanent image of the authorizing documentation.  Ultimately, we want our providers to relax when the HIPAA police come around!

Matt: I see on your site that you offer a free practice assessment – what does that entail?

Matt: Our provider advocacy team takes a look at the practice’s current record release processes to determine how they can be improved.  We offer practical advice to improve performance, and give practices a later opportunity to check out our free platform.

Mary Pat: What do you see as the future of medical record request fulfillment? Do you think medical records will be released through a Health Information Exchange (HIX) as opposed to through the medical practice or hospital itself? 

Matt: The future of medical record request fulfillment will be robust.  Insurance companies, law firms, patients and others will continue to require copies of medical records in increasing numbers.

Because of this it’s important for practices to partner with companies that understand the in’s and out’s of the industry, and have your interest in mind.

Regarding Health Information Exchanges:  while it’s doubtful commercial requesters will access records through an Exchange, it’s possible within the next few years that a treating practice may request patient records through an exchange.

Mary Pat: What is the process for signing up for your free service and how long does it take?  

Matt: Signing up is so simple!  It takes all of 5 minutes.  Go to our website here.  Watch our awesome 2 minute video and click on the Doctor Sign Up Free button at the bottom of the page.  One of our crack staff members will contact you and train your medical records staff member(s).  Training takes 15-20 minutes.  Our solution is so simple that the most difficult part of it is to remember to redirect all incoming requests to our platform.  That’s it! 

Records Photo Credit: TheeErin via Compfightcc


Disclosure: Manage My Practice receives no payment for publishing interviews with companies we think have something good to offer our readers.

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10 Reasons Why Your Doctor Won’t See Medicare Patients

Why Your Doctor Doesn't Accept MedicareMany patients are panicked that their physician will stop seeing Medicare patients, and that is not without cause.  Physicians that care for Medicare patients do so at a loss to their practice which they can only hope to make up for from other payers. As money gets tighter and tighter, physicians are forced to decide if they can continue to see any patient at a loss.

Although a number of surveys indicate that few Medicare patients (less than 18% nationally) have difficulty finding primary care physicians, much has been written criticizing the methodology of these surveys. A survey in North Carolina in August 2012 revealed that of 200 family physicians called by “mystery shoppers”, only 100 offices indicated they accept new Medicare patients.

Here are 10 reasons why physicians might consider not seeing new Medicare patients, not participating with Medicare or opting completely out of the Medicare program.

#1: Medicare does not pay enough to cover the expenses associated with the services provided.


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