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The Complete Guide to Revenue Cycle Management – A New Comprehensive Course from Manage My Practice

You spoke and we listened – you asked for a comprehensive course on Revenue Cycle Management and we brought it to you!

This series is for anyone who wants to understand the medical practice revenue cycle from the very beginning to the very end: physicians, physician assistants, nurse practitioners, advanced practice registered nurses, practice administrators, office managers, consultants, vendors, students, coders, billers and those who want a RCM foundation to enter the healthcare field. Anyone who wants to know more about how reimbursement in healthcare works in the medical practice will find this comprehensive series indispensable.

You won’t find this comprehensive course anywhere else except at Manage My Practice. Webinar leader Mary Pat Whaley, FACMPE, CPC has developed this program from 25+ years of experience in medical practice management and from requests she gets weekly for education on the revenue cycle management process.

Improve Your Medical Practice's Revenue Cycle

The Complete Guide to Revenue Cycle Management – a Five Module Comprehensive Curriculum

Module I. The Foundation

  • Payer Contracting
  • Credentialing
  • Payer Matrix
  • Setting a Fee Schedule
  • Understanding Medicare Part B

Module II. The Data Build

  • Practice Management System Set-up
  • Allowables
  • Patient Demographics & Insurance Information
  • Eligibility & Benefits
  • CPTs, HCPCS, ICD-9

Module III. The Pre-Claim Process

  • Collecting at TOS
  • Documentation: Paper vs Electronic Medical Records (EMR)
  • Physician Coding vs. Abstraction Coding
  • The Superbill vs. Using the EMR to Bill
  • Claim Scrubbing: The Three Gates

Module IV. The Post-Claim Process

  • Write-offs, Denials and Appeals
  • Daily Reconciliation Process
  • Patient Collections and Payment Plans
  • Refunds
  • Recoupments

Module V. Monitoring

  • Monthly Reports
  • The Practice Dashboard/Snapshot Report
  • Strategies for Improving Revenue
  • Benchmarks for Staffing
  • Revenue Cycle Compliance and Auditing

Also Included! Action Pack – Handouts in Word/Excel

  1. Contract Reference Matrix
  2. Contract Review Template
  3. Fee Schedule Worksheet
  4. Medicare Resources
  5. Allowable Cheat Sheet
  6. Write-off Approval Form
  7. Daily Reconciliation Form
  8. Refund Request
  9. Monthly Report List
  10. Sample Snapshot Report
  11. Sample Revenue Cycle Compliance Plan

 

Here’s what one attendee wrote about a recent Manage My Practice Webinar “Information was right on! Great examples and real life experiences.”

 

5-Week Course for $799.00 (Two Options)

Option One : Every Tuesday for Five Weeks – March 12, 19, 26, April 2, and April 9

Click Here To Register!

Module I: Tuesday, March 12 @7pm ET for 90 minutes

Module II: Tuesday, March 19 @7pm ET for 90 minutes

Module III: Tuesday, March 26 @7pm ET for 90 minutes

Module IV: Tuesday, April 2 @7pm ET for 90 minutes

Module V: Tuesday, April 9 @7pm ET for 90 minutes

——————–

Option Two: Every Thursday for Five Weeks – March 14, 21, 28, April 4 and April 11

Click Here To Register!

Module I: Thursday, March 14 @1pm ET for 90 minutes

Module II: Thursday, March 21 @1pm ET for 90 minutes

Module III: Thursday, March 28 @1pm ET for 90 minutes

Module IV: Thursday, April 4 @1pm ET for 90 minutes

Module V: Thursday, April 11 @1pm ET for 90 minutes

——————–

Mary Pat Whaley

Mary Pat Whaley, FACMPE, CPC has 25+ years managing physician practices of all sizes and specialties in the private and public sectors. She is Certified Professional Coder, is Board Certified in Medical Practice Management and is a Fellow in the American College of Medical Practice Executives. Mary Pat has been providing free information and resources to physicians, care providers and medical practice executives since 2008. For questions about “The Complete Guide to Revenue Cycle Management” webinar, contact Mary Pat at (919) 370-0504.




