Yearly Archives: 2014

It’s a great time to be a medical billing professional

During our webinar with Kareo (@gokareo, #kareowebinar) today on choosing and managing a third-party medical billing service, one of our attendees commented that it seemed like we were predicting that billing professionals were going to lose their jobs in droves, thanks to the trend toward outsourcing medical billing.  Nothing could be further from our view!  If you're a medical biller currently working inside a practice, and you're wondering if the outsourcing trend is a negative for your career, our take at C&M is that the trend towards outsourcing medical billing (which itself is driven by two other key trends: increasing billing complexity and improvements in billing and EHR software) should mean more opportunity for you in the future.  But you might need to expand your vision for how your career will unfold. As billing services proliferate -- and cloud-based tech companies like Kareo, eClinicalWorks, Athenahealth and others up the ante by creating their own services to take advantage of their integrated practice management and EHR platforms -- demand for experienced and knowledgeable billers will only increase. The key difference is that new jobs for billers are being created more quickly in billing services than in practices. While jobs inside practices may gradually become harder to come by, the growing market for outsourced medical billing services will not only maintain or even expand the total number of billing jobs available, there will be much more variety in the types of jobs, too.  Billers will have the chance to work in organizations with other like-minded professionals, perhaps even specializing on a medical specialty or other billing niche if they are so inclined. And cloud-based tech platforms like Kareo's allow motivated and entrepreneurial billers to set up their own services much more quickly and easily than ever before -- and allow billers to offer great technology to their practice clients as well. We foresee a great future for medical billers -- with more options, whether as employees or business owners, and more career growth and flexibility in the future. It's a great time to be a medical billing professional!

By |2022-01-01T22:52:07-08:00June 18th, 2014|
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Reminder: Tips for choosing and managing a medical billing service (free webinar)

Reminder: I'm presenting a free webinar this Wednesday, June 18 (10AM Pacific, 1PM Eastern) with Kareo, offering tips to maximize the benefit of outsourcing your medical billing .  Whether you're already using a third party billing service or just considering switching to one, this webinar will provide you with ideas, insights and pitfalls gathered from Capko & Morgan's years of experience working with practices that have chosen the outsourcing route. PLUS, best of all, 100 lucky attendees will get a free copy of my ebook on the subject, Get the Best From Your Medical Billing Service (Management Rx). Woohoo! Hope you will join me next week! Click here for the sign-up page on Kareo.com.

By |2022-01-01T22:52:07-08:00June 16th, 2014|
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The minimum wage conversation and your medical practice

A few months ago, when the idea of raising the federal minimum wage over $10/hour first became a hot topic in the news (with some federal workers even getting a minimum wage bump), we worked with an internal medicine practice in a rural area that had many employees earning around that proposed new figure (or even a little less).  Although the news really had no effect whatsoever on the practice's compensation structure or even the local economy (where $10/hour was still well above market rate), it still caught the attention of employees, and had started to eat at their morale. "So now I could be paid just the same if I worked at McDonald's?" said one front desk employee, whose hourly rate was right around $10, during our confidential interview.  "I might as well work there.  I'd never have to stay late," she lamented.  She was not the only employee thinking this way.  Many team members were deeply affected by the idea that their compensation level -- which in every case was at least 20% higher than the actual prevailing minimum wage in their area -- was what some people now considered the minimum standard for people with no experience and no credentials. Even though no change to the minimum wage had taken place, these employees already felt like they'd been demoted! This particular practice really prides itself (justifiably) on its attention to employee satisfaction and to paying employees a living wage -- and the minimum wage discussion in the news, and its unexpected impact on employee attitudes, really threw them a curve ball.  Employees who had previously felt appreciated and well-compensated versus their alternatives in their little rural town were suddenly wondering if they were underpaid -- or worse, under-valued. Medical practices are (unfortunately) accustomed to the unexpected impact of government actions on their business.  But in this case, the impact happened before any action has even happened.  Some markets may not be affected at all by new minimum wage rules, which seem to be much more likely (at least for now) to be driven by local market conditions

By |2022-01-01T22:52:07-08:00June 14th, 2014|
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Working with — or considering — a medical billing service? Here’s what you need to know.

If you're considering working with an outside medical billing service -- or are working with one now -- my free webinar next week with Kareo can help you get the very most from outsourcing.  Using a third party medical billing service can be a great way to improve cash flow and collections, and minimize hassles for your practice -- provided you know how to choose wisely and manage the relationship.  Perhaps the biggest mistake practices can make when deciding to outsource to a medical billing service is to lose focus and interest in the billing process -- making sure your practice gets paid is still ultimately your responsibility, even when you've got an outsourced team helping you make it happen. The key is knowing what questions to ask and to establish a relationship of communication and teamwork with your billing service partner. To explore these ideas -- and many more ways to maximize the benefit of outsourcing your medical billing -- please join us next Wednesday, June 18, for a free, lively and informative webinar that will help your practice work with an external medical billing service to improve profitability -- and your peace of mind! PLUS, best of all, 100 lucky attendees will get a free copy of my ebook on the subject, Get the Best From Your Medical Billing Service (Management Rx).  Woohoo!  Hope you will join me next week! Click here for the sign-up page on Kareo.com.

