Whether or not you are a new physician opening your first medical practice, or an established physician looking for a new office location, practice start up can be a daunting task. From choosing a contractor to furnishing your new suite, the project is certainly going to be costly and time consuming.
Doing some simple homework can save both time and money and make the project a more enjoyable, less stressful situation and assure that you will still be happy with your choices for many years after your space is complete.
Before choosing your practice location, you should study your practice demographics. For an established physician this mean running a software report outlining your patient's home towns and choose a location central to the towns and counties that support your largest number of visits. You will want to be close to public transportation and to the referral doctors that send patients your way. For new physicians, your choice of location should be close to the hospital where your completed your training and may be able to rely on contacts made during this time. Once you have a good understanding of your demographics, you can begin to scout for a location.
There are some distinct advantages in choosing a commercial building rather than a curbside location.
Commercial buildings often provide visitor security both in and outside of the building, including the parking garage or commercial parking lot. The maintenance staff is at your disposal as part of the lease agreement and many commercial buildings provide cleaning services, including daily trash pick up and snow removal free of charge. Office re-painting and additional services may also be included for reasonable rates. Larger practices should consider having some cleaning staff on hire at least on a part-time daily basis and especially if your practice contains patient restrooms or an employee kitchen.
Curbside locations, especially those with parking lots directly behind the building, can offer handicapped or elderly patients easier access to services. The ability to see these locations from the road can serve as an additional marketing tool to attract patients to your office.
Commercial or curbside, you will want to choose a location that offers patients adequate parking, especially in locations where weather may be an issue. Patients will not hesitate to leave a practice if parking is too difficult or too far away from the building. Many commercial landlords will offer physicians a number of assigned parking spaces exclusively for patient visits. If this is the case in your building, try to assure that the spaces are located close as possible to the main entrance and have ramps or elevator access into the building, especially if they are located on a higher floor of the garage.
Also, make sure that your office space is in compliance with state and federal requirements for patients with disabilities. Your architect and contractor should have a good understanding of these regulations. Don't forget to note the operating times of the building you choose. If you have evening or weekend office hours, you will want to make sure that the building remains open and staffed at these times.
Know your square footage needs before making any commitment to an office space. Many beautiful and tastefully decorated offices fail to meet the needs of the staff. Poor advance planning will eventually hinder practice growth and is usually characterized by a lack of adequate storage space or employee work areas. Consequently, the office appears messy and disorganized and may pose safety hazards. Meet with an architect well before you shop for space. Outline your daily practice flow and your hopes for future growth. Together you should be able to come up with a square footage amount that will meet your needs. Think carefully about how your practice functions on a daily basis and stress your need for adequate storage space and the necessary room to house your computer hardware and phone wiring. Restrooms, labs and testing areas should be clearly outlined and assure room for the number of current and future employees. Request that your architect give you a few possible plans and choose what works best for you.
Once you have found a space that suits your needs, you will be ready to work on your purchase or lease agreements. You may be fortunate enough to find an established space that can be redone for you or you may need to do a complete renovation. Either way, most commercial buildings will offer you a per -square foot allowance that usually has a modest amount of wiggle room, depending on the landlords motivation to move the property. Some buildings will require that you use the contractors they recommend, while others may just ask for state licensing and certifications and allow you to choose your own. Either way, get at least three estimates for your buildout and ask to see locations that your contractor has completed. Make sure that you are paying fair market value for both the space and the construction. It may not be a great idea to choose a contractor who has never worked on a medical space, since they may not have a good understanding of Federal and State requirements for this type of facility.
Your contractor will apply for work permits and should guarantee that electrical and plumbing services are certified and that the work will meet or exceed inspection regulations for the town and county.
Obtaining work permits is often a lengthy process. If you find that your work permit is unreasonably delayed, you may want to contact the town or country supervisor and advice them that patients are waiting to be treated in the space and you would appreciate their intercession on your behalf. These officials are always anxious to assist new business ventures in their community and will often be able to cut through any red tape that is delaying your permit.
Your architect will receive plans outlining specs for plumbing and electrical outlets to be included in your buildout. Be aware that the buildings contractors may only supply a certain number of outlets, lighting and water sources and additional sources for power and water may be at your expense, so check your plans carefully and assess needs well before the work is started. It is always less expensive to add these additions when the walls are open.
Orient your exam rooms so that your sinks, outlets and exam tables work well with your office visits and procedures that may be assigned to a particular set of rooms. Assure that your space will allow for standard sizes of cabinets and sinks to avoid the additional expenses of custom sizes. This is also true for any bathrooms in your suite. Think ahead about seating plans for your waiting room and imagine the types of tables and lighting that you prefer.
Your staff will need sufficient overhead lighting and enough outlets for computers, scanners, phones, adding machines, credit card machines, and tabletop faxes or copiers. Calculate for room under the desk for hard drives, wiring, and the storage of personal items and work tools. Don't forget that the average patient may spend no more than 30 minutes in your office, but your employees will be there for eight or more hours, five to seven days a week and personal space not only makes work flow more efficient, but also promotes a positive attitude. Assure that your front desk space allows for practice growth and future employees. You may want to think about having a separate area at the front desk for phone triage. This will involve an additional bank of phones, seating, tabletops and computers. If this arrangement works for you, you will want to also consider the installation of a glass wall to separate these employees from the patient check-in area.
Tomorrow - Doing Some Work Yourself
Thursday, June 30, 2011
Wednesday, June 29, 2011
Protecting Your Patient's Privacy
Congress enacted the Health Insurance Portability and Accountability Act (HIPAA) in 1996. Title I protects health care coverage for employees when they lose or change their jobs. Title II known as the Administrative Simplification (AS) requires the establishment of national standards for electronic claims submission, national identifier numbers for providers and the security and privacy of all health data.
The HIPAA Privacy Rule took effect in April of 2003, with a compliance date for most entities of April 21, 2005. Patient's medical records are referred to as Private Health Information or PHI and all covered entities that provide medical services are compelled by law to protect patient confidentiality and communication.
Any patient who feels that the Privacy Rule is not being upheld can file a complaint with the Department of Health and Human Services Office for Civil Rights (OCR).
Policy : All covered entities will be required to adopt a written set of procedures to insure patient confidentiality. A privacy officer should be designated to develop and implement these procedures and clearly document security controls. If any practice business is assigned to a third party, the practice must assure that this party is also in compliance with the safeguards required.
For Example : Medical Records must be kept in a secure location that can be locked at the end of the day. In addition, the practice should clearly identify those individuals who are allowed access to these records. Any and all conversations regarding PHI must be held in in a secure area.
Copy and fax machines as well as outgoing mail must be located away from patient access. Employees should double check all machines each day to make sure originals are not left behind. Only authorized staff should have access to incoming mail. E-mail systems must also be protected to assure HIPAA compliance.
You are required to implement a HIPAA training program for your facility, and employees are required to have a good understanding of your office's compliance policies. They must sign off after training is complete and records of their signatures must be kept on file.
An emergency plan must be in place for computer data backup and recovery.
Equipment and Records : Medical records must be disposed of properly to make sure that PHI is never compromised. Shredders must be available to destroy old documents. In addition, access to equipment such as fax and copy machines must be away from the patient waiting area or exam rooms and your office workstations must be organized so that charts are not viewable to the patients or visitors to your facility. Daily sign in sheets are now available so that after the patient signs in the name can be peeled off and placed on a secure daily data sheet not viewable by other patients.
Technical Support : Computer software should be password protected and the entity should assure that these passwords are not share or accessible to non-authorized personnel. Security is available on most of the better software and allows management to restrict or deny any non task related information in keeping with the employee job description. Configuration and authentications of software, passwords, and office equipment is the responsibility of the practice security offices who monitors access to data. A quarterly audit of all equipment and security measures should be completed to make sure the practice remains compliant.
Your HIPAA Patient Statement: All new patients should be given a HIPAA statement when they check in for their visit. This statement should outline that the practice is committed to adherence with all HIPAA policies as well as pose a number of questions to the patient's preference in matters of confidentiality. These may include:
May we share your medical records with other practitioners that are providing concurrent care?
Can confirmation calls be left on your phone answering machine?
May we call you at work with test results or appointment reminders?
Do you currently have a health care proxy that is allowed to make decisions for you, should you be unable to make these decisions yourself? Who is this person and what is their relationship to you?
Do you have any specific requests regarding your PHI?
The answer sheet for these questions should be filed in the patient chart. Any specific request should be noted on the chart and help you abide by your patients wishes.
Use common sense with implementing HIPAA procedures in your office. If your exam rooms have outside chart holders, you may want to place the chart backwards so that the patient name is not visible. You can purchase bins to store charts pulled for the day or week. Chart preparation and filing of patient records should be done in your file storage area where a small table may be a useful addition.
Physicians may often continue conversations with their patients as they leave the exam room and do not realize that this may compromise their patient's confidentiality. Doctors should complete their consultations and write any scripts inside the exam room.
Tomorrow : Your Office
The HIPAA Privacy Rule took effect in April of 2003, with a compliance date for most entities of April 21, 2005. Patient's medical records are referred to as Private Health Information or PHI and all covered entities that provide medical services are compelled by law to protect patient confidentiality and communication.
Any patient who feels that the Privacy Rule is not being upheld can file a complaint with the Department of Health and Human Services Office for Civil Rights (OCR).
Policy : All covered entities will be required to adopt a written set of procedures to insure patient confidentiality. A privacy officer should be designated to develop and implement these procedures and clearly document security controls. If any practice business is assigned to a third party, the practice must assure that this party is also in compliance with the safeguards required.
For Example : Medical Records must be kept in a secure location that can be locked at the end of the day. In addition, the practice should clearly identify those individuals who are allowed access to these records. Any and all conversations regarding PHI must be held in in a secure area.
Copy and fax machines as well as outgoing mail must be located away from patient access. Employees should double check all machines each day to make sure originals are not left behind. Only authorized staff should have access to incoming mail. E-mail systems must also be protected to assure HIPAA compliance.
You are required to implement a HIPAA training program for your facility, and employees are required to have a good understanding of your office's compliance policies. They must sign off after training is complete and records of their signatures must be kept on file.
An emergency plan must be in place for computer data backup and recovery.
Equipment and Records : Medical records must be disposed of properly to make sure that PHI is never compromised. Shredders must be available to destroy old documents. In addition, access to equipment such as fax and copy machines must be away from the patient waiting area or exam rooms and your office workstations must be organized so that charts are not viewable to the patients or visitors to your facility. Daily sign in sheets are now available so that after the patient signs in the name can be peeled off and placed on a secure daily data sheet not viewable by other patients.
Technical Support : Computer software should be password protected and the entity should assure that these passwords are not share or accessible to non-authorized personnel. Security is available on most of the better software and allows management to restrict or deny any non task related information in keeping with the employee job description. Configuration and authentications of software, passwords, and office equipment is the responsibility of the practice security offices who monitors access to data. A quarterly audit of all equipment and security measures should be completed to make sure the practice remains compliant.
Your HIPAA Patient Statement: All new patients should be given a HIPAA statement when they check in for their visit. This statement should outline that the practice is committed to adherence with all HIPAA policies as well as pose a number of questions to the patient's preference in matters of confidentiality. These may include:
May we share your medical records with other practitioners that are providing concurrent care?
Can confirmation calls be left on your phone answering machine?
May we call you at work with test results or appointment reminders?
Do you currently have a health care proxy that is allowed to make decisions for you, should you be unable to make these decisions yourself? Who is this person and what is their relationship to you?
Do you have any specific requests regarding your PHI?
The answer sheet for these questions should be filed in the patient chart. Any specific request should be noted on the chart and help you abide by your patients wishes.
Use common sense with implementing HIPAA procedures in your office. If your exam rooms have outside chart holders, you may want to place the chart backwards so that the patient name is not visible. You can purchase bins to store charts pulled for the day or week. Chart preparation and filing of patient records should be done in your file storage area where a small table may be a useful addition.
Physicians may often continue conversations with their patients as they leave the exam room and do not realize that this may compromise their patient's confidentiality. Doctors should complete their consultations and write any scripts inside the exam room.
Tomorrow : Your Office
Tuesday, June 28, 2011
Practice Compliance with OSHA and the Department of Labor
Statutes enforced by the Department of Labor require that certain posters or notices be posted in the workplace. The requirements can vary from state to state and can be dependent on number of employees, and include those staff members who may be covered under the Federal Disability Act. Failure to post these notices can result in a penalty. You can check your state requirements and order the appropriate posters online @ www.dol.gov or by calling the Department of Labor @ 1-866-4USA-DOL.
The Occupational Safety and Health Administration has guidelines covering safety in the workplace. While you will not need a comprehensive understanding of these requirements, you will be responsible for insuring that your employees and patients are working or being treated in a safe environment. Whether or not your office is located in a commercial building or curbside, you will most likely receive a visit from your local fire department. Their purpose is to insure that your are in compliance with OSHA and town ordinances.
