There are lots of reasons why write-offs are taken, and it is common practice to divide write-offs into two major categories.
Necessary or Approved Write-offs
These are write-offs that you have agreed to, either in the context of a contract, or in terms of your practice philosophy.
Contractual write-offs are the difference between the practice fee schedule and the allowable fee schedule you’ve agreed to accept.
Charity write-offs are the difference between the practice fee schedule and anything collected. Charity write-offs may be in accordance with a community indigent care effort, a policy adhered to in a faith-led healthcare system, or a financial assistance program.
Small balance write-offs are amounts left on the patient’s account that may not warrant the cost of sending a bill, which has been estimated to cost about $12.00 each, taking into account the statement process, as well as the cost to receive the check, post it, and deposit it. Many practices write off the small balance (usually $15 or less) and collect it when the patient returns. Others run a special small balance statement run once a quarter.
Recently, my friend Bob approached me with an idea. He has decided that he wants to become a medical coder. When he first told me he was interested in exploring coding as a career, I didnt really think he knew what he was talking about. As Bob itemized the reasons for his interest however, I became more and more convinced it could work.
Bob told me hes looking for:
- Something challenging that will stretch his brain.
- Something he could potentially do from a home office.
- Something in demand in the market.
- Something he could train for in a year or less.
- Something for which the training expense was affordable for him ($2000 or less.)
Knowing this gentleman fairly well, I think the characteristics he has that will potentially make him a good candidate to train for a coding career are:
- Enjoys reading.
- Has the ability to focus on details.
- Has the ability to retain details.
- Has good communication skills for interacting with physicians, patients & insurance companies.
- Has good computer skills.
- Has an interest in healthcare.
Bob had thought it through pretty well so I agreed to research programs and help him choose one. We narrowed the field down to certificate/diploma programs as he is unwilling to spend the time and money to obtain an associates degree at this point in his life he is an older adult learner.
I found many training programs out there so many in fact that I think choosing one can be a time-consuming and potentially difficult task for anyone.
I have not always been excited to hear patient complaints. As a younger manager I absolutely dreaded when a patient wanted to speak to me. I felt that I had little to offer a patient who expressed anger or frustration with something that had happened and I was very impatient to get past the complaint and get back to my “job.”
Now, I can’t wait to hear patients’ complaints. Complaints are the only opportunity managers have to understand the patient’s experience and hear in their own words what went wrong for them. By listening carefully, you have the potential to accomplish several goals.
- You can heal the patient’s complaint, first by making sure the patient feels heard, and second by addressing the problem if something needs to be done.
- You can gain insight into an experience in the practice and dissect it to see why the problem occurred and what can be done to fix it.
- You can model to the staff how important patient complaints are and how seriously you take them.
- You can retain the patient for the practice, and hopefully make them a fan who will recommend your group to friends and family.
In the past it might have taken a lot for a patient to complain to the manager as many patients will not risk disenfranchising a physician they really like. Today is the advent of the consumerist patient, and people are feeling empowered to complain about problems in healthcare ( a good thing!) Healthcare managers need to step up to the plate to meet them and make sincere attempts to cultivate a positive patient experience from beginning to end.
Here’s how I suggest you listen to patients:
- Instruct staff to prioritize patients calling and asking for the manager. Unless you are in the middle of a meeting, take all patient calls as they come in. If you cannot take the call, ask the staff to make sure to document the best time to return the call and the number. Prioritize returning the call.
- You can delegate patient complaints to subordinate managers once you feel completely confident that they can handle the complaints appropriately, but you should continue to take calls periodically and check complaint documentation to make sure everything is going as you intend it to.
- Listen to the patient until they are done talking. Apologize and let them know that their experience is not what you want for patients. Go back over the complaint and ask questions to make sure you understand what happened.
- Tell the patient you will investigate the complaint and give them a definite date and time when you will call them back to report on what you’ve found.
- Talk to all staff and physicians involved in the incident. Call the patient back and share any information that is appropriate. Most patients will be satisfied to receive a call back and hear that their complaint has been discussed.
- Offer your direct phone number to patients and invite them to call you if they have any further problems. A nice touch is to invite patients to ask for you when they come in next for an appointment so you can meet them face-to-face.
Today the Centers for Medicare and Medicaid Services (CMS) released the new pricing for flu shots for Medicare patients for the 2011-2012 flu season. The Medicare Part B payment allowance limits for seasonal influenza and pneumococcal vaccines are 95% of the Average Wholesale Price (AWP) as reflected in the published compendia except where the vaccine is furnished in a hospital outpatient department. When the vaccine is furnished in the hospital outpatient department, payment for the vaccine is based on reasonable cost.
What do Medicare patients have to pay for the flu shot?
Annual Part B deductible and coinsurance amounts do not apply for the influenza virus and the pneumococcal vaccinations. All physicians, non-physician practitioners, and suppliers who administer these vaccinations must take assignment on the claim for the vaccine. Do not collect from Medicare patients for the vaccine or the administration of a flu shot.
What will Medicare pay for the flu shot?
The payment allowances below reflect the annually updated payment allowance for the listed CPT codes and Q-codes when the vaccines are furnished outside the hospital outpatient department.
