Many practices and providers take their patient schedule for granted. They overlook the opportunity to improve both productivity and effectiveness by managing their schedule. Here are ten tips for office managers to make sure that the patient schedule works for you and for your practice.
1. Evaluate the schedule template with the providers and nurse manager quarterly.
By using actual issues from the previous period, discuss what has worked and what has not. Have providers share their concerns and
discuss their recommendations for change. Nursing often has many ideas to improve the flow of patients through the practice and is a valuable source of information. Keep track of changes made and evaluate their effectiveness at the following meeting.
2. Standardize visits types.
There are many reasons an individual provider likes their own schedule. As managers, we know that this makes it very difficult for the front desk staff to do their jobs. Standardization reduces the potential for errors and disruption that proprietary schedules may cause. Your role in the discussion with providers will be that of facilitator, staff advocate, and coach.
Bring forward options for standardized visit types. Many practices use a block template based on 10, 15 or 20-minute blocks of time. The number of blocks used per visit type are agreed to and used to fill the schedule. There may be additional restrictions placed on the schedule such as no more than one new patient per half-day session. Minimize the number of restrictions or ideally eliminate them to assure your days are as flexible as possible to meet your patient needs. You may also want to consider open access scheduling. Moving to this system often takes time and effort to eliminate the backlog of booked patients but once fully in place can be very successful.
3. Track scheduling errors and issues perceived to be scheduling errors monthly.
Errors in scheduling cause patient dissatisfaction, back up your waiting room, and lead to stress and possibly short tempers. Ask providers and staff to tell you when they think patients are scheduled incorrectly. Track this over time to determine if changes in the system are needed, how visit type use can be improved, and what training may be needed.
4. Know where scheduling bottlenecks are.
What is your average wait time in the office per provider? Do a time study on each provider and measure how long it actually takes for a patient to get through an office visit. Note the time they arrive for check in and registration functions, their time in the waiting room, when the nurse completes check in functions in the exam room, when the provider enters the exam room, when the provider leaves the exam room and when the patient exits the office. Overlay this on your schedule. The information you gather will help you identify bottlenecks and provide meaningful data to share with your providers when recommending a change in the schedule template.
5. Know how much a visit is worth in revenue.
Adding one visit per day by addressing schedule gaps, clinical start times, no-show appointments or changing the length of visits will increase your revenue. If your provider works four days per week and 48 weeks per year at an average visit reimbursement of $75, one additional visit per day will add $14,400 in annual revenue to the bottom line!
6. Train your scheduling staff and update the training regularly.
Training a new staff member often brings up questions the entire staff can benefit from. Be sure to keep track of questions and include answers in future written training materials as well as in staff meeting discussions. Develop a training checklist for scheduling staff and have both the trainer and new employee initial when each area is mastered. This checklist can also be used for annual performance reviews. For current staff, take a look at their computer terminals and see what sticky notes are posted there, indicating areas that need special consideration or additional training.
7. Have the schedule be a frequent agenda item for staff meetings.
Get the staff perspective on what is working and what is not on a regular basis. You may find that nursing can provide a great deal of information on how the schedule impacts patient flow from their perspective. Take time for staff to discuss what if scenarios and how they would handle a particularly difficult situation. The goal is to have a schedule that staff understands, is user friendly and is consistently used.
8. Have a policy on the number of providers out at one time for vacation or holidays and follow it.
Everyone deserves time off but having many providers out at once can lead to a very hectic week for those remaining. Plan as much in advance as possible for time away. If you do end up with a number of providers out at once, remember that the person remaining will also be responsible for reviewing lab and radiology results for their colleagues as well as answering questions regarding patients that they may not know. Allow extra time in the schedule for this.
9. Know what changes in demand to expect during the year and plan for it.
Do you have more requests for acute visits in January, camp physicals in April, or school sports physicals in August? Minimize last minute adjustments to your schedule by knowing any seasonal trends in scheduling. Take a look at the schedules from past years to predict when you need more or less acute slots and adjust your schedule template for this. Manage the time youve allotted by marketing efforts in the office and local papers reminding your patients to schedule in advance.
You may also want to consider adding additional clinical hours during this time to make sure you can meet demand. Consider asking part time providers for extra hours per week or using per diem staff.
10. Deal with your patient no-shows.
Consider writing a policy on no-shows if you do not have one. If you have one, follow it. Make sure that your policy follows any state regulations to avoid patient abandonment claims.