Guest Author Bob Cooper: The Leader As Talent Scout

Have you ever regretted a hiring decision?

You thought the individual would be a self-starter, but you found yourself having to give constant direction. Perhaps you needed someone with excellent customer service skills, and received complaints about the individual’s attitude and behavior.

One explanation for this dilemma can be found in the book “Now Discover Your Strengths” by Buckingham and Clifton. The authors differentiate between knowledge, skills, and talents. Talents are innate, whereas skills and knowledge can be acquired through learning and practice. You don’t teach someone to be a self-starter, no more than you teach someone to have a talent for empathy. This is why even after providing training on assertiveness skills, or how to provide excellent customer service, we don’t see much improvement or any at all.

I learned this lesson many years ago from a mentor named Bill.  Bill was Vice President of Distribution and an excellent talent scout.  During an off-site management retreat, Bill introduced his new warehouse supervisor. Bill explained that what he needed for this position was someone who has excellent communication skills, is decisive, and assumes accountability. Bill explained that he found the new warehouse supervisor in his health club. He had observed over several months how this individual communicated with others, the respect he was shown, and how he thought about resolving problems. Some of you might be thinking – “He found a manager while working out?”  The point Bill was making is that he knew that he can provide the knowledge and skills required to be a warehouse supervisor, but he needed the talent to lead. I remember the day Bill asked me to move from the position of Quality Circle Facilitator (a staff position) to Customer Service Manager (with 30 direct reports). I said “Bill, I don’t know this operation, and I have never held a management position – why did you select me?” He looked me in the eye and said “Bob, people believe in you, and will follow you. You will learn the departmental functions, I can’t teach what you have.”

The point in sharing these stories from Bill is this – you must think about your hiring and promotional decisions very carefully. If you focus primarily on knowledge and skills which can be taught, and overlook an individuals talent, you can find yourself regretting the decision.

How do you find talent?

One strategy is to use behavioral-based interviews to assess whether or not this person has the talent you need. For example, if you require someone who is decisive, you might tailor your questions toward asking the candidate to discuss difficult decisions they had to make, and how they went about it. You might need to follow-up by asking for specifics.  If empathy is an important talent, you might ask the individual to describe specific situations where a customer was very upset, and how they handled the situation. Pay close attention to how they describe the situation, and whether you get a sense that they fully connect with the importance of empathy. Although this is not an exact science, it puts the focus of your interview on the most important area – talent. We often make the mistake of looking at a resume and being overly impressed with the individual’s accomplishments. The real question is – how did they go about getting the job done? Are they consensus builders? Do they build strong teams? How did they overcome obstacles? Did they develop a successor? With an internal candidate, don’t make the mistake of promoting someone who has good technical skills and poor interpersonal skills, with the hope that they will learn to deal more effectively with others. Identify the talents needed for the role, and determine if this individual “owns” this or not. Don’t try to train them to be strategic, or nice, or anything else. They are who they are, and that’s OK. Select individuals who demonstrate on an ongoing basis the talents needed for success.

You might not find your next manager in a health club, but leaders should always pay attention to an individual’s talents.

Our role as leaders is to build on people’s strengths, not placing too much attention on improving weaknesses. Place individuals in jobs that allow them to leverage their strengths. If someone loves dealing with customers, and has a natural ability to do so, don’t put them in the back office. If someone doesn’t deal well with others, don’t force them into a position where they need to build consensus, and then be disappointed when it doesn’t happen.

I encourage you to use peer-interviewing as a strategy to find a good fit for a position. The person being hired will need to work well with colleagues, so why not engage the colleagues in the selection process. Teach your staff to also be talent scouts.

An organization is only as good as its people. Being a good talent scout is a competitive advantage. You build customer and staff loyalty, reduce turnover and the associated recruitment expenses, and build a winning team for the future.

