How CMS' EHR incentive plan is working — and what the next steps are for your practice

When family physician Christopher Tashjian attested for Stage 1 of CMS' "meaningful use" program bright and early on April 18, 2011, most other practices hadn't even picked out an EHR.

By April 2012, as few as one in five providers had attested, according to CMS' count.

The purpose of the meaningful use program, and the stimulus dollars attached to it, was to digitize America's healthcare-recordkeeping system — creating a data-based boon, say proponents, for providers and public health advocates alike. But the program got off to a slow start, and questions have emerged about the efficacy of the program and its administration by the government.

Is the incentive program working as it was intended? Let’s look at the details — past, present, and future — to find out.

The EHR incentive: a look back

CMS published the final rule for its Medicare and Medicaid EHR incentive programs to the Federal Register on July 28, 2010. Enacted in the Health Information Technology for Economic and Clinical Health (HITECH) Act — part of the American Recovery and Reinvestment Act of 2009, aka the federal stimulus — the nearly 300-page rule outlines how "eligible professionals" (EP) and hospitals can qualify for incentive payments for demonstrating meaningful use of a certified EHR.

The first step in receiving the money (a maximum of $44,000 paid over the course of five years) is to attest that during a 90-day reporting period, providers used their EHR in a meaningful way by fulfilling 15 core requirements (such as maintaining an active medication-allergy list for more than 80 percent of patients), five out of 10 menu set objectives (such as implementing drug-formulary checks), and six clinical quality measures (such as adult weight screening and follow-up).

This represents just Stage 1 of the three-stage program. To receive the full financial incentive, CMS requires the completion of all three stages. (CMS has also outlined a separate program for providers who wish to qualify through Medicaid.

To help small practices, the government's Office of the National Coordinator for Health Information Technology (ONC), has so far awarded more than $720 million through 62 Regional Extension Centers. The RECs provide free and low-cost assistance to qualifying practices to ease their EHR transition and help them achieve meaningful use.

EHRs by the numbers

What does CMS have to show for all of this effort? The government's figures show it is now meeting its objectives, despite getting off to a slow start.

CMS finished 2011 well below its stated objectives of at least 40,000 meaningful users attesting via the Medicare program and 21,100 meaningful users via Medicaid. The actual numbers at the end of last year: 15,361 for Medicare and 15,439 for Medicaid. But the government says it has already closed the gap between its projections and the reality: As of May 31, 2012, 110,000 providers (roughly one out of five eligible for the program) have received some portion of the more than $5.7 billion paid out so far to hospitals and providers under one of the two programs, according to CMS. How did CMS go from about 30,000 meaningful users to more than 110,000 in only five months? It did not respond to our request for an explanation, but if its most-recent data are correct, then it is now on track to meet its goals of between 48,700 and 154,700 meaningful users under Medicare, and between 34,000 and 93,700 under Medicaid by the end of 2012.

If it meets its most ambitious objectives, about half of America's eligible providers will be meaningfully using an EHR by the end of the year.

 
Source from Physicians Practice.

Its your time physicians , leave your billing worries to us.

Basic Medical Terms Your Practice Staff Should Know

Get the most benefits at the least costs !

Last week, we talked about the difference and definitions of major insurance types in "Medical Insurance Primer for Practice Staff." A fellow blogger pointed out that many patients are also not aware of the differences between copay, co-insurance, and a deductible. Below are some additional terms for your staff to have that will easily explain these differences to your patients.

Allowed Amount: Amount of the billed charge the insurance company deems is payable by the plan.

(MORE: Medical Insurance Primer for Practice Staff)

 

Assignment of Benefits: The patient or guardian signs the Assignment of Benefits form so that the physician or medical provider will receive the insurance payment directly.

Authorization: Approval by the health plan if the physician wants to refer the patient to a specialist.

Bundling: Method by which the insurance company decides to combine payment for two or more medical services.

Capitation: Payment methodology in which the physician is paid a set dollar amount determined by a per member, per month calculation to deliver medical services to a specified group of people (like an IPA).

Carve‐Out: Medical services that are separated from a contract and paid under a different arrangement.

Case Management: A method by which a health plan attempts to control costs by directing all of the procedures for the care of an individual through a nurse or other healthcare professional.

Claim: Request for payment by a medical provider for a given medical service or item.

Consolidated Omnibus Budget Reconciliation Act (COBRA): Continuation of medical benefits once a member has left their employer.

Co‐Insurance: A percentage the patient is responsible for on a given insurance claim.

Contracted Provider (Participating): Provider that has an agreement with a health plan to accept their patients at a previously agreed upon rate for payment. They are deemed as "in‐network."

Copayment / Copay: A fixed dollar amount an insured person must pay when medical service is received.

Deductible: Set dollar amount which must be satisfied within a specified timeframe before the health plan begins making payments on a claim.

Explanation of Benefits (EOB): Summary of the payment made by your health plan to the medical provider.

Fee-for-Service: Method of payment for medical services rendered.

Fee Schedule: List of CPT codes and dollar amounts an insurance company will pay.

HCFA 1500: Standard claim form used by health plans on which to consider payment to the medical provider.

ICD‐9 / ICD-10: Standard format of identifying the illness, injury, or disease by using a three-digit to five-digit code.

Medical Necessity: Medical procedure or service must be performed only for the treatment of an accident, injury, or illness and is not considered experimental, investigational, or cosmetic.

Out‐of‐Pocket Expense: Amount the patient must pay (and not paid for by the insurance plan).

Pre‐Existing: Medical condition diagnosed prior to the effective date of the health plan.

Usual & Customary: Reduction in the payment of benefits on a claim which is justified by the insurance company as “the going rate” to be paid in that geographical area.

These are the most common ones I receive questions about, can you think of any others that might be helpful?

Keeping this list in a convenient place for your staff is a great tool for them to utilize when communicating with your patients.

Source from Physicians practice

EHR Cloud Computing Meets Moore's Law

Searching for a billing company who understands your emr ?

In an increasingly computerized world, understanding why and how computers do what they do can have a direct bearing on how you evaluate the effects on care that are the result of having the computer in the loop. Also, in the future, today's medical students are going to be making decisions about computerization and other technology. What will form the basis for their decisions — their "knowledge" of Facebook or how to text with two fingers? This raises the question: How knowledgeable, not "computer-literate," but knowledgeable are you?

Take cloud computing for example. It's the latest high-tech buzzword but do you have any idea what that is? A new national survey by Wakefield Research, commissioned by Citrix, suggests that the answer is "not really" — over half of respondents, including a majority of [supposedly computer literate] Millennials, believe that stormy weather can interfere with cloud computing.

How about Moore's Law? In 1965, Gordon Moore observed that technology seemed to be enabling the number of transistors on a microchip to double every two years. In 1970, Carver Meade dubbed this "Moore's Law." A graph of microchip production suggests that Moore was correct. Some physicists believe that Moore's Law, while it describes the past, does not predict the future. As transistors are made ever smaller they approach the size at which atomic forces come into play, effectively defining a minimum size, and hence a maximum speed, of the circuits in question. This limit may be reached in the next five years to 12 years.