A complete list of OSHA requirements can be found @ www.osha.gov
In order to insure a safe work place, use a common sense approach to inspect your office. Sprinkler systems, lighted exit signs, and fire alarms must be operational and should be checked annually or semi-annually as required by state or local ordinances. Frayed or loose wires must be replaced, and tripping hazards to patients or staff, including carpeting or furniture should be immediately addressed. You will be cited by your local fire department for stacking boxes in aisles, or too close to the ceiling, so you will want to put your supplies in a safe place as soon as they are delivered.
The numbers for the local fire department must be posted at the front desk and in all exam rooms. You can also program this number into each practice phone, along with the number for your local police department. Scheduled fire drills for commercial buildings means that all staff and all patients must exit the office, or your practice will be fined.
Should you use any form of radioactive isotopes, you will also be subject to routine inspections. You will be required to post an emergency number in case of accidental spills as well as having a written policy for handling this situation. It is recommended that you use posters next to or below the sharps containers that will notify staff of the regulations regarding their use and proper disposal. The vendor that supplies you with your sharps containers will provide you with these posters, along with the Federal guidelines for accidental needle sticks. You can find and download this policy on a number of web sites.
Tomorrow: Safeguarding Your Patients Privacy
The Occupational Safety and Health Administration has guidelines covering safety in the workplace. While you will not need a comprehensive understanding of these requirements, you will be responsible for insuring that your employees and patients are working or being treated in a safe environment. Whether or not your office is located in a commercial building or curbside, you will most likely receive a visit from your local fire department. Their purpose is to insure that your are in compliance with OSHA and town ordinances.
A complete list of OSHA requirements can be found @ www.osha.gov
In order to insure a safe work place, use a common sense approach to inspect your office. Sprinkler systems, lighted exit signs, and fire alarms must be operational and should be checked annually or semi-annually as required by state or local ordinances. Frayed or loose wires must be replaced, and tripping hazards to patients or staff, including carpeting or furniture should be immediately addressed. You will be cited by your local fire department for stacking boxes in aisles, or too close to the ceiling, so you will want to put your supplies in a safe place as soon as they are delivered.
The numbers for the local fire department must be posted at the front desk and in all exam rooms. You can also program this number into each practice phone, along with the number for your local police department. Scheduled fire drills for commercial buildings means that all staff and all patients must exit the office, or your practice will be fined.
Should you use any form of radioactive isotopes, you will also be subject to routine inspections. You will be required to post an emergency number in case of accidental spills as well as having a written policy for handling this situation. It is recommended that you use posters next to or below the sharps containers that will notify staff of the regulations regarding their use and proper disposal. The vendor that supplies you with your sharps containers will provide you with these posters, along with the Federal guidelines for accidental needle sticks. You can find and download this policy on a number of web sites.
Tomorrow: Safeguarding Your Patients Privacy
Monday, June 27, 2011
Your Practice Handbook
Even the smallest one physician practice can experience the same employee and labor issues as any large corporation. The Department of Labor takes employee issues very seriously and unless your practice has a standard of employee behavior that keeps with your practice philosophy, employee issues can have a negative impact on both your practice atmosphere and in matters of finance.
Your practice handbook will provide your employees with a clear understanding of your mission statement as well as the behavior and demeanor that is expected in the workplace. Every new employee should be required to read and understand the handbook and complete a signature page noting that they are aware of the practice protocols and agree to adhere to the principles noted within.
A sample handbook should include the following:
Mission Statement : This message will convey the message that the practice is dedicated to providing excellence in patient care and will outline staff expectations. A typical mission statement may appear as follows :
" John Doe, Medical, P.C. is dedicated to providing excellence in medical care in an environment of courtesy and mutual respect for our patients and for fellow employees. Our staff will adhere to all HIPAA, federal and state regulations governing the privacy and protection of our patient's medical records and history. We will provide our employees with a safe work environment and will meet or exceed the Occupational Safety and Health Administration guidelines. We will actively support the growth of our practice and welcome referrals from our patients, family and friends."
Zero Tolerance Policy : Prospective employees will not be discriminated against on the basis of race, sex, or religious affiliation and any display of workplace discrimination is cause for immediate dismissal. A policy of zero tolerance will also be outlined for sexual harassment, including inappropriate dress, or the use of obscenity in the workplace.
You may also want to add a "Zero Drama" paragraph in this section of your handbook. This will point out to employees that the administration will welcome any and all suggestions for the betterment of the practice but will not welcome personal gossip or lack of mutual respect for fellow employees. A zero drama policy will make it perfectly clear that the practice has no time or patience for infighting among the staff and that such behavior will be cause for immediate dismissal.
* Note * During your interview period with any perspective employee it is necessary to point out that the ability to work well with others is part of the job description. A constant complainer is not good for any medical practice.
Probationary Period : A review of the employee skills and adaptation to the practice policies should be conducted during a 90 day probationary period. Benefits, including vacation/ sick and or personal days should only begin to accrue after probation has been completed and the employee receives an evaluation of their skill and areas for improvement. To make this process easier, employee review and evaluation forms can easily be found on most human resources web-sites and are in compliance with regulations to protect your employee privacy. They may also be an added benefit if your payroll is done by an outside service such as Paychex or ADP.
Employee Benefits : Clearly outline your policy for sick, personal and vacation days and the guidelines for how this time accrues during the year. Note whether vacation and sick/personal time can be carried over into the next calendar year. Include lunch hour and or break time policies as well as overtime compensation. Always add that overtime will not be paid unless it is first approved by management.
Health Insurance : If your practice offers any form of health insurance to your employees, the guidelines for eligibility and a general outline of the plan benefits should be included. State that the practice may change the health plan should costs become prohibitive and will notify employees at least 30 days in advance.
* Note * Many payroll services have excellent plans that will auto-track your employees sick/personal and vacation time and will provide you with your own way to input information as well. Should you wish to have them print and bind your handbook, this service is also available.
Excessive Lateness / Sick Time : Employees should report to the workplace 15 minutes prior to their shift and be ready to work at their start times. Disruptions to the work flow caused by excessive lateness or sick time will be cause for termination.
Emergency Contact Number : In case of inclement weather or any other emergency that may cause the closure of your office, a phone number should be noted for the office manager or human resources department. You should also include the phone numbers for the local police and fire departments.
Office Evacuation Plan: In case of fire, flood, or any other emergency, an evacuation plan should be in place and clearly outlined in your handbook. This plan should also be posted at the front desk so it is clearly visible to employees and patients. If your office is in a commercial building, staircases and fire exits should be located and noted. Commercial insurance plans will ask to see your evacuation plan each time they audit your practice.
Policy for Needle Sticks and/or Radioactive Isotope Spills: Standards of care for accidental needle sticks my be obtained from the Department of Health and should be posted in your lab as well as in your exam rooms. Should your practice use radioactive isotopes, you must note the emergency phone number and policy for handling accidental spills. Post clear policies for your sharps containers and/or radioactive waste and disposal of needles and containers.
Management Staff : Names, job titles, and contact numbers for your management staff should be noted. HIPAA standards require that all medical practitioners have staff dedicated to assuring privacy and protection of medical records. Staff assigned to maintain HIPAA standards should also be listed in your handbook and violations to any HIPAA standard should be immediately reported. You are also required to have a signature on file for every employee stating that they understand and will comply with all HIPAA privacy standards. You will need to assign both a security and privacy officer to meet compliance with HIPAA. Note names and phone numbers clearly.
Your office handbook is easily maintained by using a three ring binder which will allow you to add relevant topics to the manual or to make necessary changes. This binder will also allow your staff to keep important memos regarding any new insurance or practice policy. Every new employee should be armed with their own binder. In the early days, it will help them remember the address, phone, and zip code for the practice and will help them remember the names of management staff. You will be surprised how often every employee will refer to their binder each year.
Tomorrow : United States Department of Labor and OSHA
Your practice handbook will provide your employees with a clear understanding of your mission statement as well as the behavior and demeanor that is expected in the workplace. Every new employee should be required to read and understand the handbook and complete a signature page noting that they are aware of the practice protocols and agree to adhere to the principles noted within.
A sample handbook should include the following:
Mission Statement : This message will convey the message that the practice is dedicated to providing excellence in patient care and will outline staff expectations. A typical mission statement may appear as follows :
" John Doe, Medical, P.C. is dedicated to providing excellence in medical care in an environment of courtesy and mutual respect for our patients and for fellow employees. Our staff will adhere to all HIPAA, federal and state regulations governing the privacy and protection of our patient's medical records and history. We will provide our employees with a safe work environment and will meet or exceed the Occupational Safety and Health Administration guidelines. We will actively support the growth of our practice and welcome referrals from our patients, family and friends."
Zero Tolerance Policy : Prospective employees will not be discriminated against on the basis of race, sex, or religious affiliation and any display of workplace discrimination is cause for immediate dismissal. A policy of zero tolerance will also be outlined for sexual harassment, including inappropriate dress, or the use of obscenity in the workplace.
You may also want to add a "Zero Drama" paragraph in this section of your handbook. This will point out to employees that the administration will welcome any and all suggestions for the betterment of the practice but will not welcome personal gossip or lack of mutual respect for fellow employees. A zero drama policy will make it perfectly clear that the practice has no time or patience for infighting among the staff and that such behavior will be cause for immediate dismissal.
* Note * During your interview period with any perspective employee it is necessary to point out that the ability to work well with others is part of the job description. A constant complainer is not good for any medical practice.
Probationary Period : A review of the employee skills and adaptation to the practice policies should be conducted during a 90 day probationary period. Benefits, including vacation/ sick and or personal days should only begin to accrue after probation has been completed and the employee receives an evaluation of their skill and areas for improvement. To make this process easier, employee review and evaluation forms can easily be found on most human resources web-sites and are in compliance with regulations to protect your employee privacy. They may also be an added benefit if your payroll is done by an outside service such as Paychex or ADP.
Employee Benefits : Clearly outline your policy for sick, personal and vacation days and the guidelines for how this time accrues during the year. Note whether vacation and sick/personal time can be carried over into the next calendar year. Include lunch hour and or break time policies as well as overtime compensation. Always add that overtime will not be paid unless it is first approved by management.
Health Insurance : If your practice offers any form of health insurance to your employees, the guidelines for eligibility and a general outline of the plan benefits should be included. State that the practice may change the health plan should costs become prohibitive and will notify employees at least 30 days in advance.
* Note * Many payroll services have excellent plans that will auto-track your employees sick/personal and vacation time and will provide you with your own way to input information as well. Should you wish to have them print and bind your handbook, this service is also available.
Excessive Lateness / Sick Time : Employees should report to the workplace 15 minutes prior to their shift and be ready to work at their start times. Disruptions to the work flow caused by excessive lateness or sick time will be cause for termination.
Emergency Contact Number : In case of inclement weather or any other emergency that may cause the closure of your office, a phone number should be noted for the office manager or human resources department. You should also include the phone numbers for the local police and fire departments.
Office Evacuation Plan: In case of fire, flood, or any other emergency, an evacuation plan should be in place and clearly outlined in your handbook. This plan should also be posted at the front desk so it is clearly visible to employees and patients. If your office is in a commercial building, staircases and fire exits should be located and noted. Commercial insurance plans will ask to see your evacuation plan each time they audit your practice.
Policy for Needle Sticks and/or Radioactive Isotope Spills: Standards of care for accidental needle sticks my be obtained from the Department of Health and should be posted in your lab as well as in your exam rooms. Should your practice use radioactive isotopes, you must note the emergency phone number and policy for handling accidental spills. Post clear policies for your sharps containers and/or radioactive waste and disposal of needles and containers.
Management Staff : Names, job titles, and contact numbers for your management staff should be noted. HIPAA standards require that all medical practitioners have staff dedicated to assuring privacy and protection of medical records. Staff assigned to maintain HIPAA standards should also be listed in your handbook and violations to any HIPAA standard should be immediately reported. You are also required to have a signature on file for every employee stating that they understand and will comply with all HIPAA privacy standards. You will need to assign both a security and privacy officer to meet compliance with HIPAA. Note names and phone numbers clearly.
Your office handbook is easily maintained by using a three ring binder which will allow you to add relevant topics to the manual or to make necessary changes. This binder will also allow your staff to keep important memos regarding any new insurance or practice policy. Every new employee should be armed with their own binder. In the early days, it will help them remember the address, phone, and zip code for the practice and will help them remember the names of management staff. You will be surprised how often every employee will refer to their binder each year.
Tomorrow : United States Department of Labor and OSHA
Friday, June 24, 2011
Patient Registration and Associated Paperwork
There are literally hundreds of patient registrations available on line or through vendors that specialize in medical practice supplies. Choose the one that best fits your practice needs and be certain that each patient registration is completed prior to the examination or procedure.
The easiest way to insure that you have a complete registration on file for each patient is to mail or even e-mail a scanned registration to the patient prior to the visit, whenever possible. In addition to the registration you may want to include the following in your mailed package.
An appointment card.
Directions to your office with parking suggestions.
A practice brochure outlining the services your facility provides.
A reminder that patients bring their insurance cards, referrals if applicable and a reminder that co-payments are due at time of service.
Sending a registration in advance will avoid prolonged waiting times for the patient and the physician and will eliminate incomplete forms which may have implications for your billing department.
When it is necessary to add a new patient to your daily schedule, you will want to request that they arrive at your office 15 - 20 minutes prior to their appointment time to complete their paperwork and give the front office time to copy of scan their insurance cards.