Always be on the look out for talent, it’s always around you.

For a complete listing of our services, please visit us at www.rlcooperassoc.com

Bob Cooper
President
RL Cooper Associates
(845) 639-1741
www.rlcooperassoc.com
Innovations in Organizational Management




The Best of Manage My Practice – October, 2011 Edition

As we finish off another month here at MMP, we wanted to go back over some of our most popular posts from the month and get ready for another busy,  productive, and meaningful month. Presenting, The Best of Manage My Practice, October 2011!

We’ve started this monthly wrap-up to make sure you don’t miss any of the great stuff we post throughout the month on Manage My Practice, but we also want to hear from you! What were your favorite posts and discussions this month? Did we skip over your favorite from October? Let us know in the comments!




The Best of Manage My Practice – September, 2011 Edition

As we finish off another month here at MMP, we wanted to go back over some of our most popular posts from the month and get us ready for another busy,  productive, and meaningful month. Presenting, The Best of Manage My Practice, September 2011!

  • With the weather getting chillier, and coats and sweater getting pulled out of the closets again, it’s time once again to get ready for your patients’ flu shots! The CMS has released coding and pricing information for Flu shots given after September 1st, 2011, so bookmark the page or print it out for easy reference.
  • Did your providers get their e-Prescribing done to avoid your Medicare rate reduction? If not, you’ll probably want to apply for a CMS Hardship Exemption for 2012. Find out how here!
  • Mary Pat continued her series “Collection Basics” about Revenue Cycle Management in Physician offices with “Part II: Implementing Your Financial Policy
  • Do you dread patient complaints? Don’t! Patients with complaints are a GOLDEN opportunity to learn about your practice, gain new perspectives on your operation and connect and learn about your customers. Learn how to get everything you can from a complaint in “Why I Can’t Wait to Hear Patient Complaints“!
  • And finally, everything you always wanted to know but we’re afraid to ask about a common, but sometimes vague office routine: “The Right Way to Do Write-offs.”

We’ve started this monthly wrap-up to make sure you don’t miss any of the great stuff we post throughout the month on Manage My Practice, but we also want to hear from you! What were your favorite posts and discussions this month? Did we skip over your favorite from September? Let us know in the comments!




The Right Way to Do Write-offs

A write-off is an amount that a practice deducts from a charge and does not expect to collect, thereby “writing it off” the accounts receivable or list of monies owed them by payers or patients.

There are lots of reasons why write-offs are taken, and it is common practice to divide write-offs into two major categories.

Necessary or Approved Write-offs

These are write-offs that you have agreed to, either in the context of a contract, or in terms of your practice philosophy.

Contractual write-offs are the difference between the practice fee schedule and the allowable fee schedule you’ve agreed to accept.

Charity write-offs are the difference between the practice fee schedule and anything collected. Charity write-offs may be in accordance with a community indigent care effort, a policy adhered to in a faith-led healthcare system, or a financial assistance program.

Small balance write-offs are amounts left on the patient’s account that may not warrant the cost of sending a bill, which has been estimated to cost about $12.00 each, taking into account the statement process, as well as the cost to receive the check, post it, and deposit it. Many practices write off the small balance (usually $15 or less) and collect it when the patient returns. Others run a special small balance statement run once a quarter.

Prompt payment discounts and self-pay (no insurance) discounts are write-offs for patients paying in full at time of service, and/or patients who receive a discount off the retail price because they do not have insurance coverage.

 

Unnecessary Write-offs

These are write-offs that you have not agreed to and you reluctantly reduce the charge based on billing mistakes or situations that you should have been able to control, but were not.

Timely filing write-offs are caused by filing the claim past the date required by the payer. Medicare requires that claims be filed no later than 12 months after the date of service to be paid. Medicaid varies from state-to-state. Commercial payers usually have very tight timely filing limits and most average three months. (Make sure you know your timely filing limits for each payer.)

Uncredentialed provider write-offs are those caused by filing a claim for a provider before they are credentialed with the payer.