Even if Moore's law should fail, faster computers are not precluded, but speed will have to be achieved in some other way such as deploying multiple processors working in parallel. I will return to Moore's Law in a moment, but first a discussion about the cloud.

The cloud is double talk — just a shorthand for computing that takes place somewhere other than inside your computer whether that be actual computations, data storage and retrieval, communications, or search. Some bright folks thought that the concept of "elsewhere" was too nebulous so. Instead they chose a term that connotes that most nebulous of things — a cloud.

The aspect of the cloud that is important to you, especially if you are considering a cloud-based EHR, is that the cloud is at the other end of a narrow pipe. Every bit of information that you send or request has got to pass through that pipe. While it is easy and cheap to buy a faster computer, it is neither easy nor cheap to buy a faster pipe. The speed and capacity of the pipe has not been doubling every two years, it has been doubling every eight years to 10 years and there is no guarantee when or if it will double again. Conclusion, connection speeds never have, and never will, experience the exponential growth of chips.

When you are using remote computing resources, the speed of your local computer is almost irrelevant — well not completely, but if it is a recent model it is. Speed is dependent on two factors: 1) how much processing capacity the remote site is willing to allocate to YOU; and 2) the bandwidth (speed) of your connection.

There is a third piece to this story — application complexity. Every time you ask your EHR vendor for a new feature or the feds add certification criteria that require additional program code, the demands placed on the system increase. If the code is running locally, you may be able to offset the increased demand with a faster processor.

If the code is running in the cloud and if it requires more data to be transferred back and forth between your location and the vendor’s site, then the performance that you experience will get progressively worse as the applications get more complex.

Since this slowdown has to do with the speed of the connection, not the speed of my computer, Moore's Law is irrelevant. If all computing is going to be cloud computing, I will never again need to buy a new computer — and I will become increasingly dissatisfied as the speed continues to degrade.

This is one of many reasons that I choose, as much as possible, to keep my computing local. You might want to carefully consider any decision to outsource your EHR to the cloud. Assuming that you choose an EHR that has the potential to "speed you up" if run locally, it could slow you down if run remotely, in the cloud.

Source from Physicians Practice 

Obama or Romney: Who Will Address Today's Healthcare Problems?

 Better Healthcare Billing services for Physicians !

Now that flags have been waived, the confetti has been … (not sure there is a verb for confetti) and the two party convention halls have grown quiet, it is time to refocus on the major issue facing the healthcare industry — an affordable healthcare plan for everyone. The President’s plan under the Affordable Care Act (ACA) calls for universal coverage through an “individual mandate.” People with no insurance must purchase it. Insurance companies may not deny coverage on a “newly discovered policy defense,” after the beneficiary falls ill.

The Republican plan seems to involve balancing the budget through some form of voucher system, which would reduce the government’s obligation to pay for Medicare and Medicaid. It is unclear, however, if the Republican plan intends to addresses the problems created by the masses of uninsured, or protect those who thought they were insured, until they needed benefits. This is simply a problem too great to ignore.

Any capitalistic free market is supposed to act according to the laws of supply and demand, which should hold down costs, and increase efficiency. This is the heart of conservative ideology. But American healthcare is no more capitalistic than China’s economy is purely communistic. What we have is a mixture of social programs and free enterprise. While this works well in many cases, in the healthcare context, the laws of supply and demand get out of balance. This is because of the unique health-related behavior of three primary groups.

In the first group, are those whose very intense efforts affect market availability, cost, and utilization. This group includes both the supply side — doctors, hospitals — and the demand side, those who must purchase services — employers, individuals, and insurers. A second group consists of the consuming public, who are not in the market, and feel the goings on in the market do not matter to them. Then, the third group is comprised of those consumers who thought they were in the second group, and therefore did not choose to be in the market. Instead, members of this group were thrust into the market – either by unhappy (illness) or happy (a new baby) circumstance — with no ability to pay for their needs and no advance thought to what they might do I when the bill comes due. Obviously, this is going to create a problem (and a national embarrassment) if Americans are allowed to die from lack of life-saving care.

What can’t happen usually won’t, but what we did in response to the “uninsured” problem is nothing short of absurd. Think of a Rubik’s Cube. The problem facing you is that one of the colored squares doesn’t fit. Rather than make the problem go away, you could simply turn the problem to make it face someone else. This is exactly what the government did with the unfunded mandate, the Emergency Medical Treatment and Active Labor Act (EMTALA), in which hospitals with emergency rooms cannot turn away patients suffering from an "emergency medical condition" (42 U.S.C. 1395dd).. This gift to the masses might have been defensible in the early and middle years of Medicare and Medicaid. During the halcyon days of fee-for-service and reasonable hospital reimbursement rates, it seemed not too much to ask those making a fortune from government programs to pitch in. The problem came from the “dog pile” which followed.

Once everyone figured out the government would not let us die from lack of care, there was no need to plan for that contingency. A mass migration of sorts occurred in which it was suddenly safe to be in the second or even third group of Americans who made no plan whatsoever to pay for illness. Economically, this has been devastating. Hospitals struggle to meet obligations, by raising the sticker price on everyone, which leads insurance companies to engage in post-claims underwriting (wait until an insured needs coverage, then find a flaw in the application to justify denial of coverage.) We are left with a non-functioning system described in hyperbole, as a “war of all-against-all,” in which “[i]nsurers cheat patients and doctors; patients cheat doctors and insurers; doctors cheat insurers and patients; and all cheat the federal governments." See, Bartlett, Donald; Steele, James, "Critical Condition– How Health Care in America Became Big Business and Bad Medicine," New York: Doubleday (2004) 

If we do not start demanding real solutions from our candidates to the problems created by EMTALA and the masses of uninsured, it seems clear we will not be able to avoid an eventual government takeover of the healthcare industry. This is because currently, there is nothing motivating people to take care of themselves. In fact, those who try to take care of their own needs, are often thrown back into the pile of uninsured, because they failed to disclose a sore throat, 10 years before a diagnosis of cancer.

This is a crisis of financing which transcends politics and traditional conservative and liberal ideology. This is our problem. Everyone needs care, and no one wants care delivered with the same enthusiasm as government employees at a department of motor vehicles. The best thing you can do is become active in your state’s medical association.

No matter who you vote for in November, find out what your association is doing, and how you can help ensure the survival of your industry.

Source from physicians practice  

Proposed DME Prescription Rule Adds More Burdens on Physicians

 Gear up Physicians, Its your turn now to increase your revenue. 

Medical offices rely on essential professionals like physician assistants (PAs), nurse practitioners (NPs), and clinical nurse specialists (CNSs) to increase practice efficiency and patient visits, as well as support the physician with providing quality medical care. However, Medicare’s recent proposed rule revising the conditions of payment for prescribing Durable Medical Equipment (DME) may cut these practice efficiencies and increase administrative burdens.