In Part 1 of this series we explored payers. Now its time to develop your financial policy. This is your foundational document for everything that happens with patient financial interactions. Your financial policy will confirm for patients and staff what your practice financial policies are, and will support the financial goals of the practice.
The road to financial health
Putting together a new financial policy or revising your existing policy is one of the most important steps to financial health. Your financial policy is your road map and will determine how the practice will handle the collection of patient balances. The financial policy is the document you will come back to time and time again. If a question arises, ask yourself, What does our Financial Policy say?
First, decisions need to be made:
- attract and capture new patients,
- retain and engage existing patients,
- provide a platform for information and education,
- gather consumer feedback,
- be a two-way communication tool, and
- distinguish your practice as an authority.
Here’s how to manage this very important resource, choose the right professionals to be your practice’s partners in success, and spend your financial resources wisely.
Let’s define the professionals.
Web Designer: A web designer focuses on the look and feel of a website and leverages good aesthetic sense to make a website enticing and visually pleasing.
Web Developer: A web developer is focused on the way your website works. Web developers have strong programming skills and are responsible for maintaining your website and ensuring it functions well. This person may also be called a Webmaster or Site Administrator.
Web Host: Web Hosting providers give you storage in their data centers for web pages, files and databases that make your website an interactive experience for your patients, employees and stakeholders. Your web host is responsible for keeping your site secure and available 24/7.
You can have a web professional custom code a website for you from scratch, but that is not necessary, efficient, cost-effective or smart. We’ve been advocates of using blog software for websites for years for two reasons. One, the cost of using a blogging platform as software for your website is free. Two, you have control of the site and can make simple changes and post content with ease yourself. The most popular blog software, and the software we use at Manage My Practice is WordPress. With blogging software, even beginners (the manager or a staff member) can learn the basic process of tweaking information and adding information, keeping the practice website current.
Do you need a website designer? Absolutely not!
Should you use a website designer? Absolutely!
UPDATE: CMS has announced a second window for applying for the 2013 hardship exemption from 11/1/2012 through 1/31/2013. Click Here for more info.
UPDATE: CMS has released information for applying for the 2013 hardship exemption. Check out our “Medicare This Week” post from 6/8/2012 for more info.
UPDATE: The submission period for applying for a 2012 hardship exemption for failing to e-prescribe in 2011 is over.
CMS has just announced the process for applying for a hardship exemption from the 2012 1% Medicare payment adjustment (i.e. reduction.)
If you are participating as an individual Eligible Professional…
…use the new CMS provider webpage, called the Quality Reporting Communication Support Page, to enter the request and supporting rationale. Your request must be submitted by November 1, 2011. A Quality Communications Support Page User Manualis available to answer questions eligible professionals may have.
If you are participating using the Group Practice Reporting Option (GPRO)…
…Group practices selected for and participating in the 2011 GPRO I or II reporting option wishing to submit a 2012 exemption request should submit a letter to: Significant Hardship Exemptions, Centers for Medicare & Medicaid Services, Office of Clinical Standards and Quality, Quality Measurement and Health Assessment Group, 7500 Security Boulevard, Mail Stop S3-02-01, Baltimore, MD 21244-1850. This letter must be postmarked no later than November 1, 2011.
To help eligible professionals and group practices understand the key provisions and impact of the 2011 Medicare Electronic Prescribing (eRx) Incentive Program Final Rule, A Quick Reference Guide has been posted to the eRx Incentive Program website on the Educational Resources page. Frequently asked questions (FAQs) addressing the 2011 eRx Final Rule, as well as other information and resources about the eRx Incentive Program can be found at the eRx Incentive Program website here.
The new winner of my ongoing competition for the CMS Employee Speaker contest is Dr. Daniel Duvall, Medical Officer, Hospital and Ambulatory Policy Group Center for Medicare! During a recent ICD-10 call, Dr. Duvall spoke clearly, was easy to understand and kept my attention.
Why are we moving to ICD-10?
Dr. Peter Polack has a new 8 minute podcast on “Scanning Paper Records Into Your EMR System: Setting Up An Action Plan” with yours truly. We discuss some tips and best practices including:
- The importance of storyboarding your strategy for paper chart conversion
- How to decide if you need more employees for your conversion process
- Scanning vs. indexing
- When to know if you need to outsource the scanning process
- How much of the old paper record do you need to convert?
Click here to listen.
How does a medical practice meet the patients’ healthcare needs while operating a highly-regulated business on less income? Start by examining one of the most expensive processes in the practice – billing. Billing requires skilled employees, sophisticated technology, and constant vigilance from everyone in the office. Let’s explore processes that can reduce your billing expense as well as increase your collection percentage.
Clear Financial Policy
If you don’t have a written financial policy, how do patients know when and how to pay? Your practice should have a very understandable (8th grade level or less) financial policy that explains what your practice will do and what the financial responsibilities of the patient are. If you want a copy of the format I like to use, email me at email@example.com and I’ll send it to you. Use the same financial policy to train your entire staff on your policies. If any employee does not support your policies, that employee should not work for you.
How you save money: Everyone is on the same page, so there is no way a patient can game the system by claiming a staff member or physician told them no payment was needed. By the time the patient receives a service, they should have heard verbally about the policy 3 times (appointment, appointment reminder, check-in) and should have received at least one written copy of the policy, which they’ve signed.