Avoid Medicare Fraud Claims by Coding Correctly

How would you like an investment that returns $7.20 for every dollar you invest? Our government has found just such an investment — healthcare providers.

HHS recovered $4.1 billion in healthcare fraud monies in 2011 to achieve their astonishing 720 percent return on investment. And like any investor on a winning streak, the feds are investing more — another $350 million is allocated to anti-fraud policing under the new healthcare laws.

You may believe you are beyond reproach if you don't order a mobile scooter for every patient or dump your patient records in the nearest landfill, but you should exercise caution in these cautionary times: what the feds consider "fraud" is much broader than your definition. E&M coding, for instance is a potential target; the 99213 and 99214 office follow-up codes were the top two CPT codes in terms of both charges and unit volume in 2010. Don't let your practice be caught up in Medicare's recovery program. It's a simple matter to examine your own coding patterns and compare them to national utilization data collected by Medicare. Knowing how you compare to others within your specialty is important in assessing possible exposure to recovery efforts.

Here are a few reasons you should conduct your own internal chart audits:

Avoid being an outlier. The following chart compares the office follow-up code utilization of four family physicians (Drs. Lovett, Raitt, Nelson, and Jennings) to Medicare's like data for family physicians. Medicare and its fraud contractors have the ability to perform such meta-analyses. Drs. Lovett (red line) and Nelson (purple line) code similarly to the national average (dark blue line). Dr. Raitt (green line) uses a 99213 to code nearly ninety percent of his visits, which makes him a larger target for a chart audit. Dr. Jennings (light blue line) uses 99214 nearly 50 percent more than the national average and 99215 at almost three times the national average. She also is a target for a chart audit.

E&M utilization. While staying under the bell curve will not make you audit-proof, it does decrease the odds that you will be targeted. Medicare produces a data file that contains E&M code utilization and charges by specialty by year, with the most recent year being available here.

To use this data file, extract the unit volume for each E&M code — organized by code set (i.e., office follow-up, hospital admissions, etc.) — into a spreadsheet. Sum the total, as shown below.

Next, calculate a percentage for each code. For instance, family medicine physicians coded a 99211 3.7 percent of the time when Medical billing Services Medicare for an office follow-up visit in 2010.

Extract billing utilization data from your practice management system. Follow the same procedure to calculate the frequency for your utilization of each code.

These percentages can then be used to create a line charge, as shown earlier. While coding above, below, or at the national bell curve for your specialty does not mean you are coding accurately or not, knowing how your personal bell curve stacks up offers a clue to the likelihood of being targeted.

Coding and documentation audits. Regardless of whether your personal bell curve mirrors the national average, I urge you to have your coding and documentation audited on a regular basis. It is critical to know whether your CPT coding, ICD-9 coding, and documentation support one another. I subscribe to the "Noah's Ark" school of chart audits: at least two charts for every E&M code, at least twice a year, by at least two different certified coders. For frequently used codes such as 99213 and 99214, at least five charts should be audited.

Step One: Have your staff randomly pull the billing and chart documentation for recent patient visits for each E&M code. If you game the system by selecting which charts should be audited, you are only gaming yourself.

Step Two: Have a certified coder review each chart and provide a detailed report on your coding, billing, and documentation.

Step Three: Repeat step two, but use a different coder, preferably an outside coder. I say this not to insult certified coders but to protect you. All coders are not created equal, and E&M coding is much more art than science, in my opinion. Medicare will not give you the benefit of the doubt when reviewing your documentation, so you want these audits to be tough and instructive.

Step Four: Repeat this audit on a semi-annual basis. If you see no substantive differences in the findings of your two coders, you may elect to forego the second set of eyes. Still, I recommend that a second coder review your E&M coding at least every two years.

Summary

Remember the $7.20 return on investment the feds are getting on every dollar it invests in healthcare fraud? Medicare estimates it is but the tip of the iceberg. Because their definition of fraud and yours are quite different, it is incumbent on you and your practice to take steps to minimize exposure. Ensuring your E&M coding is in order is a prudent first — and ongoing — step.

ICD-10 Delay May Not Be Enough for Physicians

Physicians and practice administrators can breathe a little easier. On August 24, HHS officially announced the ICD-10  HIPAA compliance date delay from Oct. 1, 2013 to Oct. 1, 2014.

HHS said the decision to finalize the delay, first proposed in April, is due to the fact that providers and other entities need “more time to prepare and fully test their systems to ensure a smooth and coordinated transition by all covered entities.”

Still, some physicians say that while they are pleased with the one-year delay, HHS should have done more.

"The AMA appreciates the administration's decision to provide a one-year delay in response to AMA advocacy, but we have urged CMS to do more to reduce the regulatory burdens on physician practices so physicians can spend more time with patients,” emergency care physician Steven J. Stack, AMA board chair, said in a statement. “The AMA recommended that CMS delay the move to ICD-10 by a minimum of two years."

The movement toward ICD-10, which will require physicians and staff to contend with 68,000 codes — five times as many as they currently deal with — comes at the wrong time, Stack said, noting that physicians are already dealing with a variety of stressors, including transitioning to new delivery and payment models.

“The implementation of ICD-10 will create more challenges for physicians when our Medicare system is broken and cannot provide adequate funding to cover the cost of these additional administrative burdens,” he said.

Medical Group Management Association and American College of Medical Practice Executives (MGMA-ACMPE) president Susan Turney said the organization also has concerns despite the delay.

The MGMA is “not confident that critical trading partners, including Medicare and state Medicaid plans, will be ready in time to conduct testing well in advance of the October 2014 compliance date,” Turney said in a statement. “We urge CMS to significantly escalate its implementation efforts by pilot testing ICD-10, ensuring health plan, clearinghouse and vendor readiness, and developing comprehensive educational resources.”

