Manage My Practice

From the Federal Trade Commission:

“At the request of several Members of Congress, the Federal Trade Commission is further delaying enforcement of the “Red Flags” Rule through December 31, 2010, while Congress considers legislation that would affect the scope of entities covered by the Rule. Today’s announcement and the release of an Enforcement Policy Statement do not affect other federal agencies’ enforcement of the original November 1, 2008 deadline for institutions subject to their oversight to be in compliance.”

Read more here.

My post and resources on Red Flags Rule here and in the Manage My Practice Library.

UPDATE: On June 24, 2010 the House and Senate passed legislation to further delay the Medicare cuts until November 30, 2010. More here.

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Congress has yet to pass a bill delaying the June 1, 2010 21.2% reduction in physician reimbursement, but most believe it will happen and be effective retroactively.

CMS has said it is anticipating a further delay in Medicare fee schedule cuts, so they have “instructed contractors to hold claims containing services paid under the MPFS for the first 10 business days of June.”

More information on my post here.

Stay tuned!

Medicare Definition of Eligible Provider (EP)

For Medicare, physicians and some hospitals are eligible providers. “Physicians” includes doctors of medicine (MD) or osteopathy (DO), dentists or dental surgeons (DDS or DMD), podiatric medicine (DPM), and optometry (OD) and chiropractors (DC).

For providers, their annual payment will be equal to 75 percent of Medicare allowable charges for covered services in a year, not to exceed the incentives in the table below.  Payments will be made as additions to claims payments.

Hospitals include quick-care hospitals (subsection-d) and critical access hospitals  and only includes hospitals in the 50 States or the District of Columbia.

Medicaid Definition of Eligible Provider (EP)

Medicaid takes the Medicare definition of eligible providers (physicians) and adds nurse practitioners, certified nurse midwives and physician assistants, however, physician assistants are only eligible when they are employed at a federally qualified health center (FQHC) or rural health clinic (RHC) that is led by a Physician Assistant.  Eligible hospitals include quick care hospitals and children’s hospitals.

At minimum, 30 percent of an EP’s patient encounters must be attributable to Medicaid over any continuous 90-day period within the most recent calendar year. For pediatricians, however, this threshold is lowered to 20 percent.

The first year of payment the Medicaid provider must demonstrate that he is engaged in efforts to adopt, implement, or upgrade certified EHR technology.  For years of payment after year 1, the Medicaid provider must demonstrate meaningful use of certified EHR technology.

Change 1:

The  definition of “hospital-based physician” was recently clarified to include physicians working in hospital outpatient clinics (employed physicians) as opposed to the inpatient units, surgery suites or emergency departments.  This still excludes pathologists, anesthesiologists, ER physicians, hospitalists and others who see most of their patients in the ER as outpatients or as hospital inpatients.

Possible Change 2:

The Health Information Technology Extension for Behavioral Health Services Act of 2010 (HR 5040)  is a bill in the US Congress originating in the House of Representatives that would amend the Public Health Service Act and the Social Security Act to extend health information technology assistance eligibility to behavioral health, mental health, and substance abuse professionals and facilities, and for other purposes.  You can track the bill here.

For more information on stimulus money for meaningful use of an EMR, read my post here.

Operating expenses fall into two categories: fixed and variable.  Your fixed expenses are the same from month to month regardless of whether you are seeing patients or not.  Your variable expenses change from month to month based on the volume of business you do and what is needed to support that volume of business.  Purchases that fall under the operating expense category are less than a pre-determined amount – maybe less than $500 in a practice or less than $1000 in a hospital.  Any purchase over that amount will be a capital expense (defined as having a usable life of more than one year) and will appear on your monthly expense statement as depreciation.

Fixed Expenses

Rent/Mortgage

Utilities: electricity, water, garbage, cable, alarm system

Janitorial and Groundskeeping

Computer System: monthly maintenance

Phones: monthly maintenance

Leases: copiers, transcription equipment, some medical equipment

Malpractice Insurance

Other Insurance: general, business interruption, directors & officers, umbrella

Depreciation

Variable Expenses – Typically when you are looking at reducing expenses, you will look first at your variable expenses, seeing what you can cut down on or eliminate, or what you can renegotiate.