Administrative write-offs are those approved by the manager based on service issues. For instance, if the practice assures the patient that they are participating with the patient’s insurance, then it turns out that the practice is not in-network, the manager may approve a write-off based on the practice’s error. If the patient has a very bad experience in the practice, the manager may want to discount the service or to write-off the charge completely. If  you do discount the service, remember to submit the claim for the altered fee, as you cannot discount the fee to patient and charge the payer the full fee.

Bad debt write-offs are balances that you have decided to write-off and not pursue further. These are balances that for whatever reason, you are forgiving forever.

Collection agency write-offs are those that are written off the main A/R (accounts receivable) and transferred to a third-party collection agency to collect on your behalf. These balances are not forgiven. Some PM (practice management) systems maintain a separate collection bucket or A/R and others do not maintain collection accounts in the system. Most practices do not schedule appointments with patients that have a collection balance until that balance is satisfied or the patient is committed to a reasonable payment plan.

 

Some guidelines for managing write-offs

  1. Start with the basic write-offs but add write-off categories as the need arises.
  2. Decide which write-offs require managerial approval. Do not make staff get approval for routine write-offs, but do not completely relinquish approval for all write-offs as this is one place where staff could abuse their authority. Make sure write-offs are addressed in your compliance plan so staff understand their responsibilities.
  3. Review all write-off categories monthly and pay attention to unusual spikes as well as creeping trends. Keep in mind that if you raise your fees and don’t renegotiate your contracts, your contractual write-offs are going to escalate, and you’ll need to account for that difference in your evaluation.
  4. Audit write-offs periodically to make sure that they are being done correctly. Staff will know that their work is being checked and you can be sure the numbers you are making business decisions on are sound.
  5. Best practices for unnecessary write-offs are no more than 5% of your total expected collections. The formula for expected collections is gross charges minus necessary/approved write-offs.



Re-engineering Billing: Spending Less to Collect More

How does a medical practice meet the patients’ healthcare needs while operating a highly-regulated business on less income? Start by examining one of the most expensive processes in the practice – billing. Billing requires skilled employees, sophisticated technology, and constant vigilance from everyone in the office.  Let’s explore processes that can reduce your billing expense as well as increase your collection percentage.

Clear Financial Policy

If you don’t have a written financial policy, how do patients know when and how to pay? Your practice should have a very understandable (8th grade level or less) financial policy that explains what your practice will do and what the financial responsibilities of the patient are. If you want a copy of the format I like to use, email me at marypat@managemypractice.com and I’ll send it to you. Use the same financial policy to train your entire staff on your policies. If any employee does not support your policies, that employee should not work for you.

How you save money: Everyone is on the same page, so there is no way a patient can game the system by claiming a staff member or physician told them no payment was needed. By the time the patient receives a service, they should have heard verbally about the policy 3 times (appointment, appointment reminder, check-in) and should have received at least one written copy of the policy, which they’ve signed.

Formal Financial Assistance Program

You need a Financial Assistance Program if your practice discounts patients in financial need. You can discount your fees to any patient without insurance who is paying cash at the time of service. You have the money in hand and you will not be spending anything to bill the insurance company or the patient. Most patients without insurance are very pleased to pay cash at time of service at a discounted rate. Patients without insurance who are unable to pay cash at time of service should be offered an application for financial assistance. Practices can set up discounting based on multiples of the federal poverty level – many use 2 or 3 times the published level. It can be as simple as a percentage off the retail rate, or it can be a sliding scale. Whatever you choose, needy patients are typically quite happy to produce information that qualifies them for medical care at a discount. My experience has been that patients who defer completing financial assistance applications don’t really need the program.

How you save money: If you take the time to put a Financial Assistance Program in place, you will write-off the discounted amounts on the front end and do away with sending numerous statements and sending the patient to collections. Write it off to charity care, and if need be, place a limit on how much charity care the practice can support.