But Steve Sisko, a healthcare and business technology expert specializing in ICD-10, told HealthcareIT News, that if HHS had delayed the compliance date for more than one year, it could have harmful effects for the ICD-10 transition overall.

"A delay beyond one year would probably cause most people to mothball the entire project, while the Oct 1, 2014 deadline keeps momentum going and maintains the value of work already done,” he said.

And AHIMA CEO Lynne Thomas Gordon said that now at least, physicians and other entities have a deadline with which they can work toward.

“ICD-10-CM/PCS implementation is inevitable, but today’s news gives the healthcare community the certainty and clarity it needs to move forward with implementation, testing, and training,” Lynne said in a statement.

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source from Physicians Practice 

Five Common Denials Halting Payments to Your Medical Practice

What if I told you that over 70 percent of the denials you receive from insurance companies can be prevented? Seem a little extreme? It's not. In fact, most all denials from the insurance company come from claims going out that were either not checked for completeness, correct information, or patient eligibility. You can prevent all of this with a few tweaks in your front- and back-office areas.

Do you know why insurance companies deny your claims? This is an area for you to review on an annual basis and check to see how much better you've done than the previous year after implementing a few new policies and procedures. Here are some of the major reasons:

• Patient not eligible at time of service. This most often means that your front-/back-office staff did not obtain quality insurance verification prior to the patient coming in for a visit. It typically is due to the fact that the insurance had termed before you even saw the patient. In instances like this, you can bill the patient since they (hopefully) signed paperwork stating they are fiscally responsible for their bill. Whether or not they actually pay it, is a whole other blog posting.

• No Authorization. This also means that when verifying the insurance prior to the patients arrival, your staff did not obtain the correct (or any) authorization for the visit. It could also mean that the initial authorization was obtained, but any follow-up visits were not. You might want to check your software program to see if there are some limitations you can place to ensure a patient cannot be seen and schedule an appointment without the correct authorization.

•Benefits Exhausted. This means that when obtaining the eligibility and benefits, that dollar limits were not asked about and obtained. Insurance companies have cap amounts on some treatments and procedures. Know those before you perform them, and find out: if they have already been used within the benefit year/lifetime; if there are any pre-existing condition clauses, and/or; if the insurance is for a calendar (January 1 – December 31) year or benefit year (October 1 – September 30 for example).

• Coordination of Benefits. Is the patient giving you all of their insurance information, or are they withholding one because of, say, a high deductible that they do not want to pay? It is not up to the patient to make these decisions. The insurance companies know if they are not required to pay because there is another form of payment available.

• Need Chart Notes. This is one that your front-/back-office staff cannot control. This is simply the insurance company looking for the specific reason for the visit, treatment, or procedure. Utilizing your EHR system to its maximum will ensure that you do not end up with this reason for denial.

Overall, you have much more control over being paid than you think. Work closely with your front- and back-office staff, as well as billing department to identify where the denials are coming from. Then create the appropriate policies and procedures within your practice which will make sure these types of denials decrease today!

Source from Health care news portal

Can Physicians Apply Preventive Medicine Knowledge to EHR ?

A friendly EMR support to increase your cash flow from medicalbillingstar

As physicians, we devote a great deal of effort addressing things that might — not will, but might — happen to patients. The litany is familiar: smoking, drugs, alcohol(Drug information on alcohol), immunizations, guns in the home, accident prevention, cardiovascular risk factors, lifestyle issues, etc.

The list is endless; there are almost an infinite number of things that might happen. We call it preventive medicine. The goal is to prevent diseases and injuries before they exert their damaging effects. It's not a new idea. It was Ben Franklin who said: "An ounce of prevention is worth a pound of cure." The problem is that the patients feel fine and find it difficult to understand our concern. Nevertheless, we keep trying to get them to take the risks and the warnings seriously. Why bother?

First of all, we bother because we have studied medicine. We have the knowledge and we understand the underlying theory that allows us to feel confident that the risks are real and that intervention can alter the outcome. Beyond that there are several other reasons to bother:

1. We believe that the risks, although low, are high enough to warrant concern;
2. Society will be better off (as with vaccines) even if the individual gets only minimal benefit; and
3. When something we could have prevented happens, we will blame ourselves and the patients may blame us for not having tried.

How often do efforts at prevention work? Not often enough. People are notoriously resistant to suggestions that they change their behavior.

It's human nature not to worry about unseen hazards. There is no evidence that doctors do any better than the average patient in this regard.

Are there other kinds of unseen risks, not related to disease, about which we could be doing something? One is EHR. If you have been reading these articles, or practically EHR commentary on the web, you should, by now, have a general idea what they are. Some have a theoretical basis while others have been learned in the school of hard knocks. I'm not going to repeat them here because I have described a number of them in the past and will continue to do so in the future. Practically every day, articles appear that discuss the risks, bad results, cost overruns, and disruptions to work flow and productivity that could be avoided by heeding some of the advice that is offered.

There is a collective (but not organized) effort on the part of those with knowledge and experience to make the “patients” — healthcare organizations and practitioners — aware of the risks that they face and to suggest ways in which they might reduce or avoid those risks. So far the “patients” continue to react with disbelief when apprised of the risks. Perhaps the disbelief can be traced to the lure of incentive payments, the feeling that it is no longer possible to deliver healthcare without a certified computer system, the desire to keep up with the times (or the Joneses), and/or the belief that computers can solve problems. It is the rare practitioner or facility that chooses to stop following the pied pipers of EHR and take a seat in the bleachers.

To gain some perspective, it would be worthwhile to read "Is One Company About to Lock Up the Electronic Medical Records Market?"

It's very disturbing. This article describes a major vendor that favors the goal of dominating the market over technical excellence or a concern for the lifetime medical record. (Do they really think that they will still be around 100 years from now and that we will still want whey have to offer?) The vendor has done a superb job of identifying and selling to the customer’s expectations, with the understanding that those expectations rarely emphasize technical factors or the impact on productivity.