Payroll: staff wages, tax match, retirement plan match, bonuses, annual raises

Benefits: health insurance, life insurance, dental insurance, vision insurance, disability (long term, short-term), worker’s compensation, unemployment

Computer System: additional licenses, charges for claims, statements, eligibility

Phones: repair, new lines, new jacks, voice mail changes, cell phone plans, pager plans, answering service, Yellow Pages (hopefully minimal),

Inside: pest service, plant service

Medical equipment: small instruments, exam room lamps, Mayo trays

Laundry: gowns, sheets, towels, shorts, lab coats

Consumables: (medical – built-in to the price of the service) table paper, syringes, x-ray film, lab supplies

Consumables: (medical – charged separately to the patient) allergy serum, durable medical equipment

Consumables: (office) copy paper, toner, kitchen and bathroom supplies, pens

Printing: encounter forms, appointment cards, Rx pads

Education: (staff) continuing education, license renewal, CPR, coding updates, dues, subscriptions

Perks: uniform allowance, parking, lunches, holiday parties, birthday gifts

Purchased Services: transcription, radiology over-read, accountant, lawyer, consultant, auditor, inspector, outsourced billing, collection agencies

Marketing: advertising (print, TV, radio, direct), sponsorship of events, meet & greet with referrers, holiday gifts, website

Front Desk/Check-In

• Greets patients and visitors to the practice
• Registers patients in the practice management system which may mean entering information given verbally or on registration forms
• Collects identification and insurance cards and copies or scans them for the record, may photograph the patient for the record
• May collect co-pays or other monies
• Prints encounter form (also called superbill, routing slip, or fee ticket) with updated information, or updates information on the encounter form
• Has patient sign financial agreement, receipt of privacy policy, benefits assignment, etc.
• May answer phone calls, take messages and make appointments
• Directs visitor (drug reps, salespersons, etc.) appropriately

Medical Records

• Primary responsibility for the integrity and management of the medical record, whether paper or electronic
• Controls record filing (paper) or indexing (electronic)
• Fulfills requests by patients, attorneys, insurance companies, and social security for release of records
• May manage paper faxes and messages by attaching to charts and delivering to provider
• May prepare paper charts for chart audits by payers or others
• May be the HIPAA Officer

Medical Assistant, LPN or RN

• May assist Physician, Nurse Practitioner or Physician Assistant with procedures
• Depending on state laws, may give injections
• May perform procedures independently (ear wax removal, staple removal, etc.)
• Provides Medicare patients with an Advance Beneficiary Notice if any lab test or procedure to be performed in the office will not be covered by Medicare
• May perform phlebotomy (draw blood)
• May collect specimens, perform basic laboratory tests and chart results
• Provides patient education verbally and by providing written materials
• May schedule tests or procedures ordered by the provider
• May schedule surgery and prepare surgery packets for providers (*this may be delegated to a surgery scheduler if this position exists)
• Calls patients about test or procedure results; returns patients calls with answers after consulting with provider
• Prepares exam room for procedures (PAP smears, excisions, etc.), marks specimens for lab and pathology
• Cleans exam room after each patient and stocks exam and procedure rooms with supplies
• May be responsible for ordering office medications and medical supplies
• May perform lab controls daily and check and record temperatures on lab refrigerators and freezers

Triage Nurse

• Takes incoming calls from patients and gives them medical advice according to predetermined nursing protocols
• Makes decisions about patients needing to be seen urgently, same day or next day
• May be delegated callbacks from providers or other nurses
• May see walk-in patients and triage their condition

Lead Nurse, Charge Nurse, or Nurse Supervisor

• Assigns clinical staff specific responsibilities
• Manages clinical staff schedules, using agency or temporary staff as needed
• Performs annual competency exams on staff
• Ensures all staff are current on licenses, continuing education and CPR
• Problem-solves patient issues
• May be responsible for ordering office medications and medical supplies
• Has responsibility for medication sample closet upkeep
• May perform annual evaluations fro clinical staff
• Responsible for equipment maintenance and makes recommendations for medical equipment as needed
• May be the Patient Safety Officer and the Worker’s Compensation Coordinator

