How Do You Know If Your Practice Is On Target?

Many physicians are overwhelmed with their day-to-day activities and are not aware if their practice is doing well or is in need of some fine tuning.  Below are five key areas of concern that should be looked into and followed up on to see how the practice is flowing.

1. Overhead

Calculate your overhead rate which includes staff and general operating costs by the total revenue the practice is bringing in.  Do some research on other practices similar to yours and see if they are comparable.  If your overhead rate is higher than the average for your specialty, consider reviewing all the cost that are involved within your practice and see if there are areas where you can reduce expenses.

2.  How productive is your practice

It’s a good idea from time to time to check the amount of referrals you are getting every month.  Make a spreadsheet of all referring doctors and see where possibly there is a drop in referrals or you are seeing an increase in referrals for a specific doctor.  By a physician taking 10 minutes out of their day to call a physician to remind them of your practice and also thank them for referring patients in the past, this could generate future referrals for the practice.

3.  Access the practices financial situation

Start by calculating a net collection rate.  When you enter into a contract with an insurance company, you agree to take a contractual adjustment from your submitted charges.  The net collection rate tells you whether you are collecting the remainder of your submitted charges once the adjustment has been made.  Calculate your net collection rate.  It should be 97% or greater to ensure a healthy bottom line.

4.  Avoid unnecessary hospital admissions or ER Visits

Evaluate a one month period and calculate the number of ER visits and admissions that were avoidable or potentially avoidable.  If your practice has a high level of preventable visits and admissions, create a quality plan to expand continuity of care, transition management, and care outreach.  Track this over time by checking it on a quarterly basis, with the goal of reducing your practice’s rate to zero.

5.  Survey referring physicians and patients

Many offices now use a patient survey or referring physician survey to evaluate their practice better.  This could be something that could be e-mailed or mailed with a return postage envelope to patients and referring doctors.  It can be done unanimously to protect their privacy as well.  This is an excellent tool to use to find out what’s really going on with the practice.  This data can be analyzed and put into good use to further make changes within the practice to help it run better.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at http://www.inscoding.com/aboutus.php

Click here to read testimonies regarding MariAnn Medical Billing Service http://www.inscoding.com/testimonials.php

“Like” us on Facebook at http://www.facebook.com/pages/MariAnn-Medical-Billing-Service/224754564210246 

 

 

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Commonly Asked Medicare Q & A

As an outsourced medical billing company I get many questions regarding Medicare.  I will keep track of these questions and publish some of them periodically on my blog.  Below are answers to three commonly asked questions.

Do Medicare rules apply to patients who don’t have Medicare?

Medicare has rules called “conditions of participation” regarding facilities and home care agencies and these rules apply whether or not the patient has Medicare.  In order for the facility to maintain its Medicare provider status, it must meet the conditions of participation.  On the other hand, Medicare only stipulates that these rules only apply to Medicare patients and do not have any connection with other payers.  So if there is a patient that comes in for an office visit and they do not have Medicare or any other type of insurance and will be paying for the visit themselves, the provider does not have to accept Medicare’s rates and does not have to meet Medicare’s required documentation or disclosure requirements or Medicare’s performance measures.

What constitutes an “Initial Visit” for Medicare billing?

For example, if a patient comes into the office to receive results of a sleep study can this be billed as an initial visit?  An initial visit or a “new patient” visit is a face-to-face visit.  If you are going over and giving the results of the sleep study with the patient present and have given further instruction and have a treatment plan, this is an initial visit.  If the patient is not present when giving the results, then this is not a visit.  According to Medicare, a patient qualifies as a new patient when they have not been seen in over 3 years.  If the patient has not been seen for over 3 years, an initial visit can be billed.  If a patient visits the hospital, then one initial visit per patient per hospitalization is allowed.  All other visits while the patient is hospitalized are to be billed as subsequent visits.

Can more than one Nurse Practitioner bill a Medicare patient on the same day?