The proposed rule will require the physician to document and communicate to the DME supplier that he or their PA, NP, or CNS has met face-to-face with the patient no more than 90 days before the order is written or within 30 days after the order is written. Telehealth services are allowed in rural areas for physicians with an approved Medicare telehealth billing code (encounter is reported with a HCPCS code); however, face-to-face encounters exclude incident-to services. Although a majority of patients are seen before DME are ordered, this rule is expected to increase the number of office visits.

During a patient visit, the practitioner will evaluate the condition that supports the need for each DME ordered as well as conduct a needs assessment. The physician’s documented face-to-face encounter will be less cumbersome than that of a non-physician provider’s evaluation as it is sufficient for a physician to provide the DME supplier with his notes from the patient’s record regarding the patient’s history, physical examination, diagnostic tests, summary of findings, diagnoses, treatment plans, or other related information. If, however, a PA, NP, or CNS conducts the patient visit, the physician must also authorize the evaluation or attest to that meeting.

Attestation may require the physician to sign/cosign relevant sections of the patient’s chart; initial the patient’s history and physical examination for the date of the face-to-face meeting; or require the physician to actually write, sign, and date the following statement: “I, Doctor (Name) (NPI Number) have reviewed the medical record and attest that (PA, NP, or CNS) has performed a face-to-face encounter with (beneficiary) on (date) and evaluated the need for (the item of DME).”

Because physicians will spend extra time to review and authorize DME orders prepared by non-physician providers, Medicare will pay physicians $15 under a “G code” for that time. If a patient requires multiple DME orders and thus a lengthier review of the evaluation, the physician will receive one payment of $15 for the entire evaluation, provided that the physician does not separately bill an E&M code.

The written DME order must list: the patient’s name, item of DME ordered, NPI of the prescribing practitioner, prescribing practitioner’s signature, date of the order, beneficiary’s diagnosis, and necessary proper usage instructions (i.e., duration of use, correct positioning, utilization method) as applicable. If standard practice requires a DME order to have additional information, that order must include these seven minimum criteria and any additional necessary information to support a claim of payment.

The proposed rule significantly expands the list of covered DME items to include: (1) items that currently require a written order prior to delivery per instructions in the Medicare Program Integrity Manual; (2) items that cost more than $1,000; (3) items that Medicare Audit Contractors (MACs) believe are particularly susceptible for fraud, abuse, and waste; and (4) items that Medicare has determined are vulnerable to fraud, abuse, and waste. Medicare estimates that approximately 164 HCPCS DME codes are subject to the rule. Consequently, these criteria could make any DME item susceptible to the rule because MACs may subjectively find a DME item susceptible to fraud and abuse or inflation could push the cost past the $1,000 threshold.

It is also important that physicians check to see that they have properly drafted and signed collaboration agreements with their PA, NP, or CNS. Collaboration is a mutually agreed upon relationship between the non-physician provider and a physician educated, trained, and/or experienced in work related to the non-physician providers' work. Depending on the federal and state laws, the PA, NP or CNS can prescribe, dispense, and administer medical therapeutics or even evaluate the patient for a DME order without the physical presence of a supervising physician, if in collaboration with the physician. Any prescription or evaluation submitted to Medicare or Medicaid for payment without proper agreement, supervision, or reasonable review of a physician may be disallowed or viewed as susceptible to fraud, abuse, or waste.

The proposed face-to-face encounter rules will likely increase the physicians’ time spent on administrative functions. However, Medicare believes the potential reduction in fraud and abuse justifies the additional expenditure of time.

Source from Physicians Practice

Private School Parents Are More Likely to Opt Out of Vaccines

Pediatric billing now childs play !

Parents who send their children to private schools in California are much more likely to opt out of immunizations than their public school counterparts, an Associated Press analysis has found, and not even the recent re-emergence of whooping cough has halted the downward trajectory of vaccinations among these students.

The state surveys all schools with at least 10 kindergartners to determine how many have all the recommended immunizations. The AP analyzed that data and found the percentage of children in private schools who forego some or all vaccinations is more than two times greater than in public schools.

More troubling to public health officials is that the rate of children entering private schools without all of their shots jumped by 10 percent last year, while the opt-out figures held steady in public schools for the first time since 2004.

Public health officials believe that an immunization rate of at least 90 percent in all communities, including schools, is critical to minimizing the potential for a disease outbreak. About 15 percent of the 1,650 private schools surveyed by the state failed to reach that threshold, compared with 5 percent of public schools.

There were 110 private schools statewide where more than half the kindergartners skipped some or all of their shots, according to AP’s analysis, with Highland Hall Waldorf School in Northridge — where 84 percent opted out — topping the list.

Parents cite a variety of reasons for not immunizing their children, among them: religious values, concerns the shots themselves could cause illness and a belief that allowing children to get sick helps them to build a stronger immune system. Likewise, there’s no single explanation that accounts for why so many more parents who send their children to private schools apparently share a suspicion of immunizations.

Saad Omer, a professor of global health at Emory University in Atlanta who has studied vaccine refusal in private schools, surmised more private school parents are wealthy and have the time to spread five shots over a series of years and stay home should their child get an illness like chickenpox. Neal Halsey, a professor of pediatric infectious diseases at the Johns Hopkins University, said parents who choose private schools are likely to be more skeptical of state requirements and recommendations.

Bibi Reber, whose children attend the Waldorf-inspired Greenwood School in Mill Valley, had her children vaccinated only for what she sees as the deadliest diseases. Greenwood has a 79 percent opt-out rate among its kindergartners.

“I don’t think dirt or getting sick makes you a weak person; your immune system needs to work with things,” said Reber, whose children attend the Greenwood School in the San Francisco Bay area town of Mill Valley. “We certainly don’t want to go back to having polio, but on the other hand, I don’t think we need to eradicate all the childhood diseases

Public health officials say that, regardless of why parents choose not to vaccinate their children, the result is the same: an increased risk of an outbreak of whooping cough or other communicable diseases.

We’re very concerned that those schools are places where disease can spread quite rapidly through the school and into the community, should it get introduced,” said Dr. Robert Schechter, medical officer with the Immunization Branch of the California Department of Public Health.

That’s what prompted the Legislature to approve a bill requiring parents to discuss vaccinations with a pediatricians or a school nurse before they can opt-out. Gov. Jerry Brown has until the end of September to sign or veto it.

State Assemblyman Richard Pan, a pediatrician, who sponsored the bill, said he believes private school parents are more apt to mistakenly believe that the vaccinations themselves could be more dangerous than the diseases.

“In private school, these are people who have money, who are upper middle-class, and they are going on the Internet and seeing information and misinformation,” said Pan, D-Sacramento.

Increasing immunization rates for this population is critical to controlling the outbreak of diseases, he said. “Have you ever seen a child cough themselves to death? It’s not pleasant,” he said.

Those who choose not to vaccinate their children see the legislation as meddlesome and unnecessary.