Referral Clerk

• Reviews orders written by providers and determines where test and procedures may be performed based on patient’s insurance
• May provide the patient with information about the test or procedure cost and what the patient’s financial responsibility is estimated to be
• Pre-authorizes, pre-certifies, or pre-notifies the test or procedure if required by the patient’s insurance company
• Schedules the test or procedure
• Provides the patient with information about preparation for the test or procedure

Lab Technologist/ Phlebotomist

• Receives laboratory requisitions from provider and collects specimens according to provider order
• Provides Medicare patients with an Advance Beneficiary Notice if any lab test or procedure to be performed in the office will not be covered by Medicare
• Performs tests or packages specimens to be transported to reference lab
• Receives results back from the labs and matches them to charts
• Performs lab controls daily and checks and records temperatures on lab refrigerators and freezers

Check-out Desk

• Reviews services received by patients, checking to make sure that all services received were checked on the encounter form
• Enters charges in the computer system for services received
• Tells patient if any additional monies are owed if co-pay was collected at check-in
• May sign patient on to a payment plan if needed
• Takes monies owed, posts monies and produces a receipt for the patient
• Makes return appointment for the patient if needed, or enters recall into the practice management system

Biller or Collector

• Corrects claims that are rejected from the claims scrubber, clearinghouse or payer
• Files secondary and tertiary claims as needed, electronically or via paper
• Posts receipts from insurance companies and patients and edits any electronic remittance advice; may post from lockbox account on the web
• May prepare deposits and/or make deposits
• Generates patient statements
• May check eligibility on patients with appointments and call patients whose insurance is not active (*may be delegated to a financial counselor if this position exists)
• Calls patients who have not made payments in response to statements
• May turn patients over to third-party collectors
• Takes phone calls from payers or patients about billing issues and resolves issues

Coder

• Reviews notes from inpatient or outpatient encounters and codes them according to the documentation
• May post charges for services rendered
• Audits chart documentation for quality purposes to ensure that provider coding and documentation is synchronous
• Introduces changes in procedure (HCPCS) and diagnosis (ICD-9) codes and educates staff on the use of new codes
• Ensures encounter forms and practice management software is updated appropriately with new and deleted codes
• May be delegated the Compliance Officer

Billing Supervisor

• Reviews the work of coders, billers and collectors and performs quality audits to benchmark acceptable error rates
• Prepares or reviews deposits and tracks daily charge, collection, write-off and deposit information, watching for monthly abberations by payer or date
• Reviews Accounts Receivable (A/R) reports, looking for trending or specific problems to be addressed with staff or payers
• Brings to the attention of the Office Manager or Administrator any issues with non-standard payment trends, denials or non-covered services.
• Performs evaluations for billing department staff
• Takes escalated patient complaints
• May credential providers with new payers or recredential providers with payers or hospitals

Office Manager, Practice Administrator, or Practice Manager (see the Library tab for job descriptions) see my posts on what an administrator does here, and a day in the life of an administrator here

• Performs all human resource functions for the practice
• Has ultimate responsibility for all money flowing in and out of the practice – makes deposits, pays bills, etc.
• Contact person for all computer system, equipment and phone system issues
• Responsible for day-to-day operations, advises supervisors on issues and problems
• Resolves escalated patient complaints
• Meets with vendors and researches possible practice purchases
• Negotiates all practice contracts
• Meets with staff and providers on a regular basis

These descriptions will not perfectly fit most practices, this is just a generalization.  Each practice divides duties based on the number and skills of the staff in their office, and their specialty.  These descriptions should help to define what the basic tasks are in most practices.

UPDATE: On June 24, 2010 the House and Senate passed legislation to further delay the Medicare cuts until November 30, 2010. More here.

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Article by David Glendinning at amednews.com here.

CMS held a two-hour Open Door Forum today and there was so much good information shared that I thought I’d pass my notes from the call along to you.

New EFT Form

The revised EFT (Electronic Funds Transfer) authorization form 588 is available here (pdf.) The old form will still work for a few months longer before it becomes invalid.