A market dominated by a single vendor poses a risk. When the cost of an EHR is astronomical, the customer may become financially unstable. Perhaps most damaging to the future of EHR is the risk that the development of new EHR science and innovative EHR products will be stifled. It would not be the first time that market domination caused problems, if you remember IBM, AT&T and Microsoft. They were all broken up because their market dominance was deemed to be anti-competitive and anti-innovation.

There is a choice: Turmoil now, while your sanity and finances are relatively intact, or turmoil later, when the unthinkable happens and leaves you broke and crazy. I'm raising these issues because I don't want to wind up hating myself for not making an effort.

 Source from Healthcare News Portal

New HHS rule targets HIPAA, standardization the goal

Whatever may be the rules MedicalBillingStar changes according to it in caring the physcians as well as patients in their revenue growth by our medical billing services

HHS Secretary Kathleen Sebelius announced Friday a final rule establishing a health plan identifier (HPID), that officials say will boost standardization within HIPAA transactions and increase the efficiency of health billing processes. 

The final rule, established by the Office of E-Health Standards and Services (OESS), also includes a data element that functions as an “other identity” identifier (OEID), which is designated for non-health related entities or individuals that still need to be identified for standard transactions. 

The rule is one of a series of changes required by the Affordable Care Act to cut red tape in the health care system and will save up to $6 billion over ten years, according to HHS officials.

“These new standards are a part of our efforts to help providers and health plans spend less time filling out paperwork and more time seeing their patients,” said Secretary of Health and Human Services Kathleen Sebelius in a press release. 

Currently, when a care provider bills a health plan, that plan may use a wide range of different identifiers that do not have a standard format. Officials say this results in health care providers running into a several time-consuming problems, such as misrouting of transactions, rejection of transactions due to insurance identification errors, and difficulty determining patient eligibility. HHS officials say today’s rule will greatly simplify these processes.

HHS says the primary purpose of the HPID and the OEID is for use in the HIPAA standard transactions. The most significant benefit of the HPID and the OEID is that they will increase standardization within the HIPAA standard transactions. 

“The adoption of the HPID and the OEID will increase standardization within HIPAA standard transactions and provide a platform for other regulatory and industry initiatives,” HHS wrote in the final rule summary. “Their adoption will allow for a higher level of automation for health care provider offices, particularly for provider processing of billing and insurance related tasks, eligibility responses from health plans, and remittance advice that describes health care claim payments.”

From the HHS Fact sheet:

Cost and Benefits
The HPID is expected to benefit health care providers, producing savings from two indirect consequences of implementation of the HPID: the cost avoidance of a decrease in administrative time spent by physician practices interacting with health plans, and a material cost savings through automation of processes for every transaction that moves from a manual transaction to an electronic transaction.

Over ten years, the projected net savings of implementing HPID for the entire health care industry is approximately $1.3 billion to $6 billion.

Compliance requirements
Health plans, excluding small health plans, are required to obtain HPIDs by two years after the effective date, in 2014. Small health plans are required to obtain HPIDs three years after the effective date, in 2015.  All covered entities are required to use HPIDs where they identify health plans that have HPIDs in standard transactions four years after the effective date, in 2016.

Source from health care news portal

ICD-10 delay where Groups express support over it

MedicalBillingStar is moving across the forth coming process on ICD-10 codes.

The Department of Health and Human Services' Aug. 24 decision finalizing a one-year delay for the ICD-10 switchover has elicited both favor and concern among industry groups. 

 

The Medical Group Management Association (MGMA), for example, is one organization that has expressed concerns over HHS’ decision to push the compliance date for ICD-10 – which includes some 155,000 codes for new procedures and diagnoses – back to Oct. 1, 2014, citing increased physician burden as a significant worry. 

“Despite the additional year for ICD-10 implementation, MGMA remains concerned that the Centers for Medicare & Medicaid Services (CMS) has mandated this new code set without having undertaken the necessary due diligence to ensure it will not create debilitating cash flow disruptions for physician practices,” said Susan Turney, MD, president and CEO of MGMA-ACMPE. 

“We are not confident that critical trading partners, including Medicare and state Medicaid plans, will be ready in time to conduct testing well in advance of the October 2014 compliance date. We urge CMS to significantly escalate its implementation efforts by pilot testing ICD-10, ensuring health plan, clearinghouse and vendor readiness, and developing comprehensive educational resources,” added Turney.  

MGMA-ACMPE represents upwards of 22,500 members, both professional administrators and leaders of medical group practices, and more than 280,000 physicians.

Other groups, however, have expressed support for the ICD-10 compliance date pushback. 

The College of Healthcare Information Management Executives (CHIME), for instance, expressed positive sentiments regarding the ICD-10 delay. “Overall CHIME applauds the efforts of HHS to quickly and decisively signal a commitment to ICD-10 conversion and we urge the Department to develop a clear path forward, with benchmarks, so that healthcare industry stakeholders can make the conversion in 2014," said CHIME president and CEO Rich Correll.

Back in April, CHIME submitted comments urging the CMS to keep the one-year ICD-10 delay, as they said anything longer would be disruptive to any efforts moving toward the change. “CHIME is pleased that CMS understood the importance of finalizing its proposed one year delay for compliance to ICD-10,” Correll added.

CHIME is an executive organization, representing upwards of 1,400 CIO members and 70 healthcare IT vendors and firms.

Other group responses aired more on the end of neutral acceptance.
The American Health Information Management Association (AHIMA), for example, pledged it support for the healthcare community in light of the ICD-10 ruling, despite not originally being in favor of the delay.