“It’s making an extra appointment and paying extra money to go in there and essentially get permission to do what I feel is right for my family,” said Dawn Kelly, who sends her unvaccinated 5-year-old son and partially vaccinated 9-year-old son to Monarch Christian School in the Los Angeles area.

Like many parents who refuse some or all immunization shots, Kelly worries her children’s immune system could be overwhelmed by getting too many vaccines at once.

Melani Gold Friedman, president of the parent association at Highland Hall Waldorf School, is concerned with what the legislation means for families who normally consult with acupuncturists, holistic healers or other alternative practitioners.

“The bill has an assumption that everyone’s seeing one particular kind of doctor, but the people who are opting out, chances are they’re not seeing that kind of doctor,” she said.

Vaccination opt-out rates nationwide have been creeping up since the mid-2000s, spurred in part by the belief the battery of vaccinations routinely given to infants could lead to autism. Several major studies have discredited that idea.

Parents are allowed to forgo vaccines for philosophical reasons in California and 19 other states. Of those, only Washington requires parents to consult with a physician. And, in California, there’s no difference between private and public schools when it comes to what’s required for parents to opt out — they simply sign a document. The state recommends that kindergarteners receive five vaccine progressions, including protections against Polio, Hepatitis B and Measles

Politicians and public health experts across the nation are focusing more attention on childhood immunizations, driven by a re-emergence of diseases like whooping cough. The U.S. is in the midst of what could be its worst year for that disease in more than five decades, with nearly 25,000 cases and 13 deaths.
After whooping cough reached epidemic levels in California in 2010, the state took action, embarking on a public information campaign and increasing the availability of vaccines. A law was passed requiring booster shots for older students.

Yet the opt-out rate continued climbing in private schools. It’s more than doubled since 2004, to 2,228 kindergartners in last year’s state survey. While the overall rate of full immunization among kindergarteners hovers around 91 percent, places where the opt-out rate is greater could pose a risk for outbreak.

In 2008, East Bay Waldorf School in El Sobrante closed temporarily after whooping cough sickened more than a dozen students, eight of them kindergartners. The San Francisco Bay Area school had a vaccination rate of less than 50 percent.

State health officials are tracking the divergence of opt-out rates in private and public schools, but are not planning any studies or outreach efforts targeting this pupil population. The state is conducting a general education campaign to boost vaccinate rates.

The AP analysis found 20 of the 25 California private schools with the highest opt-out rates are “Waldorf schools,” a loose association of institutions founded on the teachings of 19th-century philosopher Rudolf Steiner. He favored a holistic approach to education and medicine and thought childhood illnesses could be beneficial.

Officials at these schools would not comment about Pan’s bill but say they trust parents to make the best decisions for their children’s health.

“Parents who are brave enough to say, ‘No, that’s not the right thing,’ should be supported,” said Patrice Maynard, spokeswoman for the Association of Waldorf Schools of North America.

—By HANNAH DREIER 

 Source from Heathland Time

Claims payment rule aims to cut red tape, save $9B

We follow the ERA and EFT method of posting payments

Health and Human Services Secretary Kathleen Sebelius released a new rule she says will cut red tape for doctors, hospitals and health plans. In combination with a previously issued regulation, she estimates the rule will save up to $9 billion over the next 10 years.

The regulation adopts operating rules for making healthcare claim payments electronically and describing adjustments to claim payments.

“These new rules will cut red tape, save money, and ensure doctors spend more time seeing patients and less time filling out forms,” said Sebelius.

Studies have found that the average physician spends three weeks a year on billing and insurance related tasks, and, in a physician’s office, two-thirds of a full-time employee per physician is necessary to conduct these tasks. Many physician practices and hospitals receive and deposit paper checks, and manually post and reconcile the healthcare claim payments in their accounting systems.

By receiving payments electronically and automating the posting of the payments, a physician practice and hospital’s administrative time and costs can be decreased.

The operating rules build upon industry-wide healthcare electronic fund transfer (EFT) standards that HHS adopted in January of this year. Together, the previously issued EFT standards and the EFT and electronic remittance advice (ERA) operating rules announced today are projected to save between $2.7 billion and more than $9 billion in administrative costs over 10 years by reducing inefficient manual administrative processes for physician practices, hospitals, and health plans.

Operating rules include best business practices on how electronic transactions are transmitted and often target obstacles that physician practices and health insurers have with using electronic transactions

For instance, the rule announced Aug. 7 requires insurers to offer a standardized, online enrollment for EFT and ERA so that physicians and hospitals can more easily enroll with multiple health plans to receive those transactions electronically.  The rule also requires health plans to send the EFT within a certain number of days of the ERA, which helps providers reconcile their accounts more quickly.

Today’s rule, Administrative Simplification:  Adoption of Operating Rules for Health Care Electronic Funds Transfers and Remittance Advice Transactions were developed through extensive discussions with industry stakeholders, Sebelius said. The rule adopts the Council for Affordable Quality Healthcare's Committee on Operating Rules for Information Exchange (CAQH CORE) Phase III EFT & ERA Operating Rule Set.

The regulation  will be effective upon its publication in the Federal Register on Aug. 10, 2012.  The comment period closes on Oct. 9, 2012.

The compliance date for operating rules for the health care electronic funds transfers and remittance advice transaction is Jan. 1, 2014.

Source From Physicians Practice

Using Your Practice's EHR to Boost Revenue

The right door to knock on for practice fusion users 

Proponents of EHRs say the transition from paper to electronic records will improve efficiency and patient care. But for physicians who are struggling to adopt and adapt to EHRs, it can be difficult to see the light at the end of the tunnel. 

There's a lot of frustration, a lot of loss of income, a lot of patient dissatisfaction," dermatologist Steven Shapiro recently told Physicians Practice, noting that his practice’s EHR has decreased efficiency and as a result, led to increased patient wait times, longer patient visits, and fewer total patient visits per day.

Shapiro is not alone in his frustration. Twenty-four percent of respondents to the Physicians Practice 2012 Technology Survey, Sponsored by AT&T, said EHR adoption and implementation is the most pressing IT problem at their practices; while 16 percent pointed to costs to implement and use technology as the biggest issue. In addition, 53 percent of respondents said they have not yet seen a return on their investment.

For those physicians struggling to deal with the costs of implementing an EHR, there’s some good news. More immediate revenue increases as a result of implementing an EHR may be in the pipeline for physicians — beyond the federal incentives for “meaningfully using” one.

EHR vendor Hello Health, for instance, is exploring the possibility of enabling its users to use its EHR to improve efficiency when making referrals. Practices could even receive a monetary incentive when they use the EHR feature.

The vendor hopes to allow physicians to view a list of referral specialists, as well as a highlighted list of the specialists that are “in network” for a patient’s insurance plan. Physicians could then use the EHR to send a referral to a specialist with the patient’s relevant health information included, Matt Beer, director of implementation at Hello Health, told Physicians Practice.

In addition, specialists would pay a fee to participate in the referral system, which would then be shared with the referring physician.

“We’re showing really strong numbers for what we can bring to the primary-care physician over a course of a year,” said Beer, estimating it could amount to $35,000 to $50,000.