Changes to the Medicare Program Integrity Manual

The Program Integrity Manual (publication 100-80) will have revisions related to the changes in provider enrollment.  The online-only manual here will have content moved from Chapter 10 to Chapter 15 and the provider enrollment information will be easier to understand.

The Question on Everyone’s Lips

How do I know if I’m listed in PECOS (Provider Enrollment and Chain/Ownership System) and how do I know if others are listed in PECOS?  A new downloadable file is now available here (12,000 pages!) and everyone listed in this Ordering/Referring file has approved enrollment status.  Anyone not appearing on this list is not in approved status, or has opted completely out of the Medicare program.

Advanced Diagnostic Imaging

Beginning in January 2012, all diagnostic magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging such as positron emission tomography (PET) must be performed in a facility accredited by the American College of Radiology (ACR), The Joint Commission (TJC) or the Intersocietal Accreditation Commission (IAC) for the technical component of the test to be reimbursed by Medicare.  This rule does not apply to x-rays, ultrasound, fluoroscopy, mammography or DEXA scans and does not apply to any professional component.

Hospital Revalidations

Hospitals not enrolled in PECOS or not receiving EFT (Electronic Funds Transfer) will be contacted by CMS in an attempt to get all hospitals revalidated.

PECOS (pronounced “pay-cose”)

CMS recommends that anyone with questions or just getting started in PECOS read the “Getting Started Guide”, of which there are two versions, both available here in pdf form.  One is for providers and one is for suppliers of DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies.) You need to know your corporate structure before getting started because the business must enroll before the providers can assign benefits to the business.  The 855I is for individual/solos providers and the 855B is for non-individuals (multiple owners) billing Medicare Part B and assigning benefits to a legal entity/corporation.  Dentists and pediatricians who order or refer services for Medicare patients are required to have an enrollment record in the PECOS. Residents and interns are exempt from the enrollment requirement, but an attending physician needs to be identified on the claim when a service is ordered or referred. The main page for enrollment is https://www.cms.gov/MedicareProviderSupEnroll/

Two Ways to Get Into PECOS

One is to complete the paper form in BLUE INK (and if time is of the essence CMS suggests that you use the paper form) and let the MAC enter it into PECOS for you.  The other is to use the internet-PECOS system directly, and sign, date and mail the certification statement to complete the process.  Submit the participation form or EFT form if required.  The certification form for the paper process is NOT the same as the certification from for the internet-PECOS process.

What is the 30-day rule?

The 30-day rule states that you can bill for services provided to Medicare patients up to 30 days prior to your filing date.  The filing date is the date your enrollment is accepted, not the date you mailed it.  Online it will say “Status Approved”, and you will receive an email, and then a letter confirming it. You will appear on the Ordering/Referring file on the CMS website.

What happens to payments for patients that were referred by a provider not enrolled on PECOS?

Even though you are enrolled, if the referring physician is not enrolled, you will not be paid for that patient’s services.  However, if that referrer becomes enrolled, you can resubmit the claim and it will be paid.

What happens on July 6, 2010?

July 6, 2010 is the compliance date for Part A providers (hospitals, skilled nursing homes and home health agencies) and Part B providers (physicians, ambulance) must be enrolled in PECOS as ordering/referring physicians for payments to be made.

What happens on July 13, 2010?

DMEPOS (pronounced “demmy-pos”) providers must be enrolled in PECOS to receive Medicare payments.

What should be done if a provider leaves a group?

The provider or his Authorized Official (CEO, CFO, Manager) should file a 855R or make the change in PECOS as soon as possible.

Why do provider offices still request UPINs from our office?

Unclear.  UPINs were no longer required as of May 23, 2008.  The NPI is the only number accepted on Medicare claims.

Should the information submitted on a 855 be the same information in PECOS?

Yes, if it isn’t, contact the Help Desk.  Their toll-free number is 1-866-484-8049 and their e-mail address is eussupport@cgi.com.

For more information on the nuts and bolts of PECOS, see my post here.

When Matthew Browning first described YNIO (Your Nurse Is On), I was really surprised to learn what his product was.  I don’t know what I expected, but it wasn’t the elegant solution to staffing he described.