All registration form available will contain areas that are dedicated to patient demographics, insurance and guarantor information and most importantly, for the purposes of insurance audits, and for Medicare requirements, the Assignment of Benefits.
The assignment of benefits allows the physician to bill on the patient's behalf. It also authorizes the physician to release the patient information to their insurance carrier.
This area appears on the bottom of the patient registration and requires the patient signature. This "signature on file" needs to be updated annually, since both Medicare and the commercial insurers will require a current signature whenever they conduct an audit of your practice.
If you create your own Patient Registrations in house, you will want to make sure that your Signature On File area looks something like this :
I hereby authorize John Doe Medical P.C. to release all information required by my insurance company to process claims for services on my behalf.
I hereby authorize assignment of benefits for services provided be paid to John Doe Medical, P.C.
This arrangement will remain in effect until I revoke such in writing. A photocopy of this agreement is considered to be as valid as the original.
I understand that I may be responsible for all services provided that are not covered by my insurance carrier, including the 20% due after Medicare reimbursement, along with any applicable deductibles and co-payments.
Patient Signature : Date :
Without a completed assignment of benefits, the physician does not retain the right to bill for any patient visit. Audits will be considered incomplete and Medicare may impose a fine for an incomplete assignment of benefits.
An additional reminder to the patient to bring their paperwork, insurance cards, and applicable co-payments should also be made at the time of your confirmation calls. Many vendors offer an auto-call service that will call your scheduled patients a day in advance to remind them of their appointment date and time. The patient confirms their appointment, usually by pressing 1 if they are home to receive the call, and urges them to call the office to confirm if they are not available.
Some physicians feel uncomfortable reminding patients that they have a co-payment responsibility for their visit. Patients should understand that their co-payment amount is deducted from the physicians reimbursement. You may want to add this statement when you are mailing out your registration forms.
The cost of mailing monthly patient statements can affect your bottom line and once your patient leaves the office without remitting their co-pay, the likelihood is that you will mail 3-5 statements before you receive this balance.
If for some reason, the patient does not have their co-payment, you should note the reason for non-payment on your daily data sheet. Unless there is a hardship that you plan to discuss with the physician, the patient who does not pay should be given a payment envelope, ( you may even want to provide the postage) and urged to mail their co-payment as soon as they return home.
You must provide a paid receipt for each patient who makes a co-payment. Order receipt books with a two part page to insure you have a record of the daily co-payments and mark the front of the receipt book with the date the first entry was made. When the book is completed, note this date also. Make sure you date each receipt to avoid billing disputes and to give the office manager or physician a good way to monitor the staff success for co-pay collections. Unfortunately, not everyone who will work for you will be honest, and co-pay theft is not uncommon in the healthcare industry. Your receipt book should be checked each day against your data sheet and your check copies to make sure you avoid the possibility of theft.....
If your office accepts credit card payments, please make sure the patients are aware of this service and list acceptable card vendors at your front desk.
All practices should also have a "self-pay" schedule available for any uninsured patient. Fees should be listed for office visits - new and follow up - and procedures and tests. If your practice recognizes hardship of so called "charity cases", it is important that your billing department have an understanding of this before charges are entered into your system. Patients with hardships are required to send a letter outlining their inability to pay for services rendered and this letter must be kept on file, especially when it comes to the 20% due after Medicare reimbursement.
Monday : Producing a Practice Handbook - A Must Have to Avoid Any Labor Dispute
The easiest way to insure that you have a complete registration on file for each patient is to mail or even e-mail a scanned registration to the patient prior to the visit, whenever possible. In addition to the registration you may want to include the following in your mailed package.
An appointment card.
Directions to your office with parking suggestions.
A practice brochure outlining the services your facility provides.
A reminder that patients bring their insurance cards, referrals if applicable and a reminder that co-payments are due at time of service.
Sending a registration in advance will avoid prolonged waiting times for the patient and the physician and will eliminate incomplete forms which may have implications for your billing department.
When it is necessary to add a new patient to your daily schedule, you will want to request that they arrive at your office 15 - 20 minutes prior to their appointment time to complete their paperwork and give the front office time to copy of scan their insurance cards.
All registration form available will contain areas that are dedicated to patient demographics, insurance and guarantor information and most importantly, for the purposes of insurance audits, and for Medicare requirements, the Assignment of Benefits.
The assignment of benefits allows the physician to bill on the patient's behalf. It also authorizes the physician to release the patient information to their insurance carrier.
This area appears on the bottom of the patient registration and requires the patient signature. This "signature on file" needs to be updated annually, since both Medicare and the commercial insurers will require a current signature whenever they conduct an audit of your practice.
If you create your own Patient Registrations in house, you will want to make sure that your Signature On File area looks something like this :
I hereby authorize John Doe Medical P.C. to release all information required by my insurance company to process claims for services on my behalf.
I hereby authorize assignment of benefits for services provided be paid to John Doe Medical, P.C.
This arrangement will remain in effect until I revoke such in writing. A photocopy of this agreement is considered to be as valid as the original.
I understand that I may be responsible for all services provided that are not covered by my insurance carrier, including the 20% due after Medicare reimbursement, along with any applicable deductibles and co-payments.
Patient Signature : Date :
Without a completed assignment of benefits, the physician does not retain the right to bill for any patient visit. Audits will be considered incomplete and Medicare may impose a fine for an incomplete assignment of benefits.
An additional reminder to the patient to bring their paperwork, insurance cards, and applicable co-payments should also be made at the time of your confirmation calls. Many vendors offer an auto-call service that will call your scheduled patients a day in advance to remind them of their appointment date and time. The patient confirms their appointment, usually by pressing 1 if they are home to receive the call, and urges them to call the office to confirm if they are not available.
Some physicians feel uncomfortable reminding patients that they have a co-payment responsibility for their visit. Patients should understand that their co-payment amount is deducted from the physicians reimbursement. You may want to add this statement when you are mailing out your registration forms.
The cost of mailing monthly patient statements can affect your bottom line and once your patient leaves the office without remitting their co-pay, the likelihood is that you will mail 3-5 statements before you receive this balance.
If for some reason, the patient does not have their co-payment, you should note the reason for non-payment on your daily data sheet. Unless there is a hardship that you plan to discuss with the physician, the patient who does not pay should be given a payment envelope, ( you may even want to provide the postage) and urged to mail their co-payment as soon as they return home.
You must provide a paid receipt for each patient who makes a co-payment. Order receipt books with a two part page to insure you have a record of the daily co-payments and mark the front of the receipt book with the date the first entry was made. When the book is completed, note this date also. Make sure you date each receipt to avoid billing disputes and to give the office manager or physician a good way to monitor the staff success for co-pay collections. Unfortunately, not everyone who will work for you will be honest, and co-pay theft is not uncommon in the healthcare industry. Your receipt book should be checked each day against your data sheet and your check copies to make sure you avoid the possibility of theft.....
If your office accepts credit card payments, please make sure the patients are aware of this service and list acceptable card vendors at your front desk.
All practices should also have a "self-pay" schedule available for any uninsured patient. Fees should be listed for office visits - new and follow up - and procedures and tests. If your practice recognizes hardship of so called "charity cases", it is important that your billing department have an understanding of this before charges are entered into your system. Patients with hardships are required to send a letter outlining their inability to pay for services rendered and this letter must be kept on file, especially when it comes to the 20% due after Medicare reimbursement.
Monday : Producing a Practice Handbook - A Must Have to Avoid Any Labor Dispute
Thursday, June 23, 2011
Claims Denied For Timely Filing
Claims for services provided should be transmitted no later than 24 hours after the visit date. Medicare and commercial plans have strict filing time guidelines and will deny your claims if they are not received within the specified date. Your insurance grid should be examined quarterly for the timely filing guidelines for each plan and updated should you become a participating provider for a new insurer.
The first step in avoiding timely filing denials is to do proper verification for any new patient or for an existing patient that has not been seen in your office within the past 3 months. If your demographic information is not correct, you could be transmitting the secondary as the primary or vice versa. By the time you receive the denial of claim and re-transmit to the correct plan, it may be too late. This is why the Welcome Sheet is an invaluable part of your practice.
Another big problem are those claims that are secondary to Medicare. The best way to avoid this problem is to work with your Medicare Explanation of Benefits as soon as it is received. Your billing team must examine these benefit explanations and if the claims do not list "auto-crossover", you must copy the Medicare EOB and send it to the secondary within the time frame for filing. I always include a printed HCFA for these secondary claims, so that the patient information is clearly labeled. In those cases where a patient has more than one insurance secondary to Medicare, you should accomplish this task as soon as the Primary insurance payment is posted.
Many EMR systems have the ability to recognize the claims that are not subject to "Auto Crossover" and will automatically print a copy of the EOB as soon as the primary payment is posted. Be mindful of the fact that many plans that originate through labor unions or locals may require that they receive a paper copy of the EOB, even if auto-crossover exists. It may be a good idea to include a note on your insurance grid to remind you to send a paper claim for secondary payment. The HCFA will show the amount paid and the amount pending for secondary payment.
If your practice is not EMR complete, the best way to insure timely filing is to make sure that your daily billing package is organized and complete. The Welcome should be attached to the daily routing sheet or encounter, along with the referral for service, pre-certifications if applicable, a copy of the sign in sheet, the daily data sheet showing all co-payments received, a copy of the deposit slip with the co-payment total and a copy of each patient check. For new patients or those with insurance changes, I would also include a copy of the patient's insurance card.
The billing department then has an organized package that they can check off patient by patient, making their task basically a daily data entry and transmission. Incomplete packages, such as those missing referrals or pre-certs or questions concerning demographic data can cause those claims to be put on hold and sometimes not entered in time to meet the timely filing requirements.
A Sample of Your Daily Data Sheet should include the following information and can be shown as a grid containing:
Todays Date
Patient Name
Doctor Seen
Insurance
Office Visit or Testing
Co- Payment Received
Comments
Filling in this data will assure that the daily package is complete.
Physicians must assist their staff in order to assure timely filing requirements by making sure that all of their billing sheets are completed and turned in or computed at the end of office hours each day. The number of encounters should match the number of patients listed on the daily data sheet, unless otherwise noted.
Ideally, the physician should complete the encounter immediately after patient exit and turn it in to the front desk if you have a paper system or complete it electronically if your EMR is complete. Once the billing sheet is turned over to the front desk, the patient check in sheet can be either highlighted in yellow or checked off in an electronic system.
Many EMR systems will track patients from the time they check in, note the times spent waiting and in the exam room, and notify the front office when the billing sheet is complete. If you have an EMR system in your practice, the auto check in can serve as your data sheet. Scan features will enable the billing team to view patient registrations, insurance cards, referral and authorizations. Just make sure that whatever you scan into your system is readable and clear.
Tomorrow : Patient Registrations http://www.supercoder.com/123.html
The first step in avoiding timely filing denials is to do proper verification for any new patient or for an existing patient that has not been seen in your office within the past 3 months. If your demographic information is not correct, you could be transmitting the secondary as the primary or vice versa. By the time you receive the denial of claim and re-transmit to the correct plan, it may be too late. This is why the Welcome Sheet is an invaluable part of your practice.
Another big problem are those claims that are secondary to Medicare. The best way to avoid this problem is to work with your Medicare Explanation of Benefits as soon as it is received. Your billing team must examine these benefit explanations and if the claims do not list "auto-crossover", you must copy the Medicare EOB and send it to the secondary within the time frame for filing. I always include a printed HCFA for these secondary claims, so that the patient information is clearly labeled. In those cases where a patient has more than one insurance secondary to Medicare, you should accomplish this task as soon as the Primary insurance payment is posted.
Many EMR systems have the ability to recognize the claims that are not subject to "Auto Crossover" and will automatically print a copy of the EOB as soon as the primary payment is posted. Be mindful of the fact that many plans that originate through labor unions or locals may require that they receive a paper copy of the EOB, even if auto-crossover exists. It may be a good idea to include a note on your insurance grid to remind you to send a paper claim for secondary payment. The HCFA will show the amount paid and the amount pending for secondary payment.
If your practice is not EMR complete, the best way to insure timely filing is to make sure that your daily billing package is organized and complete. The Welcome should be attached to the daily routing sheet or encounter, along with the referral for service, pre-certifications if applicable, a copy of the sign in sheet, the daily data sheet showing all co-payments received, a copy of the deposit slip with the co-payment total and a copy of each patient check. For new patients or those with insurance changes, I would also include a copy of the patient's insurance card.
The billing department then has an organized package that they can check off patient by patient, making their task basically a daily data entry and transmission. Incomplete packages, such as those missing referrals or pre-certs or questions concerning demographic data can cause those claims to be put on hold and sometimes not entered in time to meet the timely filing requirements.
A Sample of Your Daily Data Sheet should include the following information and can be shown as a grid containing:
Todays Date
Patient Name
Doctor Seen
Insurance
Office Visit or Testing
Co- Payment Received
Comments
Filling in this data will assure that the daily package is complete.
Physicians must assist their staff in order to assure timely filing requirements by making sure that all of their billing sheets are completed and turned in or computed at the end of office hours each day. The number of encounters should match the number of patients listed on the daily data sheet, unless otherwise noted.