Similarly, EHRs could improve efficiencies when practices receive third-party medical record requests from life insurance companies, health carriers, and disability plans. Again, physicians could receive a monetary incentive for distributing these records.

Hello Health recently partnered up with medical record request platform 5 O’clock Records so that physicians can easily transmit the patient’s record to a third party that requests it. Physicians will also receive a fee from the third-party as a result of transmitting the request.

Beer estimated physicians could increase top line revenue by $12,000 to $15,000 annually as a result of utilizing the third-party record request feature.

“The doctor with a click of a button will be able to send that entire record to that life insurance company in seconds, and that’s normally been a process which has taken, sometimes, weeks,” he said.
What do you think of these possible revenue boosters for EHRs? Could they benefit your practice?

Source from Physicians Practice.

Simple Methods to Reduce No Shows at Your Medical Practice

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

The only way to ensure that every patient makes it to the office for their scheduled appointment may be to send a bus to pick them up, and even then, rest assured there will be one or two that still don’t make it. In order to fix this problem in a medical practice, you have to understand first the reasons that patients don’t make it to their appointments.

 Here are some of the most common:

1. Unavoidable emergencies — this may affect one to two patients a day. Sorry folks, there is nothing you can do about Betty’s dog getting loose, or John’s child missing the bus.

2. They forgot their appointment/wrote it down wrong/are feeling better.

3. They arrived late and your front office staff turned them away. (Gasp!)

4. They owed a balance and were concerned about being harassed about it. A patient not having enough money for their copay and losing or dropping insurance coverage is also grouped with this cause.

5. The wait is unbearable to see the clinician, causing a person to have to take off a half day or a whole day for 15 minutes or less of face time with a clinician.

So, how can you fix it?

There are some simple ways to fix no shows, and by fix, I mean some of them may turn into reschedules, or official cancellations, or even seen a little late in the same day. As I briefly stated above there is going to be a small percentage of patients, one to two patients per day for a clinic with a 30 patient per day load, that are unavoidable due to a true family emergency or other urgent issue.

Here are some simple fixes:

1. Call your patients the night before their appointments. During the last 20 minutes to 30 minutes of the practice day, it should be the job of one staffer (or more) to call each patient on the list for the following clinic day and remind them about their appointment. You can also use a texting system or send e-mails — many EHRs can automate this. I caution you about automating this system: The automation should only be a backup to a real live human calling. In other words, call them, and speak to them, and mention that they will also receive e-mail/automated/ text confirmation.

2. This could really be grouped in the first section, but it is key to getting an accurate head count of who is coming to their appointment. Make sure you have up-to-date contact information on EACH patient.

3. Encourage your patients to call and cancel or reschedule 24 hours in advance. Notice I said encourage — don’t threaten them with no show fees.

4. Have a policy for patients arriving late to their appointments, but don’t post the threatening signs in the waiting room or allow your staff to threaten them. Generally patients are not late on purpose; by handling each on a case by case basis, your patients are happier and less likely to get stuck in traffic and think, “forget it, they won’t see many anyway.”

If you think this one doesn’t apply to you or your staff. It is one of the MOST common things I see happen when my team is brought in to search out the problem. It is usually someone eager for a lunch break that turns away the patient that shows up 15 minutes late before lunch. Instead of rescheduling them for after lunch or checking with doctor to see if they could squeeze them in, they turn them away.

This also illuminates the importance of not officially closing for lunch. A staggered schedule helps to eliminate this problem. If you must close for lunch, don’t lock the door!

5. See your patients on time, be honest, and offer options if you are running behind. It is a shame when a patient has to schedule half a day off from work or an entire day for 15 minutes of face time with a physician.

6. Make payment arrangements and offer options for patients that have lost coverage, have balances, or other financial issues. It is a lot easier to catch flies with honey than vinegar (in this case money sticks better to honey as well).

7. If you are reading these and you think, “we just have bad patients this will never work” and I have heard that before, it is time to call a professional to have your clinic operations re-worked and the actual “culprit” revealed.

These simple items should reduce your no shows dramatically, and lead to a more pleasant experience for the physician, staff, and patients.

It won’t happen overnight, but when the items are implemented it will take 30 days to 60 days to see remarkable improvements. Remember, the overall key to avoiding no shows is to be flexible and accommodating with your patients, and have winning customer service. There will be the patient or two that abuses this system, but the key is not to punish all of your patients for the actions of a few.

Source from Physicians Practice 

Practices concerned over ICD-10 switchover, survey says

Medical practices nationwide have expressed worry regarding the impact of an ICD-10 switchover, according to a recent survey finding 96 percent of respondents concerned about the transition to the updated coding system.

The Nuesoft Technologies sanctioned survey, “Attitudes Toward the Transition to ICD-10 and ANSI-5010,” also showed that 73 percent of respondents anticipate ICD-10 significantly affecting their practice, whether it be financially or operationally. 

With HHS issuing a final rule that establishes Oct. 1, 2014 as the ICD-10 compliance deadline, physicians and medical personnel are girding themselves for what many officials perceive to be a complex labyrinth of documentation

.

This diagnosis code is slated to replace ICD-9 and expand the number of diagnosis and procedural codes from 17,000 to some 155,000. 

“It’s not the number,” said Barry Blumenfeld, MD, CIO of Maine Medical Center in Portland, Maine. The complex addition of coding, he added, “makes things very complicated for physicians choosing codes and will require a lot of training and a lot of insight into how these codes are different.” 

Some officials say the transition to ICD-10 will be one of the most significant changes the physician practice community has ever undertaken. The more detailed level of specificity required by ICD-10 will impact areas of practice management processes, including documentation, billing, workflow and quality reporting. 

In addition, many practice software systems will need to be upgraded, and physicians and responsible staff will need extensive training to successfully make the transition.

“Most physicians are dreading the change to ICD-10 because the number of codes and level of specificity will increase exponentially,” said Barbara Dunn, president of MedRecovery Solutions, Inc., a large billing firm that works with practices throughout the country to optimize operations through appropriate coding and billing.

Julie Nobles, president of Premiere Medical Billing, echoed Dunn’s concern. “Most physicians I have spoken with are worried about the rollout of ICD-10 because they are not certain the increased costs and staff hours justify the change to a new and larger set of diagnostic codes.”

Yet, for some physicians, the impending transition is being taken in stride. According to Robert Goldman, MD, the founding physician of Georgia Hormones, with the proper training, the transition to ICD-10 will be doable.

 “We wanted to stay ahead of the curve so the transition to ICD-10 would be as streamlined as possible," said Goldman. "Our practice coding specialist, as well as all of our physicians, finished a course this year all about ICD-10 and the new diagnosis codes. Even though the list of codes will be the size of 10 Manhattan phone books, we are prepared. In fact, Europe has been using ICD-10 codes successfully since 2002.”