Here’s the description from the YNIO website:

Your Nurse Is On^TM was developed in 2000 by a trained Family Nurse Practitioner in response to the inefficient relief staffing procedures found in healthcare today. With today’s challenging environment of cost savings and instant communications it became apparent that calling replacement staff one at a time was no longer an adequate solution.

With the improvements in internet telephony that occurred around 2005, we created a system that allows you to call any available nurse to fill your vacant shift. You now have the power to contact many nurses, in any order you choose, on whatever device they prefer. Since the nurses on our system make their availability known in advance, you will never disturb another unavailable nurse or waste your time calling them.

I could really relate to this solution! Who among us hasn’t spent hours on the phone filling staff slots, getting coverage for unexpected medical leaves, and trying to piece together coverage for routine vacations?

YNIO distills the product down to four easy steps:

1. Scheduler creates a request for staff.
2. YNIO contacts all available staff – instantly.
3. Staff receives the request and accepts or rejects the shift.
4. Scheduler is immediately notified.

And what are the proposed benefits to a facility using YNIO?

• Save time – system can call dozens of nurses simultaneously
• Save money – no more dollars wasted calling nurses who are unavailable
• Fill shift vacancies – expanded pool of available nurses
• Increased employee morale – decreased shift vacancies can decrease shift call outs, injuries and burnout
• Increased efficiency – leverage technology to save money, save time, quickly fill shift vacancies and save paperwork with our paperless billing and performance tracking systems.

This sounds like a needed solution for practices, nursing homes, hospitals, and home health agencies.  I am also fascinated by the creative process of innovation and delivery to the market and asked Matt a few questions about the development of his product.

MARY PAT: Matt, what does it take (emotionally, financially and otherwise) to conceive an idea and bring it to the market?

MATT: I believe it begins with a personality that is inclined to analyze situations and procedures with an eye toward improvement. “How can we make this, or do this, better than we are today?” As this behavior becomes internalized and part of our daily routine, we begin to generate ideas, “maybe this could work” type of thoughts that can result in some solid ideas, proposals and hypotheses. This stage of innovative thought is rather common and many people have an idea that could “change the world,” however an idea at this stage is often lacking a “vision” of how it can interact with our current realities, change existing processes, improve outcomes, save time and reduce expenses. The basic business infrastructure, legal processes, finances and team that are very important considerations to bring an idea from conception to market are often not understood, at this point of the innovation cycle, by the inventor and are definite challenges. These challenges may be the reason that many potential innovations are never brought to market.

So, besides an idea, and a ‘vision’ of how it fits into the world, flexibility, determination and persistence may be the most required traits for the innovator. The key to this game is teamwork, assemble the highest quality team you can, rely on experts for knowledge outside of your personal domain and remember that the objective is bringing the product or process to the world to make it a better, safer, more enjoyable place for as many people as possible. Success is often a direct result of service to others and bringing your innovation to the world can be a great service.

On the emotional and financial fronts, expect the endeavor to take twice as long as you expect and to cost twice as much as you expect. Having an awesome team and a supportive social network are invaluable to the eventual success. I am fortunate to have a very supportive family that believes in me and our innovation and they have been very tolerant of the extraordinary amount of hours and obligations that are part and parcel of this innovator’s life. To summarize, I believe a good idea can become a vision that with a very dedicated individual can become a team working toward the release of an innovation commercially. Hard work, perseverance, flexibility, ability to learn and the ability to delegate are all requisite as well.

MARY PAT: What’s been your lowest moment to date in bringing your product to market and what has been your highest?

MATT: My personal and corporate nadir occurred, ironically, during one of the best events of my life, the birth of my son, Arthur. Our product, YourNurseIsOn.com, was struggling through the “proof of concept” phase, after nearly a year in development and design, when my wife had an unexpected, emergent delivery of our son. We were traveling in Florida on a doctor-approved combination business and family trip, when our son decided he was coming into the world, nine weeks early. Aside from a very difficult and dangerous birth experience, we were over 1500 miles from our home in New Haven, CT. Our company was being run from my laptop and mobile phone and I was juggling a fully packed calendar of business obligations all while running from ICU to NICU, for 5 weeks. It was two months before I was able to safely return my family to our home in New Haven. In addition the amazing amounts of time needed for both my wife, Phoebe, and my son, I still needed to meet with potential customers, conduct regular tech meetings, solicit further investment and continue to work on intellectual property issues, technological challenges and personnel needs.