“We were not in favor of a delay at all, from the very beginning," said Melanie Endicott, director, HIM Solutions at AHIMA. "But since there is a delay, we’re glad it’s just one year.”
HHS' ruling "gives the healthcare community the certainty and clarity it needs to move forward with implementation, testing and training,” said AHIMA CEO Lynne Thomas Gordon. “We realize that a few are still apprehensive about the implementation process, and that is why AHIMA remains committed to assisting the healthcare community with its transition to a new code set that will lead to improved patient care and reduced costs."
Endicott cited the heightened costs of providing one more year of additional training and education for providers and coders alike as a downside to the ICD-10 delay. “We feel that were a lot of healthcare entities that were ready for the Oct. 1, 2013, and delaying it a year is just causing increased costs to them,” she said.
With the new decision, however, AHIMA, which represents more than 64,000 specially educated Health Information Management professionals worldwide, is gearing up to provide increased education and resources to all the different medical settings.
The Healthcare Information and Management Systems Society (HIMSS) also released a statement, writing that the ICD-10 compliance delay "provides clarity that will allow organizations to properly allocate their resources to meet the new deadline.  Given the role ICD-10 has in providing impactful data that will support quality improvements needed for healthcare transformation, HIMSS supports active participation by all community partners in preparation for the ICD-10 transition."


source from healthcare news portal.

Crisis Management at Physicians Medical Practice Issues.

What Kinds of Issues Are Doctors Facing?

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Most doctors wrongly assume that any exposure or unwelcome publicity will be limited to issues surrounding their practice; that’s unfortunately not the only case. A review of news articles that cite doctors being, sued, arrested, or investigated covers a wide spectrum and extends in some cases even to members of their family and employees. The news loves to throw in, "A prominent local doctor was arrested tonight…"

The first and most obvious warning is simple; don’t do things, or allow others to do things that you can control, that place you and your practice in a negative light. Even a simple altercation with a neighbor or a DUI becomes newsworthy when a physician is involved and even more so if that doctor is locally prominent. Common examples of things that will get you on the news and detract from your credibility and professional standing:

• Driving while intoxicated or any drug- or alcohol(Drug information on alcohol)-related offense (or even behavior), including while traveling, flying, or on vacation. Think you are out of eye shot? I’ll bet you already know which congressman from the Southwest was just embarrassed for skinny dipping in Israel on a state trip;

• Any offense involving sexual conduct, or misconduct especially with a patient but this seems to be a no-holds-barred category and you will be named in even remote cases involving the conduct of family members and employees that has nothing to do with you; and

• Any investigative report or government, law enforcement, or task force investigation on issues like billing, prescriptions, or ID theft. Regardless of what they actually find, (or don’t find), just being mentioned is pejorative.

An Action Plan for Doctors

What should you do if you find yourself in the limelight? Public relations experts’ opinions vary widely on the best defensive course of action and damage control, but most agree on all the following guidelines:

• Have an Information Officer (IO). This simply means appointing a lead source of contact and information for the media and the public. Pick carefully, it may not always be the best idea to represent yourself in this capacity. Pick someone objective, articulate, informed, and who has the judgment and authority to answer questions on your behalf. Make your staff and family aware of the IO and their role and welcome them to politely refer questions to that person.

• The best defense is a good offense. Put out good information that you control through the IO, make sure it is true and factual and properly disseminated, you want it found first.

• If it’s an issue involving legal misconduct of any kind that requires you to have legal representation, or likely will require you to, check with your lawyer first. Don’t make any public statement either verbally or in writing. Innocent utterances, in your opinion, can certainly be twisted or used against you. In some cases, if your attorney has the personality and control it may be appropriate to have him be your IO, especially in cases involving potential civil or criminal liability.

source from physicians practice.

74% of Physicians Report EHR Adoption Enhanced Patient Care

The CDC’s Center for National Health Statistics (NCHS) has issued a data brief announcing estimates from the 2011 Physician Workflow Survey regarding the physician adoption of EHRs, which is sponsored by the ONC. Overall, in 2011, 55% of physicians in office-based practices had adopted EHRs and 45% had not. Differences were observed between physicians who were EHR adopters and nonadopters by age, physician specialty, practice size, and ownership. Generally, physicians under age 50 were more likely to adopt EHR systems than physicians aged 50 and over.

Dr. Farzad Mostashari, National Coordinator for Health Information Technology stated in his blog yesterday, "this data shows that EHRs are taking hold among a larger number of providers who believe that the use of technology leads to better, safer, more coordinated health care.” The findings reported that the majority of physicians who have adopted an EHR system (85%) were either very satisfied (38%) or somewhat satisfied (47%) with their system. About 15% of providers were either very dissatisfied (5%) or somewhat dissatisfied (10%) with their EHR system. The findings also reported that over two-thirds of adopters (71%) would purchase their EHR system again.

EHR Benefits

Physicians reported having accessed a patient’s chart remotely (74%) and having been alerted to critical lab values (50%) by using their EHR system within the past 30 days as some of key benefits of having an EHR system. A majority also reported that using their EHR system had resulted in enhanced overall patient care (74%).

Overall Key Findings of the study include:

• In 2011, 55% of physicians had adopted an electronic health record (EHR) system.
• About three-quarters of physicians who have adopted an EHR system reported that their system meets federal “meaningful use” criteria.
• Eighty-five percent of physicians who have adopted an EHR system reported being somewhat (47%) or very (38%) satisfied with their system.
• About three-quarters of adopters reported that using their EHR system resulted in enhanced patient care.
• Nearly one-half of physicians currently without an EHR system plan to purchase or use one already purchased within the next year.
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Source from Healthcare IT news 

7 critical success factors for ACOs

 32 organizations across the country are participating in the Pioneer ACO initiative, hoping to inspire others in their regions to follow suit. As the benefits of adopting this model become clear, more organizations are looking to explore the possibility of becoming an ACO. 

Ron Parton, MD, chief medial officer at health IT firm Symphony Corporation, outlines seven critical success factors for ACOs. 