Educate your patients. Develop a set of professional communications about your visit cancellation and no-show policy that begin with your welcome to the practice letter. Post a notice of your policy in your waiting room. Send letters following each no-show and then the termination letter stating the reason for the termination and that the patient is still responsible for their account balance. Be the contact person on the letter so that if the patient calls with questions, they speak with you rather than take up provider time or that of your staff.
If you have a patient that consistently no-shows but the providers do not want to terminate them from the practice, determine what other help you can provide to get the patient to the visit on time. Consider additional reminder calls, assistance with other services such as transportation, or offering the ability to come in and wait without a scheduled time. Though this may take more staff time, the revenue from the appointment should make it worth your while.
Donna Izor, MS, FACMPE is founder of West Pinnacle Consulting, LLC. Her 20 years of experience as a medical practice executive lends her special expertise in the areas of primary care and specialty practices, employed inpatient physicians, regulatory oversight, facility design, physician compensation and relations, and new program development. She has worked with academic, community hospital, and private practices. You can contact Donna at firstname.lastname@example.org.
NOTE: The date has been
changed to July 5, 2011 has been delayed indefinitely.
Many managers have told me they know their providers are in PECOS but they’re not on the list OR they never enrolled their providers but they are on the list OR they’ve sent their paperwork and have not heard back for 2, 4, 6 weeks – should they be worried? The CMS website says “It is possible that it could take 45-60 days, sometimes longer, for Medicare enrollment contractors to process enrollment applications,” so I guess we all need to chill out a little.
The massive undertaking of qualifying every single healthcare professional who refers/orders or provides medical services to Medicare patients in order to sift out those who would lie about providing goods and services is fraught with confusion, miscommunication and misunderstanding. That’s okay, though, because CMS says no checks for services or goods will be withheld due to providers not being listed in PECOS, at this time. They know it’s a mess and it will take quite a while to get everyone straightened out, on the list and able to get checks from CMS if and only if their name is on the list.
Below is the CMS fact sheet published last week.
Medicare Enrollment Guidance for Physicians that Infrequently Receive Reimbursement from the Medicare Program
Traditionally, most physicians have enrolled in the Medicare program to furnish covered services to Medicare beneficiaries. However, with the implementation of Section 6405 of the Affordable Care Act, some physicians will need to enroll in the Medicare program for the sole purpose of certifying or ordering services for Medicare beneficiaries. These physicians do not send claims to a Medicare contractor for the services they furnish.
In the process of implementing the provisions contained in the Affordable Care Act, we have become aware of several unique enrollment issues for certain types of physicians or practitioners. Specifically, we have modified the process of enrollment to accommodate the special circumstances of the following individual physicians and practitioners:
- Physicians employed by the Department of Veterans Affairs
- Physicians employed by the Public Health Service
- Physicians employed by the Department of Defense Tricare program
- Physicians employed by Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) or Critical Access Hospitals (CAHs)
- Physicians in a Fellowship
- Dentists, including oral surgeons
This document provides guidance to those practitioners.
Q: How can I verify whether I am already enrolled in PECOS?
A: If a physician is concerned or uncertain about whether s/he is actually enrolled in the Provider Enrollment, Chain and Ownership System (PECOS), s/he can review the Ordering and Referring file found in the download section of the “OrderingReferringReport tab (click here) on the Medicare Provider and Supplier Web Site.
Providers and suppliers can check with the ordering or referring physician to see if the physician is currently seeing Medicare patients and the physicians claims are being paid. Until we advise otherwise, your orders and referrals will not be rejected due to the lack of an approved enrollment record in PECOS.
Q: I am a physician employed by the Department of Veterans Affairs, Department of Defense Tricare program, by the Public Health Service, an FQHC, an RHC, or a CAH. Do I need to enroll in PECOS to order and refer items or services for Medicare beneficiaries?