In some cases this is allowed.  For example, if there are two Nurse Practioners one being the primary care nurse that bills Medicare one diagnosis and the other Nurse Practioner being in a specialty practice bills for a different diagnoses on the same day.  Will the bills for these visits through two separate practices and two separate provider numbers be paid by Medicare?  Yes. According to Medicare rules, both claims would be paid.  The reason they will be both paid is due to their being two different diagnoses on each claim and the bills are being generated by two separate providers.  However, when there are cases of two Nurse Practitioners who have billed for the same day with the same diagnosis, it is likely that one of these claims will be rejected by Medicare.  In this case, it is extremely important that the Nurse Practitioner has justification through their progress notes to back up their claim.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at http://www.inscoding.com/aboutus.php

Click here to read testimonies regarding MariAnn Medical Billing Service http://www.inscoding.com/testimonials.php

“Like” us on Facebook at http://www.facebook.com/pages/MariAnn-Medical-Billing-Service/224754564210246 

Billing Practices That Can Be Costly – Part I

Obviously, to receive proper reimbursement it is very important to have accurate coding practices for all health care practitioners however; here are several reasons.  A group that is often involved in the billing process is nurse practitioners. Generally they are billing for their own services or they may be using a billing form (superbill) provided by their employer by marking procedural codes and diagnostic codes in order to bill for their services.  The responsibility for the accuracy of the coding and billing, as well as for maintaining medical records that support the diagnosis code and procedural code that is being used to bill for specific services, is the professional provider or the nurse practitioner. 

Keeping up to date with accurate coding procedures is very important when billing to receive maximum reimbursement.  However, due to new codes being added, modified or deleted, this may cause an impact on reimbursement.  Sometimes the definition of a code may not be so clear.  That’s why it is vital to utilize sources that are available to the medical community.  Such as workshops, online information and online telephone consultation services for health care providers to get better clarification on a code before billing.

It’s also important to remember that even if billing by the physician or nurse practitioner is outsourced to an outside billing service or a trained billing clerk that is onsite, it is the person on whose professional licensure the care and billing are based is the person that is responsible for accurate billing.  A nurse practitioner or a physician still has to learn something about reimbursement and coding.

Any health care professional who knowingly cheats on coding to enhance their reimbursement, can be guilty of both civil wrongs which is considered a “breach” of the insurance contract, and it’s considered a crime, which can lead to costly legal fees.  Billing fraud can also result in having to return part or all of the wrongly paid money, fines, loss of their professional license and possibly serving time in prison.

How do fraudulent claims get noticed?  There are several ways.  Some insurance carriers have fraud detection software which they use to analyze data.  When unusual billing patterns are discovered, they initiate an investigation.  Sometimes it is the patient that is complaining about the amount of the bill or services that were billed.  Employees have revealed on their good conscience of fraudulent practices and don’t want to be part of the scheme or it violates their own ethics.  Bottom line is physicians or other health care providers who engage in this type of behavior have been costly and have led to them no longer being able to practice in the medical field.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at http://www.inscoding.com/aboutus.php

Click here to read testimonies regarding MariAnn Medical Billing Service http://www.inscoding.com/testimonials.php

“Like” us on Facebook at http://www.facebook.com/pages/MariAnn-Medical-Billing-Service/224754564210246 

 

Electronic Medical Records Part II

As was discussed in part one of this article the risks of using the technology of electronic medical records shows many things that physicians should be aware of and also how to reduce legal risks.  We will continue on with this article with five other ways to reduce these risks.

6.  Physicians should make sure to sign off the record or log out of the system

This practice is extremely important so that if a physician does not sign out and another physician continues under his or her log in name.  This can create a problem because the bill could be submitted under the wrong physicians name.  If this were to happen an insurance company can ask for a refund of payment if a medical record is submitted during an audit.

