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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 !

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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.

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 !

Its Time To Resuscitate Healthcare !

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[AnythingPopup id="13"] Time to Resuscitate Healthcare

The odds are stacked against physicians. Rising operational costs, hours lost due to data entry and compliance thresholds have made practicing medicine a nightmare for physicians. An increasing number of them are contemplating early retirement. With so much to deal with and a lot more to come, it is a testing time for the healthcare industry.

Buckling Under Pressure…

Slashes in reimbursement and compulsion to gravitate towards EHRs are the major reasons why medical practices are ailing. With divided opinions about ACOs and everybody blaming everybody else, the healthcare field resembles a war-zone. A recent study conducted by Bloomberg points that there is an estimated shortage of 13,000 doctors.

It is time the policy makers take remedial measures to help resuscitate physicians.

Over taxed slaves ?

Disincentives and pressures have made doctors feel like over worked slaves. After a long and expensive education, it is a bleak and challenging future that lies ahead. It doesn’t work for the doctor who is gasping for change and for patients who feel a strain in the physician-patient relationship.

Increasing Costs For Doctor Owned Practices !

The operating costs of a physician working in a full time in a physician owned multi-specialty climbed to 1.3% from last year. The commercial fee for service amounted to 51% of total charges.

A Few Bitter Truths…

  • Operational costs for running  a practice have increased over the last year.
  • Labor costs are the major money drainer for medical practices.
  • EHRs increase the amount of time spent on data entry tasks.

Solutions That Might Just Work…

  • Outsource to cut down on labor costs and operational expenses.
  • Train staff or vendors on using EHRs to reduce data entry pressures.
  • Select an EHR that automates workflow to a major extent, to save on time and resources.

Free EMR Critics Are Advised To Really Think Hard Before Painting A Dreary Picture

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Does Free Always Come With A Heavy Price Tag ?  

Of late there has been a spate of attacks against perfectly free EMR, on grounds that such a product is actually not free; that the increased hours/money spent on getting trained in such an EMR offsets the benefits of free implementation.  Also, another popular line of attack is that such an EMR is not certified for meaningful use and may beat the purpose of installing them in the first place.  Finally, doubts are being cast on the revenue generation models of such a product, in that they may be selling out classified patient information to all and sundry.

But there are some who argue that nothing can be further from the truth.

A free EMR like Practice Fusion has been voted the No 1 EMR among primary care physicians for two years in a row (2011, 2012,) and obtained meaningful use certification from ONC-ATCB in 2011.

Insufficient Support ?

The accusation of extra hours being spent in getting trained in a free EMR, because the support services are inadequate, is an ungrounded myth. Free EMRs n are simple to learn and free of unnecessary frills. There are a few billing vendors who pay for or offer free practice management software. This leaves the doctor with a tight budget, a choice to adopt an EHR without losing sleep over costs.

Unfounded Criticism…

Although the attack about the revenue generation model is the weakest of them all, let us make things clear here.  Free EMRs generate revenue primarily by running ads of Pharma companies etc.  As additional revenue, even if mined data is shared with federal healthcare bodies, it is suitably masked.  But hey ! Isn’t inter-connectivity of all patient databases one of the goals of the EMR project?

We really think that in the future, it would be wiser if the critics of the free EMR model to do bit of homework before firing their salvos.