We had invested our life’s savings to get to this point and now, with this amazing, yet traumatic family event, we began to question many of the decisions that had brought us to this place and time. Out of time, out of money and out of my home, it was easy to think how much ‘better’ it would be if I ‘just’ worked as a Family Nurse Practitioner as I was trained to do and could bring home a regular ol’ paycheck for ‘only’ 40 hours. Those questions never last for long, the ‘vision,’ never sleeps, it never relents and it can become all-encompassing and turn us into 4am to 11 pm machines but, occasionally, even entrepreneurs are human

Conversely, our highest point to date has been our attendence at HIMSS 2010 this March. We were selected to present at the Healthcare IT Venture Fair and after an exciting presentation we were no longer unknowns to the major players in the healthcare arena. When big names like Intel, Blue Cross, GE, McKesson, Blank Rome and the United States of America take note of your product and want to engage in investment, customer and business development discussions, you begin to realize that the power of the innovation is becoming recognized. The time since HIMSS10 has been a constant blur of inquiries, customer demos, partner requests, commercialization deals, amazing pilot discussions, customer implementations and, of course, investors.

MARY PAT: Is this a product that can be affordably scaled for any customer, or do you anticipate the ROI being on target for a specific type/size of customer?

MATT: Our product, YourNurseIsOn.com, is a Software as a Service (SaaS) product that helps allocate the right healthcare staff, where they are needed, when they are needed there, by instant, 2-way text, phone and/or email communications. We are a Software as a Service (SaaS) platform that allows for quick and easy adoption, keeps customer costs low and removes their maintenance responsibilities.

We offer a number of value propositions for the customers including faster speed of fulfillment, decreased nurse vacancy, reduced overtime spending, increased patient-provider contact hours, improved patient outcomes, license management, call order adherence, expanded communications capabilities and amazing compliance reporting performance. Flexible scheduling, with all the extra communications needed, has become a best practice for healthcare workforce recruitment and retention. YourNurseIsOn.com makes these communications effortless. For organizations that rely on communicating with a distributed workforce, to operate around the clock, our solution is quickly becoming indispensable.

The ROI metrics are being compiled presently and should prove to be favorable for any size organization. We expect the return on investment period to be very brief as we can provide over 8 hours of phone calling in under 30 minutes and provide the 2-way text and email channels for improved efficiencies. Our soon to be announced pilot with a nationally recognized health provider network will soundly demonstrate our scalability for any sized facility, organization or governmental body.

MARY PAT: Where do you want YNIO to be in 5 years?

MATT: YourNurseIsOn.com is focused on excellent customer experience, and service, for every single client that engages our services, and we will continue with that focus relentlessly as we continue to grow and scale our platform. YourNurseIsOn.com is well poised to become the de-facto communications method for healthcare organizations that need to contact and confirm their specialized, distributed workforces on demand. The ability to easily reach specific individuals, that are qualified and available for a specific function, in a quick and easy manner on any device of their choosing will only become more important given the coming increases in healthcare demand and simultaneous scarcity of all healthcare providers. YourNurseIson.com has the ability to efficiently deliver caregivers where they are needed, not only in institutional settings, but in the communities where the majority of care is being delivered. YNIO, with its international patent -pending status will be the communications ‘glue’ that holds it all together.

MARY PAT: Many people are predicting that NPs and other mid-level providers will be the future of primary care if physician shortages play out as expected.  What do you think?

