Annual Demographics Update Monday, Jan 9 2017 

In an effort to provide an explanation of the various reasons that we update demographics, we are offering this information to try to help reduce frustration for our patients and staff. Many people think completing the demographics form is only for billing purposes; however, we update patient information for both clinical and insurance reasons as well.

First and foremost, our clinical staff relies on the most current patient demographics to reach patients to communicate results of tests and to schedule patients for follow-up appointments. Initially, they make several attempts using all phone numbers provided. We have experienced phones disconnected and voicemail boxes full, which will then result in our attempt to reach a patient by mailing a note asking the patient to call our office. The last option is to try the patient’s emergency contact and explain that we have an important message. We do not divulge any confidential information unless we have a signed Designated Party Authorization.

In addition, we need to provide current information to specialists when we are referring patients, as well as for prior authorizations for prescriptions, procedures, and testing. These are the primary clinical reasons for having the patient update their information on a regular basis.

From an insurance perspective, it is our contractual obligation with insurance companies to maintain accurate records and current patient demographics to provide the best care. We are audited by all health plans several times a year for Quality Measures and frequently are required to show proof of current information on file.

Roughly 25-30 years ago, patients would pay for their medical services and the physician’s office would give them a bill to submit their own insurance for reimbursement. Now, with participation contracts, the healthcare provider extends credit while we wait for the insurance company to process and pay the claim.

To file a claim, and receive the insurance reimbursement, we have to have the patient sign an “Assignment of Benefits” authorizing their insurance company to send the reimbursement to the provider rather than the patient. This Assignment of Benefits is part of our demographic update form.

We, like all businesses, try to keep our expenses down and make every effort to collect for all services rendered. We need current addresses to mail statements for balances due. Phone numbers are required for the collection process as well. Even though we update this information, we still receive returned mail that is unable to be forwarded, which requires our staff to invest time determining the patient’s new address and/or telephone number. Each statement mailed can cost up to $2.00 per envelope. The Billing and Collection process can be even more costly if we are unable to locate the patient and they end up in outside collection because the collection company charges a substantial percentage to collect the balance due.

We dislike the extra workload as much as the patient dislikes completing the form. Please be assured that we have only included the minimum necessary for the patient to update to make it a bit easier. We appreciate our patients’ consideration and effort.

Advertisements

Yelp: When I want to find a good burger…not find a doctor! Friday, May 15 2015 

people-hate-us-on-yelpMy son just finished his first year of college. He is a business major, and I am interested in the viewpoints of his age group of 19 to 20-year-olds. I asked him his perspective on social media and rating sites like “Yelp”, especially in the medical industry. I had to laugh when he responded, “These sites are good for when I want to find a burger, but not trying to find a doctor.” I did have a proud mom moment!

Though I may be a bit bias, I have to say I agree with him. I have never been one to follow the crowd. I would prefer to experience all that life has to offer and make my own mind up based on my experiences. I have found that the vast majority of people who post on these sites are usually malcontents and self-absorbed. As an Administrator of a physician practice, when a patient is trying to “get their way” they typically threaten to go to “Yelp”. It is a threat and a method of intimidation. Before “Yelp”, people would threaten to file a lawsuit or contact their Senator/Congressperson…even the President!

A good portion of patient demands are unreasonable or not in the best interest of patient care. Sometimes, the patient becomes threatening or abusive toward the staff, which results in the patient being fired from the practice. Unfortunately, due to HIPAA, there is no way to defend ourselves against these accusations. Those of us who experience this firsthand know that IF people were to hear the whole story, they would understand our perspective! Would you trust a drug-seeker who is mad because we would not provide opiates since the patient is on marijuana, albeit “legally” with a medical marijuana card? Perhaps the review you are reading is from someone who is upset that they have a high-deductible health plan, and now they owe money to their doctor.

I have discovered that some reviews are in error. I had a review that mentioned a particular physician that was never a member of our practice. The review was regarding a service that we have never provided. It is nearly impossible to redact these erroneous reviews. Why would one want to trust a review that was a mistake?

Then, there is the fact that Yelp will contact the business to “help” them with their business reviews and create more positive responses…for a price. A great article that discusses this can be found at:

Yelp and the Business of Extortion 2.0

Bottomline, leave the reviews to film or restaurant critics…and maybe not even then! Don’t trust strangers with ulterior motives in choosing your physician. Do you want your healthcare in the hands of a trained physician or an unknown person who is trying to lash out because they didn’t get their way?

At Odds With Others: Hang up the gloves and start talking Thursday, Jan 2 2014 

This article appeared in the March/April 2008 issue of CMA Today the monthly magazine published by the American Association of Medical Assistants (AAMA). It was written by Cathy Sivak.

