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Ten Tips For Surgery Centers To Pump In More Greens!

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surgery-centers

There you go ! Another rejected claim. Well, running a surgery center billing practice can be demanding, expensive, and on a bad week, thankless! With, surgery centers constantly battling with payers, and, patients who have no idea what their financial liabilities, are. It can be an uphill climb on a snowy day, to get paid !

Here is how you can fight those financial demons and come out at the other end a winner ! And also ensure your clinical documentation is never short of perfect !

10 ways to increase the revenue of your surgery center…

  1. Encourage your surgeons on-board to have a financial stake in your surgery center to avoid losing out on case load.
  2. Create a better atmosphere to work by upgrading to better systems and work processes to attract and retain a strong physician base.
  3. Collect copay’s and deductibles at the front-desk and have multiple payment options.
  4. Compare your staff members’ cost per case with your competitors, and how reimbursement varies across different specialties. Analyze and set benchmarks.
  5. Follow a rigorous claims follow up process and fight denied claims as soon as they reach your table, to increase the revenue and valuation of your center.
  6. Physician documentation plays an important role. Surgeons should dictate clearly, name the procedure. And ensure details and events are sequenced in the operative note.
  7. Don’t put off renegotiating with your insurer. If you put off renegotiating year after year there are little chances of your insurer ever giving you a reimbursement hike !
  8. Collect and verify patient information during the pre-registration stage to avoid fall outs.
  9. Call your patients prior to their appointment and inform them about their financial liabilities.
  10. Have a quick sheet that includes pertinent questions, such as, how many surgeries were performed, the number of co-surgeons etc for physicians to fill out after a surgery.

28 Million Dollar Fine,Prevent Your Practice From Being Booked Under The False Claims Act

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False Claims And A 28 Million Dollar Lawsuit !

false-claims-act

False claims, data breaches and billing errors happen to others right ? ! No. It can happen to your practice, despite your efforts and best intentions. Don’t wait for a watershed moment to catch you unawares and throw you off the course. Federal regulations are becoming stricter, and the penalties and punishments for fraud and abuse allegations, are more unforgiving.

28 Million Dollar Fine For Fraudulent Billing…

Even as this blog is being written a nursing home based in Illinois has been booked for charges against the false claims act. Two ex employees filed a case against the nursing home for providing inadequate care. And, sending, multiple fraudulent claims to insurance companies. The hospital was penalized for offering useless services and more than 19 million dollars for filing false claims.

The employees were awarded more than 400,000 dollars for bringing to light the billing malpractices of the nursing home.

What Is A False Claim ?

There are physicians who end up with summons for faults they were not even aware of. To safeguard your medical practice from false claims you must first be aware of what constitutes a false claim.

  • Submitting an unbundled claim when the claim could have been bundled and submitted as a whole.
  • Up coding a medical service.
  • Billing for medically unnecessary services.
  • Increasing time units or any units of services for acquiring more reimbursement.
  • Submitting secondary claims that have to be sent to a different insurer, to the primary insurer.
  • Inflating patient care costs.
  • Copy pasting records in the EHR can lead to duplication of claims content.
  • Making use of automated coding tools and claim edits can lead to over-billing errors.

Tips To Safeguard Your Practice From Being Booked Under The False Claims Act !

  • Ensure your claims are, bundled/unbundled appropriately. If you are not too sure pick up the phone and discuss with your insurer.
  • Always provide additional documentation substantiating the medical necessity of a treatment prior to transmitting a claim.
  • Document facts such as time units, complexity of a medical decision and gravity of a wound, always.
  • Communicate with your patients and explain about patient liabilities.
  • Submit primary and claims appropriately.
  • Avoid copy pasting billing details in your EHR as it creates “cloned” notes.
  • Review and update information in your EHR constantly.
  • Finally, make use of the features your EHR offers but don’t rely on them completely.

 

5 Ways Small Practices Can Thrive In A Hostile Economic Environment

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Will Private Practices Be Forced To Go Off The Grid ?

