Billing your patients for uncollected co-payments, deductibles, and self pay services is always a delicate matter. Too much of a strong-arm approach can turn off patients and may prompt them to seek services elsewhere. Allowing large uncollected patient debt can have a significant impact on your practice revenue.
Co-payments are automatically deducted from the physicians reimbursement and are required by the commercial insurers as part of the patient's participation in their health plan. All co-payments should be collected at check-in rather than check-out. Patients will avoid paying their co-payments whenever they have the opportunity and will duck out without even making a return appointment in order to avoid doing so. Your policy should be that co-pays are made before services are rendered. Your confirmation calls for appointments must remind your patients to bring their insurance cards and any applicable co-payments to their visit. If you have a patient who does not bring their co-payment, they should be given a postage paid envelope addressed to your office and encouraged to write a co-payment check as soon as they arrive home. Your daily data sheet should have a comments section that lists a clear reason for non-payment of the office co-pay and these listing should be reviewed by management each day.
Many practices find themselves sending out the statements for co-payments to the same patients month after month, with little or no response from the patient. The mailing costs for sending multiple statements often end up exceeding the original co-payment amount and is clearly a waste of time and money. Any patient who fails to reimburse the office after sixty days should receive a reminder phone call from the billing department reminding them of their co-payment obligation. You may want to remind the patient that the co-payment is automatically deducted from the physicians reimbursement.
Unfortunately, sometimes even the best efforts cannot prompt a patient to fulfill their obligations. At this point the billing manager must decide that this amount be declared as "bad debt." You will want to make some notation in the patient's demographics or in the chart stating that this patient must be urged to present with their co-payment at all future visits. Including a personal note with the monthly statement may also serve as an additional reminder. In all cases, personal contact with patients regarding lapsed co-payments must be conducted in private with a sense of professionalism and courtesy. Patients who do not respond in kind should be referred to the billing manager. It will be up to you to decide if the patient who is chronically a non -payer should remain in your care. You should speak to the patient to ascertain whether or not there is a legitimate hardship on a case by case basis. Patients who claim hardship are required by CMS to have a letter on file stating the reasons they are not able to fulfill their obligations. You will want to note "hardship" somewhere in the patient notes so that these patients are not asked for payment at future visits.
It is always a good idea to assign one member of your staff to act as a liaison to Medicare and to place them in charge of outstanding Medicare claims. This staff member will also keep the practice current on any changes in Medicare billing and reimbursements as well as preparing appeals for rejected claims. In cases where the practice has a limited number of Medicare patients, this employee may also be assigned to assist with commercial and patient account reconciliation.
Practices that have not yet converted to an EHS system will also require dedicated employees for charge entry and payment posting, including the downloading of any electronic payment transfers. The billing manager can share responsibility for charge ad payment entry as well as making a careful examination of all explanation of benefits. In most cases, practices that do utilize electronic records will have charges automatically entered into the system as the physician concludes his patient visit or at the end of daily office hours. Charges will, however, still need to be checked for accuracy and to assure that each patient has the appropriate set of charges for services rendered. As mentioned in previous chapters, practices utilizing electronic records must guard against having their systems choose the level of billing. As with traditional charge entry, the employees in the billing department will have a different set of responsibilities but still remain an integral part of the practice service. This is also true for traditional payment entry positions. Although more practices are obtaining reimbursement via electronic fund transfers, the explanation of benefits for these payments will still need a thorough analysis. The employee originally responsible for payment posting will not be responsible for downloading the transfers and assuring that patient ledgers are correctly credited.
Your billing manager will be responsible for the supervision and evaluation of your billing staff. In addition, this employee will also oversee both the efficiency of the front desk in obtaining referrals and pre-certifications and as the tasks relate to the preparation of the daily billing packages. They will also receive the completed billing package each day and assign the charge entry or electronic appraisal to the staff. Having your billing manger also function as the oversight for the front office will guarantee that no charges will be entered without the necessary related paperwork and authorizations.