Ideally, the physician should complete the encounter immediately after patient exit and turn it in to the front desk if you have a paper system or complete it electronically if your EMR is complete. Once the billing sheet is turned over to the front desk, the patient check in sheet can be either highlighted in yellow or checked off in an electronic system.
Many EMR systems will track patients from the time they check in, note the times spent waiting and in the exam room, and notify the front office when the billing sheet is complete. If you have an EMR system in your practice, the auto check in can serve as your data sheet. Scan features will enable the billing team to view patient registrations, insurance cards, referral and authorizations. Just make sure that whatever you scan into your system is readable and clear.
Tomorrow : Patient Registrations http://www.supercoder.com/123.html
Wednesday, June 22, 2011
Incorrect Diagnosis Codes - Show Me The Money !!!!!
Rule # 1 - If you can't meet the criteria: Don't Perform The Procedure......
It is mind boggling to witness the number of medical claims that are denied each quarter for invalid diagnosis codes. Indeed, one leading cause of our country's current healthcare crisis is the vast number of procedures and tests performed each year without validity. This amount to millions, if not billions, of dollars in reimbursement and is part of the excessive cost of healthcare coverage in the United States.
Physicians who refuse to educate themselves on approved diagnosis codes can lose upwards of 50% of claims billed for testing and procedures. It is unimaginable when the system is so easy to understand.
First of all, Medicare's website will outline every test and procedure that you might perform, along with a list of the diagnosis codes that meet the requirements for payment. You may not believe this, but I have seen physicians bill an echocardiogram with the diagnosis code for asthma !!!! Of course, the claim was denied..
No procedure or test should ever lose reimbursement if the correct guidelines are followed. Organ systems must have a relationship to the procedure performed. Before you schedule, such as an echocardiogram, you better suspect, and have some evidence that there is a heart valve problem. While this may sound logical, it is amazing to witness some of the codes I have seen to justify this procedure. It is even more amazing to see the physicians reaction when their claims are denied again and again. There is no test or procedure that should be considered routine in your practice, and if you are not able to follow the established guidelines for the test or procedure, you should consider another option.
One way to avoid diagnosis errors is to download the Medicare Local Coverage Determinations (LCD) that you can find @ www.ngs.medicare.com. A good tip after downloading these LCD's is to make a billing sheet that contains at least 4-5 diagnosis codes that your physician may use for that procedure.
These codes should be listed on your billing sheet or encounter directly below the procedure code. For automated billing sheets, follow the same guideline. The approved codes will help the physician to determine if the procedure meets the criteria for billing purposes and will assure clean claim transmission.
Changes to diagnosis coding will appear in the Medicare guidelines and help you keep current with changes or codes that are changed or deleted. Don't just order the Part B news. Read it, highlight any changes that might affect your practice, and send a memo to each of your physicians notifying them that the change has occurred.
If pre-certification is required, you will want to make sure that you use an approved diagnosis code when requesting authorization, or you will just waste time spinning your wheels trying to get a procedure or test approved. Even if your physician has a sound rationale for ordering the test, without an approved diagnosis code, it's just not happening....
Many EMR systems have a list of approved codes built in to assure claim reimbursement, and will notify you if you choose a diagnosis that does not fit the procedure. Caution should be exercised to make sure that your software is not choosing a diagnosis code for your doctors, so a basic knowledge of approved codes is still a requirement for all physicians.
One of the hot topics for a recommended monthly meetings with your physician staff should involve a discussion of any recent changes in the Medicare and private insurance arena. Seeing these changes in writing and discussing any lost revenue is essential to assuring that your practice moves forward.
Tomorrow : Timely Filing - Another Big Problem...
It is mind boggling to witness the number of medical claims that are denied each quarter for invalid diagnosis codes. Indeed, one leading cause of our country's current healthcare crisis is the vast number of procedures and tests performed each year without validity. This amount to millions, if not billions, of dollars in reimbursement and is part of the excessive cost of healthcare coverage in the United States.
Physicians who refuse to educate themselves on approved diagnosis codes can lose upwards of 50% of claims billed for testing and procedures. It is unimaginable when the system is so easy to understand.
First of all, Medicare's website will outline every test and procedure that you might perform, along with a list of the diagnosis codes that meet the requirements for payment. You may not believe this, but I have seen physicians bill an echocardiogram with the diagnosis code for asthma !!!! Of course, the claim was denied..
No procedure or test should ever lose reimbursement if the correct guidelines are followed. Organ systems must have a relationship to the procedure performed. Before you schedule, such as an echocardiogram, you better suspect, and have some evidence that there is a heart valve problem. While this may sound logical, it is amazing to witness some of the codes I have seen to justify this procedure. It is even more amazing to see the physicians reaction when their claims are denied again and again. There is no test or procedure that should be considered routine in your practice, and if you are not able to follow the established guidelines for the test or procedure, you should consider another option.
One way to avoid diagnosis errors is to download the Medicare Local Coverage Determinations (LCD) that you can find @ www.ngs.medicare.com. A good tip after downloading these LCD's is to make a billing sheet that contains at least 4-5 diagnosis codes that your physician may use for that procedure.
These codes should be listed on your billing sheet or encounter directly below the procedure code. For automated billing sheets, follow the same guideline. The approved codes will help the physician to determine if the procedure meets the criteria for billing purposes and will assure clean claim transmission.
Changes to diagnosis coding will appear in the Medicare guidelines and help you keep current with changes or codes that are changed or deleted. Don't just order the Part B news. Read it, highlight any changes that might affect your practice, and send a memo to each of your physicians notifying them that the change has occurred.
If pre-certification is required, you will want to make sure that you use an approved diagnosis code when requesting authorization, or you will just waste time spinning your wheels trying to get a procedure or test approved. Even if your physician has a sound rationale for ordering the test, without an approved diagnosis code, it's just not happening....
Many EMR systems have a list of approved codes built in to assure claim reimbursement, and will notify you if you choose a diagnosis that does not fit the procedure. Caution should be exercised to make sure that your software is not choosing a diagnosis code for your doctors, so a basic knowledge of approved codes is still a requirement for all physicians.
One of the hot topics for a recommended monthly meetings with your physician staff should involve a discussion of any recent changes in the Medicare and private insurance arena. Seeing these changes in writing and discussing any lost revenue is essential to assuring that your practice moves forward.
Tomorrow : Timely Filing - Another Big Problem...
Tuesday, June 21, 2011
Where are the referrals ????
If you are a specialty provider, your patients should be responsible for obtaining their own referrals prior to their arrival at your office. A sign should be posted at your front desk advising all patients that they will not be seen without a valid referral.
In general, patients hate having to obtain a referral each time they visit a specialist. Their requests often mean an additional visit to their Primary Care provider, along with an additional co-payment just for permission to be treated elsewhere!!!!
Often emergency situations arise where a patient needs to be seen right away and their primary doctor may be away or have a policy that referrals require 24-36 hours advance notice. Physicians are often reluctant to turn away a patient, especially if their symptoms are cause for alarm, or they are an established patient that the specialist has been following for some time.
Logically these situations all make sense, and no doctor ever wants to turn away patients, but the fact is that lack of a valid referral is one of the main reasons that physicians fail to gain reimbursement for their time and efforts...
A good answer to this problem is a collaborative effort between the front office staff and the patient, and having an established system that promotes this collaboration is key to successful claim reimbursement.
Some practices have their referral system down to a science and obtain the referrals for their patients to assure they receive them in a timely fashion. This not only is a great help to the patient, but it also helps the specialist to continue a good working relationship with the physicians who refer to their practice.
It's an excellent system and works especially well in practices such as Cardiology, where the patients are often elderly and have more difficulty with the referral process.
Another bonus gained by your practice obtaining referrals for future visits is that you can accurately request the services that will be rendered at time of visit. For example, if you routinely perform an EKG at time of treatment, you will request that it is clearly stated on the referral. Making it even easier, you can request that your referral notes "consultation and treatment" so that services rendered will not be denied. This referral offers the specialist the options of choosing how to manage his patient, without feeling that services needed cannot be performed.
Whatever method you use to obtain your referral, it is necessary for the staff to note the referral number, expiration date, and number of visits allowed into the system or on the encounter or billing sheet. Many systems will now automatically count down the number of visits that remain for a particular patient and notify you prior to the referral expiration date.
All paper referrals should list a referral number, the patient ID, date of birth, start and end date, referring physician, and referred to physician. Note : Blue Cross requires that all referrals be faxed back to them and will deny claims if they do not have an advance copy on file.
If you require that your patients obtain their own referrals, make sure that you remind the patient when your make your confirmation calls.
As previously stated, despite the most sophisticated EHR system, at the end of your day, before your encounters go to the billing department, a copy of the referral and the Welcome should accompany each claim. If your billing staff downloads the daily claims electronically, they MUST know the requirements of each plan prior to transmission and know whether or not a referral is required.
Pre-Certification for testing and/or procedures should be noted at the time of verification and all pre-certs should be obtained at the time of insurance verification. Some of the commercial insurance plans require medical records and recent studies before granting authorizations so it is a good idea to have these on hand prior to requesting authorization.
One way to assure that pre-cert is complete prior to procedures is to assign it to the staff member directly involved in the procedure. For example, we had a separate check-in and appointment desk for Nuclear Stress testing. The employee manning this station had the responsibility for obtaining all pre-certifications for the procedure and obtaining medical records when requested. This formula allows the practice to have once responsible staff member controlling the pre-certification process, as well as the daily testing schedule. Should a nuclear stress test be denied, there was accountability at this location, or at least a good reason for appeal.
In a group practice, you may want to consider assigning a secretary for each physician. This assigned employee would be responsible for all referrals and authorizations for her physician. Either way, you must create an environment of accountability for worked performed in your office. Your employees need a clear cut definition for their work flow and know exactly what is expected of them each day.
Should a patient need to be seen on an emergency basis, a call to their primary can be made even if they have already arrived at the office. No claim should be denied for lack of referral or authorization.
Your office manager should review all encounters at the end of each day to assure that no claims go to the billing staff without a 100% assurance that the claim will be paid...
In general, patients hate having to obtain a referral each time they visit a specialist. Their requests often mean an additional visit to their Primary Care provider, along with an additional co-payment just for permission to be treated elsewhere!!!!
Often emergency situations arise where a patient needs to be seen right away and their primary doctor may be away or have a policy that referrals require 24-36 hours advance notice. Physicians are often reluctant to turn away a patient, especially if their symptoms are cause for alarm, or they are an established patient that the specialist has been following for some time.
Logically these situations all make sense, and no doctor ever wants to turn away patients, but the fact is that lack of a valid referral is one of the main reasons that physicians fail to gain reimbursement for their time and efforts...
A good answer to this problem is a collaborative effort between the front office staff and the patient, and having an established system that promotes this collaboration is key to successful claim reimbursement.
Some practices have their referral system down to a science and obtain the referrals for their patients to assure they receive them in a timely fashion. This not only is a great help to the patient, but it also helps the specialist to continue a good working relationship with the physicians who refer to their practice.
It's an excellent system and works especially well in practices such as Cardiology, where the patients are often elderly and have more difficulty with the referral process.
Another bonus gained by your practice obtaining referrals for future visits is that you can accurately request the services that will be rendered at time of visit. For example, if you routinely perform an EKG at time of treatment, you will request that it is clearly stated on the referral. Making it even easier, you can request that your referral notes "consultation and treatment" so that services rendered will not be denied. This referral offers the specialist the options of choosing how to manage his patient, without feeling that services needed cannot be performed.
Whatever method you use to obtain your referral, it is necessary for the staff to note the referral number, expiration date, and number of visits allowed into the system or on the encounter or billing sheet. Many systems will now automatically count down the number of visits that remain for a particular patient and notify you prior to the referral expiration date.
All paper referrals should list a referral number, the patient ID, date of birth, start and end date, referring physician, and referred to physician. Note : Blue Cross requires that all referrals be faxed back to them and will deny claims if they do not have an advance copy on file.
If you require that your patients obtain their own referrals, make sure that you remind the patient when your make your confirmation calls.
As previously stated, despite the most sophisticated EHR system, at the end of your day, before your encounters go to the billing department, a copy of the referral and the Welcome should accompany each claim. If your billing staff downloads the daily claims electronically, they MUST know the requirements of each plan prior to transmission and know whether or not a referral is required.
Pre-Certification for testing and/or procedures should be noted at the time of verification and all pre-certs should be obtained at the time of insurance verification. Some of the commercial insurance plans require medical records and recent studies before granting authorizations so it is a good idea to have these on hand prior to requesting authorization.
One way to assure that pre-cert is complete prior to procedures is to assign it to the staff member directly involved in the procedure. For example, we had a separate check-in and appointment desk for Nuclear Stress testing. The employee manning this station had the responsibility for obtaining all pre-certifications for the procedure and obtaining medical records when requested. This formula allows the practice to have once responsible staff member controlling the pre-certification process, as well as the daily testing schedule. Should a nuclear stress test be denied, there was accountability at this location, or at least a good reason for appeal.
