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The Face-Off Between Doctors And Nurse Practitioners!

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Working, without someone looking over our shoulder, is a secret wish of all of us. And that has led to one of the most heated debates in the healthcare industry. Coming, close on the heels, of the battle between, CRNAs, and, anesthesiologists. It is now physicians and nurse practitioners who are at loggerheads.

Endangering patients…

Physicians fear that working without their supervision can put patients at risk. And lead to fragmented, patchy patient data. Providing longitudinal care and unifying diverse factors across the care continuum is an ongoing challenge. Nurse practitioners functioning independently can lead to increased confusion, is the chief complaint of docs.

It is a known fact that recent regulations and compliance thresholds have put physicians under a lot of stress. To have nurse practitioners challenge their role in the medical fraternity. And compete for patients, is the last thing physicians need.

Nurse-practitioner

End the monopoly !

Do we know how to bill for services ? Yes.

 Do we know how to take care of patients in need of primary care ? Yes.

Do we need a physician to tell us what to do ? No.

This is the war cry of America’s nurse practitioners. They feel practicing under the supervision of physicians is unnecessary and restrictive. Despite being highly qualified and experienced, nurse practitioners feel they are being given a rough deal.

Not a turf war for money !

The request by NP’s to reduce physician interference can surprisingly prove to be beneficial. Obama care is going to result in a sudden influx of thousands of patients. As United States battles severe primary care physician shortage. Qualified nurse practitioners and a newer model of working might just be the right solution.

Once the dust settles down…

It is being hoped that once the storm settles down it will bring a lasting and mutually agreeable solution. The need of the hour is clear cut billing regulations. Reformed, payer policies, that don’t leave room for doubt. And, nurse practitioners and physicians, who work together towards a sustainable solution.

As a nurse practitioner there is enough on your plate already ! Here is the presentation on “Reimbursements guide for nurse practitioners to survive the storms in 2013 !”

Ten Tips For Surgery Centers To Pump In More Greens!

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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.

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.

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 !

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.

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 !

Compliance Thresholds and Reimbursement cuts. How can Radiologists Survive 2013 ?

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Can Radiologists cope with the changes Ahead ?

It is a particularly challenging time to be a radiologist. In fact a majority of radiologists would rather forgo financial incentives instead of participating in meaningful use programs. We all know that MU 1 left a lot to be desired. There were rumbles and murmurs about imaging being sidelined.

The stage 2 meaningful use guidelines is believed to be more achievable and radiology specific. But are radiologists ready to embrace the changes ahead ?

“I have no idea”

Most radiology practices especially solo physician practices have no idea about MU guidelines. A survey conducted by RSNA and KLAS sheds more light into this subject. It is reported that about 40% of radiologists complained about lack of clarity. Or, a steep decrease in efficiency after adopting MU guidelines, were the major reasons why they were reluctant to join the MU bandwagon.

More to it than meets the Eye !

Complicated guidelines that are difficult to report against, no penalties at least for the time being are just the apparent reasons. The pressures and financial stress associated with running a radiology practice are the stuff nightmares are made of.

Medicare Physician Fee Schedule; Can have a Chilling effect…

The reimbursements cuts for the year 2013 will lead to a drop of almost 19% in the collections of radiology practices. A 25% cut for interpretation of images has led to voices of dissent and ruffled feathers. Against this backdrop it is only natural that radiologists are not up to speed with the proposed guidelines.

A lot to cope with !

Compliance and quality thresholds, lowered payments and radiology billing issues ensure that the physicians cup of woes brims over ! There are always a million things to do. And that could well be the reason why adopting the latest guidelines, has found its way to the bottom of the priority list.

Take the First step now !

It is likely that radiologists are going to avoid MU as far as possible. But with challenges come opportunities. Though the pains faced by radiologists are not new, the pressing need to address them is increasing by the day. It is important that radiologists step back and take stock of the situation.

Innovative Solutions ?

Healthcare providers have heard this term all too often. But the remedy that radiologists need is certainly nothing unique or path breaking. It is a fact that good old outsourcing can save radiology practices from sinking into an abyss. Letting third party associates to handle billing and clinical documentation needs can reduce costs.

It can also give radiology practitioners the much needed space to concentrate and adapt to changing guidelines. And with financial incentives being available only till 2016 it is time for physicians to take a call, fast.

Here is What Physicians can do to make 2013 the best year for their Practice !

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 Time for Self Reflection…

As the year draws to an end, it is important that physicians spring clean their revenue cycle. 2013 is going to be a hectic year with major regulatory updates, compliance issues and, yes, unfair deadlines !

So, now, is the best time to take stock of their revenue management cycle process and performance, and formulate better strategies.

Run a Quick Audit ! 

Audits needn’t be extensive or time consuming. Focusing on any one major area to audit can save on time and streamline the auditing process. To start with review the codes that have a high error rate.

According to a CERT report there is a 24% error rate for 99205, 20.8% for 99204 and an 18.6% error rate for 99215.

Run a check on these codes and see if your practice is getting it right.

Cloned claims, non specific diagnosis codes, and errors while assigning evaluation and management codes, are the other few problem areas.

Bundled Payments ; Work out the Math

Work out a clear strategy for bundling and unbundling claims. Most practices lose money due to submitting separate claims instead of one single bundled claim. Determine which claims can be bundled and which ones need not. Work out a reimbursement formula that works for all concerned.

Test the waters…

ICD-10 isn’t going away, no matter how hard you pray. Have an ICD 10 implementation plan in place. If you work with a third party biller, ask them to start checking and working with the new set of codes.

Cut Costs not Corners !

Where does all the money go ? Don’t ask yourself this question again this coming year. Contain costs. Draw up a detailed income and expenditure spreadsheet and enter all the information that matters. Analyze and see where you can scale down on costs. It could be over-staffing or inefficient coordination with ancillary service providers.

Pick out the main reasons and start working on a better future for your practice, now !