7.  Understand how the system records who is accessing and writing in the record

There should be a system in place where if one is accessing the record but after a period of inactivity an automatic time-out occurs.  If a physician needs to make changes or add to a record this should be done at the end of the day but there should be a time period in which the record should lock.  In the case of changes being made, a new entry should be noted and it should be clearly written as an addendum to the record with the date of which this change or addition was made, the reason why the change or additional information was added and also at the end of the entry should be an electronic signature to verify the person who made the changes.

8.  Print out a note from time to time to be sure your entries are in your name and record the time of the medical record entry

 The past some physicians have had the habit of entering in the patients record in the era of pen and paper method, to record things that haven’t happened yet.  One example could be that a physician records a date of a cesarean section but that actually hasn’t happened yet.  So this would have to be entered as a notation with the actual date of when it was entered instead of in the future.

9.  Make sure that only appropriate staff members have access to the records

There should be a protocol in place in case of a security breach from a staff member or other person.  There should be a password that is protected when the person or persons that have authorization to log in.  Having an automatic sign-out feature is also a protection in case the physician should forget to log out.

10.  Protect records from inappropriate viewing by setting up screensavers and require a password for reentry

Having this feature helps if ever the laptop or computer is left in a room unattended.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at http://www.inscoding.com/aboutus.php

Click here to read testimonies regarding MariAnn Medical Billing Service http://www.inscoding.com/testimonials.php

“Like” us on Facebook at http://www.facebook.com/pages/MariAnn-Medical-Billing-Service/224754564210246

Electronic Medical Records Part I

Electronic medical records are currently the new trend that most physicians are heading towards.  This practice has been a way for physicians to improve the care of patients, reducing costs and to avoid medical mistakes.  On the other hand this new technology may come with some legal risks. 

There are many benefits to using a system of electronic medical records which include being able to read the record without having to worry about sloppy handwriting, immediate access to the records, built-in safety features and also it would reduce the risk of a physician prescribing a medication that the patient is allergic to.

However EMR’s may create some problems.  Some physicians could be sloppy typists and the fact that some physicians will most likely take home the laptop and that poses a problem with the patients confidentiality which could result in a HIPAA violation.  So with this in mind it’s good that physicians or any other healthcare worker that has access to patient records pay attention to the risks that are important to consider.

Here of 5 of the 10 ways to reduce legal risks.

1.  Implement personal and practice policies regarding electronic order entry

Be careful when reading messages from the system.  If there is a multitude of emails being sent often, unsubscribe these unnecessary emails.

2.  Develop a system and policies of what to do when an order occurs when the physician is not at his or her workstation or if the system is temporarily down

There must be in place a system of how to handle this situation if it happens.  For a period of time, physicians may have to go back to pen and paper to record important information for the patients record and later enter that information into the electronic medical record.

3.  Print out progress notes from time to time and evaluate the accuracy of the record

These records should then be evaluated to see if they are easy to follow and read.  They should also be evaluated to see if the record accurately show what the physician did for the patient.

4.  Back-up the records.  Make sure to check the back-up method frequently. 

It’s important to make sure the files are backed up everyday.  If a physician fails to do this, they could possibly lose patient records and have no other way of showing what the physician has done for the patient and also no documentation in the event the physician is sued.

5.  Install virus protection software on server and workstation computers

This is extremely important to install on the computers that are being used for electronic medical record technology in order to avoid a virus infiltrating your system which could be very damaging.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at http://www.inscoding.com/aboutus.php

Click here to read testimonies regarding MariAnn Medical Billing Service http://www.inscoding.com/testimonials.php

“Like” us on Facebook at http://www.facebook.com/pages/MariAnn-Medical-Billing-Service/224754564210246

Things To Consider When Using An Outside Billing Service

It’s very common for physicians that have a small private practice to a mid-sized group of physicians to feel overwhelmed by paperwork in order to process their billing.  Many physicians now are considering using an outside billing service to handle all of their claims.  It’s good to make sure the person or company you decide to hire has a back-up system and can also handle your billing in a timely manner. 