By |2022-01-01T22:52:07-08:00June 12th, 2014|
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An easy cure for password headaches

Solid, complex and properly-protected passwords are the foundation of your technological security. Maintaining good passwords is surprisingly challenging.  For one thing, the quality of solid passwords inherently makes remembering them difficult. Add an ever increasing number of passwords and you’ve got a perfect recipe for the frustration of constant password resets – a time consuming and costly headache for you and your staff. Fortunately, there are some excellent, low-cost and easy-to-implement solutions in the form of password management programs. The basic idea is that a single program keeps all of your passwords in an encrypted database. My favorite solution is the free and open-source Password Safe. After downloading and installing, simply enter your passwords – entering 30 passwords took me about 20 minutes. Thereafter, simply use this program to access all your passwords.  Any of your passwords are at your disposal with a simple click that copies it to your clipboard. It really couldn't be simpler. However, be sure to back-up your database, perhaps by sending to your gmail account, and be sure not to forget your password!

By |2022-01-01T22:52:07-08:00May 16th, 2014|
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Could an incentive ‘nudge’ improve your medical practice patient flow?

The idea of 'nudging' in behavioral economics gets a lot of play in healthcare. But most of the attention is on the public health/patient side -- i.e., how to persuade patients to do what public health administrators believe is best for them.  These ideas often focus on negatives and can be controversial -- prompting cries of 'nannying' and 'coercion.'  But some fascinating recent research by Balaji Prabhakar of Stanford shows that positive, incentive-based nudging can help reduce traffic and even help people have a little fun at the same time -- and it got me to thinking, should we take a look at this type of positive nudge as a way to improve medical practice workflow? If you have a minute, take a look at this brief article on the Stanford Business School site -- it explains how Prabhakar was inspired to try to help address the insane traffic problem he observed when visiting Bangalore on business.  A commute of 9 miles to his client's office in one of the busier areas of the city took employees an average of 71 minutes!  Prabhakar thought a scheme of incentives might help persuade employees to commute at off-peak times. His goal was to apply a key insight from his work as a computer scientist: that reducing peak load by just 10% would dramatically improve other metrics like wait times.  Could this insight also help your practice? Prabhakar used an interesting incentive to encourage off-peak commuting: lottery entries.  Each early arrival earned an entry into a weekly lottery -- so more early arrivals meant more chances to win. This was a positive approach (unlike some nudges that are perceived as punishments), and it helped make the program fun and created weekly excitement. So what if your practice wanted to reduce congestion -- say, due to late-arriving patients?  What about rewarding patients who arrive on time with a thank you and a scratch ticket or other small gift?  And are there times of day that are harder to book at your practice?  Perhaps a little reward for patients that can come in at those less

By |2022-01-01T22:52:07-08:00April 30th, 2014|
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Payer, hospital directories get in on the ratings act

There have been some interesting developments in the world of physician directories and ratings sites.  First, payers have started opening up their directories, allowing prospective patients to see which doctors are participating before deciding on a plan.  This is useful for practices, too, since it makes it much easier for you to see if your listing information is incorrect (without, for example, needing to contact your rep or access the data through a physician portal). A second interesting trend is that payer sites -- perhaps inspired by the success of commercial physician review/rating directories -- have started adding reviews and ratings to their directories.  While some of you may be groaning as you read this, I think that this is mainly a good thing, provided that patients need to log in as plan members before rating (as seems to be the case where I've seen ratings on payer sites).  This validation of membership helps ensure that the people doing the rating are actually patients -- and not, as sometimes seen on generic reviews sites, people who don't seem to be patients, but instead are just friends with opinions or even disgruntled employees attempting to pose as patients. Hospital directories have also joined the bandwagon -- providing more data about doctors with privileges and affiliations, and even adding ratings in some cases. Which relates to another trend -- it's becoming more common to see a whole bunch of directories at the top of the results for virtually any physician category in many local markets.  With hospital directories, payer directories, physician reviews and ratings sites, generic reviews sites like Yelp and Angie's List, and even Google's own Places/+ directory listings all competing for the top spots, it is becoming much rarer for any practice's own site to make it onto the first page of search results (much less the top half).  Which means it's more important than ever to take the initiative and manage your practice's (and individual physician) online image and reputation. My upcoming ebook will feature practical and quick tips on how to do it -- to be alerted when

By |2022-01-01T22:52:08-08:00April 26th, 2014|
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Authentic strategic planning for your medical practice