A: Yes, but we have abbreviated the enrollment process and documents for physicians employed by the Department of Veterans Affairs, the Public Health Service, the Department of Defense Tricare program, an FQHC, an RHC, or a CAH. However, because this is a unique solution to enrollment for a specific set of physicians, our systems will not accommodate the abbreviated forms on-line. Therefore, any physician employed by the Department of Veterans Affairs, the Public Health Service, the Department of Defense Tricare program, an FQHC, an RHC, or a CAH, who is not already enrolled in PECOS, must use the paper enrollment application process
and do the following:
Complete the following sections of the paper CMS-855I, Medicare Enrollment Application for Physicians and Non-Physician Practitioners and mail the completed form to the designated Medicare enrollment contractor:
- Section 1 Basic Information (they would be a new enrollee)
- Section 2 Identifying Information (section 2A, 2B, 2D and if appropriate 2H and 2K)
- Section 3 Final Adverse Actions/Convictions
- Section 4C/4E Practice Location Information (same as section 2B)
- Section 13 Contact Person
- Section 15 Certification Statement (must be signed and datedblue ink recommended)
- Section 17 Supporting Documentation (cover letter stating the provider is only enrolling to order and refer services to a beneficiary)
Note: Physicians who are employed by the Department of Veterans Affairs, the Public Health Service, the Department of Defense Tricare program, an RHC, FQHC, or CAH are not required to include the Electronic Funds Authorization Agreement (CMS-588) or the Medicare Physician and Supplier Agreement (CMS-460) with the enrollment form.
Q: I am a physician in a fellowship program. Do I need to enroll in PECOS?
A: If you are a physician in a fellowship, and licensed in the State, you can enroll in Medicare for the sole purpose of ordering or referring items or services for Medicare beneficiaries. To enroll as a referring and ordering physician-only you would need to complete the abbreviated enrollment application form in the same way as other physicians (VA, DoD, PHS, FQHC, RHC CAH) who are enrolling to order and refer only (see previous question.) If you elect to enroll to order and refer only, you would not be enrolled in Medicare for the purpose of providing Medicare services to Medicare beneficiaries. In order to provide covered services to Medicare beneficiaries, a physician would need to complete the full enrollment application either on-line or in hard copy.
Q: I am an Oral Surgeon or Dentist. How do I Enroll in PECOS?
A: Dentists, including oral surgeons, must enroll in the Medicare program to receive reimbursement for services furnished to Medicare beneficiaries or to order covered items or services for Medicare beneficiaries. Oral surgeons would complete the same paper forms, or on-line application, as any other practitioner enrolling in PECOS.
If you elect to enroll as a referring and ordering physician-only, you would need to complete the abbreviated enrollment application form in the same way as other physicians (VA, DoD, PHS, FQHC, RHC CAH) who are enrolling to order and refer only (see previous two questions.) If you elect to enroll to order and refer only, you would not be enrolled in Medicare for the purpose of providing Medicare services to Medicare beneficiaries.
In order to provide covered services to Medicare beneficiaries, a dentist, including oral surgeons, would need to complete the full enrollment application either on-line or in hard copy.
Note: In completing the enrollment application portion dealing with specialty, oral surgeons would check the oral surgery (dentist only) box found in section 2 of the Medicare enrollment application and any other dentist would check the box titled, Undefined Physician Type and specify that they are a dentist in the space provided. In the near future, we will revise the Medicare enrollment application to add Dentist as a physician specialty.
Physicians and practitioners who are employed by the Department of Veterans Affairs, the Defense Department, the Public Health Service, an RHC, FQHC, or CAH must complete the paper enrollment application that has been modified and shortened to accommodate the special situation of these professionals. All other physicians and practitioners who furnish services to Medicare beneficiaries must enroll in the Medicare program to receive reimbursement and order/refer in the Medicare program. For those physicians and practitioners using the on-line process, we have developed a document that will help you through the PECOS enrollment process. It will be easier to complete the process if you review this document before you begin the enrollment process.
- The document titled, Internet-based PECOS — Getting Started Guide for Physicians and Non-Physician Practitioners can be found here.
- Although you are permitted to complete your enrollment application in hard copy, it will be easier and quicker if you use the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) to complete the Medicare enrollment process. The Internet-based PECOS application is completed via the web here.
- After submitting an enrollment application via Internet-based PECOS, you must:
- Print, sign and date (blue ink recommend) the Certification Statement(s), and
- Mail the Certification Statement(s) and applicable supporting documentation to the designated Medicare contractor (no later than 7 days after you complete the online portion.)
- NOTE: The Medicare contractor will not be able to begin to process your enrollment application until it receives a signed and dated Certification Statement.
Additional Medicare Enrollment Information
To ask a provider enrollment question, contact the Medicare contractor for your State. Medicare provider enrollment contact information for each State can be found here.
To report Internet-based PECOS navigation, access, or printing problem with Internet-based PECOS, contact the EUS Help Desk at 1-866-484-8049 or send an e-mail to the EUS Help Desk to EUSSupport@cgi.com
For additional information regarding the Medicare enrollment process, visit the website here. Of course, if you have any additional questions about the Medicare enrollment process, you can contact the designated Medicare contractor for your state.