1. Align the payment model with value. The key for organizations to be successful in these types of new payment arrangements, said Parton, is to make sure they have the payment arrangements in place as they change their care delivery models. "There are organizations and integrated systems around the country that have introduced their quality improvement programs before entering into a shared risk arrangements, and [they] have improved quality significantly but have lost revenue because they reduced fee for service business," he said. "So one of the keys is to try to make sure you're matching your payment model with your quality improvement efforts so you don't get ahead of yourself." And once you've created that type of payment model, Parton added – whether it's participating in a Medicare shared risk arrangement, or a local or national insurance company that's creating a pay-for-performance or a shared risk opportunity – it becomes a question of investing in the right type of infrastructure. 

2. Pay attention to leadership and cultural change. According to Parton, one of the most pressing things to understand when changing payment models is that specialty physicians, in particular, may struggle with understand the importance of these new arrangements, since most have depended on fee-for-service to be successful through their careers. "So, it's important to pick leaders who are forward-thinking and who will support the new care payment arrangements," said Parton. These selected individuals can help lead initiatives across the medical staff. "Once you get some of the medical staff bought in, it's important to invest in infrastructure that helps them be successful in the new model," he said. 

3. Hire experienced health professionals, especially nurses and health coaches. Part of driving cultural change, said Parton, is to hire staff to help make these new initiatives successful. "One of the key factors of all this work is to identify complex patients who have difficulty navigating the system, managing their own illness, taking medications, etc.," he said. "The professionals who have skill sets to change that behavior may be different than what current integrated systems have hired." Identifying nurses who understand how to implement specific techniques and help patient manage their illness can drive the transition more quickly, said Parton, therefore making it essential to have these types of staff members on board. 

4. Take the time to gain buy in from the primary care practitioners and their staff. Naturally, there will be practices that are resistant to change, said Parton, so make sure you touch base with every practice and have a contact and leader in each to help educate and lead their group. "This is extremely important, otherwise, people will give lip service but they won't change their workflow of how they're managing their practice day to day," he said.  He added that a lot of the work doesn't need to be done by physicians, but by associated in their offices, like nurses, medical assistants, nutritionists, etc. "Getting that buy-in across the entire staff of a practice is important," he said. "It's not just the practitioners." Keep in mind the role EHRs will play in the transition, Patron added, especially when it comes to adding more work to learning the new IT system. "Doing this work for an ACO is additional stress," he said. "So helping them understand some techniques, some new tools they can use to improve their work is part of the issue."

5. Develop the data model, IT infrastructure, and tools to support reporting and analytics. One key piece for larger organizations, said Parton, is getting all organizations involved in the transition on the same page. "There are multiple organizations involved, and they come together to do the shares risk arrangement," he said. "So they may be on multiple systems and multiple data sources, and one of the challenges upfront is integrating and taking data from all those sources into one common data warehouse." The first step, he added, is to identify who's participating in the ACO and what the differences are in their data infrastructures. The next step is to create interfaces with each separate data source to do mapping. "That's where the data model comes in," he said. "You need to make sure you understand the differences in data from one entity to the next … all that detail is extremely important." The last step, said Parton, is pulling the data and integrating it into a common platform, "so if you invest in that, you have the data to do any of the programs, projects, or measurements, and it makes your life so much easier if you do all that upfront."

6. Invest in a population health and care management system, and integrate with the EHR. A population care management system allows you to take data from all your sources and use it specifically to track and manage subpopulations, said Parton. "You want to target and allow care teams to do follow-up work with care plans, " he said. "The population care management system can be the common care plan platform that allows professionals to track and manage patients across the system... care is coordinated in a way that helps people stay out of the EMR and out of the hospital." In turn, the system takes nightly feed of EHR data and makes it available to care teams, allowing them to determine gaps in care by seeing the care across an entire population. "Whether they're following evidence-based guidelines and are looking for patterns of someone not taking medication, or they have multiple doctors managing care and it's uncoordinated, they can look for that pattern," said Parton. "They can target the right patient and give them the care they need."

7. Match the organizational readiness for change. "All the things an ACO needs to do simultaneously, it's a lot of work and a lot of change for an organization," said Parton. "It's important for the organization to continuously monitor how well these initiatives are going on a daily or weekly basis and make sure you're not getting ahead of yourself." Constant communication and listening, Parton continued, in terms of feedback from physicians is key. "At some point, you may find you have to step on the brakes for a bit because you have to wait for your IT team to catch up," he said. "Or, from a payment model perspective, you have the model in place and need to accelerate those results-oriented projects because you need results from the bottom line sooner. It's about stepping on the brake or the gas to make sure things are moving."

Source from Physicians Practice

Why They Happen and What Your Medical Practice Should Do

Physician practices are audited all the time. It may even be considered a routine occurrence in your office. I am certainly seeing more clients than ever being asked to send in charts and other documents for review. Not all audits are routine, however, and it’s important to make sure you know who is asking for charts and the reason for audit before shipping off requested documents.

When you receive an audit demand, look for the following red flags:

1. Have you recently expanded into new services or items such as offering durable medical equipment (DME) or acupuncture services?

2. Have you switched your billing company, personnel or billing practices? This can mean a switch to a new system or following new guidelines which you believe apply to your practice.

3. Has an employee with knowledge about your billing practices recently left? Was this departure on good terms?

4. Has anyone questioned your supervision standards or other components of your practice which may relate to billing and reimbursement?

5. Have you had a visit from a payer representative asking questions and requesting an “educational meeting?”

These are only a few of the situations which can precede an audit or investigation. If you are not already running independent audits on a regular basis, any one of these red flags should prompt you to do so.

Once you receive the request for charts, how do you respond appropriately?

1. Pull the requested charts, claim forms, and other documents as quickly as possible. This will allow the practice the time needed to do its own internal audit or to have an outside auditor review the charts. Remember that you cannot alter the charts, but it’s helpful if you can determine if there is a reason the charts are being requested before they are submitted.