Medical practices are taking note of the importance of strategic planning, as they tread the unknown waters of healthcare reform and adapt to changes they may not have invited if given a choice. But do the key stakeholders of most private medical practices really understand what it takes to succeed with efforts to create and successfully execute a strategic plan? Do they know the importance of developing an authentic and that in order to be authentic it must be driven by the practice mission? If the strategic plan is not authentic in consistently delivering on the mission it is likely to fail.  But if it is authentic, it will guide the practice in achieving its strategic goals. Start on your path to strategic success by keeping these essentials in mind while going through the strategic planning process. Begin the strategic planning process by making sure the plan encompasses what the practice is all about and what it represents to the community. This means the goals and the decisions outlined in the strategic plan must be aligned with the practice’s mission and vision.  It is important to articulate the significance of this from the onset and revisit it as you go through the many processes of strategic brainstorming, goal-setting and formulating the written plan. This helps ensure that the decisions and actions identified in the strategic plan are authentic to your very purpose in being a medical practice. Next, identify what differentiates your practice from its competition. It is critical to examine market data to understand external factors that may impact the practice now and in the future. It is also critical to take an objective look at the practices strengths and weaknesses, exploring what opportunities this presents and what obstacles must be overcome.  Sometimes, this is referred to as a "SWOT" analysis, for "strengths, weaknesses, opportunities and threats."  These analytical steps help the practice address issues it must contend with and make appropriate strategic decisions based on the reality of your market position. Practice-wide engagement is needed to succeed with implementing a strategic plan.  This means communicating your strategic goals

By |2022-01-01T22:52:08-08:00April 22nd, 2014|
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The patient-centered specialty practice (how special are you?)

In 2013 NCQA rolled out the Patient-Centered Specialty Practice, PCSP, Recognition Program to distinguish specialists that achieve specific marks with: Developing and maintaining referral agreements and care plans with primary practices; Providing superior access to care (including electronically) when patients need it; Tracking patients over time and across clinical encounters to ensure patient care needs are met; and Providing patient-centered care that includes the patient, and when appropriate, the family or caregivers, in planning and setting goals. The motivation behind the PCSP program began when reporting discrepancies were identified between referring physicians and the specialists they refer to.  For example, referring doctors claimed that between 25 and 50% of time they were unaware if the patients they refer are actually seen by the specialists.   Another discrepancy was the specialist claiming they sent consult reports 80% of the time, but the primary care physicians state they receive this information only 60% of the time. With the PCSPs intent on improving care coordination and communication between specialists and their primary care physician, managing chronic and acute conditions across continuum of care will be better accomplished. The PCSP program also evaluates medication management, test tracking and follow-up and information flow over care transitions. This recognition program is expected to result in a better patient experience and improved outcomes.

By |2014-04-17T18:31:36-08:00April 21st, 2014|
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Special Judy Capko webinar event: The Secret to Strategic Planning – Making the Most of Your Practice’s Future (May 8, 2014)

Join Judy Capko, author of Secrets of the Best-Run Practices, for a special, 90-minute webinar for physicians on strategic planning. A strategic plan will provide your practice with a strategy to respond to key regulation like the Affordable Care Act and secure your future in times of rapid change.   A strategic plan will help you clarify where you are, help you understand your needs and determine what strategies will help you achieve your goals. By participating in this webinar you will learn how to: Overcome challenges and obstacles that hinder performance; Understand the essential requirements in preparing a strategic plan; Take concrete steps that capitalize on your strengths; and Develop a plan that positions your practice for success. Regardless of practice size or specialty, a strategic plan is essential in guiding a practice to achieve its objectives, stay competitive, and be profitable without compromising the quality of care and service you provide. This course covers the key elements required in developing and structuring a strategic plan – and how to get everyone on board – so you can guide your organization in this time of unexpected change. To learn more about this webinar and enroll, visit this link: https://www.greenbranch.com/store/index.cfm/product/1405_20/secrets-to-strategic-planning-making-the-most-of-your-practices-future.cfm

By |2022-01-01T22:52:08-08:00April 14th, 2014|
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Thinking portals and Meaningful Use Stage 2? Join my free webinar

Does Meaningful Use Stage 2 have you thinking (perhaps worrying) about offering a patient portal to your EMR?  Or do you have a portal, but wonder if it's getting the use that it should -- and whether it's really helping to engage your patients? Next Wednesday, 4/16/14, I present a free webinar on successfully implementing your portal as part of Kareo's webinar program.  I'll take a look at: Why patient engagement matters -- and how portals fit in Keys for a successful portal roll-out Tips for promoting your portal to patients How portals satisfy Meaningful Use -- and why it's not just about Meaningful Use! Please join me on 4/16 to explore this important and exciting topic. Click to sign up for the free webinar on Patient Engagement, Patient Portals and Meaningful Use  

By |2016-03-04T11:54:55-08:00April 10th, 2014|
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“We are not a bank” — Lessons from CNBC’s “The Profit”