MATT: Personally, as a nurse practitioner, I feel that this is all too often the focus of discussions about the future of healthcare and is, just as often the beginning of contentious debate that ends in a turf war between doctors and other providers. I do not believe that either of us are the future of healthcare. I believe that we cannot possibly train sufficient numbers of providers to care for the onslaught of demand that is quickly approaching. The future of primary care will lie in the hands of the individual, their families and their communities. This will be supported by tele-medicine, bio-sensors and smart homes to begin and eventually lead to caregiver robots and software algorithms diagnosing and treating your ailments:

• A wristwatch, scale and shoes that track your fitness regimen, downloaded nightly into your Personal Health Record and gently recommending tomorrow’s diet or workout schedule.
• Personal reminder software to gently prod you to take your medicine, engage in physical activity or to remember a wellness event or medical appointment.
• Accentuated reality software to help make informed dietary, activity or purchase selections based on wellness scales, provider recommendations or personal preferences.
• The ability to export this information to your Electronic Health Record to share with your providers, specialists or family
• A smart home with a bed that signals that Grandma woke up later than usual after a restless night, a chemical sensor toilet that signals she may be a bit dehydrated, a pill bottle that alerts when she hasn’t opened it- these types of events triggering personal reminders, check-in requests to a neighbor, visit requests to family, or send an alert to her community caregivers, etc. If no one is able to check on her status, emergency services could be automatically notified.

Couple these technologies with instant, 2-way, verifiable communications systems, and these networks will provide the bulk of care in the near future. There simply are not enough resources to provide care any other way. I hope to see NPs continue to expand their roles, earn autonomy and continue to provide excellent care to millions of people. NPs, MDs, therapists, etc. are all going to be in short supply and high demand. All of these professionals are important to the healthcare delivery team and will have to be allocated with, supported by and communicated to with advanced technologies to expand their practice reach, improve their collective effectiveness, begin to decrease costs, and continually improve outcomes.

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It was a real pleasure talking with Matt and getting to know more about YNIO and more about him (the geek in me enjoyed the geek in him!)  I truly appreciate how open he was in the interview. Thanks, Matt!

The YNIO (Your Nurse Is On) website is here. Matt recently guest posted on HealthcareIT Today which can be found here. You can connect with Matt here:

Email
Twitter
LinkedIn

The Centers for Medicare & Medicaid Services (CMS) will hold a Special Open Door Forum (ODF) to discuss Medicare provider enrollment issues. During this call, CMS staff will discuss:

• The May 5, 2010 provider enrollment regulation titled, “Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements (CMS-6010-IFC)”
• Medicare ordering and referring issues, including physician notification
• Documentation requirements
• Internet-based Provider Enrollment, Chain and Ownership System (PECOS)
• Physician, non-physician practitioner, provider and supplier organizations
• Upcoming availability of Internet-based PECOS for DMEPOS suppliers
• Pharmacy accreditation issues
• Advanced diagnostic imaging accreditation
• Provider and supplier reporting responsibilities
• Revalidation efforts

Afterwards, there will be an opportunity for the public to ask questions.

May 19, 2010
3:00PM – 5:00PM ET
2:00 PM – 4:00 PM CT

Open Door Forum Instructions:

Capacity is limited so dial in early. You may begin dialing into this forum as early as 2:45 PM ET.

Dial: 1-800-603-1774

Reference Conference ID 61448973

Read my post on the date change for PECOS enrollment that relates to CMS-6010-IFC here.