This article is regarding conflict with others in the office environment and is increasingly a challenge for every office.

“Meaningful conflict actually enhances communications by relating the expectation up front between the parties. Communication can be painful, you may have to correct somebody, but in the end you gain more respect from each other,” says Charlene Burgett, MSHCM, CMA (AAMA), CPC, CMSCS

AT ODDS WITH OTHERS Article CMA Today

Boxing Gloves

What Insurance Companies Don’t Want You to Know! Friday, Oct 26 2012 

Finally! A long awaited and much anticipated book about ERISA by two well-respected leaders in the health care industry! This book will provide the secrets in getting claims paid, how to fight denials, and halt recoupments using the features within the ERISA regulations.

This is a must buy! Quite frankly, this is important even if you are a layperson covered under your employer’s group health plan! These are the secrets that your insurance company doesn’t want you or your doctor’s office to know!

Book Description

Publication Date: October 15, 2012
New book helps medical practices use the secrets within the ERISA regulations to their benefit to increase practice profitability The Medical Practice Guide to ERISA: Employee Retirement Income Security Act The Federal law ERISA (Employee Retirement Income Security Act) helps the majority of medical practices make carriers pay on claims that are now being denied, delayed and recouped. Only a small percentage of practices understand how ERISA works — yet with this new book, ERISA could possibly become a practice’s best friend! ERISA is complex and most medical practices, “Don’t know what they don’t know when it comes to dealing with ERISA!” Practices are in the dark in understanding how to protect their employer’s rights in collecting the monies owed them. ERISA regulates the practice s health benefits, health benefit payments, EOBs, and most importantly, appeal rights Using this book will allow the reader to not only capture the funds on thousands of dollars that the carriers are now unfairly denying, but will empower the reader to stop the unfair recoupments, illegal timely filing and improper appeal periods that carriers mistakenly quote to physicians and hospital offices. The authors map out the smart but ingeniously simple tactics that practices can use to force insurance carriers to honor their responsibilities on the policies owned by patients — and to convince the carriers to adhere to what the policies actually require them to cover. Providing an overview of the ERISA law, the Self/Verno book provides tips, tools and techniques to leverage ERISA for practice advantage. They take a close look at real-world ERISA situations, violations and outcomes. Armed with this roadmap, physicians and executive staff can better put their resources to work– leveraging ERISA to improve practice profitability. Noteworthy Features Clear Roadmap Written in layman’s terms so practice leaders can immediately begin to implement a strategy of getting claims paid, how to fight denials and halt recoupments. Practical Guidance Includes real world examples and case studies of how medical practices can use the ERISA rules to work for them. Also included is practical information on how to use the ERISA website and answers to the most frequently asked questions about ERISA. Templates to Get You Started Sample letters (describing exact situations and how they can be handled) will get you started and help your practice take control of the process. Selected Table of Contents Healthcare Basics Definitions Laws Employee Benefits Security Administration: Frequently Asked Questions about ERISA Using ERISA Claims Issues Sample Letters – Timely Filing Denial Response, Refund Demand Layperson Response, Unpaid Claims Letter, Incorrectly Paid Claims Letter, Bundling Denial Letter, Down Coding Letter, Payment to Patient Letter Additional Resources – Helpful Websites, Layperson Documents Authorized Representation, Assignment of Benefit Form

You can purchase through Amazon by clicking on this link:

http://www.amazon.com/The-Medical-Practice-Guide-ERISA/dp/0988304007/ref=pd_rhf_cr_p_t_1

OAISYS Call Recording Case Study Tuesday, Oct 2 2012 

A few years ago, I did a video case study for OAISYS on their call recording solutions. I never thought, until now, to include it on my blog…here goes!

http://www.youtube.com/watch?v=R6Ikzy87h5A&feature=plcp

 

 

 

 

ICD-10-CM implementation date is October 1, 2014 Saturday, Sep 1 2012 

The final rule setting the ICD-10-CM implementation date as October 1, 2014 was released by the Centers for Medicare & Medicaid Services (CMS) on August 24, 2012.

I’d rather buy a month’s worth of Starbucks than…pay my doctor bill Wednesday, Jul 6 2011 

One of the biggest frustrations we have in the health care industry is due to patients not understanding their own health insurance benefits. Oftentimes, patients think that just because they carry insurance, that means that everything is covered and they don’t have to pay anything. Patients receive health care service and a month later they discover that their insurance doesn’t cover that particular service; however, instead of accepting the responsibility of paying, many patients fight, demand, and threaten the physician’s office staff to make the balance go away.