I just got around to watching the episode of  The Profit focused on A.Stein Meats. Now, you may be wondering why on earth I'd be posting about a meat business here -- what could that have to do with medical practice management?  Well, The Profit deals with a variety of small businesses, and there are often take-aways that apply to almost any business, but the A.Stein Meats episode really hit some notes that are so important for managing the business side of a physician practice -- especially the under-appreciated perils of poor management of accounts receivable. When Marcus Lemonis arrives at A.Stein Meats, he learns that the 75-year-old company is losing $400,000 per year -- despite $50MM in annual revenue.  He's initially confused about how the company's expenses could be exceeding their revenues.  But he soon figures out that the biggest missing piece lies in the back office: accounts receivable.  The office manager -- who nominated the business for the show -- reveals that the receivables are more than $4MM.  And Lemonis quickly notes, many are so old, they'll likely never be collected.  The owners, meanwhile, seem almost unaware of why they should be concerned about accumulating A/R -- after all, they're just trying to "work with" customers, many of whom are "friends." But, as the old saying goes, with friends like that, who needs enemies? The business's inattention to collecting the money they're owed was putting their solvency at risk; revenue is almost irrelevant if it isn't realized as cash coming into the business promptly.  Moreover, the business was essentially financing its customers -- without getting paid to do so.  Lemonis stated clearly, "we are not a bank" -- the same message we give our medical practice clients when they're too quick to say, "sure, we'll bill you" instead of asking patients for a credit card at the time of service, or a credit card on-file for procedures that need to be paid for over time. Medical practices are perhaps a bit luckier than a business like A.Stein Meats in that insurance payments still usually provide the biggest portion

By |2022-01-01T22:52:08-08:00March 31st, 2014|
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Small practices: PCMH is not out of reach

The Patient-Centered Medical Home is so much more than just a payment innovation -- it's an idea that appeals for clinical reasons to so many physicians and practice managers, who were already aiming to provide the higher level of care-coordination and patient engagement that is the foundation of the PCMH.  But many small practices we work with have been nervous about the hurdles for certification -- is it too much for a solo or two-physician practice to take on? A recent AAFP blog post offers a wonderful idea for smaller practices daunted by the prospect of tackling the PCHM checklist on their own: form an informal network with other, like-minded practices in your area, and divvy up the research and learning.  What a great solution -- and a great way to expand your connections with other professionals in your community. Read about it here.  

By |2022-01-01T22:52:08-08:00March 24th, 2014|
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Patient use of physician ratings sites increasing — not waning

If you've been among the practice managers and physicians ignoring the 'fad' of physician ratings sites, hoping they'll just fade away eventually, there's bad news for you in last month's JAMA: more people than ever are aware of the existence of physician ratings sites.  And more people than ever are using them. As has long been the trend, though, patients aren't flooding sites with rants of disgruntlement; positive views continue to heavily outweigh negative ones. The most important take-away from this new research?  If you haven't started taking control of your listings on ratings sites, the time to act is now.  Hiding won't help ... and taking charge is easy, once you learn a few key steps. Interested in learning more about online reputation management?  I will be publishing a new Management Rx ebook on this subject in the next few weeks.  To be notified (and take advantage of free review copies if you're interested), sign up here: Subscribe to the Management Rx interest list by Email

By |2014-03-24T16:37:12-08:00March 24th, 2014|
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Bullying can be a problem at medical practices

Yahoo! reports that a recent study by the Workplace Bullying Institute showed that bullying -- defined as "abusive conduct that is threatening, intimidating, humiliating, work sabotage, or verbal abuse" -- is a problem at nearly half of all US workplaces.  They also found that 27% of all adult Americans have directly experienced it, 21% have witnessed it and 56% of perpetrators are bosses. More discouraging, the study found that employers are doing little to combat bullying. Among employers who had received complaints about bullying, only 12% established policies to combat bullying, and only 6% reported a zero-tolerance approach to eliminating it.  And, the researchers also found that all this bullying has a high cost in employee turnover: 61% of employees who were victims of bullying either quit, were fired or were forced to quit. Medical practices exist to help patients, and usually most of the employees in a practice were attracted to the field for that reason -- so you wouldn't think that bullying could be a problem in the practice workplace. But bullying is something we often uncover in working with practices, especially when we're brought in because of high turnover or operating problems that the physician owners are having trouble solving. Despite being rooted in a caring profession, medical practices often have characteristics that make it possible -- even easy -- for bullying to take hold.  These include: Physician owners are most often with patients and have little time to observe ordinary interactions between staff Physicians often dislike the management side of their practices and become too trusting of and over-reliant on one or a few key managers -- who then have too much power Managers spot the opportunity to seek excess power from uninvolved physicians -- becoming expert at managing upward and hiding the true nature of their relationships with staff* Physicians may have experienced very demanding, bullying (or quasi-bullying) environments throughout their medical training -- and may adopt the same management style almost automatically, without appreciating the costs When our analysis of a practice suggests that a manager, supervisor or physician colleague may be creating a threatening