If you haven’t started yet but plan to use the online process to enroll your providers or yourself, here’s a really excellent SlideShare presentation by David Zetter that steps you through the enrollment process by showing screen shots of each step. You can contact David Zetter here.
I was fortunate enough to be listening by phone to the historic (yes, historic) announcement of the final meaningful use rules by Kathleen Sebelius, Secretary HHS; Don Berwick, MD, new CMS Administrator; David Blumenthal, MD, national coordinator for health information technology at HHS; Regina Benjamin, MD, Surgeon General and a surprise speaker, Regina Holliday, artist and activist for patient rights.
The memorable quotes I wrote down were:
Kathleen Sebelius: “When electronic health records are well-designed and implemented correctly, they can be a powerful force for reducing errors, lowering costs, raising quality of care, and increasing doctor and patient satisfaction.” That is the best one-sentence description of “Why EHR?” I’ve ever heard.
Don Berwick: “If it’s (EHR) so good, why doesn’t everyone use it? Because it’s HARD.” There is a little slice of honesty that you won’t get from most EHR vendors.
David Blumenthal: “We are only as good in treating patients as the information we have.” Wow, an admission that could rock the medical world if we stopped and thought about it.
Regina Holliday: “I will not stop until we all have the right see our own information.” Regina’s Medical Advocacy Blog is here. Her lauded mural “73 Cents” refers to how much per page she was told by the hospital medical records department she would have to pay to get a copy of her husband’s records while he was still in that hospital.
The Meat: Specifics of Stage 1 Meaningful Use (2011 and 2012)
Meaningful use includes both a core set and a menu set of objectives that are specific for eligible professionals and hospitals.
For Eligible Professionals (definition here), there are a total of 25 available meaningful use objectives. 20 of the objectives must be completed to qualify for an incentive payment. 15 are core objectives that are required, and the remaining 5 objectives may be chosen from the list of 10 menu set objectives.
For Hospitals, there are a total of 24 available meaningful use objectives. 14 are core objectives that are required, and the remaining 5 objectives may be chosen from the list of 10 menu set objectives.
Stage 1 (2011 – 2012) sets the baseline for electronic data capture and information sharing.
Stage 2 (est. 2013) and Stage 3 (est. 2015) will continue to expand on this baseline and be developed through future rule making.
(full article from New England Journal of Medicine here)
As I am sure you expect, there will be much more information to come.
U.S. Department of Health and Human Services
WHO: Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services Donald Berwick, M.D, Administrator, Center for Medicare & Medicaid Services David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology Regina Benjamin, M.D., M.B.A., Surgeon General
WHEN: Tuesday, July 13, 2010 10:00 a.m. EDT
WHERE: Great Hall, Hubert H. Humphrey Building 200 Independence Avenue, S.W., Washington, D.C. 20201
Call in: 800-857-6748 Verbal Passcode: HHS
Note: I am republishing this to my email subscribers because none of the links worked the first time around. I’ve fixed everything now – so sorry for the error – must have been healthcare fatigue!
I’ve noticed that a lot of people in healthcare seem unusually tired and even, if I dare say so, somewhat cranky. This includes me. I’ve decided we’re all suffering from healthcare fatigue – fatigue from dealing on a daily basis with so much change, uncertainty, and financial stress. Here’s my top ten list of healthcare management stressors accompanied by posts I’ve written that discuss the topic or suggest resources for the challenge.
10. Red Flags Rules – on again, off again, patients don’t want to have their pictures taken or let you copy their driver’s licenses.
- Red Flags Rules (RFR) Delayed for the Fifth Time This Time Until December 31, 2010
- Red Flags Rule and Identity Theft Prevention: You Dont Have To, But You Should!
9. HIPAA - don’t be fooled, HIPAA is not something we handled years ago and it’s taken care of; there are new requirements and penalties associated with HIPAA breaches. HIPAA is a biggie and something that now infiltrates almost every facet of healthcare.
8. Employment Uncertainty – both for you and your staff – the aftermath of layoffs can be even more demoralizing to those who didn’t lose their jobs. Also, many healthcare entities are still freezing raises. If I hear one more time “we’ll just have to do more with less” I might just scream.
- My Take on 10 Ways to Keep Employees Happy in Medical Practices
- Dear Mary Pat: Should Staff Be Allowed to Use The Internet on Their Smart Phones at Work?