Independent practices are dying a quiet death all across the country. It is becoming increasingly difficult to manage expensive transitions, pay the bills, and focus on patient care. Every statistic about healthcare, points to one grim fact- it might be the end of private practices. Unable to withstand mounting financial and regulatory pressures, small practices are shutting their doors.Private-Practices

Between, A Rock And A Hard Place…

Most independent physicians feel like a fish out of water when working in the hospital environment. It means getting used to different terminology, processes and working hours. And it is not just adjustment issues. As with any big organization, the red tape involved can confound and trip up medical practitioners. Small, perfectly reasonable requests may take forever to be processed.

Small clinics are way below the food chain and will be treated that way.

Is Concierge Medicine The Answer ?

Forget third party payers. A, complicated, billing process. And those nasty cuts and audits ! Is concierge medicine a heaven-sent option? Yes, if you are a competitive physician who doesn’t mind being on call 24/7. If being at the beck and call of patients doesn’t scare the daylights out of you. Or, the “I paid you, you work for me” approach doesn’t deter you, opt for concierge medicine.

But the limitations, drawbacks, pressures and financial stability of the concierge model needs to be analyzed before you arrive at a decision. “Boutique practices” or “Personalized healthcare” sounds sweet. But for the physician who is not good at money or time management, it can spell doom.

For Those Determined To Stay The Course !

There are quite physicians who are refusing to buckle under pressure. “I am sticking to my private practice as I don’t know, and cannot stand, any other way of working” is what Terry Williams a private practitioner based in Mississippi has to say. And there are several physicians who echo his views.

Here Are Five Tips For The Small Practice Owner To Fight The Good Fight !

  • Consider relocating your practice to a neighborhood where there is a shortage of medical care, to get better reimbursement rates.
  • Become a micro practice to slash-down on operational expenses.
  • Optimize your workflow and outsource tasks that don’t have to be done in-house.
  • Focus on the business side of your practice.
  •  Market your practice and go active on social media sites.

At 84,000$ Will ICD 10 Sound The Death Knell For Private Practices?

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Will Your Practice Get Caught, In The ICD 10 Quicksand ?

ICD 10 is lurking round the corner. 55,000 more codes and an entirely new coding structure is no stroll in the park.  Medical practitioners might just be thrown of track. It is being feared, that it could be a deathly blow to practices, which operate on small budgets. Small medical practices will be forced to align with hospitals to survive in this tough economic climate.

ICD-10-Medical-Coding-Infographic

Another Nail In The Coffin For Small Practices…

ICD 10 is being likened to Y2K. Though it petered out eventually and died a natural death, the panic and havoc it caused still remains fresh in people’s memories. But with ICD 10 coding we may not be as lucky. It is highly unlikely that ICD 10 will be postponed once again. Or like what most medical practitioners, pray for nowadays, simply disappear.

ICD 10 Comes With An 84,000 $ Price Tag  !

Don’t gasp! That is the figure put down by the MGMA. For the small practice that is barely making ends meet, this is an astronomical amount. Consolidation is the only glimmer of hope. But it can prove to be a double edged sword. As physicians will lose their freedom to decide their working hours and make key clinical decisions, independently.

It seems to be a throwback to the 80’s when there was a mad scramble to partner, align and consolidate.

And The Price Is Not The Only Headache…

If the fear of hogging headlines is the major fear of big hospitals. To keep the lights on in the building is the biggest challenge of small and medium practices. A few of the challenges that ICD 10 throws in the face of medical practitioners are:

  • Loss of productivity.
  • A hit in the coders efficiency and working hours during the transition.
  • Expensive system upgrades.
  • Additional staff to handle the workload especially when both ICD 9 and ICD 10 are used to submit claims.
  • Higher chances of fraud and abuse charges due to the lack of training, knowledge and resources.

Here Is What Small Practices Can Do To Keep Their Head Above The Water !