By |2023-05-23T17:23:30-08:00March 17th, 2014|
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Outsource your practice management pain

It’s a common error for physicians to think their manager and the staff can do anything they ask of them.  Although it’s admirable, it may place an unfair burden on everyone.  And if the practice has grown, but the staff hasn’t, you may be expecting too much. If you have major projects that get put on the shelf or get derailed, you may be missing out opportunities or losing your competitive edge. And, if you find yourself picking up the slack for staff that is inundated with their workload demands and things just aren’t getting done, it may be time to outsource your pain.  Even if staff has enough time, you might be asking someone to take on a responsibility they don’t have the acquired skill set required to get the best outcome. Physicians and managers also face tremendous demands that sometimes cause them to put off important projects that would help the practice become more robust and put you in control of your future. For example, most practice leaders don’t have time to take on something as important as a developing a strategic plan. Such a project requires tremendous upfront research and analysis, prepare the report and plan the strategic planning retreat?  Hire an expert to do the leg work and facilitate the retreat and you will not only get the job done, but you’ll get it done on time. And how about using a payroll service with automatic deposit to the employee’s account? You can select a service designed to track accumulated paid time off, and allows you to download the employee time records, which is a real relief to managers. This is a cost effective way to get a reliable outcome and allow the manager’s time to deal with other pressing issues that need attention. Whether it’s outsourcing a specific one time project, ongoing responsibilities like revenue cycle management or an important daily task like seeking a technology partner to electronically manage appointment reminders, you can find a good match for your needs.  Check with your colleagues, do research on-line and take advantage of those annual conferences

By |2022-01-01T22:52:09-08:00March 13th, 2014|
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Windows XP: a potential HIPAA risk — and an opportunity to boost productivity

Microsoft recently announced it will end support for the Windows XP operating system on April 8, 2014 -- and this may have HIPAA implications for your practice. What could 'support' have to do with your HIPAA compliance? The biggest implication is that hackers could discover new ways to breach XP security -- and no support means Microsoft will no longer issue patches to plug the holes.  That means you'll potentially expose protected health information to hackers if you continue using the unsupported operating system. Even if you're using cloud-based EMR and other systems, your office PCs may still contain protected information -- for example, if documents are scanned and saved to their drives. The good news is, PC prices are lower than ever, and upgrading can make your team more productive.  (In virtually every practice we visit, we find at least a couple of computers that are so slow that they are adding to patient wait times at check in, check out and while scheduling on the phone -- and cutting into staff productivity.  Inevitably, the practices believe they're saving money by not upgrading, but at today's prices, faster computers would likely pay for themselves very quickly.) If you act fast, you might even be able to get Windows 7 machines -- you'll miss out on the pizzazz of the new Windows 8 interface, but also skip the longer learning curve when transitioning from XP.

By |2022-01-01T22:52:09-08:00March 10th, 2014|
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Using benchmarks wisely: staff, staff expense per provider

Our work with medical practices often involves analyzing a practice's data against benchmarks from sources like MGMA, NSCHBC, specialty society surveys, etc.  But, it's not enough just to compare against the averages and percentiles; you have to know whether meeting or beating a benchmark is a good thing.  Believe it or not, this is not always obvious. Among the benchmarks most subject to misinterpretation are staff per provider and staffing expense per provider.  Most physicians and practice managers we work with are very focused on keeping headcount and staffing expense low -- and so they're pleased to learn they're in the lower tiers for headcount and staff expense ratios.  The pleasure shifts to confusion, though, when we explain that squeezing staffing down to the lowest possible expense is not usually a path to higher profitability -- and can often be associated with lowering profitability! There are several reasons for this.  The most important is that well-trained, well-paid, motivated staff -- and enough of them -- free up providers to focus all their attention on the tasks only they can do.  Coincidentally, the tasks that only providers can do are almost always also the only tasks that generate revenue for the practice.   Increase provider time spent on revenue generating activities (and not on unpaid tasks that don't require their training), and you're on the way to more profitability. Consider that an additional medical assistant might cost a practice about $100-$150 per day.  If that additional assistant allows a practice to see as few as 1-2 more patients per day, that's a profitable addition.  Often, one additional assistant can help more than one provider -- and help the practice quickly generate more revenue than is needed to make the addition a profitable one. When a practice is focused primarily on expense control and minimizing headcount, sometimes that results in providers doing too many tasks that could be handled less expensively by staff -- an opportunity cost for the practice and a direct hit to revenue potential.  What's more, when a practice is too reluctant to add headcount, existing staff can quickly become

By |2022-01-01T22:52:09-08:00March 3rd, 2014|
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What’s the payoff for being patient-centered?