Centralize your billing department in an area away from the front desk, keeping HIPAA policies for privacy in mind. All daily packages, including cash and checks should be returned to this location each day. Multiple location practices may choose to utilize either a messenger service or a staff member who travels between locations to handle this responsibility. Some physicians choose to make their bank deposits themselves, but this task is most often assigned to the administrator or billing manager.
Tomorrow : Your Chain of Command
Wednesday, July 13, 2011
Tuesday, July 12, 2011
How Many Employees?
A guarantee that patient care will never be compromised is the first determining factor in deciding on the number of staff that you will need to employ. Patient requests for appointments, prescription refills or test results must be handled in a timely manner or slowly but surely your number of return patients will diminish. If your phone system is not operating properly or your front office is not able to triage calls, your patients will let you know it, first by their loudly voiced opinion and finally by their absence.
It is no surprise that everyone hates automated messages under any circumstance, and patients seem to be the most frustrated group of consumers when it comes to the ability to be able to speak to a live person when they are sick, or in pain. Unfortunately, patient volume and time demands on physicians and staff have made automation a necessary evil, but any time your call volume can be handled live, you should make every effort to do just that. If you absolutely need to automate your system, you will need a program that has the fewest number of prompts and allows the patient to leave a detailed message after a certain number of rings. The patient should be reminded to spell their last name, clearly state their phone number and the reason for their call. Your system should be designed so that messages have an annoying flash to assure that all calls are returned prior to the end of business each day.
In the case of a medical emergency, patients should be prompted to dial 911 or go to the nearest emergency room. A dedicated phone extension for prescription refills also aids in phone triage. Let your patients know that they can expect a call or e-script to their pharmacy within 48 hours. When they become familiar with this routine, they are more likely to refill their medications before they take their last few pills. In the best case scenario, your practice will have a licensed medical assistant or RN to man the prescription line. Problems with medications can be immediately referred to the physician and you are less likely to have a medication error if your script line is handled by a medical professional.
Many practices now have a short series of prompts that can alleviate call volume. Appointment calls should be your number one priority, but you will want to include a prompt for fax number, directions to the office, parking information and the like. This will allow your front office more time for face to face patient care and take care of calls where a live person communication is not necessary.
Some of the more sophisticated larger practices have a dedicated call center to handle only incoming phone calls for appointments. Usually, two telephone operators will be able to effectively handle a six-person practice. New patient calls for appointments can also be sent to the verification department where more time can be spent with the patient without interruption. This will also free the front desk to handle check in and out and their other associated tasks without answering a constantly ringing phone.
Filing, copying, scanning and faxes can often be handled by part time employees. The guidance offices at your local high schools and colleges will be only too happy to post your job needs and steer good students your way, often for minimum wage. You may also want to contact university nursing programs and offer to participate in their internship programs. Often these internships last six months or longer and you may find a valuable future employee by utilizing these programs.
Billing - If your billing is done in house, you will want to dedicate at least one full time employee to work on your accounts receivable. This employee will be responsible for running a weekly report for outstanding receivables for both the commercial insurers and patient accounts. Commercial accounts receivables can be shown either by insurance name or via an aging report. Listing outstanding receivables by insurance provider is preferable since it allows the billing employee to check a number of claims with one call or visit to the particular web-site. Some systems can accommodate both name and aging in the same report.
It is reasonable to expect that all outstanding claims have received attention within thirty days. The billing manager should analyze a completed accounts receivable report, with special attention paid to any difficulties posed by individual insurance providers. The manager may choose to personally handle the more difficult reimbursements problems and may utilize the help of the insurance provider representatives to make payment a smoother process. A quarterly analysis for the aging trial balance will highlight the efficiency of the accounts receivable employee and assure that the oldest outstanding claims have been paid.
Tomorrow: Medicare and Patient Statements
It is no surprise that everyone hates automated messages under any circumstance, and patients seem to be the most frustrated group of consumers when it comes to the ability to be able to speak to a live person when they are sick, or in pain. Unfortunately, patient volume and time demands on physicians and staff have made automation a necessary evil, but any time your call volume can be handled live, you should make every effort to do just that. If you absolutely need to automate your system, you will need a program that has the fewest number of prompts and allows the patient to leave a detailed message after a certain number of rings. The patient should be reminded to spell their last name, clearly state their phone number and the reason for their call. Your system should be designed so that messages have an annoying flash to assure that all calls are returned prior to the end of business each day.
