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Make Sure Your EMR Doesn’t Make You Face Medical Billing Malpractice Charges

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EMR-Overbilling

Beware your EMR could land you in a tight spot !

There is a lot of dust raised about EMR’s again. According to recent reports an EMR can lead to inflated costs and fraudulent billing. Allegedly, physicians have added about 11 billion more to their fees, over the last decade alone. The Center for Public Integrity’s “Cracking the code” series, has found that the usage of EMR/EHR’s have resulted in widespread billing malpractices.

More to it than meets the eye…

Healthcare experts argue that this a strong marker of the negative impact, wishy-washy rules can cause. It can not only make physicians vulnerable to fraud and abuse charges, but also be potentially life threatening for patients. Mostashari, the National Coordinator for Health IT rues that “documenting care that didn’t occur, that’s not just fraud, it’s really dangerous medicine.”

It is being argued that the system is flawed. And it is high time the government sat up and took notice before it snowballs into a huge issue and causes irrevocable damage.

Has coding higher become par for the course ?

Upcoding is rampant. And emergency rooms in particular have been pulled up for assigning high level codes, despite the treatment not warranting it. Whistle-blowers  worried physicians and confused patients are making one collective demand. For, strong auditing tools, and transparent uncomplicated regulations.

The new CMS directive !

The centers for Medicare and Medicaid have issued a new directive to restrict billing malpractices. Federal authorities will be keeping a close eye on EMR users to curb this unhealthy trend.

Where the cracks appear…

Physicians are unusually busy people. Most doctors fume that EMR’s have reduced them to efficient machinery. Nobody likes to sit, and copy paste information. Or, working with straight out of a can, point and click templates. Long loading times and a maze of options can drive physicians round the bend. Impatience with the system, more than the willful intent to over-bill  might be the reason behind improper billing.

A quick guide to bill right !

  • Train your billing team to work closely with your EMR/EHR system.
  • Use an accredited medical billing software.
  • Conduct regular in-house financial audits.
  •  Ensure the same information isn’t entered again. Redundant data is the major cause of over-billing.
  • Educate your practice about CMS guidelines and updates.

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 !

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.

Are Doctors,The Casualty Of Recent Healthcare Reforms?

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Doctors in Critical Condition !

Hate spending time in the waiting room of your physician’s office ? In a few years time you should count yourself to be lucky if you get to meet a physician at all! A recent study by the, The Physicians Foundation brings home an uncomfortable truth. That physicians are overworked underpaid, and, most are planning to leave the profession all together.

The Ailing Healthcare Industry…

Healthcare experts’ critic the latest reforms in the healthcare field and predict that there would be fewer physicians, in the years to come.

Though there may not be a mass, dramatic and headline grabbing exodus, if the current trend persists there could be 44,250 doctors lost in the next 4 years.

This coupled with 32 million newly insured Americans, can lead to longer waits to meet the doctor. And, less or no, patient engagement.

Has the Healthcare Industry Become too Expensive and Complicated?

Escalating costs of healthcare and mind bending regulations have made doctors, ailing patients desperately looking for a cure.

In a survey by Shana felt and colleagues of the Mayo clinic, a shocking 46% of doctors suffered from signs of a burnout.

We’ve Become Data Entry Clerks !

Money is hard to come by. But that is not the only reason physicians are contemplating early retirement. Family practitioner Mark Laza, in a recent summit, said that he’d cut 15% of his patient load.

He’d stopped seeing patients with low paying plans. But one major complaint he had was that doctors had become data entry clerks. The number of hours lost due to data entry made it harder to practice medicine, he complained.

It is a Crisis and not a Passing Phase…

This is a crisis that demands collective attention and action. It is a bitter truth but a truth nevertheless, that caring for patients isn’t the only priority of the doctor. To help a sick industry recover, it is essential that every physician maps out a game-plan.

It could be the tried and tested outsourcing solution or revamping compensation formulas. To hire part time staff to handle data entry tasks or working with a billing company. Whatever needs to be done needs to be done now ! To help physicians tide over challenges and emerging fiscally fit !

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.

Is Consolidation an Imperfect Solution for Small Practices ?

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Are Small Practices Given A Rough Deal ?

Your friendly neighborhood small practice could soon belong to the hazy past. The growing regulatory and financial pressures on independent practices have made most of them gravitate towards big hospitals. Economic realities and a spate of regulatory thresholds are making small practice owners seek shelter under the relative safety of big practices.

Hurried Goodbyes…

Almost every recent stat released recently, Point to just one thing, The demise of small practices.