The buzz about being patient-centered is not just hype, the patient-centered movement is very real and there is much to gain.  The primary premise of the patient-centered movement is that by building stronger relationships with patients they will be healthier.  Healthier patients mean a healthier population.  A healthier population reduces healthcare expenses which have soared in the United States over the past few years. Reducing these expenses is a goal that health plans are increasingly willing to pay practices to help achieve. Understanding what it means to be patient-centered is a complex process as it intends to recognize patients in terms of their own social worlds.  This means throughout the patients’ healthcare experience they should be respected, listened to, informed and involved in their care.  It is believed that shared decision-making results in better compliance and reduces health risk factors.   Focusing on individual patient’s needs an applying evidence-based medicine is meant to improve the healthcare population. Insurance companies, recognizing these factor,s are in the process of implementing financial incentives and bonus structures based on key elements that improve the delivery of health care and manage costs by reducing complications and emergency room visits, and by complying with best preventive practices. Your intentions to be more patient-centered can be reached by: Strengthening the patient clinical partnership; Promoting communication about things that mater to the patient; Helping patients know more about their health and healthcare needs; Facilitating patients’ and caregivers involvement in the patient’s care; and Setting metrics to measure improvement. Being patient-centered is rewarding for your practice in so many ways: happier patients, potential financial upside, and stronger relationships between providers and patients. All of these themes are discussed in greater depth in my and Cheryl Bisera’s new book:  The Patient-Centered Payoff (click the link to see the book's page on Amazon).

By |2014-02-24T11:21:01-08:00February 24th, 2014|
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Internal chart audits, the basics, part 2: conducting the audit

Conducting an internal chart audit require team effort to plan, execute and analyze the results.  You will get far more out of the audit by involving team members from different departments and presenting it as an exciting time to learn more about the inner works of the clinic visit and their implications on practice finances.  A team of five is perfect; a receptionist or scheduler, a biller, a nurse or medical assistant, a medical records or data entry person and a physician or other provider. Begin by gathering five random patient records per each provider and selecting one date of service for each patient; the date of service should be three to six months prior.  This allows adequate time for insurance processing and receipt of third party payment on the records being reviewed.  Staff should break into teams of two – preferably one administrative staff and one clinical staff person.  Each team should review a minimum of five charts and document discrepancies.  When the review is completed, they should analyze the results to determine if the same errors are recurring or if there are different areas of the practice or service where problems occur.  They should then calculate the potential cost of the errors over a twelve month period.  The next step is to make a recommendation on how to approach correcting the deficiencies for long term benefit. Common problems detected: Discrepancy in evaluation and management level of service (E&M code) Wrong diagnosis Missing dictation Incomplete charge slip Missed office charges:  Procedures, lab, x-ray Missed hospital charges:  ER visits, consultations Insurance write offs taken that are not justified  (payment overlooked or discounted by payer) Patient balances written off on Medicare patients All of these problems have the potential to both cost your practice money in the short term (e.g., by causing denials or delays or down-coding) or in the long term by triggering an audit by Medicare or a private payer.  By conducting your own internal audit, not only will your staff learn what kinds of mistakes you've unwittingly been making (and be able to correct them), everyone will understand

By |2022-01-01T22:52:09-08:00February 20th, 2014|
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Internal chart audits: the basics, part 1

Auditing charts is nothing new; Medicare has been doing such audits for years. They are looking for coding irregularities within a practice to determine if they want to do a more extensive audit. That's when a practice gets the dreaded notice to prepare and submit charting documentation on a selected number of charts and submit them to CMS for a detailed review. Often when this happens the stakeholders in the practice have no idea what they have done to trigger the audit. We suggest you take a proactive approach to understand your coding patterns and whether you are coding appropriately based on the services rendered and the documentation essential to support the codes you billed for. Here are steps you can take to prepare for a practice-wide internal audit, which may help you avoid the dreaded Medicare audit – or at least be ready to pass with flying colors. Empower staff to understand the importance of their individual actions in helping the practice get paid for the services performed. A mini audit involves everyone in analyzing charge and payments for services rendered.  The staff teams up to examine documentation of services rendered, diagnostic coding for encounters and the payment received for those services. Increase the staff’s awareness of the significance of accurate documentation and its relationship to revenue generated in the practice.  By examining charts and billing information the staff will begin to understand how important it is to account for every single service rendered. With reduced reimbursement no office can afford to drop a charge or to neglect following up on an inappropriate reduction in reimbursement.   For example if you missed charging for one EKG and one Urinalysis a day, it would add up to as much as $12,000 a year in lost revenue.  If you missed charging for one hospital consultation a month per doctor in a four doctor practice, you would take an annual hit of $6,000. Increase the reimbursement IQ of reception and nursing staff, as they examine EOB’s and see a 30 to 40% adjustment in the payment rendered by third party payers. This will

By |2016-03-04T11:56:39-08:00February 14th, 2014|
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Patient payments: In 2014, it’s ‘pay as you go’