 

Check Eligibility

Check every patient at every appointment to make sure (as sure as you can be) that they have the insurance you think they do. Most practice management (PM) systems have eligibility built in or available as an add-on service. If your system can’t check eligibility, there are standalone systems that can extract appointment information from your software, or you can check the patient eligibility individually.

How you save money: The time it takes to file the wrong insurance for a patient, have it reject, obtain the correct information and refile the claim will eat a hole in any profit attached to the service.

 

Require Payment at Time of Service

Your co-pay collections should be 100% every single day. I can think of very few reasons why you should see a patient who has not paid their co-pay. At every step of the way, patients should be told their co-pay will be collected before they receive the service. If the patient checks in without a co-pay, staff should offer the patient the choice of leaving to get their co-pay (where is the closest ATM?) or reschedule the appointment. Yes, there are a few times when the patient should be seen despite not having their co-pay, but they are much rarer than you might think.

How you save money: Removes billing for co-pays, and collection efforts for small amounts of money.

 

Collect Deductibles

Many practices are afraid to collect deductibles. Or they don’t want to over-collect them and have to refund the patient. Or they don’t know how to find out what the patient’s deductible is. But as deductibles get larger, practices are leaving more and more money on the table. The best solution is to ascertain the deductible information during the eligibility process and collect the appropriate amount at check-out. Using a credit card, you can refund (with most web-based credit card systems) the patient if needed via their credit card – no need to write a refund check.

How you save money: As soon as a patient walks out the door without paying, the value of that money has decreased, and the possibility that you will collect 100% of what is due starts to drain away.

 

Don’t Accept Checks

Very few people do not have credit or debit cards. Take all kinds of credit cards, but don’t take checks. They are time-consuming to handle, they have to be scanned or deposited and they bounce! A bounced check charge usually only covers the bank charge and so the time your staff spends collecting on a bad check is eating away at any profit. If a patient truly does not have a credit/debit card, ask them to bring cash or a money order.

How you save money: Reduce staff time, risk of bounced checks and bank transaction charges. No charges for check vetting services.

 

Don’t Send Statements

You knew I was leading up to this, didn’t you? I don’t think statements, unless they are email statements for reference, are cost-effective tools. Take credit/debit cards, and then adjust the amount due up or down when the insurance company pays. If the patient needs a payment plan for a larger, unexpected service, make it an electronic payment plan that drafts automatically without staff intervention.

How you save money: No statements, no postage, no mail to process, no overdue payments, no self-assigned payments plans, reduced staff management.

 

Outsource Billing

Most Practice Administrators have very strong opinions on whether billing should be outsourced or not. About 50% believe it should and 50% believe it should not. What do I think? I think every practice is unique and the answer for each practice will be different. If you have the technology and the staff and are hitting your benchmarks month after month, then you have the resources to handle it in-house. If you have trouble finding or keeping quality staff, your physicians don’t want to invest in the technology, or you need the square footage for revenue-producing activities, you might want to consider hiring remote staff to work out of their homes, or you might want to consider outsourcing.

The good news is that outsourcing billing has never been easier or more feasible. There is a buffet of choices for every size and specialty, from small local companies to large national, even international companies. Some software companies offer free EMR software when you use their billing services, which could be a boon for smaller practices shooting for the Medicare or Medicaid Incentive Program dollars.

How you save money: Your billing will be done within guaranteed time frames regardless of staffing, weather or internet outages. You reduce payroll, benefits and office space. You pay only on what is collected.

Related Posts:

Collection Basics – Part 1: Know Your Payers

 




PM, EMR and Portals: A Primer on Healthcare-specific Software for Ambulatory Care

Note: This article was first published as PM, EMR and Portals: A Primer on Healthcare-specific Software for Ambulatory Care on Technorati.

Few industries are currently changing as much as the US healthcare system. While many perspectives and ideas are shaping the debate on how to change the system to meet current and future demands, most believe that technology can and will have a huge positive impact on the ability of the industry to deliver quality care in a cost-effective way. Network technologies that can support the ubiquitous exchange of health information in a secure, efficient and collaborative environment hold the potential to streamline and modernize the current system to maximize resources and positive patient outcomes.