According to a study by Accenture only 36% of physicians will have a practice ownership stake in 2013. 87% of participants complained that sky-high operational costs were the major reason for most of them to bid goodbye, to, The independent model of working.

Acquisition of small practices is growing at an alarming rate. But will this be the remedy for struggling physicians?

Bigger Not Always Better !

Mergers and consolidations are hoped to bring about positive change. The much needed respite for small practices battling a lopsided battle. But they aren’t a foolproof solution. A recent controversy surrounding a major healthcare provider, has posed a question that nobody has an answer for. What is the future of small practices ?

A, Whole Lot Of Dust Raised…

If somebody told that the calm metropolis of Boise, would stage a fierce medical battle, It might have sounded like a joke a few years ago.

Cut to 2012 St Lukes health system, found itself in the midst of controversy.

Independent doctors complained that referrals were dropping steadily and of almost complete domination by the health system.

An Echo Of A Hundred Other Voices !

Repeatedly, large scale health systems have been in the news for dominating and pressurizing small practices to attain difficult financial goals. Everybody is blaming everybody else and very few physicians are happy with the whole set-up.

Opening New Avenues !

Experts argue that it is too early in the day to give ‘consolidations and acquisitions’ the thumbs down. The trend is still young and can lead to better care and lower costs in the long run. It can also put an end to fragmented patient care and documentation.

For Those Who Want To Remain Independent…

What about the doctor who doesn’t want to wait for a pay check every month? There is got to be a way! This is most definitely a challenging time for small practices. But with every challenge comes an opportunity to turn things around !

Operating in less populated, remote, areas that cannot accommodate huge organizations, can provide steady income and clientele. Independent practices can also Outsource Billing to contain costs. In the end what matters most is that small practices must focus on offering a distinct, tangible value for its patients.

2013 Ahead ! Will your Practice fly across the Fiscal Cliff or fall into an Abyss?-Infographic

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Beware Medical Practices 2013 Ahead !

And we are not exaggerating. The whole nation is gone into a huddle, discussing about the eminent Fiscal Cliff. Medical practices, small independent practices in particular, are going to be the worst hit. Across the board sequestration cuts and a 2% reduction in Medicare reimbursement, have left physicians fuming.

716 Billion Payment cut over the Next Ten Years…

The patient protection and affordable care act are aimed at improving the quality of patient care and reduce duplication. But, at what, cost ? From 2013 to 2022 it is going to be one rollercoaster ride for medical practitioners. Hospitals are increasingly merging and affiliating to handle the reimbursement cuts.

Declining reimbursement means, acquiring and consolidating independent practices seems to be the most viable and sustainable model. Doctors, who want to continue to be independent, are facing the possibility of becoming endangered species.

Small Practices Shutting their Doors…

A recently published whitepaper by the Physicians Foundation and Merritt Hawkins suggest that small practices will be uniformly replaced in the coming years. It is a known fact that physicians are under-compensated.

Small and medium practice owners should focus completely on maintaining RUV production at a sustainable level to tackle operational costs.

A Few Ways to Survive the Tough Years Ahead !

  • Review and rework on existing physician compensation formulas.
  • Renegotiate contracts with payers.
  • Develop a strategic plan. Every staff member should remove themselves from the everyday workday, to reflect, and devise strategies to stay profitable.
  • Concentrate on meeting Meaningful Use standards to receive MU incentives while they are still around.
  • Consider outsourcing certain aspects of the Medical Billing Workflow such as  to cut back on costs.
  • As reimbursement models place a greater share of financial risk on physicians, it is important that they focus more on their Revenue Management Cycle.
  • Conduct internal analysis and identify throughput issues.

Bracing for Change !

Change is the only constant. This is the time for medical practices to scale up and meet the financial pressures placed on them. And wait for the regulatory changes to see how they play out !

In-fact, the Fiscal Cliff can even prove to be a good thing. According to a poll conducted by TCB around 51.7 % respondents felt that going over the cliff, could prove to be a good thing after all !

It could induce people to look beyond the tried and tested, and focus on coming up with novel solutions. The reimbursement and tax cuts can help a staggering economy get back on its feet. And, like they say when you hit the bottom the only is up ! As with every New Year, this is the time for reflection, resolutions, and most importantly, hope.

Can Free EHR’s bring about big changes to the Small Practice ? Yes, According to a recent study.

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Busting a Few Myths !