2014 will be a winning or losing game for medical practices – depending on their patient payment policies and efficiency with collecting patient payments. Patient responsibility has spiked over the years and has taken a quantum leap in 2014 with annual deductibles of $5,000 and more.  Patient share of responsibility beyond the deductible can be as much as 20%.  So if you haven’t already done so, it’s time to beef up your patient collection procedures and track performance to ensure you are collecting at the time of service.  Here are a few key ways to get paid sooner rather than later. Train staff on how to ask for money.  Give them scripts and practice so they are comfortable.  Help them understand it is appropriate to expect payment at time of service. I mean, like where else do you go and not pay for services at the time you receive them? Start at the beginning.   Staff should explain your payment policies when they are scheduling a new patient.  For established patients that are scheduling appointments on the phone, remind them of an existing balance and inform the patient that payment of an existing balance must be paid at the time of their scheduled visit – if not paid in advance.  You might even consider asking the patient to pay their previous balance with a charge card at the time they are scheduling their appointment and be ahead of the game. Plan ahead.  Every day assign someone in the office the responsibility of reviewing the next day’s schedule  to verify insurance coverage and plan for Use technology.   Automate confirmation phone calls or text messages to be placed 48 hours before a patient appointment.  The script used should include a message reminding the patient that any balance remaining on their account must be paid at the time of the visit. Avoid exceptions.   Keep providers out of the payment discussion.   Help physicians by giving them the script for a reply to patients that want to talk about payments.  Something as simple as “Mary, my main concern is your health, our billing department manages collection. 

By |2022-01-01T22:52:09-08:00February 14th, 2014|
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Position your practice for growth: free webinar tomorrow

There's still time to register for my webinar tomorrow with Kareo and Physicians Practice.  "Position Your Practice for Growth" will explore tactics to ready your practice to handle more patients without sacrificing patient service.  Whether you're hoping for or expecting growth from the ACA, whether you're aiming for it with increased marketing, or whether you just want to learn some ideas for increasing efficiency and profitability, there's something in this webinar for you! To join us at 9AM Pacific/12Noon Eastern tomorrow (Feb 6), register at the following link: Free webinar: Position Your Practice for Growth

By |2022-01-01T22:52:09-08:00February 5th, 2014|
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Dashboards: Practice performance at a glance

A medical practice performance dashboard is a great time-saver to help keep your finger on the pulse of practice performance and understand your position in real time. It is similar to the one in your car – a set of indicators  provide a simple, practical way to know what’s going on and to let you know when you’re headed for trouble. The dashboard is a metric reporting tool that makes it easy to look at business performance so you know when the practice is doing well and are alerted when something is wrong.  Dashboards provide a layered interface that conforms to the way you work.  When performance dashboards are aligned with the practice’s operations, productivity, finances and strategic plan, managers and physicians begin to work more efficiently and effectively toward achieving shared objectives. Typical indicators revealed on the dashboard focus on practice productivity and finances. However, the power of the dashboard can be extended to include other data. For example, if a new provider was added recently or you opened a new satellite clinic, monitoring growth and financial progress of this entity can be added to the dashboard. The dashboard can be designed to compare internal performance from the prior year or to look at how you compare to your colleagues across the nation. Medical Group Management Association’s (MGMA) has conveniently packaged a set of dashboard metrics with its Cost Survey on disc.  This enables the user to create a dashboard based on six indicators that are benchmarked against other practices in a few short minutes. The spreadsheet used to prepare the dashboard shows your ranking when compared to the MGMA database. If you find yourself on information overload with management and financial reports screaming for attention, think about implementing dashboard technology to monitor your practice's business performance at-a-glance.   With web-embedded technology some applications can update information automatically eliminating the need to repopulate the spreadsheets.  Charts and tables can be configured to support drill-down capabilities. Keep in mind, though, that dashboards are only as good as the data that supports them.  Success is dependent on the quality and flexibility of

By |2022-01-01T22:52:09-08:00January 31st, 2014|
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Managing includes developing practice staff

Sometimes, the business of medical practice management is a fuzzy science.  Managers have to keep the patients, and their bills, moving through the practice.  Most often, physicians are satisfied if their managers accomplish that much. But managing optimally includes softer skills, like bringing out the best in staff.  Recently, we've worked with several practices with managers who do a great job of managing upward -- reinforcing the confidence their physicians feel for them -- but who don't have much insight into really managing their own teams effectively. Keeping an eye on the team, and making sure everyone's doing what they're supposed to do, is a huge chunk of a manager's role.  But it's not the entire role of a truly effective manager.  A truly effective manager helps each member of the team develop his/her skills, understanding each person's strengths and weaknesses, and figuring out how each direct report can contribute more and be challenged and grow.  This is not just key to helping the practice improve its short-term results, it is critical to retaining the best staff and successfully completing growth initiatives. Turnover alone can be so costly to practices.  Hiring and replacing employees is a time-and-money sink.  And while critical jobs stay unfilled, mistakes can happen -- and patient service can suffer. This recent Harvard Business Review article delves into this issue -- and makes the important point that a poor relationship with their direct manager is a primary reason (if not THE primary reason) employees quit.  We see it every day! Medical practices often pay a great deal of attention to provider education -- partly by necessity. And managers can often attend conferences and find other paths to learning and development.  But staff are often left out of the equation.  And if managers aren't finding out what staff career goals are -- and how they can help them learn, grow and achieve them -- then the practice will suffer as a result.  Make sure you're evaluating your managers on this important skill!

