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...
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