7. Unrealistic Workloads – directly related to #9, most staff and managers have much more work to do than they did just two years ago. Couple that with the ability for managers to be available and work by computer, phone, text message, email or Skype 24/7 and you have fatique that you understand only when you truly, truly stop and wind down for more than three days at a time.
6. Hospitals Buying Practices – this could be a good thing or a bad thing, but as you and I know, change is completely unnerving to most people. Hospitals have very different cultures than private practices and trying to marry the two takes skill, patience and excellent leadership.
5. Stimulus Money for Using EMRs – it’s a big decision and many practices are very nervous about purchasing an EMR. Many think that meaningful use components are unrealistic and even more are fearful of the inevitable productivity drop when the EMR is implemented and for months afterwards.
- ARRA Eligible Providers: Who Is Eligible to Receive Stimulus Money and How Much is Available Per Provider?
- FAQ on HITECH, Meaningful Use, Eligible Providers, and the Stimulus Money
- Ten Reasons Why (Some) Physicians Arent Rushing to Adopt EMRs
- Electronic Medical Record Guru Rosemarie Nelson Reveals Best EMR Product on the Market Today
4. Unhappy Patients – lots of patients are also trying to do more with less (argghhh!) and are avoiding coming to the doctor whenever possible. The front desk staff and the phone staff in particular are getting a lot more heat when they inform patients they’ll have to make an appointment.
- 50 Customer Service Ideas to Treat Your Patients to Friendly, Easy and Unexpected Service
- How To Be A Billing Advocate for Your Patients
- How to Apologize to a Patient
- A Memo to the Staff: The Preciousness of Patients
3. PECOS – be glad if you don’t know what PECOS stands for, or be very, very afraid.
- Providers Without a PECOS Record Will Receive a Letter From Their Medicare Administrative Contractor (MAC)
- My Notes from the CMS Open Door Forum on May 19, 2010: PECOS, DMEPOS and Blue Ink on Paper Forms
- Is Your Practice Ready for the 60-Day PECOS Countdown?
2. Medicare Reimbursement – this year has been as exhausting as watching a single point of ping pong played for hours – there will be cuts, there won’t be cuts, there will be cuts, there won’t be cuts. Gird your loins as the November 30 deadline looms for the next potential cuts.
- Deja Vu All Over Again: The Medicare Fee Cut is Pushed Back to November 30, 2010
- Attention Medical Practice Staff: Medicare Changes the Rules for Credentialing and Retro-Billing
- 91 Physician Organizations Sign Statement Naming Congress in Mismanagement of the Medicare Program and Imploring it to Honor its Obligation
1. The Bottom Line – we have RAC audits, more pre-certification and pre-authorization and pre-notification requirements, more denials, high deductible plans, formularies and 50 other things that are making it difficult to know which hoop to jump through to get paid. Expenses continue to go up, reimbursement continues to go down, and the healthcare world spins faster and harder, making us all wonder when it will, or if it ever will slow down.
For more information on the Medicare accreditation requirement for entities billing the technical component for advanced diagnostic imaging (CT, MRI, PET/Nuclear Medicine) effective January 1, 2012, read my post here.
Medicare Learning Network (MLN) just released MM6912, effective August 2, 2010: Mailing To All Individual Practitioners, Medical Groups and Clinics and Independent Diagnostic Testing Facilities (IDTF) Who Are Billing or Have Billed For The Technical Component of Advanced Diagnostic Imaging Services
What exactly is an IDTF?
Some suppliers that perform diagnostic tests, other than clinical laboratory or pathology tests, are required to enroll with Medicare as an Independent Diagnostic Testing Facility (IDTF). Not all suppliers that perform these diagnostic tests are required to enroll as an IDTF. Generally, entities can bill for the technical component of the diagnostic tests without an IDTF enrollment if it has the following characteristics:
- A physician practice that is owned, directly or indirectly, by one or more physicians or by a hospital
- A facility that primarily bills for physician services and not for diagnostic tests
- A facility that furnishes diagnostic tests primarily to patients whose medical conditions are being treated or managed on an ongoing basis by one or more physicians in the practice
- The diagnostic tests are performed and interpreted at the same location where the practice physicians also treat patients for their medical conditions
- If a substantial portion of the facility’s business involves the performance of diagnostic tests, the diagnostic testing services may be a sufficient separate business to require enrollment as an IDTF. In that case, the physician or physician group practice can continue to be enrolled as a physician or physician group practice but are also required to enroll as an IDTF. The physician or group can bill for professional fees and the diagnostic tests they perform on their patients using their billing number. Therefore, the practice must bill as an IDTF for diagnostic tests furnished to Medicare beneficiaries who are not regular patients of the physician or group practice.