This phenomenon has gotten worse in the past twenty years or so. I subscribe to the theory that much of this mentality is due to the inception of HMO’s. In the beginning, HMO’s had either zero patient financial responsibility, or an exceptionally low out-of-pocket cost. People have been conditioned in thinking that health care is an entitlement. After about a decade, due to insurance companies (and employer groups) not being able to withstand the expense of higher utilization of “free” health care, they began to make the consumer more responsible by charging higher co-pays and not covering certain services. Unfortunately, most Americans expect the same Cadillac coverage without any additional expense (beyond their insurance premium and co-pay).

A major challenge in physician practices is to help their patient’s understand their insurance company’s reimbursement policies, all the while maintaining good will. Physicians are finding themselves having to develop various financial informed consent forms to assure that the patient understands that they may be responsible for some of the cost. Medicare has required this, in the form of Advanced Beneficiary Notices (ABN), for years.  Even so, we often hear patients state, “I signed it but didn’t read it.”  Or, “I was afraid if I didn’t sign it that I wouldn’t get the service.” Perhaps the days of accountability are long gone.

One of the biggest threats we hear from patients is that they will leave our practice if we don’t write off their balance. Not much that you can do about that. Health care is a business and we cannot pay the bills with altruism. In addition, it is fraud to bill the insurance company for services and write off the patient’s responsibility. Aside from financial hardship cases, routine adjustments of patient responsibility can get a physician excluded and/or fined by the government when it is a government program such as Medicare or Medicaid. Worst case scenario for commercial insurance is the insurance company dropping the physician from their network.

With lower reimbursements, practices really need to devote more energy in collecting all revenues due. The average overhead for a primary care physician practice is reaching 60%. There are no government subsidies for physicians, other than rural health care, community health care centers and native american health centers. More and more physicians are closing their offices, retiring early, selling their practices to hospitals, transitioning to concierge medicine, or going to cash only practices. This is devastating to primary care because of the physician shortage; however, many specialists are also getting hit hard as well.

AZZ Cardfile Saturday, Jan 1 2011 

Happy New Year!   Many of us make new year’s resolutions and one such resolution that is often made is to get more organized.  I wanted to recommend a helpful computer program that can assist you in creating a database of useful information and to provide easy access to information that you regularly use, both professionally and personally.

Let  me introduce you to AZZ Cardfile:

http://www.azzcardfile.com/

You can download a trial of this program for free and see how other people have used it by looking at collections that have been submitted:

http://www.azzcardfile.com/collections/

There are so many ways that this program can be used and one is only limited by their imagination.  The collections provide some ideas and may be useful to others.  Many people use this program for recipes (ethnic dishes, beverages, desserts, etc.) or a way to create a database of gift ideas.  One thing that I use this program for is to organize my professional letter and form templates for easy reference.

If it’s not documented… Thursday, Dec 2 2010 

I want to share with you my call recording system in our office. Initially, we had phones that would record, but it was only after someone pushed the record button on the phone and I would never get anything prior to the record button being pushed. In addition, the telephone system’s call recording speaker was very sensitive and if one of my employees sighed, breathed, or there was any other noise on our side of the phone, it would override the speaker and I would only hear our side of the conversation. It was very frustrating!

I have been recording our inbound and outbound telephone calls for over three years now and it is one of the best things I have ever done in my 25 years of practice management! The system I have was developed by OAISYS. They have two products, Tracer and Talkument. Talkument is more basic. I started with Talkument and upraded to Tracer about a year ago!

I did a case study for them because I love their product so much!

http://www.oaisys.com/casestudies/NSFM.aspx

and

http://www.oaisys.com/movies/flash_only/NSFM_Case_Study_flash.html

There is really no Federal Law regarding telephone recordings in this scenario. Each state has their own regulation and can either be “one-party” or “two-party”. One-party states only require one party to know about the telephone call being recorded and that would be the recording party. Two-party states require both parties and that is where you would hear the message that states “all calls are being recorded for quality assurance purposes.”

Arizona is a one-party state. I have my staff and physicians sign a disclaimer that they know that the phones are recorded, just to be on the safe side in my office. I also have a label on all phones reminding people that their conversation is recorded. I am the only person who can access the recordings…the physicians can not even access them!

Here is a website that covers telephone recording laws:

http://www.rcfp.org/taping/.