2. When the charts are submitted, include a cover letter which shares any findings from your own internal audit, the steps that have been taken to correct the problem and, if appropriate, reimbursement for the claims related to the requested charts. These steps should become part of the practice’s compliance plan related to billing.

3. Consider consulting with a billing expert for the audit. This is especially important if you handle your own internal billing and use self-trained billers. You cannot rely on the same person who oversees your day-to-day billing to complete an audit of their own work.

4. Depending on the size and type of audit, consider having the independently-retained auditor hired through legal counsel. If there are findings that present legal concerns, the legal privilege may provide some additional protection.

5. Remember that anyone you hire to review your charts will be accessing patient health information. All appropriate HIPAA safeguards are required.

As always, talking with legal counsel is a good step. Audits can be the start of something bigger depending on who is making the request. Zone Program Integrity Contractor (ZPIC) audits, charts requested through a subpoena, and other similar scenarios are indicators that legal advice is absolutely required.

Sometimes physicians become overconfident that they are doing everything correctly in their practice. Reading books on billing and sending your staff to an occasional coding class do not mean you are handling things appropriately. A client of mine who is under investigation swears he has done everything right — he has read every book, he sends his biller to coding classes, and uses a billing company with expertise. His practice brings in an enormous amount of revenue and he is highly respected. There is no question he is a fine physician.

Our external audit of the requested charts have so far revealed insufficient documentation and improper coding While the findings reflect a lack of knowledge, as opposed to intentional fraud, it’s unknown how the pattern of billing will be labeled by this investigation. The repercussion could be tremendous for the physician, his practice, and his family. What should he have done differently? What should you do to prevent this from happening to you?

One final piece of advice: Spend the time and the money NOW to review your practice’s billing, coding, and compliance. This is by far the smarter, and less expensive, alternative to that non-routine audit which may be just around the corner.

Source from Physicians Practice

How to Ensure a Successful EHR Implementation for physicians

 Leave your worries physicians ,The right door to knock on for EMR/EHR users!

MedicalBillingStar takes care of you in implementing the EHR services  in success full manner.

It took about six months to train the physicians and staff for EHR implementation at ophthalmologist Peter Polack's practice in Ocala, Fla. It also took about a year of planning and preparation prior to training. "A lot of people were asking why it was taking us so long," says Polack, who was writing about the process in an ophthalmology magazine at the time. "It's because that was our intention."

In total, all 11 physicians and 50 clinical staff members at the five-site practice learned to master the EHR. The success, he says, is due to the fact that they took their time with the process and formed a solid training plan. "If you don't have the right plan in place, if you don't have everybody involved, if you don't have buy-in from the stakeholders in the project, then you're going to fail," says Polack. "It's not like any other thing that you're going to do, so don't treat it that way."

Practices like Polack's that successfully implement EHRs know that adequate preparation and proper training is key. Here's how to launch a successful EHR transition at your practice.

• Get a head start

Proper preparation for EHR training begins as soon as you identify which system you will be using at your practice, says orthopedic surgeon Eric Fishman, president and CEO of speech recognition software distributor 1450, Inc., and managing member of EHR Scope, LLC, which provides health IT consulting services to physicians. Immediately tell all staff members what system you will be using and when you plan to implement it, says Fishman, who is based in Palm Beach Gardens, Fla. Then, direct them to the EHR vendor's website to watch available videos and demos and learn more about the system. "There's a lot to be learned and it's impossible to learn all of it in a short period of time for most employees," he says. "Getting a head start is beneficial."

It's also a good idea at the start of the process to identify which staff members will play key roles in the planning and training process, says Polack. One is a "physician champion" who will motivate the other physicians. "If all the other doctors are supportive of this one doctor, then that creates a trickle-down effect as far as the attitude of the whole practice," he says.

Also, identify a staff member on the clinical side to "oversee" the training process. This individual should "work in concert with someone on the technical side of things — unless you have someone on the clinical side that has very good technical skills," says Polack.

• Form a strategy

You also must determine what type of training to provide your physicians and staff. Depending on your vendor and your practice's budget, there will be various options available — from intensive one-on-one training with a vendor trainer to training that is solely Web-based. Of course, the more one-on-one vendor training your practice uses, the pricier the process gets.

Adina Friedman, medical marketing director for CTS Medical Software Selection Guides, a Rockville, Md.-based company that provides advice, reviews, and ratings of software, including EHRs, suggests looking for a mix between in-person training and Web-based training.

A smart option is to identify one staff member (or a few staff members if your practice is larger or if it is a multi-site practice) to receive vendor training, says Polack. Once this staff member — often known as the "super user" — is trained, he can assist with training the rest of the staff, and he can answer any simple questions that arise.

Prior to training staff members, it's crucial that the super user has a firm understanding of the EHR, says Fishman. As the super user learns to use it, he may realize that the system needs to be modified to fit your practice's needs. The super user can then arrange for the necessary modifications to be made early on in the process. That way, staff members "only have to learn [the EHR] once, in the way that it will actually be implemented," says Fishman.

The super user doesn't necessarily need to be a physician or administrator, but he should be a motivated tech-savvy employee who has some management experience, says Friedman.

• Assess needs

Prior to training employees on the EHR, you must test their basic computer skills, says Polack, noting that abilities tend to vary widely among staff. At his practice, for instance, some of the older employees were unfamiliar with using a mouse and drop-down menus. "These are things that a lot of us that use computers know — and almost feel like we know intuitively — but you can't take those things for granted," he says.

Some of the "crucial" skills to measure are an employee's comfort level with using Windows, using a mouse, printing, scanning, and logging on and off a computer, says Suzanne Houck, president and CEO of Houck & Associates, a healthcare consulting firm in Boulder, Colo. If employees need a skills boost, the super user or another tech-savvy employee should conduct basic training, she says. "It becomes very expensive if you're trying to get people up to speed and blend that in with your EHR training."

