In between polishing off leftover turkey and stuffing, we’re looking back over some of our most popular posts from the month in case you might’ve missed them the first go round. Thankfully Presenting, The Best of Manage My Practice, November 2011!
- Compliance: a critical issue for all practices, but a subject so expansive, where do you even begin? Learn the “Big Three” with Stark, False Claims and Anti-Kickback Laws: Easy Ways to Stay Compliant with the Big Three in Healthcare
- Are your record retention policies up to date? Can you say with confidence that you have hard copies of everything you should? Find out with Record Retention Simplified – The Ultimate Guideline
- Are you or someone you know thinking about Medical Coding as a a possible career? Follow along with Coder Bob in Tales of a Coder Part III: School Begins
- Are you the kind of leader that can see your group through the toughest of times? Bob Cooper asks practice managers in Are You a Resilient Leader?
We’ve started this monthly wrap-up to make sure you don’t miss any of the great stuff we post throughout the month on Manage My Practice, but we also want to hear from you! What were your favorite posts and discussions this month? Did we skip over your favorite from November? Let us know in the comments!
This is a guest post from Joe Hage, CEO of medical device marketing consultancy Medical Marcom.
My friend Michael Paquin is a fellow of HIMSS, the Health Information Management Systems Society, and an expert in EMR connectivity, Meaningful Use, and the pitfalls of both. Michael shares his thoughts on both in this short video, which is also in transcript form below.
Michael Paquin: I think if we are looking at physicians today and trying to address some of the problems they’re having in their offices and what they’re afraid of in purchasing an Electronic Medical Record, I think we have to start from the beginning and that is service and implementation.
I want to empower all physicians to make vendors give them the service they need. Getting an EMR is just one part of the puzzle in being successful in achieving your Meaningful Use dollar.
The Meaning Use dollars over a five-year period can add up to about $48,000 to $64,000 depending if you’re applying for Medicare or Medicaid. What you really need to think about is that purchase price and negotiate it well, don’t overspend but do overspend if you will, I know that’s contradictory, but do overspend when it comes to implementation and training.
A lot of doctors purchase an Electronic Medical Record and think they can have the training done in 3 days. I’d like you to think about that for just a moment.
If each and every one of you just bought Microsoft Office and brought it into your practice for the first year or first training, could you get trained on PowerPoint, Outlook, Word, Excel all the different features of Microsoft Office in three days while you’re not seeing patients or you are seeing patients? Can you train all 3-4 nurses in your office? What does that mean?
So what I’m suggesting to you is take the time to get trained so that you can use the product correctly. What I’m seeing out in the marketplace is doctors starting to go with their second or third vendor for their Electronic Medical Record software because they have an unsuccessful first brush with Vendor A or Vendor B – they weren’t trained.
All these systems have workflow issues, all of them are trying to address them, and all of them are trying to get better. None of them are going to be perfect but what’s going to make a perfect EMR installation for you is the training.
- Make sure you negotiate all the prices.
- Make sure you buy from a vendor that is certified by the ONC.
- Make sure you’ve got that certification.
Certification means when you get your Meaningful Use dollars you can show your product was certified. So there is a lot to getting ready for purchasing an EMR, there is a lot to choosing the right vendor.
Make sure that you get in touch with an EMR consultant, there are a lot of lessons learned that will pay for a consultant’s time. Anyway in this first video I think we’ve covered enough but feel free to contact me with any questions.
Joe Hage: So I’ll paraphrase. When you’re choosing an EMR partner make sure that it is going to be around and one that can provide you with the level of training you need.
Michael Paquin: And certified.
Joe Hage: And certified, Michael thank you very much.
Mary Pat: If you remember, my friend Bob decided he wanted to become a medical coder and asked for help. He chose Allied Schools because he felt he made a connection with the people at Allied and they also offered an attractive payment plan. Bob has started the program and wrote this for me about his experience so far.
Bob: I recently received my first package of school supplies from the Allied Schools. When I opened the box I found a welcome packet with instructions for getting help online, two textbooks (Medical Terminology and Anatomy and Physiology) and a couple of CD-ROM discs. I was ready to begin.