The Centers for Medicaid and Medicare Services (CMS) has stressed that ICD-10 will provide more specific data than the 30-year-old ICD-9 and better reflect current medical practices. CMS indicated that the added detail embedded within ICD-10 codes will inform health care providers and health plans of patient incidence and history, which improves the effectiveness of case management and care coordination functions.

Your patients are your first priority; leave your coding worries to  MedicalBillingStar

Source from healthcare IT news

6 questions compare Ryan, Obama on Medicare

It may come as a surprise that President Barack Obama and GOP vice presidential nominee Paul Ryan are pushing the same target rate for controlling federal spending on Medicare. Each would set it at half a percentage point higher than the growth rate of the economy – the gross domestic product – after a phase-in period.

Looking at their plans in more detail, however, their approaches to curbing costs are very different. And the practical effects on seniors are also likely to be different.

"There is a consensus, an agreement that Medicare is unsustainable," Ryan spokesman Conor Sweeney said in the spring after the House approved Ryan’s proposal as part of the budget resolution. "That's where the agreement is, and it's where the agreement ends."

That hasn’t changed. Republican presidential nominee Mitt Romney has embraced the broad outlines of Ryan’s proposal. Like Ryan, he would replace Medicare’s current defined-benefit coverage of all medical costs incurred by a beneficiary with a defined contribution toward premiums for private health insurance or traditional, government-run, Medicare.

While Democrats have criticized Ryan’s Medicare proposals for years, their attacks have become more vociferous since Romney tapped the House Budget Committee chairman as his running mate. Democrats charge that Ryan’s plan would raise out-of-pocket costs for seniors and ultimately destroy traditional Medicare. Republicans have countered with a spirited reprise of their claims from the 2010 congressional elections that Democrats already cut hundreds of billions of dollars out of Medicare as part of that year’s Affordable Care Act.

Here are some questions and answers about the Democratic and Republican approaches to moderating spending on the popular program, which covers 47 million seniors and disabled people.

1. If both Obama and Ryan are proposing a target growth rate of GDP plus half a percentage point for Medicare, shouldn’t federal spending be the same under both scenarios?

There are important differences. Ryan's plan, which would only affect people currently under age 55, would impose a hard cap on federal spending on the program.

Obama is proposing a softer cap. His proposal follows an effort in the 2010 health law to curb Medicare cost growth by tying the spending target to the Consumer Price Index in early years, and later on to the rate of GDP growth plus 1 percentage point. If federal spending per Medicare beneficiary is rising faster than that – a determination made by the Medicare actuary – then cuts would be triggered. The cuts would come as a percent reduction in Medicare spending, but they wouldn’t necessarily be sufficient to meet the target.

Later, in budget deficit reduction negotiations, Obama proposed to lower the target to the growth of GDP plus half a percentage point.

2. On the campaign trail, Democrats say that seniors would pay more for coverage under Ryan’s Medicare plan, but Ryan suggests they could choose from one or two plans at no cost. Who’s right?

Seniors currently pick up some of the tab for Medicare, so it is unlikely that the federal government would pay the entire premium of even a lower-cost plan and still come in under Ryan’s spending cap, say both liberal and conservative health care policy experts.  

Under Ryan's so-called premium support proposal, all plans, including traditional Medicare, would submit bids for how much they would charge to cover a beneficiary's health care costs. All plans would have to provide a minimum set of benefits equal to the value of those in the traditional program, although not necessarily identical in makeup. They could provide additional benefits beyond that minimum. The government would pay the premium for the private plan with the second lowest bid, or for traditional Medicare, whichever is lower. Beneficiaries would get a rebate if they chose the lowest-cost plan, but would have to pay the difference if they chose a plan that set premiums higher than the second-lowest.

3. Republicans are accusing Democrats of cutting $716 billion from Medicare to finance the health law. Didn’t they used to say $500 billion?

The Congressional Budget Office, using a different time frame to assess the law’s impact, has updated its estimate of reductions from future Medicare spending to $716 billion over 10 years. The Ryan plan calls for the same dollar amount of savings from Medicare, even though it would repeal the health care law. But Ryan says the money would be plowed back into the program.

The reductions in the health law mostly affect hospitals, health insurers, home health and other providers who supported the measure because it extended coverage to 30 million uninsured Americans, raising the number of paying customers. The law also significantly reduced payments to private Medicare health plans.

4. How would Obama's plan for Medicare affect beneficiaries ?

Obama is a critic of premium support. He would retain Medicare's defined-benefit structure, meaning that the government will pay whatever it takes to cover a specified set of services.

The health law seeks to hold down costs by promoting changes in the ways providers are organized and paid, to shift from rewarding volume of services to improving quality and patient outcomes.

The health law also created the Independent Payment Advisory Board (IPAB) to come up with proposals to reduce spending if Medicare grows at a higher rate than the target. But the board's 15 members, who will be appointed by the president subject to confirmation by the Senate, are not allowed to recommend anything that would ration care or change benefits, eligibility or cost sharing for Part A (hospital services) or Part B (physician services). It also couldn't do anything to change the percentage of premium that seniors pay for prescription drug coverage or the subsidies that low-income individuals get. The expectation is that reductions would come from medical providers, although hospitals are protected at first.

Beginning in fiscal year 2015, if Medicare spending exceeded the target, the board would send its recommendations to Congress. The secretary of Health and Human Services would have to implement those recommendations unless Congress passed alternative cuts. The future of the IPAB is in doubt, however, as Republicans – and some Democrats – have sought to kill it, arguing that the board will end up rationing care and have too much control over Medicare. Obama has yet to nominate panel members.

Some health care analysts argue that reducing payments to medical providers could drive them out of Medicare and create access issues for beneficiaries. Richard Foster, Medicare's chief actuary, warned in the 2012 Medicare trustees' report that the health law will eventually lower payments to medical providers so much that "Congress would have to intervene to prevent the withdrawal of providers from the Medicare market and the severe problems with beneficiary access to care that would result."

5. And under Ryan?

Ryan is not specific in his plan about what he’d cut to keep spending below his proposed cap, but he has said that Congress could expand requirements for higher-income beneficiaries to pay more for their coverage. Spokesman Conor Sweeney has said that competition among both public and private health plans would hold down costs, and seniors would be able to choose the health plans best suited to their individual needs. "Seniors want more power and control over their Medicare dollars," he said. If competition doesn’t keep Medicare spending below Ryan’s target, then automatic cuts would occur.

The nonpartisan Congressional Budget Office estimated that Ryan’s proposal from 2011 would require a typical 65-year-old person to pay thousands of dollars more for Medicare by 2030 than would be the case under its current structure. However, his latest plan, included in the fiscal 2013 House budget resolution, is missing key details, so the CBO has said it is unable to assess its impact on beneficiaries.

Although Ryan would give future seniors the option of remaining in the traditional, government-run Medicare program, it would have to compete with private plans. Critics predict that traditional Medicare could become unaffordable if it attracts the sickest people while private plans lure the healthiest. They also say that beneficiaries might have trouble finding physicians if they abandon the program because their rates are cut.