Before training on the system begins, also assess the current high-volume work flow areas at your practice, says Houck. She suggests putting a flip chart in a staff area and writing down key work flow items, such as making referrals, ordering labs, and rooming patients. Then, ask staff to write down their responsibilities related to each item. Next, decide how, when, and who will complete these tasks in the EHR. "Planning upfront is really crucial in terms of mapping processes and deciding if you want to change them and optimize them," says Houck. Of course, a work flow assessment will also help you decide which staff members will be trained on what tasks.

• Learn and explore

The actual training method you use will vary, of course, depending on the technique and type of trainer your practice has chosen. Regardless, staff members need to be trained on each of the modules of the EHR that match up to their responsibilities, says Houck. They also need some time to play and test the system on their own, then return to the module to reinforce what they are learning. At Polack's practice, for instance, he placed computers in a spare room so that staff could be trained there, and later during downtime, explore the system on their own.

Even if an employee will not be frequently using the EHR, there are some core things everyone needs to learn, says Houck, such as how to log on and log off the system. They also need to understand where the EHR and the practice-management system interface with each other, says Friedman. "Everyone has to have the big picture view and then it has to split off into function."

The duration of the training process will vary depending on your EHR and your practice, says Houck. "There are some really easy systems that people can learn in a day, and then there's some that take weeks, literally." When determining how much time to allocate to training, Houck recommends asking a practice similar to yours that has already implemented an EHR.

• Test and assess

Just prior to your go-live date, the super user, or whoever has trained each employee, should assess trained employees' new skills, says Polack. That way you know who is ready for implementation and who needs a training refresher.

Then, top off training with a full-staff practice session as close to the go-live date as possible. At Polack's practice, all employees came into work the weekend before the system went live for a "simulation Saturday." Those who would not be frequently using the EHR posed as new and established patients, while those who would be using it more heavily moved the "patients" through mock visits using the system. It's a great way to "identify any problems with work flow and any technical glitches," says Polack. "You're always going to uncover something and that's the time to discover it — not on your go-live date."

source from physicians practice

Effective Appointment Scheduling Tips for the physicians Medical Practice

Getting and maintaining control of the medical practice schedule has a bigger positive impact on resource utilization, profitability, and the general satisfaction of patients, physicians, and staff than almost anything else. Here are five elements of effective scheduling.

•  Be realistic :

Industry standards for appointments and procedures can be very useful in identifying areas in which one medical practice is different from others. Arbitrarily scheduling according to industry standards, however, is not productive. For the purpose of scheduling a particular practitioner's day, industry guidelines are no more than interesting information. The germane question for scheduling Dr. Jones' day is "How long does a particular type of exam or procedure take Dr. Jones?"

Something similar is true relative to structuring schedules to produce a certain amount of gross revenue. All things being equal, increasing time-related capacity requires lengthening the clinic day. Shortening appointment allotments produces a schedule that only appears to be more productive. The day gets longer in an ad hoc manner, with all the frustration associated with consistently running behind.

The bottom line is that the work takes the time it takes. It is possible to decrease the time required by redesigning tasks and work flow, but scheduling to a more efficient environment needs to wait until the more efficient environment is more than a fond hope.

• Build in lead times :

Even if he is on time, or a little early, a patient with an 8:30 a.m. appointment will not be in an exam room waiting to be seen at 8:30 a.m. Depending upon practice processes, he may not be ready to be examined until 8:45 a.m. or 9 a.m. Knowing the lead times relative to different types of appointments allows the physician to correctly interpret the real appointment time.

• Plan on work-ins :

It can feel good to look at the next day's schedule and see it booked solid because the promise is one of maximized resource utilization. Unfortunately, if all practice resources are committed, there is no slack available to respond to the unexpected. Protect specific times for same-day appointments. If the practice seldom has the need to work in a patient, the specific appointment times can be outside of the regular schedule, at the beginning of the lunch break or after the last appointment of the day. Other practices will find that one or two "work-in" slots within the regular schedule are almost always utilized.

• Acknowledge variability :

If an analysis of practice activity reveals that an annual physical takes 28 minutes on average, scheduling appointments at 28-minute intervals is both intuitive and ill-advised. The problem is with the nature of the measure. Widely divergent data points produce an average that is between the two measures, but far from each. Variance is the statistical value that measures the disbursement of observations from the mean or average.

Depending upon your tolerance for running behind and your tolerance for waiting on patients, schedule appointments at the average time required plus one standard deviation to predictably finish two-thirds of exams within the allotted time, or the average time required plus two standard deviations to complete 95 percent of exams within the allotted period.

• As much as possible, stay on time :

Patients will adjust their appointment times to match what they expect from the practice. If a physician is often an hour late, the patient will consider herself on time if she arrives within an hour or so of the appointed time. If the physician's timeliness is sufficiently erratic, she'll consider herself timely if she appears on the scheduled day. The result is that the physician, on those occasions when he is running close to on time, will find himself waiting for patients to arrive. An added benefit to consistently running close to schedule is that providers and staff have to deal with fewer angry patients.

Getting and maintaining control of a clinic schedule pays huge dividends. What has worked for you? What seems to be an intractable challenge?

source from physicians practice :

We MedicalBillingStar provides affective medical billing and coding services with neat appointment scheduling process 

"Don't miss out on appointments ! We ensure you have every detail in place."

  

10 New Social Media Tips for Physicians to avoid issues with HIPAA

10 short tips you’ll learn return on investment (ROI) strategies for social media, avoid issues with HIPAA, and discover how to protect your efforts for long-term success.

