What are the hallmarks of a well-managed practice? There are many, but here are 10 basics.
- The practice has foundation documents appropriate to the corporate structure and written agreements describing how income and expenses are shared by physicians and/or other providers and how partners enter and exit the practice. The owners of the practice and management meet monthly.
- The practice has documents that set the guidelines for operations such as a compliance plan, disaster plan, personnel handbook, job descriptions and requirements for annual evaluations, raises, bonuses and progressive discipline. Management and staff meet monthly.
- The net collection percentage is 95% or more. This means that of the expected collectible dollars, 95% is collected.
- The practice has a budget and variances are addressed.
- The unfilled appointment percentage is 5% or less. This is in retrospect, so it includes no-shows. The practice has a marketing budget and a written marketing plan.
- The practice has a line of credit or other means to draw upon in the case of unexpected cash flow drop.
- A single commercial payer comprises no more than 50% of the practice business.
- Employee turnover rate is 10% or less. New employees are onboarded with training, coaching and competency testing.
- The practice has the ability to produce management reports to track and trend production, payments, adjustments, and denials. Process Improvement (PI) is used to address negative trends.
- Patient satisfaction is prioritized and measured, and improvement is valued.
What other hallmarks would you add?
Alcohol Misuse Screening and Depression Screening
On July 19th, the Centers for Medicare & Medicaid Services (CMS) proposed to add alcohol screening and behavioral counseling, and screening for depression, to the comprehensive package of preventive services now covered by Medicare. These proposed national coverage determinations (NCDs) are issued under authority granted by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which allows CMS to add coverage of new preventive benefits that are recommended by the U.S. Preventive Services Task Force and are appropriate for Medicare beneficiaries.
Last week I gave a talk to a group of Transworld salespeople from across the United States. Transworld is the top name in collections across a variety of industries and they asked me to give a presentation on “How to Use Social Media to Reach Your Target Audience,” with the target audience being…people like you and me: managers, administrators, healthcare executives, and pretty much anyone in healthcare dealing with patient accounts receivables.
I described how much harder it is for today’s manager to make time to meet with salespeople. More than ever administrators are pulled in a million different directions, and it is not unusual for a manager’s priorities to shift from day to day and hour to hour. This must be incredibly frustrating for the salesperson who is trying to keep things flowing, but it’s a fact of life in healthcare.
In my talk I featured the work of two gentleman who really get how social media can positively impact sales. Chris Brogan is a prolific author and consultant who always has an interesting perspective on social media. I discussed his ideas around the sales circle as opposed to the sales cycle. You can read about it here.
If you are a physician, non-physician practitioner or Independent Diagnostic Testing Facility (IDTF) who supplies imaging services and submits claims for the Technical Component (TC) of Advanced Diagnostic Imaging (ADI) procedures to Medicare contractors (carriers and A/B Medicare Administrative Contractors (MACs)), you should know that you must be accredited by Sunday, January 1, 2012. If your facility uses an accredited mobile facility, and you bill for the TC of ADI, you must also be accredited. The accreditation requirement is attached to the biller of the services.
Those not accredited by that deadline will not be able to bill Medicare until they become accredited.
For those planning on seeking accreditation to continue performing the technical component of ADI services, know that accreditation is dependent on the demonstration of quality standards, including (but not limited to):
- Qualifications and responsibilities of medical directors and supervising physicians;
- Qualifications of medical personnel who are not physicians;
- Procedures to ensure that equipment used meets performance specifications;
- Procedures to ensure the safety of beneficiaries;
- Procedures to ensure the safety of person who furnish the imaging; and
- Establishment and maintenance of a quality assurance and quality control program to ensure the reliability, clarity and accuracy of the technical quality of the image.
Additionally, the accreditation process may include:
Today’s CMS call reviewed the guidelines for the IPPE (Initial Preventive Physical Exam) and the AWV (Annual Wellness Visit), what they include and how to code for them.
What is the IPPE (also called the “Welcome to Medicare Visit”)?
The IPPE is a one-time visit, covered within 12 months after the effective date of Part B coverage and including:
- Review of medical and social history.
- Review of risk factors for depression.