6. What's next for Medicare?

Lawmakers are unlikely to consider legislation that would restructure Medicare in any significant way until a new Congress -- and possibly a new president -- are seated in 2013. Still, after the elections, Congress may try to pass deficit reduction legislation that would avert automatic 2 percent cuts in Medicare required under last year’s budget agreement. In the meantime, Medicare is proving to be a contentious issue in presidential and congressional campaigns nationwide, as both parties vie for the coveted senior vote. Behind the scenes, stakeholders - from seniors' advocates to insurance leaders - are working to produce proposals that protect Medicare and their interests.

Lay out your billing worries physicians ! MedicalBillingStar gears your up in revenue. 

Source from Physicians Practice

Physicians Need to Be Aware of New Federal Anti-Fraud Weapons

Ten steps towards a better future in your billing process !

Medicare pays approximately 1.5 million doctors, hospitals, and providers each year, approximately $750 billion in claims. By some estimates, $65 million of this is "fraudulent." The term “fraud” usually means malum in se fraud, (bad in itself, like stealing) but can include "abuse." This means engaging in behavior which defines malum prohibitum (bad because the government told you "don’t do it."). In cases of criminal fraud (the “stealing” kind) CMS and the Office of the Inspector General (OIG) have been widely criticized for a system of “pay, then chase.” Often, the worst abusers have been highly sophisticated, stealing or paying for Medicare claim numbers, and getting away with payments of massive amounts of money.

Criminals use real patient IDs to bill for wheelchairs that were never delivered or exams never performed. Dishonest doctors — a small percentage of physicians, to be sure — charge for care they never deliver or perform unnecessary operations. In one scam, criminals bill Medicare and a private insurer for the same patient. The federal health law and other legislation directed the federal government to start using sophisticated anti-fraud computer systems. Budetti said the systems, which are being used first with Medicare, are similar to those used by credit card companies to detect suspicious purchases.

"We're able to now verify whether a person was being treated by two different physicians in two different states on the same day or a variety of other possibilities," he said. This permits the government to do what credit card issuers have done for years.

The computer program crawls around the heaps of Medicare claims — some 4 million a day — to look for outliers: spikes in prosthetics in Miami or heart stents in Missoula, for example. And for the first time, doctors and others who want to bill Medicare are being assessed based on their risk to commit fraud. Those who seem crooked are kept out.

What’s also new, under the ACA, is the ability of CMS and OIG to temporarily suspend payments upon a "credible report" of fraud. Hence, no more "pay, then chase." According to a story by Kaiser Health News, the Obama Administration's approach to fighting fraud has been more systematic than previous ones. Indeed, the number of so-called Medicare Strike Force teams operating around the country has quadrupled since 2009. Still, the mantra of the fraud fighters sounds a lot like a department store sale: The more you spend, the more you save.

In the meantime, those in charge of the government's anti-fraud efforts say the new approach is working. The number of defendants facing fraud charges jumped sharply last year. At the end of September, Medicare is expected to report to Congress the number of new scams detected and the number of new cheats kept out of the program.

How does all of this affect the average physician’s practice?

The case of U.S. v. Krizek is familiar to anyone who has read a health law textbook. The case resulted in three appellate decisions, six federal opinions in total, and one appeal to the U.S. Supreme Court. The texts report how a Washington, D.C.-based psychiatrist was sued for $82 million in penalties, though he barely earned $125,000 a year, ultimately suffering judgment of $225,000. What you won’t see is the back story of how Dr. Krizek got in trouble in the first place.

Krizek didn’t understand CPT codes, and excessively used Code 90844. Code 90844 is the code for a one-hour therapy session. Krizek used it when his time spent working on a particular case reached one hour in the aggregate, not simply for face-to-face time. Krizek also did not realize, (which you should) excessive use of a particularly highly reimbursable CPT code is exactly what genuinely fraudulent criminals would do, if they wish to claim payment for treatment never given.

According to Mrs. Krizek, even though she could prove the patients were genuine, the government was on the scent, and would not give up. The moral of the story is this: Now that the government has new tools for identifying excessive use of suspect codes, you must vigilantly keep abreast of what those codes are, lest you find the FBI in your practice lobby.

source from Physicians Practice

How Physicians Can Negotiate the Best Hospital Employment Deal

A medical billing company that never sleeps !

 The prospect sounds appealing: Your local hospital or hospital-owned medical group makes you an offer to join them. Money up front, the practice is run for you, reduced calls, no payroll, no expenses — you just do what you were trained to do and still get financially rewarded for doing well. Whether you go with a group or as a solo, the precedent is already well established — 65 percent of physicians are already similarly employed, a number that is rapidly approaching 75 percent.

A proposal is made and an agreement tendered. Assets are purchased, debt goes away, and you have guaranteed income, performance incentives, and benefits. It seems like heaven on earth, but the devil lives in the details. Dense and often misinterpreted small print rises to get you when you least expect it. But it is not just the small print; it is far more often the plain, unambiguous terms and conditions having to do with compensation that create problems.

Performance clauses are the most common cause of disputes and disappointments, particularly when compensation includes bonuses dependent on revenue-based goals. Not because they are unrealistic, and most often not because of the physician, but because there is often little or no marketing support, and little appreciation for the impact of payer mix because hospitals are reimbursed more generously than physicians.

Things are fine at first — the patients that follow you will make your initial payer mix more balanced but, over time, as your original patients thin out by attrition, the void is typically filled with lower reimbursing patients through the general referral system.

Complicating matters, hospitals are generally not very good at collecting deductibles and copays, causing your accounts receivable to mount, further impeding accessing performance incentives. Further, hospitals are also quick to send past due amounts to collections, alienating many patients and giving others incentive to drift to other physicians, further diluting patient volume in the most critical area, private insurance.

It gets harder and harder to achieve incentive income until, as often happens, you don’t.

These are an often repeated laments, and ones that are difficult to remedy. The obvious choice is to avoid the situation in the first place, however, with precedent having been set by predecessors, it is easier said than done. It’s no one’s fault, nor is it everyone’s fault, it’s just business

.

The good news is that there are steps you can take to protect your interests:

• Talk to physicians and staff already in the group. If they are happy, be wary — you probably will be too, but only if you get the same deal. If they are not, you don’t want the same deal.

• Don’t use your regular attorney unless they are expert in negotiating physician employment agreements. Hire a specialist to represent you, attorney or not, with as much experience in negotiating hospital and medical group employment agreements as you can find. They will know how to avoid terms and conditions that may cause you to regret your decision.