In a group practice, you may want to consider assigning a secretary for each physician. This assigned employee would be responsible for all referrals and authorizations for her physician. Either way, you must create an environment of accountability for worked performed in your office. Your employees need a clear cut definition for their work flow and know exactly what is expected of them each day.
Should a patient need to be seen on an emergency basis, a call to their primary can be made even if they have already arrived at the office. No claim should be denied for lack of referral or authorization.
Your office manager should review all encounters at the end of each day to assure that no claims go to the billing staff without a 100% assurance that the claim will be paid...
Monday, June 20, 2011
Welcome Sheet Sample- Your Aid to Complete Verification....
If you want to assure 100% claim reimbursement, the Welcome Sheet is your first line of defense against billing errors and claim denial. It is simple to use and quickly becomes your reference to patient demographics and insurance information. I believe that a complete Welcome will provide your practice with your best chances for reimbursement and the initial time it takes to use this tool will not only give your billing department a clean claim, but also cut down on your accounts receivable and follow up calls to Medicare and the private insurance companies.
Welcome Sheet Sample
Welcome Sheet Sample
Dr. 1 Dr. 2 Dr. 3 Dr. 4 ( please circle )
Part 1
Date of Patient Appointment Todays Date:
Patient Name : Date of Birth:
Social Security Number : Address :
Phone : Home : Work: Cell:
Phone : Home : Work: Cell:
E- Mail Address:
Employer :
Referring Provider : Phone:
Guarantor : Date of Birth:
Guarantor Social Security Number :
Part 2 Are we par with the patients insurance : Y N
Primary Insurance : ID Number :
Group Number : Effective Date:
Co - Payment Amount : Co-Payment For Testing:
Out of Network Benefits : Deductible Met :
Referral Required :
Authorization Needed For Testing :
Phone Number For Authorization :
Phone and Mailing Address For Claims :
Part 3
Secondary Insurance : ID Number :
Group Number : Effective Date:
Co- Payment Amount : Co-Payment For Testing: Y N
Out of Network Benefits : Deductible Met:
Authorization for Testing :
Mailing Address For Claims :
You may want to add an additional section tailored to your specialty: This may serve as a sample for
testing for a Cardiology Practice :
What are the Pre-certification Requirements for :
Nuclear Stress Testing : Echo : Carotid : AAA : Vascular :
Comments :
Employee Name : Provider Representative Name :
Medicare and many private insurers will allow you to use their automated systems to acquire the information for your Welcome Sheet. However if you need to schedule a test or procedure, I believe that it is absolutely necessary to speak to a Provider Representative to make sure that the patient is covered and that you have obtained the correct authorization that applies to the test or procedure.
EHR systems that contain auto-eligibility will make it even easier to use the Welcome, but many of the smaller labor locals or union plans are not aligned with these systems, so it will be necessary to make a phone call to avoid billing problems. Plans that are secondary to Medicare may have their own requirements for testing or procedures, so make sure all information for the secondary insurance is complete.
If you use one sheet of paper in the new paperless society ( frankly I had more paper than ever before! ) I believe you should use the Welcome Sheet. I cannot stress the impact that its use had on our accounts
receivable. Every claim went out clean and there were no questions as to eligibility or pre-certification.
My Welcome Sheets were printed on colored paper so they were easy to find in the patients chart. If you no longer utilize a chart, I would recommend that a front desk employee or office manager print all encounters before they go to the billing department. The daily completed Welcome Sheets can be kept in a folder along with any paper authorizations or referrals and these should be attached to the billing sheets at the end of each day. A complete package should also include a daily schedule.
Don't forget to include your add-on or emergency patients. The five minutes that it takes to complete a Welcome Sheet will save countless hours for the billing department. Electronic eligibility features for your EHR system will require that you pay for this service as part of your monthly support. For a large practice, this feature may vary from a single price to a charge for each physician. Check with your vendor as these fees can be expensive.
Welcome Sheets should be updated every 3 months and older Welcomes should be marked : NO LONGER VALID.
Using the Welcome Sheet can save your practice from serious revenue loss and can also help to make your staff more involved in assuring that all claims are clean and that they are part of the team assuring that the practice has a standard of excellence that involves all employees working together.
Tomorrow : Where is the Referral ?????
Friday, June 17, 2011
Verify, Verify, Verify
Each year, The American Medical Association provides physicians with a National Health Insurer Report Card ( NHIRC). This report covers the percentage of medical claims each year that receive zero payment.
If we look, for example, at a 2009 report for Anthem Blue Cross, 4.34% of their received claims were not paid.
Although these numbers will change from year to year, the fact remains that the percentage of claims denied by Medicare and commercial insurers translates into millions of lost dollars for physicians and health care allied practitioners.
Services provided in good faith and for the purposes of diagnosing and treating disease, should be reimbursed in the same good faith. There is really no reason why any medical claim should be denied and yet the numbers released each year by NHIRC show a different picture.
With the implementation of ICD-10 and the other demanding changes by CMS and private insurers, we need to be more vigilant than ever in making sure our claims go out clean.
There are four major reasons why claims are denied :
Incorrect patient demographics or insurance information.
Lack of referral/ authorization.
Incorrect diagnosis code.
Timely Filing.
Incorrect Patient Information - In an environment where phones are constantly ringing and patients are being checked in and out, the front office may not always be as diligent as they should in obtaining patient information, or when entering patient information into the computer system. Claims are often denied for incorrect spelling of patient names, incorrect address, date of birth, even zip code.
Medicare will deny any claims where the name listed in the transmission of claims does not match the exact name as it is show on the Medicare ID card. Unless Jr. / Sr. or an abbreviated form of the name is shown on the Medicare card, do not put this name into your system.
Another serious issue facing seniors today is that the Medicare managed plans aggressively market Medicare patients and many seniors find the low or no deductible and the prescription plans offered are an attractive alternative to Medicare. Unfortunately, I have found that many seniors are not aware that once they join these plans, they surrender their Part B Medicare coverage. They present in the physicians office, their Medicare card in hand, and often it is not discovered that the patient no longer has Medicare,
until the claim is denied by the private insurer for timely filing. Many of these plans also require a referral so they will also be denied for lack of prior authorization.
This has proven common enough in medical practices that do not perform adequate verification prior to the date of patient appointment, but luckily the problem is easy enough to solve.
1. Create a verification department - Every medical practice should have at least one employee whose sole function is insurance verification. In large practices, where each physician has a staff member assigned to track his daily activities, this task can be performed as part of the daily ritual. Print out your appointment schedule every day and list the verified insurance next to the patients name. When the patient arrives for the appointment, look at the listing and make sure to check that the insurance has not changed between the time of verification and appointment.
An easy way to assure that verification is done correctly is to utilize a practice Welcome Sheet. I understand that in the techo-world we inhabit, many systems have electronic verification, but in order to make sure that we avoid any and all pitfalls to revenue, I still recommend that a paper Welcome be utilized especially since you will learn patient deductibles, and the correct mailing address for every claim. Once your practice recognizes that the Welcome is the best way to verify insurance, it will become an essential part of the daily office routine and the billing department will have easy access to insurance information, since the Welcome for each patient will be attached to the patient encounter.
A new Welcome should be done each time a patient changes their insurance affiliation and should be updated for return patients who have not been seen for three months or longer. For those practices, who refuse to have even one extra piece of paper, the Welcome can be scanned into your system and completed on system and the billing department will still have easy access to the patients information.
The Welcome is completed as follows :
Your patient calls to make an appointment - Whenever a new patient calls to schedule an appointment, the front office or verification staff member will note the patient's personal demographic information for both the primary and secondary plans. This information will also include the relevant demographics for the guarantor of the plan. * I always request that the patient has their insurance card in hand, when I ask for their information *
The patient will provide all insurance ID numbers for both the primary and any secondary insurances. The phone number for member services is listed on the back of the card and this number should also be noted on the Welcome. Some of the smaller insurance companies, and many local and union plans have a variety of phone numbers so it is important to note these for future reference.
After the demographics are noted, the patient is given an appointment, and the Welcome is given to the verification department.
Verification staff calls both the primary and secondary insurance companies and answers all questions listed on the Welcome sheet. They will also make sure to check that the physician who is rendering services is a participating member of the insurance plan. Timely filing requirements for the plan will also be noted. The verification department will also note the date the insurance was verified along with the name of the representative that they spoke with to gain benefit information.
For specialty practices, a section can be created where pre-certification requirements are noted for each procedure. Only after completion of the Welcome is the patient insurance information entered into the system. You can easily adjust any system to accommodate this feature.
The Welcome should be available to attach to the daily encounters or billing sheets and I always attach a copy of the patient referral and authorizations to the encounter as well. If the Welcome sheet is scanned into your system, the physician can also pull this up at time of visit and learn whether the patients insurance covers certain procedures or testing and discuss other options with the patient if they are underinsured.
The Welcome is an easy way to make sure that each one of your claims goes out squeaky clean
Monday : A Sample Welcome Sheet for Your Practice and other tips for Clean Claims....
If we look, for example, at a 2009 report for Anthem Blue Cross, 4.34% of their received claims were not paid.
Although these numbers will change from year to year, the fact remains that the percentage of claims denied by Medicare and commercial insurers translates into millions of lost dollars for physicians and health care allied practitioners.
Services provided in good faith and for the purposes of diagnosing and treating disease, should be reimbursed in the same good faith. There is really no reason why any medical claim should be denied and yet the numbers released each year by NHIRC show a different picture.
With the implementation of ICD-10 and the other demanding changes by CMS and private insurers, we need to be more vigilant than ever in making sure our claims go out clean.
There are four major reasons why claims are denied :
Incorrect patient demographics or insurance information.
Lack of referral/ authorization.
Incorrect diagnosis code.
Timely Filing.
Incorrect Patient Information - In an environment where phones are constantly ringing and patients are being checked in and out, the front office may not always be as diligent as they should in obtaining patient information, or when entering patient information into the computer system. Claims are often denied for incorrect spelling of patient names, incorrect address, date of birth, even zip code.
Medicare will deny any claims where the name listed in the transmission of claims does not match the exact name as it is show on the Medicare ID card. Unless Jr. / Sr. or an abbreviated form of the name is shown on the Medicare card, do not put this name into your system.
Another serious issue facing seniors today is that the Medicare managed plans aggressively market Medicare patients and many seniors find the low or no deductible and the prescription plans offered are an attractive alternative to Medicare. Unfortunately, I have found that many seniors are not aware that once they join these plans, they surrender their Part B Medicare coverage. They present in the physicians office, their Medicare card in hand, and often it is not discovered that the patient no longer has Medicare,
until the claim is denied by the private insurer for timely filing. Many of these plans also require a referral so they will also be denied for lack of prior authorization.
This has proven common enough in medical practices that do not perform adequate verification prior to the date of patient appointment, but luckily the problem is easy enough to solve.
1. Create a verification department - Every medical practice should have at least one employee whose sole function is insurance verification. In large practices, where each physician has a staff member assigned to track his daily activities, this task can be performed as part of the daily ritual. Print out your appointment schedule every day and list the verified insurance next to the patients name. When the patient arrives for the appointment, look at the listing and make sure to check that the insurance has not changed between the time of verification and appointment.
An easy way to assure that verification is done correctly is to utilize a practice Welcome Sheet. I understand that in the techo-world we inhabit, many systems have electronic verification, but in order to make sure that we avoid any and all pitfalls to revenue, I still recommend that a paper Welcome be utilized especially since you will learn patient deductibles, and the correct mailing address for every claim. Once your practice recognizes that the Welcome is the best way to verify insurance, it will become an essential part of the daily office routine and the billing department will have easy access to insurance information, since the Welcome for each patient will be attached to the patient encounter.
A new Welcome should be done each time a patient changes their insurance affiliation and should be updated for return patients who have not been seen for three months or longer. For those practices, who refuse to have even one extra piece of paper, the Welcome can be scanned into your system and completed on system and the billing department will still have easy access to the patients information.
The Welcome is completed as follows :
Your patient calls to make an appointment - Whenever a new patient calls to schedule an appointment, the front office or verification staff member will note the patient's personal demographic information for both the primary and secondary plans. This information will also include the relevant demographics for the guarantor of the plan. * I always request that the patient has their insurance card in hand, when I ask for their information *
The patient will provide all insurance ID numbers for both the primary and any secondary insurances. The phone number for member services is listed on the back of the card and this number should also be noted on the Welcome. Some of the smaller insurance companies, and many local and union plans have a variety of phone numbers so it is important to note these for future reference.
After the demographics are noted, the patient is given an appointment, and the Welcome is given to the verification department.
Verification staff calls both the primary and secondary insurance companies and answers all questions listed on the Welcome sheet. They will also make sure to check that the physician who is rendering services is a participating member of the insurance plan. Timely filing requirements for the plan will also be noted. The verification department will also note the date the insurance was verified along with the name of the representative that they spoke with to gain benefit information.
For specialty practices, a section can be created where pre-certification requirements are noted for each procedure. Only after completion of the Welcome is the patient insurance information entered into the system. You can easily adjust any system to accommodate this feature.