The opportunities for improvement have generated a lot of buzz in both the private and public sectors, and incentivizing adoption of Healthcare Information Technology (HIT) through the American Recovery and Reinvestment Act of 2009 (the ARRA or “Stimulus” bill) has led to considerable interest in an industry often known for lagging behind in the adoption of new technologies.

For many, the healthcare-specific technical jargon and operational knowledge of how healthcare works can be as complex as the products themselves. Here then are descriptions of the three types of medical software used by ambulatory care providers.

Practice Management (or PM) Software

Practice Management (or PM) software has been in wide use in the healthcare industry for almost three decades. Its primary use is the collection of patient demographics, patient insurance detail and the healthcare services and related diagnoses provided. This information is formatted to conform to payer requirements and is submitted electronically to request reimbursement for services. PM software also manages the responses from the payers in electronic format and invoices any balance to the patient in the form of printed and mailed statements. PM systems can be all-encompassing in functionality or can be a la carte in modules.

Functions of Practice Management Software

  • Payer billing
  • Patient billing
  • Patient scheduling
  • Patient recall for future appointments or services
  • Referral management (inward and/or outward)
  • Visit counting
  • Patient eligibility and benefits determination
  • RVU (relative value unit) reports for compensation by productivity
  • Payer contract management
  • A/R (accounts receivable) management
  • Procedure / surgery estimating

Electronic Medical Records (EMR) and Electronic Health Records (EHR) Software

EMRs require and store some of the same patient information as PM software. Patient demographics, patient insurance information and scheduling are actually found in both types of software. When the two programs are integrated, one database typically serves both sides. While the PM system focuses on relating to the financial side of the practice, the EMR system organizes patient medical data.

Although the terms “Electronic Medical Record” and “Electronic Health Record” are used interchangeably by vendors and providers these days, the strict definition of the two terms provided by the Healthcare Information and Management Systems Society(HIMSS) defines an EHR as an individual record of a specific patient’s care, defining an EMR as the software platform that houses all of the EHRs the practice generates.

EMR systems are newer to and less evident in the outpatient healthcare industry. Tools to secure the system while making the data accessible, as well as installing hardware in clinical settings like exam rooms, are still fairly recent developments, especially for small to medium-sized private physician groups. As adoption continues, and the Federal government encourages entities to move to EMR, the interoperability of the software means a patient can easily and securely have records sent from one provider, healthcare system, or location to another – reducing mistakes and costs to inform providers and patients making decisions.

Functions of Electronic Medical Record Software

  • Capture and reporting of discrete data
  • Coding assistance
  • Clinical visit summary
  • pdf record repository
  • Data aggregation in graphical form
  • Access to patient records from other locations
  • Medication reconciliation
  • Patient recall for disease management or medication review
  • Standards of care protocols / algorithms
  • E-prescribing
  • Data collection for interface with research or accreditation registries

Patient Portals

While PM and EMR systems seek to capture and organize patient data to support the practice’s operations and patient care, Patient Portals facilitate communication of sensitive health information between patients and care providers. Most Patient Portals are web-based systems that attach to the provider’s website to allow patients to securely send and receive information.

By allowing more data to be transferred securely in a digital manner, patients can save time and effort communicating with their healthcare provider. Some patient care (eVisits or virtual visits) can take place via the Patient Portal, and organizations can save overhead and human resources on phone calls and in-person visits when replaced by secure emails or chats with nurses, insurance clerks, medical records clerks or lab technologists.

