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?

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

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.

Why am I being Charged for my “FREE” physical? Saturday, Sep 1 2012 

Due to the Patient Protection and Affordable Care Act (PPACA), or commonly called “Obamacare”, Health Plans are starting to cover Preventive Medicine services at 100% with no copays, coinsurance or deductible. Unfortunately, insurance companies are not informing patients that dealing with medical issues during these preventive medicine visits will result in an out-of-pocket charge that could result in a co-payment, or a substantial out-of-pocket expense if they have not met their deductible. Insurance companies require all services to be itemized and coded appropriately. One of the primary reasons is to prevent the health plans from paying for services that are not covered. Providers cannot code problem visits as preventive because this would be insurance fraud and could result in the insurance company denying the claim, dropping the physician from their network, and/or, if a government plan, the physician can face imprisonment and fines.

This has resulted in patients becoming angry with their doctor’s offices. Many practices are trying to figure out how to deal with this issue. At my practice, we notify patients before their preventive visit by posting signs on the exam room walls and the medical assistant provides a written notification for the patient to sign that they understand the billing policy. We are also trying to have the physician alert the patient, during the preventive medicine visit, when their concerns become a medical visit and may result in an out-of-pocket expense to the patient. Depending on the severity of the patient’s concern, the physician may be obligated to address the medical issue because, if he didn’t, it could result in a bad outcome for the patient. For example, if the patient states that they have been dizzy and having terrible headaches, this could mean that the patient may have a brain tumor or other significant medical issue. If the physician ignored this complaint, it would harm the patient or could harm others if the patient were driving a vehicle and had an episode. In addition, this would easily become a malpractice lawsuit against the physician.

Some physicians have chosen not to do both a preventive medicine visit and a problem visit on the same day. If the patient is scheduled for a wellness visit and a problem comes up, the physician would either make the decision to change the visit to a problem-oriented visit and reschedule the preventive if the problem is high risk; or have the patient return to deal with the problem issue at a later date if the problem is a low risk. This method keeps the appointments separate and easier for the patient to understand the difference. The downside is that it requires the patient to come back for a second visit, taking additional time off work, to deal with something that could have been handled during one visit.

Why is my doctor always late? Tuesday, Jul 20 2010 

Doctor late

Recently, a friend of mine posted a note on her Facebook account about being upset that she was at the doctor’s office and she had to leave after waiting for an hour. And, though, I do empathize with her because I dislike waiting, I do have a different perspective because I have been in health care management for over 25 years.

Certainly, there are cases that the physician has poor management skills or may not have the ability to achieve closure of an office visit with patients. Perhaps, the practice has a poor scheduling system. In defense of medical offices, there are many reasons for physicians running late that are beyond the physician’s control and not the intention to create dissatisfaction to the patient. The top one is due to the inception of managed care, physicians are forced to see more patients in a day. Physicians would prefer to spend more time with patients to make sure that the patient has the physician’s undivided attention and to create a relaxed atmosphere rather than one that is rushed. Many physicians enjoy the teaching perspective and would prefer to educate their patients on prevention and/or management of their condition.

Secondly, the front office staff tries their best to find out what the patient needs to be seen for and schedule appropriately. However, patients don’t feel that they need to tell the front office what their issue is and say it’s something minor. Then, when they get into the exam room, the doctor comes to find that it is not minor and the patient really needed a thirty-minute appointment instead of the fifteen-minute appointment. We have heard many times, “It’s none of your business.” or “It’s personal.” Patients need to understand that we need this information to help prevent delays and by making sure that the physician is prepared to deal with the problem (equipment or supplies) prior to the patient’s arrival.

In addition, patients oftentimes throw in that “Oh, by the way…” which also adds to delay for other patients down the schedule. Many times, the patient comes in for a minor problem and when the physician asks if there is anything else, in an attempt to close the visit, the patient will add “While I am here…I’ve been having this chest pain for the past three days!”

And, lastly, we can never tell when there is an emergency that will delay us and we are not able to conveniently schedule them late in the day. Case in point, we had to have the ambulance come and pick up a patient who was scheduled for a 15 minute appointment for a medication check. The patient did one of those “Oh by ways…” which led the physician to determine that the patient was probably having a heart attack and the physician was not going to leave the patient’s side to see another patient.

Physicians are starting to limit appointments by telling patients that they can only have two concerns addressed, or they tell them that they were scheduled for A and that they only have time to deal with A, so they have to schedule another appointment to deal with B. This upsets patients even more than the delay.

Ideally, staff should communicate with patients about any delays as soon as they arrive to check-in for their appointment, or as soon as they realize that there is a delay. This gives the patient an option to stay or reschedule the appointment. Though, patients still may not react favorably to this news, they would much rather have the opportunity to make that decision.

Rating physicians on websites Sunday, May 24 2009 

I’ve been troubled by the fact that patients can go to websites that allow them to rate their physicians and add comments. The main problem is that physicians can not defend themselves on these sites without breaching patient confidentiality. How is it fair for someone to provide a one-sided statement that usually is derogatory toward the physician or practice and we can not refute the claims by giving our side of the story. Who can make an informed decision based on one person’s claim of being treated poorly or unfairly?