The Welcome should be available to attach to the daily encounters or billing sheets and I always attach a copy of the patient referral and authorizations to the encounter as well. If the Welcome sheet is scanned into your system, the physician can also pull this up at time of visit and learn whether the patients insurance covers certain procedures or testing and discuss other options with the patient if they are underinsured.
The Welcome is an easy way to make sure that each one of your claims goes out squeaky clean
Monday : A Sample Welcome Sheet for Your Practice and other tips for Clean Claims....
Thursday, June 16, 2011
Review of Systems
In January of 2012, physicians and non-physician practitioners must start using the new version of HIPAA transaction standards, known as 5010. The current version 4010 will not accommodate the use of the new ICD-10 codes which have the October 1, 2013 deadline for compliance.
The difference between ICD-9 and ICD-10 are significant. ICD-CM codes are used to document diagnoses. They are 3-7 characters in length and total 68,000 in contrast to the ICD-9 codes which are 3-5 digits in length and total over 14,000. The ICD-10 PCS are the procedure codes and they are alphanumeric, 7 characters, and total over 87,000. ICD-9 codes are 3-4 characters and total approximately 4,000. Outpatient procedures codes will not change so at least doctors in private practice will have somewhat of a break, even though these changes can represent a nightmare scenario for most physicians.
The changes required by Medicare mean updating software, training your staff, and managing to do all this without losing too many practice dollars to include these new requirements. Medical billing staff will need a good understanding of anatomy and physiology and will need to have an adequate medical record in order to bill correctly. Hopefully, in your role as Medical Director or Administrator, you have already spoken to your software vendor, prepared your billing staff for the new changes and have taken any available seminars and tele-conferences to prepare you for these changes.
It is expected that revenue cycles will suffer for the first few months, as practices come onboard with the changes. Hopefully, your practice can sustain these losses and quickly adapt your physicians and billers to the new world of healthcare.
One way to assure that your losses are minimal is to make certain that your physicians understand how to bill patients according to the acceptable limits approved by CMS and most private insurers.
As a Practice Administrator in Cardiology, I had the opportunity to assist in hiring new physicians for our group; several who had recently completed their fellowship program. Although they had treated patients in the hospital for some time, most of these physicians had never seen a billing sheet for private practice, let alone had any clue understanding how to bill for their services. This is probably not as amazing as it sounds, since most physicians, even those who have practiced for years really don't understand what a review of systems entails and how this review should translate into adequately billing for patient care. I decided that as part of my new physician integration, each doctor would be oriented to Review of Systems before they saw their first patient in our office.
The new changes that will occur starting in 2012 and the ICD-10 in October of 2013 will no doubt have some impact on each private practice and may affect your revenue for some period of time. You want to assure, however, that you do not lose revenue based on billing below par, so you may want to add a billing audit for each of your physicians as an addition to your preparation for new ICD changes.
Hopefully the information in todays' blog will give your doctors some valuable insights into understanding the three factors that determine a review of systems.
First let's understand some basic definitions:
New Patient - One who has not received services from the physician, or any doctor of the same specialty in the group within the past three years.
Established Patient - Once who as received services from the physician, or any doctor of the same specialty in the group within the past three years.
Note * There are no distinctions between New and Established patients for those seen in the Emergency Department.
Concurrent Care - Same or similar services provided by more than one physician on the same day.
Chief Complaint - A statement describing the symptoms reported by the patient, usually provided in the initial interview.
History of Present Illness - Description of the signs and symptoms presented by the patient including time from onset to visit date.
Review of Systems - An inventory of body systems that can help define the symptoms presented by the patient. The system review will help the physician ascertain diagnosis and the need for testing or treatment. For informational purposes, they include some of the following: Eyes, ears, nose, mouth, throat, cardiovascular, respiratory, gastrointestinal, musculoskeletal, neurological, endocrine... etc.
Past History - A review of the patients experience with illness or treatment that will include, prior surgeries, current medications, allergies, immunization status, dietary status.
Family History - A review of the medical evens in the patient's family that may or may not have contributed to their present illness.
Social History - Age appropriate information regarding: marital status, employment, use of drugs, alcohol or tobacco, education, sexual history, etc.
There are 3 major factors that are involved in Evaluation and Management services:
1. History - Four Major History Levels :
The difference between ICD-9 and ICD-10 are significant. ICD-CM codes are used to document diagnoses. They are 3-7 characters in length and total 68,000 in contrast to the ICD-9 codes which are 3-5 digits in length and total over 14,000. The ICD-10 PCS are the procedure codes and they are alphanumeric, 7 characters, and total over 87,000. ICD-9 codes are 3-4 characters and total approximately 4,000. Outpatient procedures codes will not change so at least doctors in private practice will have somewhat of a break, even though these changes can represent a nightmare scenario for most physicians.
The changes required by Medicare mean updating software, training your staff, and managing to do all this without losing too many practice dollars to include these new requirements. Medical billing staff will need a good understanding of anatomy and physiology and will need to have an adequate medical record in order to bill correctly. Hopefully, in your role as Medical Director or Administrator, you have already spoken to your software vendor, prepared your billing staff for the new changes and have taken any available seminars and tele-conferences to prepare you for these changes.
It is expected that revenue cycles will suffer for the first few months, as practices come onboard with the changes. Hopefully, your practice can sustain these losses and quickly adapt your physicians and billers to the new world of healthcare.
One way to assure that your losses are minimal is to make certain that your physicians understand how to bill patients according to the acceptable limits approved by CMS and most private insurers.
As a Practice Administrator in Cardiology, I had the opportunity to assist in hiring new physicians for our group; several who had recently completed their fellowship program. Although they had treated patients in the hospital for some time, most of these physicians had never seen a billing sheet for private practice, let alone had any clue understanding how to bill for their services. This is probably not as amazing as it sounds, since most physicians, even those who have practiced for years really don't understand what a review of systems entails and how this review should translate into adequately billing for patient care. I decided that as part of my new physician integration, each doctor would be oriented to Review of Systems before they saw their first patient in our office.
The new changes that will occur starting in 2012 and the ICD-10 in October of 2013 will no doubt have some impact on each private practice and may affect your revenue for some period of time. You want to assure, however, that you do not lose revenue based on billing below par, so you may want to add a billing audit for each of your physicians as an addition to your preparation for new ICD changes.
Hopefully the information in todays' blog will give your doctors some valuable insights into understanding the three factors that determine a review of systems.
First let's understand some basic definitions:
New Patient - One who has not received services from the physician, or any doctor of the same specialty in the group within the past three years.
Established Patient - Once who as received services from the physician, or any doctor of the same specialty in the group within the past three years.
Note * There are no distinctions between New and Established patients for those seen in the Emergency Department.
Concurrent Care - Same or similar services provided by more than one physician on the same day.
Chief Complaint - A statement describing the symptoms reported by the patient, usually provided in the initial interview.
History of Present Illness - Description of the signs and symptoms presented by the patient including time from onset to visit date.
Review of Systems - An inventory of body systems that can help define the symptoms presented by the patient. The system review will help the physician ascertain diagnosis and the need for testing or treatment. For informational purposes, they include some of the following: Eyes, ears, nose, mouth, throat, cardiovascular, respiratory, gastrointestinal, musculoskeletal, neurological, endocrine... etc.
Past History - A review of the patients experience with illness or treatment that will include, prior surgeries, current medications, allergies, immunization status, dietary status.
Family History - A review of the medical evens in the patient's family that may or may not have contributed to their present illness.
Social History - Age appropriate information regarding: marital status, employment, use of drugs, alcohol or tobacco, education, sexual history, etc.
There are 3 major factors that are involved in Evaluation and Management services:
1. History - Four Major History Levels :
Problem Focused - Chief complaint, brief history of present illness or problem.
Expanded Focused - Chief complaint, brief history of present illness or problem, a review
of the relevant body system.
Detailed - Chief complaint, extended history of present illness, review of relevant body
systems, expanded review of other systems, related past, family and social history as to
chief complaint.
Comprehensive - Chief complaint, extended history of present illness, review of all body
systems, complete past, family, and social history.
2. Examination- Four Levels
Problem Focused - Concentration on affected body part or system.
Expanded Focused - Concentration on affected body part of system, with other related
reviews of systems that may be affected or affect the outcome of the disease.
Detailed Focused- An extended examination of the affected body part of system,and other symptomatic or related body systems.
Comprehensive - Multi-system examination or a complete comprehensive examination of a single body system.
3. Medical Decision Making - Refers to the complexity of establishing a diagnosis for the patient's symptoms and the management options that may have to be considered to treat this diagnosis. It also includes the amount of medical records that will need to be reviewed and considered and the risk of complications that the diagnosis presents.
4. Time - Amount of time spent with the patient and/or the patients family has been included to give the physician an additional tool in selecting a level of E/M services. These time recommendations are meant to serve as an average and may slightly differ depending on the circumstances of the visit.
When we correlate this information to use in coding we may use it as follows:
New Patient:
99201 - Problem Focused History / Problem Focused Exam / Straightforward Medical Decision/ 10
minutes spent face to face with patient or family.
99202 - Expanded Problem Focused History / Expanded Problem Examination / Straightforward Medical Decision / 20 minutes.
99203 - Detailed History / Detailed Examination / Low Complexity Decision Making / 30 minutes.
99204 - Comprehensive History / Comprehensive Examination / Moderate Complexity Decision Making / 45 minutes.
99205 - Comprehensive History / Comprehensive Examination / High Complexity Decision Making /
60 minutes.
Established Patient
99211 - History / Examination / Decision Making / 5 minutes or less
99212 - Problem Focused History / Problem Focused Exam / Straightforward Decision / 10 minutes or less.
99213 - Expanded Focused History / Expanded Focused Exam / Low Complexity Decision / 15 minutes.
99214 - Detailed History / Detailed Exam / Moderate Decision / 25 minutes.
99215 - Comprehensive History / Comprehensive Exam / High Complexity Decision/ 40 minutes.
You may find it helpful in the initial stages of the ICD-10 implementation to provide your physicians with a paper billing sheet that lists the procedure code, along with several choices from the new ICD-10 as it relates to your specialty. Hopefully, we will refine our ICD-10 choices and limit them to the particular specialty so we do not have to memorize 10,000 codes for each of our visits. I would also recommend that you provide your doctors with a pre-cheat sheet that shows a variety of the most common ICD-10 codes as it pertains to your office. Let's not overcomplicate these new changes and soon enough they will become as commonplace as the old.
Tomorrow: Verify / Verify / Verify
Wednesday, June 15, 2011
Online Provider Applications - Becoming A Medicare Provider
CMS allows providers to enroll in Medicare with an online application. This system is called the Internet Based Provider Enrollment Chain and Ownership System or PECOS
PECOS is available to physicians, non-physician practitioners, and provider and suppliers organizations in all 50 states and the District of Columbia. It has a number of advantages over the paper system, including quicker access to your enrollment status.
After you have completed your enrollment online, you must : Print, Sign, and Date the Certification Statement and mail it along with the required documents within 7 days of your electronic registration. Medicare will not accept any application that is not signed and dated. All signatures must be original - no stamps or copies signatures allowed and CMS recommends that you sign your application in Blue INK.
The Centers for Medicare and Medicaid Services (CMS) Standard Electronic Data Interchange (EDI) Enrollment Form must also be completed before a provider can submit electronic claims or other EDI transactions to Medicare. Each provider in your group must complete their own EDI application before submitting claims to Medicare on their behalf.
In addition, Medicare will deposit their payments for service directly into your practice account, via electronic transfer. The advantages are similar to any direct deposit system and hopefully your practice software will allow you to auto-post remittances on behalf of your patients directly into your system.
Electronic Fund Transfer paperwork is done through form CMS 588 and is included in your enrollment package. You will need to include a voided check along with this form and most providers can expect to receive their first EFT reimbursement in as little as 2 weeks.
In many cases your software vendor will prepare both the EDI and EDF forms for your practice You will, however, want to check these forms carefully before you submit them to Medicare to make sure that both the NPI and Medicare numbers are correct and that the vendor has included all physicians and non-physician practitioners that will be submitting claims through your practice.
Finally- we are practicing medicine in an every changing environment. We have seen the loss of the consultation codes for both private and hospital claims and the new ICD-10 will be effective in 2013.
It is vital that each practice is constantly aware of these new changes before they are enacted in order to avoid claim rejection, audits, and appeals.
There are 2 publications that I recommend each practice subscribe to that will help you keep abreast of changes in Medicare policy and coding. The first is Medicare Part B News. This monthly publication will not new and upcoming changes in Medicare policy and will prove invaluable to your billing department. You can receive a free trial subscription by logging on to: www.partBnews.com
The second publication comes from The Coding Institute - www.codinginstitute.com. Their monthly newsletters are tailored specifically to your specialty and they offer tips that will assist in billing and predict changes in the insurance market.
Both CMS and The Coding Institute offer a wide variety of seminars that will provide you with billing and coding information so that your practice is always up to date on the latest changes. They also provide a number of excellent tele-conferences that are advertised well in advance.
I recommend that office managers read both the Part B news and The Coding Institute publication and advise their staff in writing of any pending changes.
Don't forget that your software vendor may also provide you with tools for keeping current with CMS changes....