Functions of Patient Portals

  • Online completion of patient paperwork – demographics, insurance information, medical history, Notice of Privacy Practices (NPP) and other signatures necessary to receive care
  • Online bill pay
  • Medication/refill requests
  • Appointment requests
  • E-commerce – secure purchase of health products
  • Secure email between physician and patients
  • Online chat with staff
  • Virtual Office Visits (reimbursed by some payers)
  • Laboratory Results Communication
  • Self-scheduling appointments
  • Patient billing via secure email
  • Online referrals (inward/outward)
  • Exchange of patient records between physicians/providers sharing a patient’s care
  • Personal Health Record (PHR)
  • Kiosk for patient check-in
  • Patient submission of vital signs and other health data

Putting it all together

All three types of software are designed to make information work for patients and providers without bogging down the delivery process with paper. By harnessing advances in network security, performance and usability, PMs, EMRs, and Patient Portals have the potential to make today’s patient experience cost-effective, efficient, pleasant and safe.




Kris Jones of Healthcare Management Services: Baby Stepping Your Way to EHR

 

Kris Jones of Healthcare Management Systems

Some of worst horror stories in healthcare operations right now have to do with the failure of Electronic Health Record, (or EHR) installations. The high rate of EHR failures is being compounded by the pressure to attest in 2011 and start recouping some money against the EHR purchase and implementation.

To help organizations adopt EHRs smoothly and successfully, billing and management specialist Kris Jones, owner of Healthcare Management Services, is providing her clients with an innovative EHR program that she calls “Crawl. Walk. Run. Fly.”  Kris told me “I found my clients so resistant to EHR, so paralyzed by the horror stories of money spent and productivity lost that I couldn’t help them move forward like we both knew they should.”

So Kris created the program that she thinks of as “Baby Steps” to make the process much more manageable and less intimidating. She brings the practice team on board a step at a time, removing the fear of the unknown and the greatest fear of all – change! Because Kris supplies the practice management software as well as the EMR, it is feasible for for her to let the practice take as much time as it needs to move through each stage.

Step 1. Crawl

The practice uses the EHR as a repository for medical record images. Staff makes first contact with the software.

Step 2. Walk

The practice adds e-prescribing and the staff enters data into the EHR for the problem list, the medication list and vitals. The software begins a functional role in patient interactions.

Step 3. Run

The physicians start with partial, then move to a full progress note. Physicians make first contact with the software.

Step 4. Fly

The practice achieves Meaningful Use with full implementation of the EHR.

What Kris has developed for her clients is the antithesis of the experience most practices have with the purchase of an EHR. It gives her clients the continual support and incremental change they need to preserve their workflow while slowly integrating the new software. This “slow and steady” approach has allowed her clients to be able to get their feet wet in the Electronic Health Record before being assured that the water’s fine and taking a full dip.

Click here to see the special free offer Kris and her team have put together for Manage My Practice readers.

Kris Jones-Bartley founded Healthcare Management Systems in 1985. Over the last 25 years, Kris built HCMS in to a multi-faceted practice management company with clients nationwide. Kris has personally managed every phase of a medical practice, from start-up to retirement, and including the recovery of practices “on the brink” of insolvency. Critical thinking, candor and eye-for-detail, make Kris a valuable partner in the business of medicine.  HCMS is focused on specialty Revenue Cycle Management  deployed in conjunction with E.H.R. capability. 

HealthCareManagementSystems – Experience. Expertise. Integrity. Determination. Results.  Value.




How to Tell if Your Medical Practice is Well-Managed

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What are the hallmarks of a well-managed practice?  There are many, but here are 10 basics.

  1. The practice has foundation documents appropriate to the corporate structure and written agreements describing how income and expenses are shared by physicians and/or other providers and how partners enter and exit the practice. The owners of the practice and management meet monthly.
  2. The practice has documents that set the guidelines for operations such as a compliance plan, disaster plan, personnel handbook, job descriptions and requirements for annual evaluations, raises, bonuses and progressive discipline. Management and staff meet monthly.
  3. The net collection percentage is 95% or more. This means that of the expected collectible dollars, 95% is collected.
  4. The practice has a budget and variances are addressed.
  5. The unfilled appointment percentage is 5% or less. This is in retrospect, so it includes no-shows. The practice has a marketing budget and a written marketing plan.
  6. The practice has a line of credit or other means to draw upon in the case of unexpected cash flow drop.
  7. A single commercial payer comprises no more than 50% of the practice business.
  8. Employee turnover rate is 10% or less. New employees are onboarded with training, coaching and competency testing.
  9. The practice has the ability to produce management reports to track and trend production, payments, adjustments, and denials. Process Improvement (PI) is used to address negative trends.
  10. Patient satisfaction is prioritized and measured, and improvement is valued.