Medical Terminology
I began with Medical Terminology. The instructions that I found when I logged online for the first time were to read and complete the exercises in the first chapter of the textbook.
The course began with basic word structure. I learned about suffixes, prefixes and root forms. The various incarnations of all of these parts were a matter of pure memorization. It was reassuring that I did know some of them from family medical issues and from studying Greek and Latin words in school many years ago. The instructions were to look at the ending first for part of the term’s meaning, and then to move to the left for the root form and any prefix. By combining these, the meaning of the term emerges.
For instance: HEMATOLOGY.
- logy means the study of.
- hemat/o the root form for blood.
Therefore, hematology is the study of blood.
There are hundreds of root forms, suffixes and prefixes but thankfully, Chapter 1 did not try to teach me all of them at once! Examples were given for the words presented, the text was full of colorful illustrations and short cuts, and memory devices were introduced along the way. Next came over twenty pages of exercises with answers so that I could check my progress. The exercises were offered in a variety of formats in an effort to keep you from getting too focused on one method of memorizing, as well as keeping it as fresh as possible. There were fill-in-the blank and multiple-choice quizzes, medical word scrambles and even some short word problems that described simple medical cases where you had to determine what term best described the cases. It was a very thorough attack at memorizing a fair amount of material.
After I made myself work through the book exercises twice, I logged online and started the computer work. What I discovered was a rehash of the book but it was presented in an easy-to-follow manner that moved very quickly. What I also discovered was that if I had absorbed the material well from the text, the computer rehash went quickly.
Then I was presented with an online practice test that they said could be taken as many times as I wanted, but they recommended that I not move on to the real test until I had achieved at least a 90% score.
Im proud to report I got 90% on my first try and them moved on to do the formal test that required a 70% to pass. And ta – dah.. I passed with 100%! (OK, I just could not help but brag a little bit.) The real point though is that by studying hard on the book you should achieve great success with the computer portion of the program and success is what we all want.
In addition to the books I received two computer discs and I found them to be wonderful additions to the study program. One disc has a collection of additional exercises, glossaries, flash cards and animated lessons that examine different parts of the body. There were even some arcade games based on Wheel of Fortune and Concentration – cute, fun and one more way to get the information lodged in your brain forever.
The second disc went over all of the terms introduced in each chapter and gave an audio definition that was very helpful in making sure I understood the correct pronunciation. There was a spelling bee section on this disc as well that presented yet another approach for people more inclined toward audio learning as opposed to visual. All in all, the discs were a very comprehensive and a powerful reinforcement of work to memorize the material thoroughly. I am now on to the next section covering body cavities, body planes, body systems and sections of the spine.
What I’ve Learned
My normal procedure for working on this class is to sit down at the kitchen table and review the exercises in the book for the section I am studying. I can easily spend an hour or two with the book and seldom do I realize how much time has passed before I stand up for a break. Two hours a day writing out answers in a notebook (I am not writing in the book) helps me to get the material down. In an effort to mix it up a little bit, I sometimes pull out the discs and play one of the arcade games for fun. When I feel confident about a section I move on and do the online portion. I try to get two hours in every day but I am lucky to actually do it 3 or 4 days a week.
Over the last few weeks I have made progress but I have also learned a lot about what is required to be successful in this ambitious endeavor.
- You must make the time to work at the program. If you do not set aside time every day or at least every other day, you will move slowly. If you cant make yourself sit down and do the work, you will not be able to get through the program.
- You must get your mind in study mode. It has been a few years since I was in school and even though I spent quite a bit of time with homemade flash cards and a couple of the Dummies books, I still had to make the old brain work. It is a challenge, but it is refreshing.
- You must memorize. A lot. Study the different sections and don’t let yourself take any short cuts because it is not good enough to be able to answer just the multiple-choice questions. You must know the terms and meanings and they must be in your head and ready to spring forth when needed.
So far, I am really pleased with the program I chose. A number of different approaches are offered in order to reinforce the memorization required, and practice quizzes and exams allow you to feel comfortable before moving on to new material. There is no short cut to what must be done – it’s all about putting in the time and the discipline. I am not moving as fast as I hoped I would, but I think I will pick up some steam when I get through the terminology and anatomy and start on the actual coding portion.