Who will receive a mailing?
Enrolled physicians, non-physician practitioners, including single and multi- specialty clinics, and IDTFs who have billed the Medicare program for the technical component of advanced diagnostic testing services within the preceding six month period and who continue to have Medicare billing privileges with Medicare contractors (carriers and Part A/B Medicare Administrative Contractors (A/B MACs)) are affected.
If you have billed the Medicare program for the technical component of advanced diagnostic testing services within the preceding six month period and continue to have Medicare billing privileges with Medicare contractors, you will receive a letter from your Medicare contractor advising you of the need to become accredited by January 1, 2012, in order to continue to provide these services and bill Medicare.
When more than one physician or non-physician practitioner is operating within a group, such as a single specialty or multispecialty clinic, only the group will receive the letter, not each of the individual physicians or non-physician practitioners working for the group.
What will the mailing say?
You must be accredited by one of the three Centers for Medicare & Medicaid
Services (CMS) approved national accreditation organizations by January 1, 2012,
in order to be eligible to continue to furnish the technical component of advanced
diagnostic testing services to Medicare beneficiaries and submit claims for those
services to your Medicare contractor.
Your contractor will be mailing the letter quarterly beginning with July 2010 through July 2011. If necessary, follow the instructions in the letter to become accredited by January 1, 2012, in order to continue billing for the technical component of advance diagnostic imaging services. Make sure that your office staffs are aware of these new accreditation requirements and begin the accreditation process as soon as possible to protect your Medicare billing rights for these services.
Why do IDTFs have to become accredited now?
Section 135(a) of the Medicare Improvements for Patients and Providers Act of
2008 (MIPPA) amended section 1834(e) of the Social Security Act and required
the Secretary, Health and Human Services, to designate organizations to accredit
suppliers, including but not limited to physicians, non-physician practitioners and
Independent Diagnostic Testing Facilities, that furnish the technical component
(TC) of advanced diagnostic imaging services.
What qualifies as an advanced diagnostic imaging procedure?
MIPPA specifically defines advanced diagnostic imaging procedures as including:
Diagnostic magnetic resonance imaging (MRI),
Computed tomography (CT), and
Nuclear medicine imaging, such as positron emission tomography (PET).
MIPPA expressly excludes from the accreditation requirement x-ray, ultrasound,
and fluoroscopy procedures. The law also excludes from the CMS accreditation
requirement diagnostic and screening mammography, which are subject to quality oversight by the Food and Drug Administration under the Mammography Quality Standards Act.
How long does it take to become accredited?
Since CMS expects that it may take as much as nine months from the time you initiate the accreditation process to completion, you should begin the accreditation process for advanced diagnostic imaging services as soon as possible, but not later than March 2011.
Who are the accrediting organizations?
CMS approved three national accreditation organizations — the American College
of Radiology, the Intersocietal Accreditation Commission, and The Joint
Commission — to provide accreditation services for suppliers of the TC of advanced diagnostic imaging procedures. The accreditation will apply only to
the suppliers of the images themselves, and not to the physician interpreting
the image. All accreditation organizations have quality standards that address the safety of the equipment as well as the safety of the patients and staff.
If you have questions, contact your Medicare carrier and/or A/B MAC at
their toll-free number, which may be found here (zip file.)
The letter will look like this:
[Supplier Name and Address]
Dear Physician/Non-Physician Practitioner/IDTF owner:
In accordance with Section 135(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), suppliers, including but not limited to physicians, non-physician practitioners and Independent Diagnostic Testing Facilities that furnish the technical component (TC) of advanced diagnostic imaging services must be accredited by January 1, 2012 in order to continue to furnish these services to Medicare beneficiaries.
Our records indicate that you have furnished advanced diagnostic imaging procedures such as diagnostic magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging such as positron emission tomography (PET) within the last six months. If you are not accredited by one of the organizations shown below by January 1, 2012, you will not be eligible to bill the Medicare program for advanced diagnostic imaging services. This letter requests that you take the necessary action to become accredited by the January 1, 2012 deadline. Since we expect it can take up to nine months from the time you initiate the accreditation process to completion, we urge you to begin the accreditation process for advanced diagnostic imaging services as soon as possible.