By |2022-01-01T22:52:10-08:00January 28th, 2014|
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Trade shows – there’s so much to gain

There are lots of reasons to spend time in the exhibit hall when attending practice management and other medical conferences. By visiting the exhibit hall you will learn a lot about what’s going on in the industry, how vendors are seeking to meet your future needs and what technology changes have emerged that can make a practice more efficient and profitable, while improving service and outcomes. Yes, there are lots of reasons to get down to the exhibit hall, but it's also important to plan how you can do this without being overwhelmed or wasting your valuable time.  Forget about seeing everything – it’s just not possible and can lead to unnecessary frustration. However, with thoughtful planning you can see those things that can make a difference in your very own practice. Get off to a good start. Conference materials at the convention will include a list of all the vendors that are exhibiting. Match these with your interests. Then check-out their location on the exhibit floor. This will allow you the opportunity to plot your course.  Visit your selected vendors, by covering one section of the floor at a time. It’s a strategic move that will get you off to a good start. Refer back to your vendor list as you move through the convention. You might want to take photos using your mobile phone or make notes. This will be valuable for follow-up and decision-making when you get back to the office. Pace yourself.  Be realistic in evaluating how much time must be spent on the floor of the exhibit hall to achieve your goals and meet with the different vendors you have targeted.  Allow an average of 5 minutes for each of the vendors on your list. When you meet with an exhibitor, it’s important to be a good communicator and get right to the point.  Let the sales representative know what information you want and why.  At the same time, if the sales rep is not a good listener you could be wasting valuable time.  Don’t allow him or her to lead the conversation to information

By |2022-01-01T22:52:10-08:00January 21st, 2014|
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Will the ACA bring a wave of new patients? Prepare for the best

Will the ACA bring a big increase in patients to your practice? For most of the practices we've been working with, the ACA's impact on patient volume is still pretty unclear.  Since we're less than a month into the new coverage year for ACA exchange plans, and the open enrollment period continues through March 31, we're still at the very early stages; the actual impact is hard to gauge at this point.  Moreover, the impact may vary widely based on local demographics, practice type, and state participation in the Medicaid expansion. But we're still advising practices to take steps to prepare for more volume -- whether it comes from the ACA or their own marketing.  Readying your practice for growth is good business.  Better processes not only allow you to handle more volume, they help you serve all of your patients more effectively. Preparing your practice to handle more patients is the subject of my upcoming webinar sponsored by Kareo and hosted by Physicians Practice.  Join me on Feb 6 for this free presentation entitled "Position Your Practice for Growth: Responding to the Dynamic Healthcare Market."  I plan to share some ideas that can help almost any practice prepare from and profitably realize more growth -- whether from the ACA or their own internal marketing efforts.  Plus time for your questions!

By |2022-01-01T22:52:10-08:00January 20th, 2014|
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The cost of poor decision-making

We were recently called into a group practice where the physician owners of Struggles Medical Group were disillusioned with the practice of medicine. Their concerns were typical, shrinking reimbursement, dismal profits and the threat of new competition, as a large urban academic faculty practice was beginning to penetrate this suburban community.  Sound familiar?  This is happening around the country as a response (or reaction) to healthcare reform, where larger healthcare organizations see new opportunities to get a bigger piece of the revenue pie.  Struggles timing was perfect for bringing this consulting team in and here’s why. We performed a detailed practice assessment, examining the implications of past decisions and analyzing the current state of Struggles Medical Group in primary areas of performance including practice structure, finances, human resources, billing, clinic operations and work flow and marketing.  One physician owned this practice and the other physicians and providers were employed.  We soon discovered the physician owner had a history of making bad decisions. They did not analyze return on investment (ROI) before making investment decisions that would impact the practice operations, finances and possibly patient care. A perfect example of Struggles poor decision-making was buying very costly diagnostic equipment that they were unable to use because payers were contracted with a lab to provide these services.  This meant the investment was rendered useless to the practice. Besides this, with new models on the market every six month,s there was no way to attract another buyer for the equipment.  There were other equally disastrous investments Struggles made over the past two years. The most recent strategic error was changing the direction of the entire practice.  In their quest for new revenue opportunities the practice decided to focus on expanding its service to workers compensation patients.  Attracted solely by somewhat higher gross reimbursement rates, they went ahead with this in this in 2013 without thinking of the implications with would have on staff, workflow and profit.  This was a costly error. Workers compensation is a practice model that is significantly different from other payers and requires specific expertise in report writing and tremendous

By |2022-01-01T22:52:10-08:00January 10th, 2014|
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