• DO NOT get directly involved in the negotiations or discussions. Ever. Let your representative do that. Your job is to approve terms and conditions when you are comfortable with them, or when you believe you have gotten the best deal to be had. Negotiations can be contentious. Let any animus remain between administration and your representative. Stay back, smile, be friendly, be reasonable — you’re the one that has to work there for years to come. The hospital or practice negotiator will rarely be the decision maker. There is good reason for that. Any negotiator that does not need approval from others is at a substantial disadvantage. That would be you without representation

• Make the change for the right reasons. If, for example, you are leaving a partnership because of the politics or issues with managing partners, keep in mind that politics equally exist in the workplace, and you can rarely effect a change in management as an employee. If you are leaving because you are seeking stability, a better quality of life and relief from the burden of running a practice, and are willing to trade control and some upside in compensation for eliminating the downside, you are likely making a good decision.

source from Physicians Practice

Simple Methods to Reduce No Shows at Your Medical Practice

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

Let your revenue and cash flow curves climb up

The only way to ensure that every patient makes it to the office for their scheduled appointment may be to send a bus to pick them up, and even then, rest assured there will be one or two that still don’t make it. In order to fix this problem in a medical practice, you have to understand first the reasons that patients don’t make it to their appointments.

1. Unavoidable emergencies — this may affect one to two patients a day. Sorry folks, there is nothing you can do about Betty’s dog getting loose, or John’s child missing the bus.

2. They forgot their appointment/wrote it down wrong/are feeling better.

3. They arrived late and your front office staff turned them away. (Gasp!)

4. They owed a balance and were concerned about being harassed about it. A patient not having enough money for their copay and losing or dropping insurance coverage is also grouped with this cause.

5. The wait is unbearable to see the clinician, causing a person to have to take off a half day or a whole day for 15 minutes or less of face time with a clinician.

So, how can you fix it?

There are some simple ways to fix no shows, and by fix, I mean some of them may turn into reschedules, or official cancellations, or even seen a little late in the same day. As I briefly stated above there is going to be a small percentage of patients, one to two patients per day for a clinic with a 30 patient per day load, that are unavoidable due to a true family emergency or other urgent issue.

Here are some simple fixes:

1. Call your patients the night before their appointments. During the last 20 minutes to 30 minutes of the practice day, it should be the job of one staffer (or more) to call each patient on the list for the following clinic day and remind them about their appointment. You can also use a texting system or send e-mails — many EHRs can automate this. I caution you about automating this system: The automation should only be a backup to a real live human calling. In other words, call them, and speak to them, and mention that they will also receive e-mail/automated/ text confirmation.

2. This could really be grouped in the first section, but it is key to getting an accurate head count of who is coming to their appointment. Make sure you have up-to-date contact information on EACH patient.

3. Encourage your patients to call and cancel or reschedule 24 hours in advance. Notice I said encourage — don’t threaten them with no show fees.

4. Have a policy for patients arriving late to their appointments, but don’t post the threatening signs in the waiting room or allow your staff to threaten them. Generally patients are not late on purpose; by handling each on a case by case basis, your patients are happier and less likely to get stuck in traffic and think, “forget it, they won’t see many anyway.”

If you think this one doesn’t apply to you or your staff. It is one of the MOST common things I see happen when my team is brought in to search out the problem. It is usually someone eager for a lunch break that turns away the patient that shows up 15 minutes late before lunch. Instead of rescheduling them for after lunch or checking with doctor to see if they could squeeze them in, they turn them away.

This also illuminates the importance of not officially closing for lunch. A staggered schedule helps to eliminate this problem. If you must close for lunch, don’t lock the door!

5. See your patients on time, be honest, and offer options if you are running behind. It is a shame when a patient has to schedule half a day off from work or an entire day for 15 minutes of face time with a physician.

6. Make payment arrangements and offer options for patients that have lost coverage, have balances, or other financial issues. It is a lot easier to catch flies with honey than vinegar (in this case money sticks better to honey as well).

7. If you are reading these and you think, “we just have bad patients this will never work” and I have heard that before, it is time to call a professional to have your clinic operations re-worked and the actual “culprit” revealed.

These simple items should reduce your no shows dramatically, and lead to a more pleasant experience for the physician, staff, and patients.

It won’t happen overnight, but when the items are implemented it will take 30 days to 60 days to see remarkable improvements. Remember, the overall key to avoiding no shows is to be flexible and accommodating with your patients, and have winning customer service. There will be the patient or two that abuses this system, but the key is not to punish all of your patients for the actions of a few.

 Source from Physicians Practice

Don't Waste Patient, Physician Time with Unproductive Visits

 Offer greater convenience to your patients with MedicalBillingStar !

The medical profession is a service industry. Part of what makes any service business successful is the manner in which it treats its clients. Although I hear a lot of complaints from physicians about how poorly they are treated by patients, many patients are also mistreated by physicians, whether or not it’s intentional.

As a good example, let me relate to you an interaction I had with a physician this week when following up on a radiology test for my daughter. It should be noted that this appointment was rescheduled three times in order to accommodate the doctor’s schedule, and I was "informed" of the change without any effort to consult my schedule. Although I found this unusual, I let it slide.

Upon arrival, I sat in the waiting room for almost one and a half hours before meeting the physician. Although I approached the receptionist multiple times to check the status of the visit, I was provided with neither an apology nor an explanation, other than being told the doctor was with the prior patient. A long delay with a hungry and tired 4-year-old is not a fun experience. I am surprised I did not walk out!

While some delays cannot be avoided, this physician was not called away to an emergency nor did she perform procedures in her office. When I (finally) saw her, she offered no explanation or apology for the delay (although I was clearly unhappy). She then asked if I had brought the radiology CD with me. I was confused by this question, since I was informed by the hospital that a report/CD would be sent to the doctor. When I related this, she indicated that she had received nothing. Although I had spoken to her office numerous times, at no time was I told this was my responsibility or that they had not received the materials. At this point, it became clear to me that not only had I wasted my time waiting for her, but that the appointment was worthless as well. I will end my story here, but suffice to say I will not return to her office.

As fine a physician as you may be, your interactions with patients affect their impression of you and whether they recommend others to you. How should you avoid the outcome I experienced?

1. A physician and his or her staff should apologize and provide an explanation for delays. An estimate of the delay and an offer to reschedule may be appropriate. Assurances that such delays are out of the ordinary is reassuring to a patient. Train your staff accordingly.

2. There is no reason for hour-plus delays in a typical medical practice. If you are not watching the time you spend with your patients, have a staff member keep you on schedule. While delays do sometimes occur, avoid seeming disrespectful to your patients. Imagine if you went to see a lawyer and had to sit one and a half hours without explanation — would you return? Treat others as you would want to be treated.

3. Inform your patients of expectations regarding materials needed for an appointment. Do so when the patient makes the appointment and in any  AR follow up calls. Note in the file every time the patient is informed. Had I known the physician did not have what she needed, I would have made necessary arrangements! Remember, in the end I am out time, but this physician was not able to bill or be reimbursed for any services. If there is no practice policy to avoid this issue, lost revenue and patient frustration is sure to build.

4. Don’t let your patients leave the office upset, whenever possible. No practice needs patients who are likely to file Internet complaints or spread bad will regarding you or your practice, especially if it’s avoidable.

Interacting with clients in any industry can be challenging. Proper management and training of staff can help avoid many patient issues. While practicing medicine is certainly a noble profession, it is also a business. Success or failure of any business can depend on how your customers are handled.

 Source From Physicians Practice.