Tomorrow : Review of Systems : What Doctors Don't Know
PECOS is available to physicians, non-physician practitioners, and provider and suppliers organizations in all 50 states and the District of Columbia. It has a number of advantages over the paper system, including quicker access to your enrollment status.
After you have completed your enrollment online, you must : Print, Sign, and Date the Certification Statement and mail it along with the required documents within 7 days of your electronic registration. Medicare will not accept any application that is not signed and dated. All signatures must be original - no stamps or copies signatures allowed and CMS recommends that you sign your application in Blue INK.
The Centers for Medicare and Medicaid Services (CMS) Standard Electronic Data Interchange (EDI) Enrollment Form must also be completed before a provider can submit electronic claims or other EDI transactions to Medicare. Each provider in your group must complete their own EDI application before submitting claims to Medicare on their behalf.
In addition, Medicare will deposit their payments for service directly into your practice account, via electronic transfer. The advantages are similar to any direct deposit system and hopefully your practice software will allow you to auto-post remittances on behalf of your patients directly into your system.
Electronic Fund Transfer paperwork is done through form CMS 588 and is included in your enrollment package. You will need to include a voided check along with this form and most providers can expect to receive their first EFT reimbursement in as little as 2 weeks.
In many cases your software vendor will prepare both the EDI and EDF forms for your practice You will, however, want to check these forms carefully before you submit them to Medicare to make sure that both the NPI and Medicare numbers are correct and that the vendor has included all physicians and non-physician practitioners that will be submitting claims through your practice.
Finally- we are practicing medicine in an every changing environment. We have seen the loss of the consultation codes for both private and hospital claims and the new ICD-10 will be effective in 2013.
It is vital that each practice is constantly aware of these new changes before they are enacted in order to avoid claim rejection, audits, and appeals.
There are 2 publications that I recommend each practice subscribe to that will help you keep abreast of changes in Medicare policy and coding. The first is Medicare Part B News. This monthly publication will not new and upcoming changes in Medicare policy and will prove invaluable to your billing department. You can receive a free trial subscription by logging on to: www.partBnews.com
The second publication comes from The Coding Institute - www.codinginstitute.com. Their monthly newsletters are tailored specifically to your specialty and they offer tips that will assist in billing and predict changes in the insurance market.
Both CMS and The Coding Institute offer a wide variety of seminars that will provide you with billing and coding information so that your practice is always up to date on the latest changes. They also provide a number of excellent tele-conferences that are advertised well in advance.
I recommend that office managers read both the Part B news and The Coding Institute publication and advise their staff in writing of any pending changes.
Don't forget that your software vendor may also provide you with tools for keeping current with CMS changes....
Tomorrow : Review of Systems : What Doctors Don't Know
Tuesday, June 14, 2011
Medicare and Your Practice - Helpful Tips for Becoming a Medicare Provider
Physicians and office managers and administrators will certainly become more organized after becoming a Medicare Provider. The Medicare requirements will compel you to learn how to bill your claims correctly, keep abreast of the current Federal clim guidelines, and to always have your credentialing paperwork in tip top shape.
Additionally, Medicare allows and will mandate that all physicians participate in their Physician Quality Reporting Initiative (PQRI). Doctors will report data on specific quality measures furnished to Part B beneficiaries and paid under the Medicare Physician Fee Schedule. The program was first implemented in 2007 and by 2010, 30 individual and 6 measure groups on which EP's may report have been added to the PQRI system. Indeed by June 30, 2011 physicians must start reporting data on E-prescribe or face reimbursement losses in 2012.
In 2010, physicians earned an incentive payment of 2.0 percent of their estimated total allowed charges for Medicare covered professional Part B services.
These incentives are based on provisions in the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA). One of the goals of MIPPA is to provide such incentives based on participation in the investigation and implementation of electronic health records. It is MIPPA's intention to have all providers and group practices participate in Electronic Health Records by 2012.
Providers will be able to report their use of e-prescribe through certified MIPPA registries or through e-prescribe vendors who have been successfully recognized as qualified to provide these services.
A fact sheet providing more information about both the e-prescribe program and PQRI provisions can be found at : www.cms.hhs.gov/apps/media/factsheets.asp
Providers can enroll in the Medicare program either by mail or via an online application.
Physicians who are enrolling in Medicare for the first time will need to complete CMS form 855I and 855R (in order to reassign their benefits) Do not attempt to complete this paperwork before reading the specific guidelines for each section. The physician/ non-physician practitioner should refer to:
Tips to Facilitate the Medicare Enrollment Process for Physicians and Non-Physician Practitioners as well as CMS 855I Section Specific Tips prior to completing the applications.
If your application is not filled out correctly, chances are that it will come back to you hole-punched and voided and you will have to download the forms and start the process from page 1.
Form 855I requires personal and professional information regarding the applicant along with all pertinent practice details. In order to make life easier, you will refer to your physicians information folder or scanned documents mentioned in a earlier blog. You will not be able to submit the 855I without having an NPI number.
To create a web user account and apply for an NPI at NPPS go to:
https://nppes.cms.hhs.gov.NPPES/
Make sure you include each supporting document requested. Once completed, your application can be mailed to the Medicare contractor in your state, who can usually process your paperwork in 60 days.
Form 855R is required for any provider who has billed Medicare in the past and would like to reassign their benefits to an eligible provider or supplier or to terminate an existing agreement. You should routinely include an 855R with any new physician application or for any physician change in reimbursement, location, or practice name.
All signatures and dates requested in the applications must be original. No stamped or copies signatures will be accepted.
Nurse Practitioners and Physician Assistants will also have to complete this paperwork in order to bill Medicare for their services.
A list of all CMS forms for physicians can be found at :
https:// www.cms.hhs.gov/CMSForms/list.asp You may also refer to www.medicare.gov to obtain forms.
Tomorrow : Applying For Medicare Reimbursement Online
Additionally, Medicare allows and will mandate that all physicians participate in their Physician Quality Reporting Initiative (PQRI). Doctors will report data on specific quality measures furnished to Part B beneficiaries and paid under the Medicare Physician Fee Schedule. The program was first implemented in 2007 and by 2010, 30 individual and 6 measure groups on which EP's may report have been added to the PQRI system. Indeed by June 30, 2011 physicians must start reporting data on E-prescribe or face reimbursement losses in 2012.
In 2010, physicians earned an incentive payment of 2.0 percent of their estimated total allowed charges for Medicare covered professional Part B services.
These incentives are based on provisions in the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA). One of the goals of MIPPA is to provide such incentives based on participation in the investigation and implementation of electronic health records. It is MIPPA's intention to have all providers and group practices participate in Electronic Health Records by 2012.
Providers will be able to report their use of e-prescribe through certified MIPPA registries or through e-prescribe vendors who have been successfully recognized as qualified to provide these services.
A fact sheet providing more information about both the e-prescribe program and PQRI provisions can be found at : www.cms.hhs.gov/apps/media/factsheets.asp
Providers can enroll in the Medicare program either by mail or via an online application.
Physicians who are enrolling in Medicare for the first time will need to complete CMS form 855I and 855R (in order to reassign their benefits) Do not attempt to complete this paperwork before reading the specific guidelines for each section. The physician/ non-physician practitioner should refer to:
Tips to Facilitate the Medicare Enrollment Process for Physicians and Non-Physician Practitioners as well as CMS 855I Section Specific Tips prior to completing the applications.
If your application is not filled out correctly, chances are that it will come back to you hole-punched and voided and you will have to download the forms and start the process from page 1.
Form 855I requires personal and professional information regarding the applicant along with all pertinent practice details. In order to make life easier, you will refer to your physicians information folder or scanned documents mentioned in a earlier blog. You will not be able to submit the 855I without having an NPI number.
To create a web user account and apply for an NPI at NPPS go to:
https://nppes.cms.hhs.gov.NPPES/
Make sure you include each supporting document requested. Once completed, your application can be mailed to the Medicare contractor in your state, who can usually process your paperwork in 60 days.
Form 855R is required for any provider who has billed Medicare in the past and would like to reassign their benefits to an eligible provider or supplier or to terminate an existing agreement. You should routinely include an 855R with any new physician application or for any physician change in reimbursement, location, or practice name.
All signatures and dates requested in the applications must be original. No stamped or copies signatures will be accepted.
Nurse Practitioners and Physician Assistants will also have to complete this paperwork in order to bill Medicare for their services.
A list of all CMS forms for physicians can be found at :
https:// www.cms.hhs.gov/CMSForms/list.asp You may also refer to www.medicare.gov to obtain forms.
Tomorrow : Applying For Medicare Reimbursement Online
Monday, June 13, 2011
Your Insurance Grid
In order to effectively manage your insurance affiliations and allow your front office and billing departments easy access to this information, you should create a simple Insurance Table. This can be updated as needed, but should contain the insurance ID numbers for each physician in your group as well as the plan requirements for timely filing of claims.
I always found that managing and billing for your physicians was ultimately easier if you assigned your physicians numerically. I did this by seniority or hire date and as each new physician joined our group, they were assigned the next numerical place. This made it easier for the billing staff and came in handy for me when I prepared the monthly practice demographics.
A sample of your insurance grid could appear as follows:
You should update your grid as needed and as applications are accepted and ID's are assigned to each physician. Each front office employee should reference copies of the grid whenever they schedule a patient appointment. This is especially true for new patients and if some doctors in your group are non par with a plan and the patient does not have out of network benefits.
Remember that you may not be able to enroll your physicians in every insurance plan offered in your demographic area. Commercial insurers will often gauge the number of providers in your area and close their panel to new applicants when a certain number of physicians have contracted. This is often the case for specialty practices.
In addition to your insurance grid, you should store a copy of each plans fee schedules for reference by your billing department. All practices should perform a monthly audit for each of its affiliated plans. Using the Explanation of Benefits provided with your remittance, CPT codes should be checked against the fee schedule to assure that commercial insurers are honoring their contracted rates, or for errors in your remittance checks.
I always found that managing and billing for your physicians was ultimately easier if you assigned your physicians numerically. I did this by seniority or hire date and as each new physician joined our group, they were assigned the next numerical place. This made it easier for the billing staff and came in handy for me when I prepared the monthly practice demographics.
A sample of your insurance grid could appear as follows:
Insurance Timely Filing Doctor 1 Doctor 2 Doctor 3
Aetna 60 Days Tax ID Tax ID Tax ID
Blue Cross 45 Days B6221 B6222 B6223
GHI 30 Days G1100 G1100 G1100
You should update your grid as needed and as applications are accepted and ID's are assigned to each physician. Each front office employee should reference copies of the grid whenever they schedule a patient appointment. This is especially true for new patients and if some doctors in your group are non par with a plan and the patient does not have out of network benefits.
Remember that you may not be able to enroll your physicians in every insurance plan offered in your demographic area. Commercial insurers will often gauge the number of providers in your area and close their panel to new applicants when a certain number of physicians have contracted. This is often the case for specialty practices.
In addition to your insurance grid, you should store a copy of each plans fee schedules for reference by your billing department. All practices should perform a monthly audit for each of its affiliated plans. Using the Explanation of Benefits provided with your remittance, CPT codes should be checked against the fee schedule to assure that commercial insurers are honoring their contracted rates, or for errors in your remittance checks.
Sunday, June 12, 2011
Medicare Deadline Approaching
Please remember that June 30, 2011 is the deadline date for adhering to Medicare's requirement for E-Prescribing.
As of this date, you must have submitted at least 10 eligible claims containing electronic prescribing.... If you do not meet this requirement, your Medicare claims will be reduced by 1% in 2012.
Hopefully your billing system already contains CPT code G8553 which reports claims with E-prescribe. If not, then you are running out of time and this should be your number one priority in the next week.
You will not be exempt from this requirement, even if you have earned a Meaningful Use bonus in 2011....and must still report G8553 on 10 claims during the period of January 1, 2011 and June 30, 2011...
For more information on further Medicare EHR requirements, log onto the Medicare web-site at
www.Medicare.gov The site is easy to follow and will give you dates and requirements for your compliance..
As of this date, you must have submitted at least 10 eligible claims containing electronic prescribing.... If you do not meet this requirement, your Medicare claims will be reduced by 1% in 2012.
Hopefully your billing system already contains CPT code G8553 which reports claims with E-prescribe. If not, then you are running out of time and this should be your number one priority in the next week.
You will not be exempt from this requirement, even if you have earned a Meaningful Use bonus in 2011....and must still report G8553 on 10 claims during the period of January 1, 2011 and June 30, 2011...
For more information on further Medicare EHR requirements, log onto the Medicare web-site at
www.Medicare.gov The site is easy to follow and will give you dates and requirements for your compliance..
Friday, June 10, 2011
Universal Provider Datasource
Promoted by the center for Affordable Quality Healthcare,the Universal Credentialing Datasource is now known as UPD or Universal Provider Datasource.
UPD is the industry standard for collecting data used in physician credentialing and currently serves over 7770,000 health care professionals and over 550 participating health plans and health care organizations. UPD information, provided by physicians is stored in a centralized database in the united States and physicians in all 50 states and the District of Columbia have access to this simple online form that is also utilized in claims processing, quality assurance, emergency response, member services, referrals and more.