  • Partner with a medical billing agency to handle the transition.
  • Make use of online resources to the fullest extent.
  • Start early and phase out the implementation to avoid drastic changes and expenses.

13 Ways You Can Ensure Better Revenue Performance For Your Medical Practice Survives The Challenges And Setbacks Of 2013 !

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Here are 13 ways you can tweak your revenue cycle to get the maximum out of it !

1. Assess your revenue cycle based on five major components. Existing workflow and revenue, future process, key competency needs, key performance indicators and compliance thresholds.

2. Set targets for each department and follow the time-tested carrot and stick approach.

3. Have a specific strategy to collect self-pays and reduce self pay balances. Having an electronic remittance option will enable patients to pay after office hours, easily.

4. Analyze your payer contracts and contracted allowables. There are some insurers who may be paying way below, or not paying your most used CPT codes at all !

5. Pending claims should be worked on and followed up every single day. This will ensure that the window doesn’t close on any claim. To, prioritize begin with the claims that are of the highest value.

6. Inform your patients beforehand, the documents they need to bring in, and if money has to be paid at the front-desk, notify the exact amount and payment options.

7.  Implementing a new technology is a major expenditure and according to a recent study contributes to 68% of a practice’s costs and can initially affect your cash flow adversely. Phase out the implantation, review and correct the pitfalls, of each stage.

8. Conduct training programs and workshops regularly. Educate your staff on regulations, State laws and guidelines. Small oversights can lead to big consequences.

9. Analyze your billing procedures against CMS norms, ratio of adjustments and collections and the reimbursement amount and policies of each insurer.

10. Send prompt appeal letters. Some practices never appeal denied claims and it can lead to not just a dent in your revenue cycle but mar the credibility of your medical practice.

11. Sit with your coders and discuss about bundled and unbundled claims and on how to code to get maximum results. Analyze if your coders have missed out on procedures or codes.

12. Enroll your staff with trade organizations, healthcare educational resources and forums to keep themselves abreast with the latest buzz !

13. Make it a point to run quick audits every month.

Only 38 % of Doctors are Happy with their EMR. Are you one of them?

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EHR-Pros-and-Cons

Have EHR’s Reduced Patients to Faceless Data ?

The jury is still out on this one. Have EHR’s helped in bettering patient engagement or are stealing away the doc’s time? Patients complain that watching a medical practitioner silently collect data is the most frustrating sight on earth! After struggling to get an appointment from your busy neighborhood doc, it can drive you nuts to see that he is busy clicking on templates.

A Crude truth…

CRUD which means Create, Read, Update and Delete is not just another smart abbreviation. It is a sad fact that reflects what goes on in the physician’s office today. Creating information, analyzing it and editing data, eats up an enormous amount of time. Most docs are contemplating retirement to get away from the bureaucratic interference and hum drum of working with systems.

Has Someone lost the Plot ?

There is a growing disillusion with EMR’s because most of them are designed to be high-end data entry machines. A huge doubt is being cast on whether they actually help in bettering healthcare. EMR’s were supposed to reduce clinical documentation mistakes, prescription errors, retrieving data and saving on costs. And according to a few doctors fail on all counts.

Physicians fume that they are doing the same thing, several hundred times a week. Data entry takes time because of the frustrating loading times. E-prescribing is strenuous, as it is one drug at time. The, point, click, wait rigmarole results in point and click errors, and can be a potential hazard for patient safety.

Times they’re a Changing…

This immortal Bob Dylan cult number could well be the anthem of the healthcare industry today. Despite scathing criticism and the flak EHR’s face it is an indisputable fact that there are several upshots to using one. Accountable, traceable care, across all points in the healthcare continuum is a godsend for busy physicians without a photographic memory.

Data structures are improving. Integrated, inter-operable  and more secure data architectures that are more physicians friendly are rolling out. Contrary to what the naysayers complain, this could well be the best time to be a medical practitioner.