MIPPA expressly excludes from the accreditation requirement x-ray, ultrasound, and fluoroscopy procedures. The law also excludes from the CMS accreditation requirement diagnostic and screening mammography which are already subject to quality oversight by the Food and Drug Administration under the Mammography Quality Standards Act.
The Centers for Medicare & Medicaid Services (CMS) approved three national accreditation organizations the American College of Radiology, the Intersocietal Accreditation Commission, and The Joint Commission – to provide accreditation services for suppliers of the TC of advanced diagnostic imaging procedures. The accreditation will apply only to the suppliers of the images themselves, and not to the physician interpreting the image. All accreditation organizations have quality standards that address the safety of the equipment as well as the safety of the patients and staff. The accrediting organization that issues your accreditation will notify Medicare once your accreditation is complete and approved.
To obtain additional information about the accreditation process, please contact the accreditation organizations shown below.
American College of Radiology (ACR)
1891 Preston White Drive
Reston, VA 20191-4326
Intersocietal Accreditation Commission (IAC)
6021 University Boulevard, Suite 500
Ellicott City, MD 21043
The Joint Commission (TJC)
Ambulatory Care Accreditation Program
One Renaissance Boulevard
Oakbrook Terrace, IL 60181
If you have questions about this letter, contact [carrier or A/B MAC phone number/contact person].
[Name of carrier or A/B MAC]
Supplier Billed Advanced Medical Imaging CPT codes for Section 135 (a) of the MIPPA to Receive Accreditation Requirement Notification Letter
70336 70540 71250 72125 73200 74150
70450 70542 71260 72126 73201 74160
70460 70543 71270 72127 73202 74170
70470 70544 71275 72128 73206 74175
70480 70545 71550 72129 73218 74181
70481 70546 71551 72130 73219 74182
70482 70547 71552 72131 73220 74183
70486 70548 71555 72132 73221 74185
70487 70549 72133 73222
70488 70551 72141 73223
70490 70552 72142 73225
70491 70553 72146 73700
70492 70554 72147 73701
70496 70555 72148 73702
70498 70557 72149 73706
70558 72156 73718
70559 72157 7371972158 73720
75557 76360 77011 78000 78811
75559 76376 77012 78001 78812
75561 76377 77021 78003 78813
75563 76380 77058 78006 78814
76390 77059 78007 78815
76497 77078 78010 78816
76498 77079 78011 78891
Report by Frank Cohen
Frank Cohen, MPA, MBB
The Frank Cohen Group, LLC
As many of you may already know, July 1, 2010 CMS released yet another RBRVS (Resource Based Relative Value Scale) data set that will be used to pay physicians under Medicare effective June 1, 2010. This data set includes the 2.2% increase in the CF. This puts the current conversion factor at $36.8729.
The link to the CMS file is here.
The good news is that the Conversion Factor (CF) increased by 2.2%.
The bad news is that for 2,226 procedure code/modifier groups within the database, the RVU (Relative Value Unit) values decreased by anywhere from 0.65% to 50% (or 0.01 to 2.04 RVUs). The median change was only 0.12 RVUs, which in and of itself doesn’t seem like much, but if you add them up, you get a total reduction of 492.95 RVUs for just these procedure codes.
This doesn’t consider frequency of use. For example, procedure code 75825 26 saw a reduction in RVUs of 1.16. In 2008, this procedure was reported to Medicare 60,864 times. That results in a net decrease in RVUs to those practices of 70,602 RVUs. At the current conversion factor, that is a payment reduction of $2.6 million.
In addition to the RVU changes, there were 180 non-RVU changes, including changes to the PC/TC (Professional Component/Technical Component) policies, new records, modified status, etc.
Note: Frank ran a side-by-side analysis of the changes for these procedure codes. If you would like a copy of his worksheet, go to his site and click on the Download tab. Even if you don’t want this file, he has lots of other goodies on his site for free. As always, thanks Frank!
What Makes Us Happy
The bilious oil hemorrhaging from the bowels of the Earth, coupled with the usual stressors of life, makes me feel sad and pessimistic of late. And while Im still pretty sure that ignorance, intolerance, and our polluting routines will be our ruin, I also search for ways to retain optimism and hope. Amid the constant erosion there are basic roots that hold life together. If you share the belief that life is fundamentally absurd, then life is truly what you make it. Are there small steps proven to make us happier?