Next time – Bob reconsiders his choice.
In health care, we are “blessed” with an abundance of rules, policies, standards and laws. In Health Care Regulation in America: Complexity, Confrontation, and Compromise, Robert I. Field, professor of health management and policy at Drexel University School of Public Health, observes the following:
”Regulation shapes all aspects of America’s fragmented health care industry, from the flow of dollars to the communication between physicians and patients. It is the engine that translates public policy into action. While the health and lives of patients, as well as almost one-sixth of the national economy depend on its effectiveness, health care regulation in America is bewilderingly complex.”
Here are some of the most important regulations in health care that you should not only know about, but should be actively managing with a robust compliance plan.
CMS Announces 90-Day Period of Enforcement Discretion for Compliance with New HIPAA Transaction Standards
Today the Centers for Medicare & Medicaid Services Office of E-Health Standards and Services (OESS) announced that it would not initiate enforcement action until March 31, 2012, with respect to any HIPAA covered entity that is not in compliance with the ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0) and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards. Notwithstanding OESS discretionary application of its enforcement authority, the compliance date for use of these new standards remains January 1, 2012 (small health plans have until January 1, 2013 to comply with NCPDP 3.0).
CMS has posted the transcript from the National Provider Call on Thursday, October 27, 2011
Dont miss this opportunity to hear from CMS experts on this important topic. Click on National Provider Call on Revalidation of Medicare Provider Enrollment to view the transcript. This transcript contains a number of post call clarifications such as where to find the listing of providers which have received a notice to revalidate. The audio file will be posted in the near future.
Now Available Online: List of Providers sent a Revalidation Request
In response to provider requests, CMS has posted a listing of providers who have been sent a request to revalidate their Medicare enrollment information. The listing containsthe name and national provider identifier (NPI) of each provider sent a letter, as well as the date the letter was sent. To see the listing, click on Revalidation Phase 1 Listing in the Downloads section of the Medicare Provider Supplier Enrollment Revalidation Page. NOTE: You must widen each column in the spreadsheet to view the contents. CMS will be updating this list monthly.
A personal health record (or PHR) is an individual electronic health record that is stored securely on the Internet so it can be accessed by medical providers and caregivers who have permission.
PHRs allow the storage of all critical health history information in one place. In the event of an emergency, the patient, caregiver or family member can give providers access to health information. By having the most current information always available, duplicate or unnecessary tests can be avoided as can possible drug interactions. This benefit is achieved without having to rely on the memory or incomplete records of the patient. PHRs also allow patients, caregivers or third-party vendors to update information regularly over the Internet so that new data can always be accessed by stakeholders.
Although Personal Health Records have been around for more than 10 years, they have gained little traction. Amidst a healthcare environment that is increasingly supportive of the empowered patient, most patients have neither the time nor the knowledge to enter their own records into a PHR. Many PHRs can interface with an individual hospital or physicians EHR system, but most are unable to share information bi-directionally with more than one entity or flow seamlessly into a Health Information Exchange (HIE).
Mary Pat’s Note: This post has always been popular because it answers one of the most burning questions in Healthcare: “How can I improve my bottom line?” If you have used any of these ideas in your practice- or have some of your own to share- let us know in the comments below!
BUILD ON WHAT YOU’RE CURRENTLY DOING:
1. Add physician hours – add evening or weekend hours; start your office hours earlier and end hours later.
2. Reduce physician time off – decrease vacation or change weekly days off to 1/2 days off.
3. Set a minimum number of providers to be in the office seeing patients at all times the office is open.
4. Have each provider add one new patient visit to his/her schedule weekly.
5. Add ePrescribing to recoup additional Medicare revenue and streamline prescribing (there are free ePrescribing software packages available, but evaluate them carefully so they don’t add more complexity to the system instead of less.)
6. Report PQRI measures to recoup additional Medicare revenue.
7. Charge patients an out-of-pocket fee for completing patient forms – disability forms, etc. and reserve office visits for treating patients.
8. Choose an EMR that qualifies your practice for the ARRA money (although it has been widely promoted that in a larger practice, an EMR and its associated work will cost more than you will get from the government.)