The healthcare industry is evolving. From unwieldy and time consuming paper records to streamlined electronic medical data. As with every transition, there are bound to be a few myths. And by far the most widely popular among them is that EHR’s are expensive.

Are free EHR’s too good to be true ?

There is a long held belief that, anything that comes with a “free” tag is bound to be inferior and counterproductive. So you cannot blame people who turn up their noses at free EHR systems. It is bare boned and doesn’t offer training or support, are the usual complaints. But there are a few free EHR systems that have managed to hold their own in a highly competitive industry.

If free EHRs are half as bad as they’re claimed to be, they simply wouldn’t exist.

Nobody likes being out of Business !

It is a big lie that free EHR vendors are, non responsive, and offer no support. Unlike paid for models, charge-less EHR’s are largely dependent on advertisers for revenue. And we all know advertisers know where to invest. If the support leaves a lot to be desired, it means fewer clients. Fewer clients mean no big advertisers.

So, Obviously…

It doesn’t take a genius to figure out that free EHR vendors should actually be pulling out all stops to offer their clients great support. It works for everyone, the EHR vendor, advertisers and the most important person in the equation, physicians !

Tie-ups that work !

Costless EHR’s tie up with practice management systems so users not just get all that they want but are also offered a great deal of flexibility. Users can integrate the PMS or medical billing software that works for them. But doesn’t all this sound like too much of DIY?

Oops ! so the physician will have to deal with technical issues ?

Thankfully no ! Most popular free ehr’s have partnered with certified consultants to offer integration support and training. There are also a few billing firms that go a step further and offer free practice management systems as well. This means the entire argument of paid ehr’s being a whole lot superior to free ones, doesn’t hold water anymore.

Not a Bad choice at all !

This is not to say cost free EHRs were designed in health IT heaven and have an edge over high end EHR systems. But for the small practice down the road saving on a few hundred dollars can mean a lot.

Here are a Few Facts and Figures that prove Free EHRs help Small Practices…

  • 60%  of doctors report they are doing better than last year due to the adoption of technology.,

  • 45% of small practices cite they’re doing much better than last year.

  • In 2011 only 26% practices said they were doing better than the previous year.

But what is all this got to do with free EHRs. Well, this survey was conducted by Practice Fusion, one of the leading free EHRs in the market.

Costless EHR’s can ultimately act as an incentive and motivation for those who are reluctant to make the switch, due to the costs involved. And that includes a majority of healthcare providers.

Practice Fusion – The free, web-based EMR

It is time for Small Practices to tie up the loose ends.

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Beware of the Money Drainers ! 

Money is had to come by. As pressure mounts on small practices to stay in business without drowning from financial losses. It is important for small and solo physician practices to identify where they lose money.

Unfair reimbursement cuts and onus on offering higher quality of care, have added to the big troubles small practices face. Even as you device new strategies to improve the collections of your practice, it is more than likely you are losing money down the drain.

Sticking to middle of the Road Coding ?

A small sized medical practice cannot afford to hire smart lawyers straight out of a Grisham novel. Having to cough up money for upcoding penalties is the worst nightmare of small practice owners.

What is the safe way out? Downcoding! Most practices resort under the relative safety of downcoding. But the fact remains that leaving money on the table can be a costly mistake. According to a study published in Medical Economics downcoding can cost a single doctor 40,000$ annually!

Insurance plans, and fee schedules, that are miserly…

You bill and code perfectly, but why is it you still find it difficult to make ends meet ? It could be because of a poorly reimbursing insurance plan. If your insurer pays you 25% less than normal you will have to see 40% more patients, to make up for the loss.

Where is the Doctor ? 

Probably learning the ropes of working with an EMR! Or, trying to make sense of the, latest CMS update. Compliance and regulatory pressures mean physicians see fewer patients. And fewer patients mean lesser revenue. Loss of productivity is the major threat to the survival of small practices.

A few ways to Sail through Reimbursement Storms !

  • One way to prevent undercoding from eating its way into your profits is to conduct regular billing compliance audits.

  • Educate billing staff that coding level 3 for a service that demands level 4 is not just a lost opportunity, but plain laziness.

  • Update fee schedules annually. If you are good with numbers do it on your own or hire a consultant.

  • Advice your patients to switch to better insurance plans.

  • To increase productivity and see more patients, consider outsourcing billing and administrative tasks.

Opportunity of Building a Niche Market !

While everybody gravitates towards partnering with, or, becoming salaried employees, it is going to open a small niche market at the other end. That’s how economics works! It is not the time for small practices to back down but to scale up and work towards healthier practices !