1. Before you attempt anything else on the Internet please fix your online reputation first. The last thing you want to do is attract attention to a negative reputation.
2. Physician ratings are the most socially-relevant channels in 2012. Starting in January, these companies have started spending millions of dollars urging patients to screen doctors. Angie’s List, one of the most disturbing review sites as there is no verification process, has literally taken over the entire medical industry by storm. Planning for this should be a priority. Bad online reputations are disastrous for practices. For some doctors with negative reviews, our reputation management program can save them from lawsuits and protect their patient volumes, but for some it’s too late for a quick fix. My advice is to establish your online reputations now because it’s harder to destroy a reputation that is positive. One bad review is not going to bring your practice down. But if it’s the only review, you can bet that this will affect your new patient volume.
3. Google Search is the most cost- and time-effective social media tool available. Plan on being on page one of results for key terminology. Where do patients find you first? Twitter? Facebook? No, Google. Once they find you on Google, they will go to your website, and only then will they want to further screen you on your other social media channels. If you don’t have a website you’re simply missing out.
4. For doctors who perform elective procedures, who accept out-of-network benefits, or have fee-for-service practices, social media is a requirement. People earning incomes of $100,000+ are influenced by social media more than anything else.
5. Learn to blog. Too many doctors and their administrators jump on Twitter and Facebook without learning how to plan for success with a medical blog. Your blog is the opportunity for you to become the most trusted source of medical education for your patients and referring doctors.
• Have you read something interesting in a medical journal for your specialty? Put together a summary for your network without the medical jargon. Also, learn how to respond to comments on your blog first.
• Think of the time savings when you make it a requirement for patients to read your blog posts before they come in for appointment or while they’re in the waiting area.
• There are no HIPAA issues here. Have a short info link on your blog that explains your social media policy.
6. Learn the basics of medical search engine optimization (SEO). I have resources from top medical SEO experts in the country and will make them available upon request. Five terms you absolutely need to understand are meta titles, meta descriptions, H1, H2, and H3. Social media lasts seconds. Social media with SEO lasts months or years. Why do you need SEO? Blogging, Tweeting, and using Facebook are ineffective unless you understand how to optimize every single time before you hit “Enter.” If you’re spending a few minutes of your life writing something, plan on it to last. Without planning, you’re just “blurping.” Blurping has no ROI and loses relevance in seconds.
• This is especially valid for physician bloggers. I’ve seen doctors who are very active on Twitter whose blogs have hundreds of articles. But when you go to their blogs there is no organization, you see only five blog posts —the rest of articles are hidden in archives that nobody will ever read, and they lack even the most basic SEO components. Planning for user experience is just as important as SEO.
7. Link to articles and resources that are yours. Remember, you spent serious time and money on getting that one person to come to your Facebook page, Twitter page, or blog. Don’t send them away. If you don’t have the time, hire someone that will spend the time researching what your patients and referring doctors love to read and how it relates to your expertise. Write short summaries and articles about them on your blog. This is the biggest social media ROI strategy: Link your Twitter and Facebook posts to your blog and nowhere else. If you must link to an external resource make sure that clicking on it will open a new browser window.
8. Do not advertise your services. Advertise your expertise through educational resources. At all costs avoid saying things like “top surgeon” or “best doctor,” etc. This is an automatic red flag for anyone with a brain. In several case studies, when we eliminated such terminology case volumes dramatically increased. If you want to advertise on your blog or website the only thing you should advertise is “Schedule an Appointment.”
9. There is serious ROI that can be identified with Google Analytics. Install it into anything and everything.
10. Protect your social media ROI. You’ve spent hours, days, months learning how to blog and how to build effective social media campaigns. Don’t let Internet companies plagiarize content from your blogs, websites, and articles and monetize on it. Don’t get sucked in with the promise of “badges, recognition, etc.” Just because your colleagues are doing it doesn’t mean you have to. When in doubt, just ask me. Google your website, your articles, and your name often; at least once a week. Every month, hire someone or spend an extra hour to Google all the titles on your blog.
source from Physicians practice blog site 

Physicians are getting paid from secondary insurance from their medical practice

Normally, patients land at your office with a major and a minor insurance that they would like you to bill. Out of courtesy to the patient, you let the cards, enter the information and send it all off to your billing department. But, how many of these secondary insurances are actually being billed, and how many are sitting there in your accounts receivable (A/R) aging out and reaching timely filing deadlines?

There are several secondary to Medicare that have routine crossover like Blue Cross and Blue Shield, so a majority of those when billed automatically characteristically are not ones to worry about. But there are thousands of insurance plans that patients use ranging from the big names, like Medical Billing Services to smaller private insurances and employer-funded plans that the automatic crossover does not apply to. Sure, it's only $12 per claim to $25 per claim, but step back and look at how many of these you have aging out. If you have 1,000 accounts with inferior claims pending, this can add up very quickly to inflow that is yours for the taking, and hard earned at that!

Take these steps to observe and remedy this situation as soon as possible:

• Do you have direct access to your patient accounts and system reports that show balances and your aging out Accounts Receivables? This is your first step in realizing what is actually sitting out there in your 90+ days. It is critical to identify these specific accounts.

• Once identified, it's time to meet with your billing director. This is a very important next step. It will define the lines of liability by addressing the specific reasons why these accounts are being allowed to age out. If your billing manager feels that “it's not worth their time to bill out such a small amount,” it's time to find a new billing company. It is not their money, it's yours.

• Now that you have recognized and addressed these aging out accounts, you will need to follow up within 30 days. You can do this by running specific aging reports, or going into each account and checking when/if those claims were indeed sent out. Most software programs used by highly regarded billing organizations have complicated enough reports that you should be able to obtain this information quickly and easily.

Taking this step right now is very important with your 90+ accounts receivable. Many insurance companies are tapering their "timely filing deadlines" such as some Cigna plans, which are now 90 days from the date of service. You would not have any recourse on claims passing this time limit if you continue to allow those aging claims to sit.

It's always a good idea to review your Accounts Receivables on a monthly basis to insure you are being paid on claims, are being paid your tapered rate, and know why you are receiving denials. All of these areas are so easy to examine and are critical to your overall practice's health.