Psychology often concerns itself with helping ailing people get back to a neutral ground, but the field of positive psychology aims to do more. University of Pennsylvania psychologist Dr. Martin Seligman, positive psychologys most renowned proponent, once said: I realized that my profession was half-baked. It wasnt enough for us to nullify disabling conditions and get to zero. We needed to ask, What are the enabling conditions that make human beings flourish?
To that end, research on happiness, optimism, positive emotions and healthy character traits has been increasing in psychology. Some surprising results challenge our assumptions, such as the fact that once basic needs are met, money does not increase happiness. Neither do high education or high IQ. Older people tend to be happier than young. The sunny weather in California and Florida does not make people happier than those living in colder and cloudier climes.
The trait most shared by happy people seems to be close connections with family and friends, bolstered by a commitment to spending time with them.
Other factors that are associated with happiness include contributing to the lives of others, a good relationship with a spouse, control over ones life and decisions, time for leisure, spirituality or religion, and the holiday periods. The following graphic comes from a Time Magazine article on positive psychology:
The daily activities of life versus the overall experience also effects our opinions of what makes us happy. For example, parents typically consider their children the greatest source of happiness in their lives, but when asked about the day-to-day activities of caring for children, most considered it less than inspiring. One study of 900 women in Texas found that caring for children ranked well below sex, socializing, relaxing, praying or meditating, exercising, and watching TV. In fact, taking care of children ranked below cooking and only slightly above housework. Yet when asked what one thing has brought people the most happiness, children and grandchildren are most frequently cited. There is a difference between the experiencing self and the remembering self.
In addition to the big things in life, are there small steps we can take on a daily basis to improve our sense of happiness? According to positive psychology the answer is yes. Research supports the following measures that increase engagement, pleasure, and meaning:
1) Count your blessings. At the University of California at Riverside, psychologist Sonja Lyubomirsky is using grant money from the NIH to study different kinds of happiness boosters. One is the gratitude journal a diary in which subjects write down things for which they are thankful. She has found that taking the time to conscientiously count their blessings once a week significantly increased subjects overall satisfaction with life over a period of six weeks, whereas a control group that did not keep journals had no such gain.
Instead of only complaining at the dinner table of the things that went wrong at work, recounting three positives each day will produce more happiness in your life. Gratitude exercises also help physical health and may alleviate the distress of chronic pain and illness to some degree.
2) Practice altruism. Volunteering at a hospital, cooking a meal for a friend, letting a stressed mother cut in front of you in the grocery line, mowing a neighbors lawn, sending a care package to a grandparent all these examples of kindness create connections between people, increase your sense of capability, generosity, and perhaps open the door to reciprocal acts that foster community and friendship. Altruism is a fine way of pleasing yourself and others at the same time.
3) Take time to delight in the world. Did you really taste that bowl of coffee ice cream? Did you pause to wonder at the crescent moon and the stars beyond? Did you revel in the moment you pulled up the cotton sheets and felt luxurious in your safe bed before sleep? Living in the moment sensually, intellectually, creatively, wondrously helps to ward off despair.
4) Thanking a mentor in your life is important, and actually benefits you, too. One study showed that writing a letter to someone to whom you owe a debt of gratitude produced positive effects on the writer that were significant for over a month. Of course the recipient of such a letter is thrilled.
5) Forgive others. Writing a letter of forgiveness, whether delivered or not, helps purge negative emotions and desires for revenge. It the first and most important step in moving on.
6) Devote time and energy to relationships. Ties with family and friends are the most consistently cited predictors of happiness. Although the deserted island in the middle of the tropics sounds great, in reality we are fulfilled by the webs we weave and the connections we make throughout life.
7) Use your body. Stretch. Exercise. Laugh. Walk. These things reduce anxiety and improve mood.
8 ) Develop effective coping mechanisms. Hardship, adversity, and tragedy will always be a part of life. Cultivating faith, whether religious or secular, has been shown to help people cope. Even believing a simple dictum like This too shall pass relieves the stress of the moment.
A perpetual state of happiness is not possible. As I write this I finish a fairly crappy day, and I just learned that Medicare (thanks to Senate Republicans) is cutting its payments to physicians by 20%. This will be disastrous for doctors, medical practices, and ultimately patients. But I went for a run today. I ate tasty fish cooked with garlic and tomatoes. I saw a beautiful sky at dusk and basked in a breezy, humidity-free day. I am thankful that I am not in pain, and that I was able to help some people through my work.
Flourishing isnt easy, and positive psychology sounds like fluff when you are in the dumps, but its worth a Sisyphean try to be happy.