In the case of a medical emergency, patients should be prompted to dial 911 or go to the nearest emergency room. A dedicated phone extension for prescription refills also aids in phone triage. Let your patients know that they can expect a call or e-script to their pharmacy within 48 hours. When they become familiar with this routine, they are more likely to refill their medications before they take their last few pills. In the best case scenario, your practice will have a licensed medical assistant or RN to man the prescription line. Problems with medications can be immediately referred to the physician and you are less likely to have a medication error if your script line is handled by a medical professional.
Many practices now have a short series of prompts that can alleviate call volume. Appointment calls should be your number one priority, but you will want to include a prompt for fax number, directions to the office, parking information and the like. This will allow your front office more time for face to face patient care and take care of calls where a live person communication is not necessary.
Some of the more sophisticated larger practices have a dedicated call center to handle only incoming phone calls for appointments. Usually, two telephone operators will be able to effectively handle a six-person practice. New patient calls for appointments can also be sent to the verification department where more time can be spent with the patient without interruption. This will also free the front desk to handle check in and out and their other associated tasks without answering a constantly ringing phone.
Filing, copying, scanning and faxes can often be handled by part time employees. The guidance offices at your local high schools and colleges will be only too happy to post your job needs and steer good students your way, often for minimum wage. You may also want to contact university nursing programs and offer to participate in their internship programs. Often these internships last six months or longer and you may find a valuable future employee by utilizing these programs.
Billing - If your billing is done in house, you will want to dedicate at least one full time employee to work on your accounts receivable. This employee will be responsible for running a weekly report for outstanding receivables for both the commercial insurers and patient accounts. Commercial accounts receivables can be shown either by insurance name or via an aging report. Listing outstanding receivables by insurance provider is preferable since it allows the billing employee to check a number of claims with one call or visit to the particular web-site. Some systems can accommodate both name and aging in the same report.
It is reasonable to expect that all outstanding claims have received attention within thirty days. The billing manager should analyze a completed accounts receivable report, with special attention paid to any difficulties posed by individual insurance providers. The manager may choose to personally handle the more difficult reimbursements problems and may utilize the help of the insurance provider representatives to make payment a smoother process. A quarterly analysis for the aging trial balance will highlight the efficiency of the accounts receivable employee and assure that the oldest outstanding claims have been paid.
Tomorrow: Medicare and Patient Statements
Monday, July 11, 2011
Building A Team Mentality
So many practices find themselves constantly under or overstaffed. In most cases, this problem can be alleviated if the employees have a clear understanding of their job descriptions and are willing to embrace the teamwork attitude.
One way to accomplish the team mentality is to institute a standard training program for each new clerical employee. Proper training is vital to overall accomplishment of any new employee. Don't wait until your practice is overwhelmed before you take on new hires. Staff your office in advance of critical situations and you will have time to promote a better understanding of required responsibilities.
The most successful training program is one in which the new hire spends their first week on arbitrary tasks that may not even be a part of their future job description. Tasks, such as verifying patient insurance, preparing charts, filing and copying will expose the employee to the daily routine of the practice and give them time to find a comfort level in their new home. A senior staff member should be assigned to shadow the new hire and to assure that tasks are accomplished according to practice guidelines and provide them with a sense of security and familiarity in the new environment.
The senior staff member would also be responsible for introducing the new hire to all staff members and physicians. They would conduct a review of the practice handbook, outline job descriptions, and provide the employee with all practice materials needed to make a smooth transition to their assigned role. In a specialty practice, the employee would also be provided with materials that would give them a basic understanding of the testing and procedures done in the office. In cardiology, I recommended that every new hire spend some time in the nuclear and echo labs for the express purpose of readying them to answer patient questions and to promote the feeling of professionalism for the office in general.