1. How would you describe a work environment that fits your personality best?
2. What are the signs that an employer is good to work for?
3. What do you consider your pet peeves in the workplace?
4. How do you learn best? Seeing? Doing? Hearing? Taking Notes? One-on-one? In groups?
5. Do you have a computer at home? What do you use it for?
6. What computer programs have you used most?
7. What might make you angry at work?
8. Do you prefer to have a window visible from your workstation?
9. What’s the best vacation you ever took in your life?
10. What’s the worst vacation you ever took in your life?
11. What do you know about our practice?
12. What do you think the responsibilities of this job are?
13. What do you think compassion is?
14. How do you have compassion for a patient who is yelling at you?
15. Have you ever been asked to do something at work that made you uncomfortable? What was it and how did you handle it?
16. What’s the best present you ever received?
17. What’s the worst present you ever received?
18. What was the very first job you had as a young person where you got paid?
19. Is it difficult for you to see people in pain?
20. If you were asked to bring a home-cooked dish to a work gathering, what would you make?
21. How would you describe appreciation in the workplace?
22. What are some ways you like to be appreciated?
23. Give me an example of a project that you made a significant contribution to (at work or any other environment.)
24. Tell me something about yourself that would surprise me.
25. What was your favorite task at your (present or last) job?
26. What was your least favorite task at your (present or last) job?
27. What skill that you learned at another job do you think you could use in this job?
28. What interests you about this practice?
29. How do you define compassion?
30. If you consider yourself a compassionate person, describe how you display it.
31. Do you enjoy movies? What kind?
32. Do you enjoy books? What kind do you like?
33. What is your best mechanism for relieving stress?
34. Have you ever collected money from people as a part of a job?
35. What do you wish you could learn to do if you had the chance?
36. What do you think your current/last boss would say about your job performance?
37. What’s your favorite outdoor activity?
38. Describe a failure that taught you something.
39. What is your response to someone who is verbally threatening you?
40. Who (outside of a family member) has taught you the most?
41. Have there been tasks at previous jobs that you enjoyed that others didn’t? What were they?
42. What’s the best team you’ve been on and why?
43. What would you do about a close co-worker who isn’t pulling her weight and is making you work harder?
44. Based on your work experiences, what is one thing most employers could do better?
45. What do you hope to gain from this job?
46. What in your life are you passionate about?
47. What is offensive to you in the workplace?
48. What do you think “being to work on time” means?
49. Tell me about a special pet you’ve had or have now.
50. Why do you/do you want to work in healthcare?
51. What have you heard about us as a company?
52. Name 5 things you could do with a cantaloupe besides eat it.
53. What is the best employment benefit you’ve ever received at a job?
54. What’s the hardest thing you’ve ever been asked to do at work?
55. What makes you laugh?
56. What accomplishment are you proudest of?
57. What do you think the expression “rolling with the punches” means?
58. Describe a situation (work or non-work) when you were the team leader.
59. What would you do in a situation where a problem occurs over and over again without anyone taking steps to fix it?
60. Describe your current boss/last boss using three words.
61. What do you think it means to give someone “the benefits of the doubt”?
62. What is the best conference or seminar you’ve ever attended, either for work or outside of work?
63. How would you handle a co-worker who uses language that you feel is inappropriate in the workplace?
64. Do you consider yourself a detail person? If so, give an example of your attention to detail.
65. What motivates you to go the extra mile in the workplace?
66. When was the last time that you felt you really made a difference at your job? Please describe.
67. What’s your favorite sports team?
68. What do you think the expression “It is what it is” means?
69. What kind of music do you like?
70. Do you play any musical instruments?
71. What would you do if your boss had really horrible bad breath?
72. How do you define professionalism?
73. Do you think you are good with money? if so, why?
74. How do you know when it’s time to schedule a mental health day?
75. If you were asked to choose between writing a report by yourself, giving a report at a staff meeting or being part of a team writing a report, which would you prefer to do?
76. What’s your favorite soft drink and why?
77. If you were in charge of collecting money for an office function and one person never paid up, how would resolve this?
78. Do you consider yourself good with technology?
79. Describe the last time you had to ask your supervisor for help.
80. What do you think irritates others about you?
81. Do you have any problems remembering to clock in and out daily?
82. Do you any trips or time off already scheduled going forward?
83. What’s the favorite city or house you’ve ever lived in?
84. Would you be available to work overtime if needed?
85. What type of co-worker is the hardest for you to deal with?
86. What do think are the signs of a well-run office?
87. Have you ever made a suggestion at work that you thought was “out of the box”?
88. Are you a good speller?
89. What is the dress code at your current/former employer?  What do or don’t you like about it?
90. What do you think “casual day or dress down day” means?
91. What questions do you have for me?

Questions for Supervisors:

1. What do you find hardest about supervising people?
2. Give me an example of a situation where you made an exception to an office policy and why.
3. What is the best way to handle a face-to-face patient complaint?
4. What do you think should be the first priority for the person in this position?
5. How do you stop people from gossiping in the office?
6. What is your personal philosophy on customer service?
7. What do you do when you find your stress level increasing?
8. What’s your favorite trick for staying organized?
9. Is there ever any situation when you think it is appropriate to share something an employee said to you in confidence?
10. What’s your favorite technique for achieving a win/win outcome to a problem?

Let me know about any great questions you think should be added to the list!