- Review of functional ability and level of safety.
- Measurement of height, weight, body mass index, blood pressure, visual acuity, and other factors deemed appropriate.
- Discussion of end-of-life planning, if agreed upon by the patient.
- Education, counseling and referrals based on results of review and evaluation services performed during the visit, including a brief written plan such as a checklist, and if appropriate, education, counseling and referral for obtaining an electrocardiogram (a/k/a EKG, ECG).
- Note that although the IPPE has the word “exam” in it, there is NO physical exam associated with it. Most practices attempt to call it the Welcome to Medicare Visit and try never to use the word “exam” in association with it.
Who can provide the IPPE?
- Physician (doctor of medicine or osteopathy)
- Qualified non-physician practitioner including nurse practitioner physician assistant or Clinical nurse specialist
How is the IPPE Billed?
Asking for feedback can be tough.
Asking for feedback as a physician or care provider is unexplored territory for most practices.
My primary care provider has a simple and effective way to ask patients to leave feedback online.
First the facts on what has taken place so far in the 2011 EHR Incentive Programs.
- As of June 30th, the total of Medicare EHR Incentive Program payments is over $94 million.
- As of June 30th, over $166 million has been paid in Medicaid EHR incentives since the program began in January. In May and June, four states launched Medicaid EHRIncentive Programs – Indiana, Ohio, Pennsylvania, and Washington, bringing the total states with Medicaid EHR Incentive Programs to 21. More states will launch in July.
- There are 68,001 active registrations of eligible professionals and eligible hospitals for the Medicare and Medicaid EHR Incentive Programs.
If your group hasn’t received a check and hasn’t registered for the Medicare or Medicaid Incentive Program, then this blog post is for you! For anyone who is really just beginning their EHR journey, today’s presentation clarified previous information given by CMS, as well as giving listeners new information about the programs.
Most managers long for the end of paper charts and the day when all of our data is at our fingertips. Lost charts waste so much time and effort in the practice that an EMR seems destined to offer major improvements in efficiency. But getting converted from paper charts to EMR can be a rocky road, with one of the biggest obstacles being scanning current patient paper charts.
There is no single accepted best practice for scanning charts into an EMR, as a conversion game plan must be specific to each individual practice and coordinated with the new record’s training and go-live.
Every group has to decide which date range and type of charts to scan prior to go live, and additionally which data points will need to be preloaded (or sometimes called “back-loaded”).
As social media matures and more healthcare groups gain experience using it, we understand more about it and the role it will play in the future of healthcare.
Last week, Abraham and I gave a program called “Starting the Conversation: An Introduction to Using Social Media In Healthcare” to a group of healthcare managers. We discussed social media’s potential to influence patient satisfaction, which is expected to influence reimbursement.
There is no one, and I do mean no one, in your medical practice who does not need to know the basics of coding. Here is why:
- Providing services to patients is the business of healthcare. Every person who relies on healthcare for their living should understand something about the business they are in. This should not outweigh the fact that we are privileged to care for patients, but as the saying goes “No money, no mission.”
- It takes a team to produce care. The silos of front desk, billing, nursing and scheduling must come together to share their knowledge and produce a high-quality, reimbursable patient visit. Here are the roles each member of the team plays:
- The patient calls for an appointment and the scheduler matches the patients problem to an appropriate appointment type. The scheduler finds out if the patient is new or established and what the patient’s appointment is for.
- The patient arrives for the appointment and the front desk assures that all current demographic and insurance information is collected.
- The nurse rooms the patient, taking vitals, reviewing medications and reviewing the reason for the visit – the chief complaint.
- The physician or mid-level provider cares for the patient, documenting the visit and choosing the appropriate service and diagnosis codes.
- The patient completes the visit by paying any deductibles or co-insurance due and making any future appointments needed. The checkout staff enters the payments and/or charges if the service codes have not already been posted via the EMR.
- The biller scrubs the claim, checking for any errors and electronically submits the claim to the payer. The hope is that the claim is clean and will be accepted and paid immediately (within 30 days.)
When staff understands how important their contribution is to the financial viability of the practice and how all the pieces fit together, they are more incentivized to perform.