Doctors use an online form to tenter their professional data and allow healthcare organizations
of their choice to access this data for credentialing. The information entered is managed solely managed by the physician and changes are done at his or her own convenience. UPD does conduct its own audits to assure that data is entered correctly.
Once you have a contracted agreement with one recognized UPD plan or affiliated hospital, you will be invited,by mail, to participate with CAQH. You will receive a Provider ID number and the password needed to access your information online.
Many commercial insurance plans use CAQH in lieu of a paper application and only require that you attach copies of those documents previously discussed to complete the application process.
Once you have been accepted by a commercial insurance plan as a participating provider, you will receive a copy of your managed care contract, along with and ID number you will need to use when transmitting your claims for payment. Many plans will allow you to your your Tax ID as your provider number. Please note that group practices should request a single ID number that covers all the doctors who are par with the plan. This single ID will allow you to bill under any doctor that participates and to bill and receive remittances under your group name. You can speak to your provider representative about the best way to manage your groups billing under your Tax ID.
CAQH is available for help with physician questions by phone @ 888-599-1771 or via e-mail to
caqh.updhelp@acsgs.com
Monday : Your Insurance Grid
UPD is the industry standard for collecting data used in physician credentialing and currently serves over 7770,000 health care professionals and over 550 participating health plans and health care organizations. UPD information, provided by physicians is stored in a centralized database in the united States and physicians in all 50 states and the District of Columbia have access to this simple online form that is also utilized in claims processing, quality assurance, emergency response, member services, referrals and more.
Doctors use an online form to tenter their professional data and allow healthcare organizations
of their choice to access this data for credentialing. The information entered is managed solely managed by the physician and changes are done at his or her own convenience. UPD does conduct its own audits to assure that data is entered correctly.
Once you have a contracted agreement with one recognized UPD plan or affiliated hospital, you will be invited,by mail, to participate with CAQH. You will receive a Provider ID number and the password needed to access your information online.
Many commercial insurance plans use CAQH in lieu of a paper application and only require that you attach copies of those documents previously discussed to complete the application process.
Once you have been accepted by a commercial insurance plan as a participating provider, you will receive a copy of your managed care contract, along with and ID number you will need to use when transmitting your claims for payment. Many plans will allow you to your your Tax ID as your provider number. Please note that group practices should request a single ID number that covers all the doctors who are par with the plan. This single ID will allow you to bill under any doctor that participates and to bill and receive remittances under your group name. You can speak to your provider representative about the best way to manage your groups billing under your Tax ID.
CAQH is available for help with physician questions by phone @ 888-599-1771 or via e-mail to
caqh.updhelp@acsgs.com
Monday : Your Insurance Grid
Thursday, June 9, 2011
Navigating the Crazy World of Insurance
Now that your paperwork is in order, you are ready to enter and conquer the world of Medicare and commercial insurances. Armed with a simple understanding of the process and with the right connections, any physician can become an expert in the insurance game.
All of the larger insurance plans, such as Blue Cross, Aetna, or United Healthcare will assign a provider representative that will cover your demographic area. Once you have become a provider that accepts reimbursement from an HMO, PPO, or other health plan, your first order of business is to find out the name and number for your provider rep; call and arrange a meeting.
Provider representatives for commercial insurers function in much the same way as a pharmaceutical salesperson. They are available to sell their product, monitor its use, handle patient complaints, and assure that physicians are honoring the terms of their contracts. They may also function as auditors and request annual or semi-annual examination of your charts and billing protocols for their members. During the course of these audits, they will also ascertain whether or not your office is in compliance with state safety and CLIA protocols, as well as your offices timely scheduling of appointments and return phone calls.
Physicians and administrators who show even the smallest shred of courtesy and interest in these overworked and often underpaid reps, are kept constantly aware of the changes in reimbursement and coding policies, upcoming seminars that may offer CME credits, and helpful suggestions for chart audit and patient monitoring. They will assist you in becoming an expert on navigating through their web-sites and some of them come complete with handfuls of goodies for patients and staff, such as pens key chains, coffee mugs and the like.
Representatives are also available to guide you through the application process and will often expedite your application and re-credentialing each year. So spending as little as 15 minutes with your provider representative can save you hours of time and grief.
At the beginning of your plan membership and each year that you continue to participate in an insurance plan, you should request the following from your representative:
Current Annual Fee Schedule
Requirements for timely filing of claims
Referral, testing and test site protocols
A user ID and password for using the insurance web-site
Handbook for participating providers ( check to make sure your listing
is correct)
Protocols for claims appeals
Name, address, and phone for the Medical Director of the plan
There may be times when a test or procedure is denied for medical necessity. In this case, you may have to contact the Medical Director of the plan and make an appeal based on necessity. Easy contact information for this agent will expedite the process.
Some doctors are interested in making a fee for service arrangements with one or more commercial plans. This means that the company will pay you a flat rate for each participating patient seen in your office. Your practice may be appealing to insurers for fee for service especially if you provide a specialty service that is not readily available in your demographic area and is covered under their plan.
You may pitch for this arrangement by mail to the Medical Director of the plan.
* Note of caution* Make sure you thoroughly research a fee for service arrangement before moving forward. Physicians who have arranged these so called "capitated" agreements can find themselves overwhelmed by the number of patients they are expected to treat or find that the reimbursement rate is not equal to the time it takes to service these patients. You may want to seek the advice of a health care attorney before finalizing any contract that involves fee for service.
Tomorrow : Universal Provider Datasource
Wednesday, June 8, 2011
Who Are You ?
Your first order of business is to prepare a file that contains your personal paperwork pertaining to your training and state competency. In order to become a participating provider in any insurance plan or to gain and maintain your hospital privileges, you will need constant access to this information.
The Medical Staff Office at your affiliated hospitals will remind you when relevant certificates expire and most hospitals will deny you consulting and admitting privileges if these documents are not covered. Your participation in insurance plans will require you to re-credential every 12 months, so it is necessary and time saving to have the following documents on hand.
* You can either scan these documents into your computer, or create a paper file. I have used both methods to retrieve documents and I have found that a paper file ultimately afforded more efficient control over the multiple documents required.
If you or your Practice Administrator is dealing with a multiple physician practice, the outside of each folder should be marked with the following: Physician Name, Address, Phone (home and mobile), Date of Birth, Social Security Number, Marital Status, Name of Spouse, Emergency Contact number. You may also include the dates of completion of college, medical school, internship, residency and fellowship.
You will need the following documents :
1. Curriculum Vitae - It is a good idea to update your C.V. on an annual basis. You can use the anniversary date of your employment to update your personal information and CME credits. Make sure that your address and phone number are current. Always include the start and end dates for graduation from college, medical school, internship, residency, and fellowships. These dates will be required for most, if not all, hospital and insurance affiliations.
2. IRS Certificate assigning your Tax ID number - Medicare and most insurers will request a copy of this certificate before completing credentialing.
3. W-9 - Include and annual W-9 showing your business name and Tax ID number. Make sure this document is signed and dated properly.
4. Current State Registration - To register for your state license or to renew an existing license online, contact your State Education Department.
5. DEA Certificate - For a new application or to renew your existing certificate online, go to :
www.deadivison.usdoj.gov. The instructions are easy to follow and payment for renewal can be made by credit or debit card.
6. Malpractice Coverage - Make sure your factsheet for coverage contains the name, address, and phone number of the company providing your coverage.
In addition to the above, you will need copies of the following certifications:
Medical School Diploma
Internship Certification
Residency Certification
Fellowship Certification
Board Certification in Internal Medicine
Board Certification in Specialty if applicable
Your file should contain :
National Provider Identification Certificate - You must retain a copy of the original certificate from NPI showing your assigned number. https://nppes.cms.hhs.gov will allow you to search for a specific physician NPI number and will direct you to a site for obtaining an NPI number for the first time user.
Infection Control Certificate - Online certificates are offered via short course and exam. Your state nursing associations offer a variety of online courses that cam be completed in less than two hours. You will be able to pay for the course via credit or debit card, and upon completion, you will be prompted to print out your certificate.
ACLS Certification - Your affiliated hospital may require this certificate. The American Heart Association offers online courses, where providers are given a combined 32 hours to complete the program. Most doctors are able to complete the entire coursework in 3 to 4 hours. A skill testing session is also required. www.actnt.com/ACLSAnywhere.htm will direct you to the American Heart Association course.
CLIA Certification - Clinical Laboratory Improvement Amendments state all entities that perform even one test - including waived tests - on materials derived from the human body for purposes of diagnosis, prevention, or treatment of any disease or for the general assessment of health are in essence considered a laboratory and must meet certain Federal guidelines. The CLIA application collects information regarding a laboratory's operation. Applications for a CLIA Certificate can be found online at:
http://www.cms.hhs.gov/forms/cms116.pdf
Hospital Privileges - Letters from your affiliated hospitals noting the date and type of privileges should be included in your personal file and updated as the terms and dates for these arrangements are modified or ended.
Continuing Medical Education Credits - ( CME ) Your affiliated hospitals and some insurance companies will require that your complete a number of CME credits each year. Many courses are available online. You may also check with drug companies or medical equipment suppliers. They may be able to offer you CME's for attending seminars or meetings.
Insurance Affiliations - This file should contain your acceptance letters as a participating provider for both Medicare and private insurance plans.
You will be amazed at how many times you will need to access this file each year. Having this information readily available saves time and will assure that your credentialing process runs smoothly.
Tomorrow : Navigating the Crazy World of Insurance...
The Medical Staff Office at your affiliated hospitals will remind you when relevant certificates expire and most hospitals will deny you consulting and admitting privileges if these documents are not covered. Your participation in insurance plans will require you to re-credential every 12 months, so it is necessary and time saving to have the following documents on hand.
* You can either scan these documents into your computer, or create a paper file. I have used both methods to retrieve documents and I have found that a paper file ultimately afforded more efficient control over the multiple documents required.
If you or your Practice Administrator is dealing with a multiple physician practice, the outside of each folder should be marked with the following: Physician Name, Address, Phone (home and mobile), Date of Birth, Social Security Number, Marital Status, Name of Spouse, Emergency Contact number. You may also include the dates of completion of college, medical school, internship, residency and fellowship.
You will need the following documents :
1. Curriculum Vitae - It is a good idea to update your C.V. on an annual basis. You can use the anniversary date of your employment to update your personal information and CME credits. Make sure that your address and phone number are current. Always include the start and end dates for graduation from college, medical school, internship, residency, and fellowships. These dates will be required for most, if not all, hospital and insurance affiliations.
2. IRS Certificate assigning your Tax ID number - Medicare and most insurers will request a copy of this certificate before completing credentialing.
3. W-9 - Include and annual W-9 showing your business name and Tax ID number. Make sure this document is signed and dated properly.
4. Current State Registration - To register for your state license or to renew an existing license online, contact your State Education Department.
5. DEA Certificate - For a new application or to renew your existing certificate online, go to :
www.deadivison.usdoj.gov. The instructions are easy to follow and payment for renewal can be made by credit or debit card.
6. Malpractice Coverage - Make sure your factsheet for coverage contains the name, address, and phone number of the company providing your coverage.
In addition to the above, you will need copies of the following certifications:
Medical School Diploma
Internship Certification
Residency Certification
Fellowship Certification
Board Certification in Internal Medicine
Board Certification in Specialty if applicable
Your file should contain :
National Provider Identification Certificate - You must retain a copy of the original certificate from NPI showing your assigned number. https://nppes.cms.hhs.gov will allow you to search for a specific physician NPI number and will direct you to a site for obtaining an NPI number for the first time user.
Infection Control Certificate - Online certificates are offered via short course and exam. Your state nursing associations offer a variety of online courses that cam be completed in less than two hours. You will be able to pay for the course via credit or debit card, and upon completion, you will be prompted to print out your certificate.
ACLS Certification - Your affiliated hospital may require this certificate. The American Heart Association offers online courses, where providers are given a combined 32 hours to complete the program. Most doctors are able to complete the entire coursework in 3 to 4 hours. A skill testing session is also required. www.actnt.com/ACLSAnywhere.htm will direct you to the American Heart Association course.
CLIA Certification - Clinical Laboratory Improvement Amendments state all entities that perform even one test - including waived tests - on materials derived from the human body for purposes of diagnosis, prevention, or treatment of any disease or for the general assessment of health are in essence considered a laboratory and must meet certain Federal guidelines. The CLIA application collects information regarding a laboratory's operation. Applications for a CLIA Certificate can be found online at:
http://www.cms.hhs.gov/forms/cms116.pdf
Hospital Privileges - Letters from your affiliated hospitals noting the date and type of privileges should be included in your personal file and updated as the terms and dates for these arrangements are modified or ended.
Continuing Medical Education Credits - ( CME ) Your affiliated hospitals and some insurance companies will require that your complete a number of CME credits each year. Many courses are available online. You may also check with drug companies or medical equipment suppliers. They may be able to offer you CME's for attending seminars or meetings.
Insurance Affiliations - This file should contain your acceptance letters as a participating provider for both Medicare and private insurance plans.
You will be amazed at how many times you will need to access this file each year. Having this information readily available saves time and will assure that your credentialing process runs smoothly.
Tomorrow : Navigating the Crazy World of Insurance...
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