The OAISYS server is attached to our phone system. It has it’s own IP address, so there is no software to install on your phone system or computer server. I don’t remember how much hard drive space is on the server, but we have not filled the hard drive up yet. I do have another external hard drive attached to the system so when we do fill the drive, it is programmed to have the oldest calls dump into the external hard drive. All phone calls are saved and will be saved permanently, or until we decide to purge. I spoke with our malpractice insurer and they suggested that we retain the calls using the same guidelines as retaining patient medical records.

I am able to log into the server and the calls appear similar to how Outlook is laid out. I can search using various parameters, such as date of call, outside telephone number, office extension, inbound/outbound calls, etc. I can combine those parameters and do a search to drill down even further.

We have had three licensing board complaints and, in all three, I used the voice recordings as evidence…we won all three! All three licensing board complaints were completely dropped! Think about the malpractice savings because these things could have resulted in a malpractice lawsuit as well. This alone has covered the cost of the system over ten-fold!

In addition, I have used the voice recordings to help my staff in understanding that they made a mistake or may have sounded rude on the phone. Oftentimes, I can just let them listen and they discover the problem themselves…makes my job so much easier when they have the buy-in!

I have used it to fight insurance companies. I have used it for the smallest, mundane things, like the front office hanging up without getting a name or phone number of the patient…I go onto Talkument/Tracer and can pull the actual voice recording and re-listen to the person identifying themselves and the phone number shows up on caller ID on the system.

And, how many times, have you had a disgruntled patient who has stated that someone told them something and you know darn well that the person is not sharing the full truth with you? Yes, I have brought patient’s in my office to listen to their own conversation. I have emailed their telephone call to them proving that they made their appointment on a specific date, time and with a specific doctor because they state otherwise.

Bottomline is that I detest being lied to and I hate not knowing who to believe. If it happened on our phone line, I can hear it for myself and make my decisions based on fact! There is no better place to be and that, to me, is priceless.

My physicians and several other key staff, initially, had some trepidation about the system and now they bless the day we got it.  In fact, they wrote recommendation letters themselves sharing their feelings on having this system in our practice:

http://www.oaisys.com/downloads/NSFM_Letters_of_Recommendation.pdf

I seldom put this much passion into another company…OAISYS has won me over from the minute I saw them as a vendor at another conference I attended. I have had many dealings with OAISYS and they are a top notch company…if I ever think of ending this healthcare gig, I would be on their doorstep asking them to hire me! They use a third-party to do the installation, for us it was Sonoran Integrations, and they were excellent as well.

Oh, and another thing that we use it for, that may be of specific interest to those of you in Pediatrics:  Arizona has really strict laws regarding caring for minors and parental consent. As we all know, there are those parents that will drop their toddler off at one end of the block and expect him to get to the office, sign in and make informed medical decisions and pay their copay in Cheerios. Okay, maybe I am embellishing a little bit, but we all know that parents will drop off their teenagers and we cannot see them because we do not have parental consent.  With Talkument, I have the ability to record the parent’s consent and note in the chart that it was given and recorded (a verbal is okay, but I hate to have that “he said/she said” thing in a court of law!).

The Importance of Endorsements Thursday, Sep 30 2010 

As a rule, I don’t like to endorse companies or people; however, there are a few I would like to mention because I have had personal experience with them and find that they have exceeded my expectations on many levels.

OAISYS

OAISYS provides call recording for telephone systems; both inbound and outbound calls.  This has helped me as a Practice Administrator in so many ways and it is difficult to list all of them in a short summary.  I plan to provide a complete summary in an upcoming blog post.  Bottom line, though, there is not one single resource that has helped me as much as their Tracer system for call recording.  I have enjoyed benefits in the areas of Risk Management, Human Resources, Patient Relations, Insurance and Accounts Receivable/Revenue Cycle management.

Greenbranch Publishing

I believe this is the leader for publishing in the healthcare industry!  Their publication,The Journal of Medical Practice Management, is, by far, the most professional and informative resource available in the medical industry.  Greenbranch, also, publishes a wide variety of books, audiobooks, podcasts, and newsletters.  They offer AAPC CEU’s for many of the audioconferences, as well. Greenbranch has co-developed Codapedia, with Betsy Nicoletti, which is a “free encyclopedia of medical reimbursement”.

Don Self

Very generous in offering his time and resources, Don offers a database of free documents donated by others.  This alone is a valuable resource to anyone in the health care industry!  Recently, Don authored a book entitled, “The Unfiltered Guide to Medical Office Management“; this is a comprehensive guide for many issues relevant to a physician’s practice.  Don is in the business of consulting with the medical community to increase revenue; however, he also educates by speaking at conferences, publishing a newsletter and offering webinars.  Also, check out his E&M Sliderule…sure to be a hit for physicians and coders!