Treading with care…

Transitory phases can be tricky. It is the last man standing who comes out at the other end as a winner. Every medical practice should ensure that they sign up for a free trial with the EHR they are planning to use. So it is not the first time they’re handling the system. EHR users must demand better and frequent, tech-support.

It is important that physicians are healthcare IT savvy but we don’t want them to be reduced to impersonal, data collecting, super efficient machines. Do we ?

 

Don’t let your Anesthesiology Practice hog the headlines for the wrong reasons

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Anesthesia

The Inside Story Of Anesthesiology Billing !

What is it about anesthesiology billing that always attracts scrutiny ? Every medical journal worth its salt has been running reports on the alleged riff between CRNA’s and anesthetists. The battle has finally drawn to an end with the latest CMS rule. From 2013 CRNA’s will be able to bill separately for their services.

But unfortunately that hasn’t been the only headline grabbing news on anesthesiology, recently.

The Storm Over PPO’s…

An anesthesiologist based in New York has brought to light, the alleged billing malpractices of two major hospitals. According to his statement the 37x code had been misused repeatedly to inflate charges. He also felt that PPO’s prevented insurers from performing claim audits. The dust is unlikely to settle down soon and has brought into focus, the complicated task that is anesthesiology billing.

It is important that anesthesiologists pay attention to contractual obligations and ensure they bill correctly.

Easier Said Than Done !

Billing for anesthesiology is tough, complicated and if you don’t get the basics right, downright crazy ! It is a known fact that most physicians find themselves in a spot, for over billing inadvertently. Or, for not performing regular audits to spot the errors before somebody else does. With revised regulations demanding more accountable care, it is time for the doctors to pull up their socks.

Let your Biller walk you Through the Paces…

Knowing what happens in the engine room is the best billing practice ever. Several factors play a key role in the process. Here is a quick walk-through of the important components that make up your billing.

1. Keep tabs on the various types of anesthesia administered. Using an unnecessarily expensive or stronger drug, can result in billing malpractice.

2. The formula that is most commonly used to bill anesthetic procedures is

Base units + Time units + Modifying units) x Conversion factor = Anesthesia procedure cost.

3. The base unit value is based on the difficulty of a medical procedure and the complexity of the medical decision involved.

4. Time units are another unique component of anesthesiology billing. It denotes the time taken for administering services and modifying units are used to reflect unusual circumstances

5. Maintain updated financial reports.

Medical Practice Managers Needn’t Sulk ! Take It One Step At A Time.

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Medical Practice

What are your Plans this 2013 ?

Agreed ! It is probably too late in the year to make a resolution list, and berate yourself the whole year for not following it. But it is never too late for change. The year brings with it lots of changes to the way you work. From working towards Meaningful Use requirements to choosing those nine CQMS you want to qualify for !

Ten Steps you must take to Ensure you roll with the Punches !

1. Being the first one off the block does have its advantages! Whether it is testing ICD-10, or educating patients on your EHR do it now !

2. Choose clinical quality measurements keeping your patient population, practice workflow and specialty in mind.

3. Perform an audit. It needn’t be an extensive one that brings everything to a standstill. But make a vow that you conduct “mock audits” on important processes such as billing, regularly.

4. Try to reduce costs on every aspect of your medical practice’s food chain. From stationary supplies to revenue cycle management.

5. Focus on maintaining accurate clinical documentation. RAC audit might just be around the corner.

6. Hire a financial counselor or if it’s too expensive, train your front office staff on financial counseling to collect self pays. Remember it consists of a significant revenue opportunity.

7. Have a clinical discussion with your pharmacist to reduce drug costs.

8. Analyze your AR reports, revenue cycle management reports and look for ways to optimize your workflow and exploit revenue opportunities.

9. Be active on social networking sites. That could be the easiest way to engage with your patients.

10. Instead of setting an ambitious annual goal, set small, practical and immensely achievable monthly goals to increase collections !

Has the Doc-Fix formula saved Physicians but put Hospitals in a Quandry?

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Happy New Year !