There is always another side to the story! What is not being told is that the disgruntled patient may have wanted something that violated policy, the physician’s license, or the medical practice act. Perhaps the patient was abusive toward staff and was discharged? Maybe the patient just didn’t want to pay their bill and became upset that the practice sent him to collection? I can definitely say we have had our share of demanding patients who “want what they want when they want it”, otherwise known as the Burger King mentality. They do not want to go along with our rules and policies. They dont care that it was against the medical practice act to provide a prescription for something that the physician never treated them for.

I believe that anybody who looks at these rating websites really take it with a grain of salt. More often than not, satisfied people rarely go out of their way to find one of these sites and give their feedback. The patients who are fired up to get revenge are the ones that frequent these sites on a regular basis. Just think about how many patients a physician has and if you go to one of these rating websites and see 2 or 3 negative comments, is that really bad? Can you trust everything someone else tells you? What is their motive? Did that person have any part of the conflict? Have you ever met someone that was adamant that they were right about something and would not have an open mind to accept anything beyond what they believed?

Wall Street Journal article Saturday, May 23 2009 

I recently read this article in the Wall Street Journal. The intended audience are patients; however, I think that the comments are very informative to see the physician side of the equation. Yes…of course…I had to add my say and have commented on a variety of other people’s comments!

Why Patients May Be Billed for Free Exams
Coding-System Confusion Can Cause Insurers to Deny Coverage of Preventive Care

http://online.wsj.com/article/SB124287021368941879.html

Wall Street Journal
HEALTHY CONSUMER
MAY 21, 2009
By ANNA WILDE MATHEWS

Do I need to hire a bouncer for my medical practice? Sunday, May 10 2009 

The bad economy has resulted in many people losing their jobs, their homes, and/or their insurance coverage. People are overly stressed and panicking; resorting to actions that they would probably not have done under normal circumstances. One such response that I have seen increase in my practice is disrespectful behavior and abuse by patients toward me, my staff and the physicians.

The staff is trained on appropriate “customer” service techniques and they know that if they cannot diffuse the situations they need to ask for assistance from a supervisor. There have been extreme situations that require me, as the Administrator, to intercede. I can remain calm and in control in just about all situations. Confrontation, though not sport, is not something that I fear. I have had several experiences, however, that have given me pause.

One such moment was a result of a patient who demanded that we change his name in our computer system from his legal name to the name he preferred. His insurance card and driver’s license both had his legal name. Our system only allows one version of the patient’s name. Because it is mainly for billing, we have to use the name that appears on the patient’s insurance card or the claim would get denied. Several people attempted to explain this fact in a calm manner; however, the patient was very adamant. The front office supervisor called me to discuss the issue with the patient and, again, I proceeded to explain the reasoning behind using his legal name. I suggested that he notify his health plan and have them change his name on his insurance card and we would be able to accommodate his request. Apparently, he did not find that to be a reasonable suggestion and became increasingly irate and lunged over the counter at me, while yelling. As I was backing up, I asked him not to lunge toward me. He continued to yell, adding that he wasn’t lunging, all the while he is halfway over the counter hands flailing in the air.

On another occasion, a male patient wanted the medical assistant to code his labwork with a diagnosis code that would be covered by his insurance; however, it was not an accurate code for the services provided and not something approved by the physician.  She tried to explain this to him and he verbally assaulted her in the hallway on the way to the lab.  I was notified of this episode and confronted him about what had transpired.  He was very aggressive.  He proceeded to tell me that it was none of my business, even though I introduced myself as the Administrator of the practice.  I explained that what he did was not acceptable and his language was offensive and that is why it is my business.  I asked him to explain what had happened so I could attempt to respond to his concern and attempt to rectify the problem.  He proceeded to explain the request for the code change and that the medical assistant would not comply.  Unfortunately, I could not grant his request and attempted to explain the reasoning behind it.  His anger level rose another level and he yelled that I was supporting my employee and I was not providing “customer” service.  Vulgar name calling began spewing out of his mouth.  As I was trying to get him to calm down, I saw his right arm cock, fist closed, and knew that I was about to receive a blow.  Luckily, I was very aware of my surroundings and had my peripheral vision in tune…I backed away, picked up the telephone and called the police.  The patient left the office screaming.

These are just two of the more extreme examples of what I have personally experienced.  I fear for the safety of my staff, the physicians and myself.  Recently, I installed security locks on the doors between the reception area and the back office.  The ones that require someone from the back to “buzz” the door to unlock it.  About a year ago, I installed panic buttons at check-in and check-out.  When depressed, an alarm sounds and an immediate call notifies the police department.  I have only had to use the panic button once, but that was for an employee who was not happy that she was terminated and would not leave the premises.

I remain concerned and cautious regarding the safety in our office.  The threats are ever increasing, some of the known causes of these threats include:

  • Insurance companies creating an antagonistic reaction in patients toward their physicians.
  • Entitlement mentality that health care is a right.
  • Poor economy and resulting financial problems experienced by patient.
  • Belief that physicians are “rich” and the patient needs the money more than the physician.
  • Narcissistic society, “I want what I want when I want it and I am not accepting no for an answer!”.
  • Our society has entrenched the “squeaky wheel” mentality and many people start out with that approach.

I don’t have the answers.  I am very interested in hearing other people’s stories, recommendations, and thoughts to improve safety.  Please comment!