What other hallmarks would you add?




Maximizing Your Career Potential With Practice Management Credentials

In addition to onsite and online undergraduate and graduate programs in healthcare administration and management, there are a number of programs that offer certification and registration (both terms meaning the same thing) for career healthcare managers.

When researching programs, some questions you should ask are:

  1. How long has the program been in existence?
  2. How many people have been credentialed through the program?
  3. What are prerequisites (education, experience, references, other)?
  4. Does the program have an education component in the form of mentoring, coaching, conferences, webinars, online classes, or in-person classes?  Cost associated with each?
  5. What information is covered in the exam? How can I learn this information?
  6. What is the exam format (objective, essay, interview, presentation, other)?
  7. What is the exam media (paper & pencil, online at home, online at testing center, other)
  8. What are costs if the exams have to be repeated?
  9. Do you have any data about the earning power or success of those credentialed through your program versus those from other programs?

*****

American College of Healthcare Executives (ACHE)

Cost: Membership requires a Bachelor’s degree. Annual dues are tiered and escalate from $150/year to $325/year over five years.  Fellow exam is $450, recertification is every three years.

  • Fellow American College of Healthcare Executives (FACHE)

*****

American College of Medical Practice Executives (ACMPE)

Cost: The education arm of Medical Group Management Association (MGMA), $275 annually (one-time $95 application fee), knowledge assessment $95, Body of Knowledge Review $29 each domain, exam workbook $119, objective exam $165, essay exam $165

  • Certified Medical Practice Executive (CMPE)
  • Fellow American College of Medical Practice Executives (FACMPE)

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American College of Physician Executives (ACPE)

Cost: Membership $280/year, Master’s degrees for physicians only

  • University of Massachusetts, Amherst (online part-time MBA)
  • University of Southern California (Master of Medical Management)
  • Carnegie Mellon University (Master of Medical Management)

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International Association of Registered Health Care Professionals (ARHCP)

Cost: $120/year for membership, $385 per exam

  • Registered Medical Manager (RMM)
  • Registered Medical Coder (RMC)

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Physician Office Managers Association of America (POMAA)

Cost: Annual membership $110, study guides $100 each, exams $275 each

  • Certified Practice Manager (CPM)
  • Medical Coding Specialist (CPM-MCS)
  • Human Resource Specialist (CPM-HRS)

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Practice Management Institute (PMI)

Cost: $799 – $999 for each program and exam – program available in-person, online or self-study.  Annual recertification $75/year

  • Certified Medical Office Manager (CMOM)
  • Certified Medical Compliance Office (CMCO)
  • Certified Medical Insurance Specialist (CMIS)

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Professional Association of Health Care Office Management (PAHCOM)

Cost: $195/year membership, study guide $150, practice test $150, exam $385, recertification every 2 years $75

  • Certified Medical Manager (CMM)

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The American Academy of Medical Management (AAMM)

Cost: $378/year membership – certification is available with or without exam for $259, recertification is $179 every 3 years

  • Certified Medical Staff Recruiter (CMSR)
  • Certified Administrator in Physician Practice Management (CAPPM)
  • Executive Fellowship in Practice Management (EFPM)
  • Physician Fellowship in Practice Management (PFPM)
  • Fellowship in Medical Staff Development (FMSD)

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You may also want to read an earlier post on Manage My Practice: “How Does One Become a Medical Practice Manager?”
and read the other posts in the Category : A Career in Medical Management by clicking on the category on the sidebar to the right.