The year started on a high note for healthcare professionals. The SGR formula that meant 26.5% cuts in reimbursement has been averted. But nobody is popping the champagne just yet. It is a temporary reprieve and only means that physicians can continue seeing Medicare patients, without the fear of working for free. Till the end of this year.

Left to pick up the Tab !

As the healthcare industry, should by this time know, no reform comes without a heavy price to pay! Hospitals have been forced to face the brunt of the “Doc fix solution”. Heavy operational costs and compliance pressures are giving hospitals, sleepless nights. An additional pain of decreased payment is certainly not what they need, at this juncture.

Bedridden Hospitals…

Many feel that the recently released deal to avoid the fiscal cliff is only going to help in pushing pressing problems, down the stream. The 10 million dollars reduced Medicare payment to hospitals, coupled with the ACO cuts, can lead to bedridden hospitals.

Both Peter and Paul are unimpressed !

The latest move by the government has come in for scathing criticism.

With Chif Kahn the president of the Federation of American Hospitals, to famously quoting that it was like “robbing Peter to pay the fiscal cliff of Paul”.

Though physicians are happy about escaping from the deathly blow of almost 30% cuts in reimbursement. The growing need and frustrating lack of a permanent, workable solution has left neither physicians nor hospitals particularly thrilled with the new arrangement.

Can hospitals manage to stick their neck above water ?

In the present climate it is important for hospitals to take a stock of the situation and act quickly. Hospitals will have to create an annual budget that excludes unnecessary costs. Utilize every resource available whether it is manpower or healthcare IT, to the maximum.

Operational costs need to be reduced to at-least break even for most hospitals. Outsourcing is an option that can cut back on expenses. It requires smart out of the box thinking. Identifying and eliminating money drainers. And start the year with a new and revamped revenue cycle, lots of positivity and a smart annual budget.

Have You Planned Ahead ? It Is Important That CFO’s Have A Plan Of Action Ready To Handle 2013.

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CFO-TipsDon’t Work, Like Everybody Else !

Being the CFO of a hospital is challenging enough. Every minute is spent slogging it out to increase revenue and insuring your medical practice against financial blizzards. But sometimes working till you drop, is sadly, barely enough.

Blame it on reimbursement cuts. On a government policy that’s come in, for a lot of flak. Or, stop blaming and work on a strategy that will help you weather out the storms. And come out at the other end, a more financially sound practice.

Include Patients In The Equation…

The mistake that most medical practices and hospitals make is to never discuss financial details with patients. It is a fact that almost 30% of a practice’s revenue come from patient responsibilities.  Caring for your patients is important, but so is getting paid for it.

Fresh Approach !

If you are following the old fashioned approach of sending out confusing patient statements and making mildly threatening calls. It is time to change. Educate your patients on co-pays, deductibles and their healthcare plan. Instruct your staff to insist on collecting balances and offer payment options, your patients are comfortable with. Promise yourself you wouldn’t leave money on the table, ever !

Gazing Into The Crystal Ball !

Analyzing and tracking important financial metrics can be the crystal ball that offers a glimpse into your practice’s future. This is easier said than done. Request, your, billing staff, to provide a detailed financial spreadsheet of your practice.

Reflect , Strategize…

Develop work lists and set specific targets for your billing team. Understand what your weaknesses are, it could be no-shows or ineffective payment collection process. Identify the Achilles heel of your practice. Insist on a thorough, insurance verification process, medical necessity checks and authorization management.

Conduct regular labor productivity assessments. Follow department to department benchmarking. CFO’s can use this data to make informed decisions about labor force and clinical improvisations.

Make Everybody Contribute Their Two Bits !

Nothing, quite, succeeds like teamwork. This is not just another bumper sticker slogan ! Encourage everybody in your practice to participate in weeding out money drainers and developing sustainable solutions. It is after all, the responsibility of a CFO, to ensure not just a better financial future for their practice, but to make sure everybody contributes, to that end !