Assigning a staff member gives the sense of belonging to the new hire and helps them feel part of the team from day one. It avoids any uncomfortable and often solitary lunch and break times and allows the senior staffer to immediately identify possible future problems or the need for more intensive training.
The second week of training will move the new hire to their department to observe and participate on a basic level. For example, a prospective new front office employee will be seated with a more senior worker to observe and learn the procedures for check in and check out and listen to appointment calls. They will perform simple tasks such as pulling charts for future visits and/or scanning-copying insurance cards.
A new billing hire will work directly with the billing manger. They can be given a small accounts receivable and asked to make phone calls to check on claim status or assist in mailing the monthly patient statements. This busy work will help the new hire feel as if they are part of the team and take care of those early butterflies that can plague all of us whenever we find ourselves in unfamiliar surroundings. It also helps us to make an immediate assessment of the strengths and weaknesses of the new employee and to gauge their people skills. The office manger can then sit down with her senior staffer and make arrangements for an extended training period or a faster transition into their future roles. In some cases, the training period might show that this employee is not a good fit for their hired position and they will need to be transitioned into another role or let go.
A standard training program will assure that each of your departmental employees can perform all the tasks required by the entire department. This means that you will never be lacking for team members in case of illness or vacations and it also allows employees to feel they have a good grasp of each others roles. Encourage employee questions and be prepared to repeat the same information over and over to make sure that each of your staff members are a confident well prepared member.
The concept of teamwork should be well defined in your interview process and employees should understand that they may be requested to perform tasks deemed necessary for the success of the practice and that these tasks may not necessarily be specifically listed in their job descriptions. This does not mean that you multi-task your employees to death, but rather that each member of the team understands that patient satisfaction is priority number one and that the practice is committed to achieving this goal. Job number one is making this goal a reality.
Recognize the difference between discipline and rigidity and don't trap yourself into a set of rules that leave you no room for adaptation. The ebb and flow of a medical practice can easily be affected by emergencies or add-on patients, so leave yourself a bit of wiggle room when organizing your daily schedule. If you establish strict lunch or break times and suddenly ten patients are checking in without anyone to greet them, your rules are ineffective and harmful to the practice. If you never pay overtime, and three patients are still in the waiting room at the end of hours, the practice is not working. Adapt and move forward. Give yourself the opportunity to make changes and create an atmosphere of trust rather than suspicion.
Keep in mind that life goes on outside of the office. Children or parents of employees become ill. Personal problems arise and mental health days are critical every once in a while. As long as these issues are not habitual to an employees routine, be cautious in your response to them. Constant disciplinary actions towards your employees will guarantee that you are spending a large part of your tenure interviewing and training. If you manage with a steady hand, and set a good example, you employees will consider the office their second home, and invest their time and energy to make the workday as productive as possible.
Tomorrow : How Many Employees
One way to accomplish the team mentality is to institute a standard training program for each new clerical employee. Proper training is vital to overall accomplishment of any new employee. Don't wait until your practice is overwhelmed before you take on new hires. Staff your office in advance of critical situations and you will have time to promote a better understanding of required responsibilities.
The most successful training program is one in which the new hire spends their first week on arbitrary tasks that may not even be a part of their future job description. Tasks, such as verifying patient insurance, preparing charts, filing and copying will expose the employee to the daily routine of the practice and give them time to find a comfort level in their new home. A senior staff member should be assigned to shadow the new hire and to assure that tasks are accomplished according to practice guidelines and provide them with a sense of security and familiarity in the new environment.
The senior staff member would also be responsible for introducing the new hire to all staff members and physicians. They would conduct a review of the practice handbook, outline job descriptions, and provide the employee with all practice materials needed to make a smooth transition to their assigned role. In a specialty practice, the employee would also be provided with materials that would give them a basic understanding of the testing and procedures done in the office. In cardiology, I recommended that every new hire spend some time in the nuclear and echo labs for the express purpose of readying them to answer patient questions and to promote the feeling of professionalism for the office in general.
Assigning a staff member gives the sense of belonging to the new hire and helps them feel part of the team from day one. It avoids any uncomfortable and often solitary lunch and break times and allows the senior staffer to immediately identify possible future problems or the need for more intensive training.