9. If you are in an underserved or rural area, check to see if there might be grants or funds available locally, in the state or federally, for adding a service to your practice.
10. If your practice does Independent Medical Exams (IMEs), reviews records or depositions, make sure that your fee schedule for such services is current and that the fees are collected before the physician provides the service.
ADD TO YOUR CURRENT SERVICES:
11. Allergy testing & treatment
12. Dispensing pharmaceuticals
Record retention can be a significant problem for healthcare groups. Different federal and state regulations require different retention schedules for medical records and other medical-service related documents. Many managers and physicians are confused on how long they should maintain records and how best to store all this paper. Here’s an updated record retention schedule that is in sync with medical malpractice insurers (check with your malpractice carrier) and accounting firms.
There are all kinds of numbers floating around for retaining records, but unless you are focusing ONLY on record retention, you”d have to be very organized to separate what can be shredded in 1 year, 3 years, 6 years, 7 years, etc. I prefer to categorize everything into three basic categories: Save it Forever, Save it for 7 years, and Save it according to state requirements. Here is (almost) everything broken into my three categories.
I lost power in my home and office from last Saturday until this past Thursday evening due to an unexpected snow storm.
What did I learn about being resilient over these last few days, and what are the lessons that can benefit all leaders?
My family and I returned to our home last Saturday to find that we did not have heat or electricity. Our assumption was that the utility company will have the problem resolved within 24 hours. After the 24 hours came and went, we realized that we may have to deal with this problem for several days (that’s the information we were being given by our neighbors).
Each night, my wife, son, and I would wear several layers of clothes to deal with the cold environment. We listened to the radio and tried to make the best of the situation. During the day I found myself going to Starbucks so I could have e-mail access and charge my phone. This became my office. I found neighbors to be very helpful, with everyone looking to pitch in and assist each other. This routine continued until the lights came back on Thursday.
What are the lessons learned during this period?
Mary Pat’s Note: This first ran in 2009 and it continues to be a visitor-favorite! If you are using it and added your own rules to it – leave us a note in the comments and share your own “Golden Rules.”
Sometimes employees do not understand or follow the most basic of workplace guidelines. Here is a simple but comprehensive list that you can tweak to make your own. It covers about 25 basics in a short list of ten “Golden Rules”. Make it part of each job description or personnel handbook and/or post it in strategic places.
- Report to work on time daily. Be ready at your desk to begin work at the designated time. Leave promptly for lunch and return to work when you should, unless you’ve made special arrangements with your supervisor. Take breaks on the honor system and do not abuse the privilege. Clock in and out faithfully.
- Command respect from the physicians, managers and employees of (your practice name here) by demonstrating total professionalism in the workplace with your dress, your demeanor and conversation. Represent the practice in a way that would make your Mother and your boss proud of you. Treat your co-workers as you would like to be treated.
- Be economical by not wasting time or supplies or doing sloppy work that must be re-done.
- Give every patient your total attention, patience and courtesy. Do not assume you know what the patient is going to say, but listen carefully to the patient (in-person or on the phone) so you can assist them to the best of your ability. Remember how good it feels to be the center of someone’s attention and give that gift to every single patient.
- Keep your supervisor aware of any problems in your workload, whether too much or too little. Do not expect your supervisor to know if you are falling behind or caught up.
- Document all interactions with patients and other medical facilities to assist your co-workers in knowing what you have done, and document your resolution of the situation to the customer’s satisfaction.
- Strive for a positive attitude every single day. Don’t whine.
- Be a team player. This means both covering for your co-workers and knowing that they will cover you. This means supporting your co-workers to their faces and behind their backs. This means having (your practice name here) goals for your goals, and knowing that your success will be your team’s success, and ultimately, the success of the practice.
- Clean up your own messes and act as an adult acts in the workplace: responsibly, maturely, and with thought for others. Accept blame for your own mistakes, knowing that everyone makes them, and that if no one is making any mistakes, nothing is improving.
- Contribute to making (your practice name here) a good place to work. Only you can create a place where everyone enjoys working. Only you can make this place a good place to be.
For more medical office rules, read “21 Common Sense Rules for Medical Offices.”
Photo credit: Barbara Helgason | Dreamstime.com