Important Requirements

Bill only for services rendered

Claims should be correctly coded for services performed

All bills should be submitted in a timely fashion

EOB’s should be read and checked for proper payment

Late payments from patient’s should be follow up on and monitored frequently

Patient’s should be made aware of charges that may not be covered

Charges that were not covered or co-payments should be collected from the patient’s

Provide monthly reports on the status of claims submitted for payment

Before an account is turned over for collections, it should be discussed with the physician first

Complying with HIPAA

 

A written agreement and contract should be signed and clearly identified within the agreement before signing. Just because the physician decides to use an outside billing service does not relieve them of the responsibility of complying with HIPAA.

Selecting a reputable outside billing service

When selecting an outside billing service it is good to do your homework.  One way is to ask your colleagues for recommendations.  Ask for their references and talk with them.  Below are a some key questions to ask potential outside billing services.

Do you have a written compliance plan?

What billing system do they use?

Can the software they use be networked with the office so that the physician can view billing and collection data?

What are the security and access features to assure HIPAA confidentiality compliance?

Does the system being used have a back-up system that can retrieve information if the computer fails?

Does the billing service educate the physician about accurate coding to get maximum reimbursement for services rendered?

Finalizing the contract agreement

Once you have made your decision on the billing service you intend to use, make sure there is a written contract.  The contract should detail exactly what services you are to receive for the fees agreed upon and also list what services are available for additional fees.

The contract should also include renewal, dispute resolution, and cancellation terms.  If you feel uneasy at first, set a short-term agreement so that will give you time to find out whether you feel comfortable with the billing service and you can test out their service without being held up into a long term contract.

Billing and Collections During Hard Economic Times Part II

As we discussed in the preceding article the fact that it’s getting harder and harder to collect patient balances.  This can definitely be frustrating, time consuming and often unsuccessful.  The Commercial Collection Agency Association showed that after 3 months of an outstanding bill, the probability of collecting is 73%, after 6 months 57% and 29% after a year.  When the amount of the bill is minimal the figures are even less. 

Staff should be well trained as to how to collect payment from patients.  When visiting a retail store and you decide on what you’re going to purchase, do you walk past the registers and say “bill me”, that would and could never happen.  So why do physicians allow this to happen in their offices? 

One way to tactfully implement payment is due upon service, is setting up signs in the office where they can clearly be seen.  Staff members should also be trained as to how to ask for payment.  Such as “how would you like to pay?”  Then the staff member should start to write out a receipt to show the patient that payment is due.  Reminding patients when confirming appointments is another opportunity to inform them of the policy.

Consider accepting credit cards and debit cards.  This is a good way to collect payment due to the fact you have the assurance in a matter of seconds if the payment went through.  One suggestion is due to some patient’s having high deductibles and it’s difficult to figure out what the exact bill will be, have the front desk take an imprint of the credit card and bill half the amount and then let them know that they will be billed the remainder and will receive a statement when they learn of the final amount from the insurer. 

Sometimes it becomes necessary to use a collection agency.  It’s best to come up with a plan in this case.  How many statements should go out before action must be taken?  Some physicians send up to 6 statements.  It should suffice to send 3 statements over a 3 month period.  One method used by a physician’s office was to send the 3rd statement as a certified letter; this ensures that it has reached the appropriate address with a person’s signature showing that the statement was received.  A phone call after the 2nd statement would do well also.  After the 3rd statement is sent, give the patient 15 days to respond with an actual date printed on the statement of the day it will be sent to collections. 

Collection agencies generally charge a percentage of the monies collected.  Most companies fees range from 12% to 50%.  It would do well for you and the patient to not have it get to that point but if necessary there are many good collections agencies to choose from.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at http://www.inscoding.com/aboutus.php

Click here to read testimonies regarding MariAnn Medical Billing Service http://www.inscoding.com/testimonials.php

“Like” us on Facebook at http://www.facebook.com/pages/MariAnn-Medical-Billing-Service/224754564210246