The second week of training will move the new hire to their department to observe and participate on a basic level. For example, a prospective new front office employee will be seated with a more senior worker to observe and learn the procedures for check in and check out and listen to appointment calls. They will perform simple tasks such as pulling charts for future visits and/or scanning-copying insurance cards.
A new billing hire will work directly with the billing manger. They can be given a small accounts receivable and asked to make phone calls to check on claim status or assist in mailing the monthly patient statements. This busy work will help the new hire feel as if they are part of the team and take care of those early butterflies that can plague all of us whenever we find ourselves in unfamiliar surroundings. It also helps us to make an immediate assessment of the strengths and weaknesses of the new employee and to gauge their people skills. The office manger can then sit down with her senior staffer and make arrangements for an extended training period or a faster transition into their future roles. In some cases, the training period might show that this employee is not a good fit for their hired position and they will need to be transitioned into another role or let go.
A standard training program will assure that each of your departmental employees can perform all the tasks required by the entire department. This means that you will never be lacking for team members in case of illness or vacations and it also allows employees to feel they have a good grasp of each others roles. Encourage employee questions and be prepared to repeat the same information over and over to make sure that each of your staff members are a confident well prepared member.
The concept of teamwork should be well defined in your interview process and employees should understand that they may be requested to perform tasks deemed necessary for the success of the practice and that these tasks may not necessarily be specifically listed in their job descriptions. This does not mean that you multi-task your employees to death, but rather that each member of the team understands that patient satisfaction is priority number one and that the practice is committed to achieving this goal. Job number one is making this goal a reality.
Recognize the difference between discipline and rigidity and don't trap yourself into a set of rules that leave you no room for adaptation. The ebb and flow of a medical practice can easily be affected by emergencies or add-on patients, so leave yourself a bit of wiggle room when organizing your daily schedule. If you establish strict lunch or break times and suddenly ten patients are checking in without anyone to greet them, your rules are ineffective and harmful to the practice. If you never pay overtime, and three patients are still in the waiting room at the end of hours, the practice is not working. Adapt and move forward. Give yourself the opportunity to make changes and create an atmosphere of trust rather than suspicion.
Keep in mind that life goes on outside of the office. Children or parents of employees become ill. Personal problems arise and mental health days are critical every once in a while. As long as these issues are not habitual to an employees routine, be cautious in your response to them. Constant disciplinary actions towards your employees will guarantee that you are spending a large part of your tenure interviewing and training. If you manage with a steady hand, and set a good example, you employees will consider the office their second home, and invest their time and energy to make the workday as productive as possible.
Tomorrow : How Many Employees
Friday, July 8, 2011
Your Employees - The Key to Your Success
Your shop needs to be a strong cohesive entity, with as little separation as possible between the medical and clerical staff. The most successful corporations practice the rule that employees will live up to your expectations or down to them. If you expect a daily atmosphere of excellence in your day-to day operations, and you participate in trying to attain this status, you will achieve exactly that.
Unfortunately, too many practices are structured where the physician operates on one plane and the employees may as well be functioning in a foreign country ! Consequently, employees are not challenged, they never practice their problem solving skills; their day becomes one boring set of routines. Eventually, the practice transmits a "who cares" attitude that is quickly passed on to any new employee who joins the staff. Patients become aware that the practice operates on a drudgery bandwagon and will leave the office with a negative impression that they will only be too happy to share with family and friends.
If this scenario is at all familiar to your practice, you had better make some changes and make them fast. The attitude of your staff and the feelings that they send the patient's way is often the first clear sign that your practice is in deep trouble. If your staff is not engaged or challenged and have not been geared to prioritize your expectations, if indeed they don't even have an idea of what your expectations are, you will soon begin to wonder where all your patients went.
Face the fact that every employee in the world would like his or her day to be as simple as possible. Without a vested interest or a clear set of goals, you can expect that your staff will actively pursue "doing nothing" whenever possible. Certainly, six appointments are easier than ten. Leaving the office early is preferable to working late. If no one notices, why knock yourself out!
You will not have a successful growing practice if the only area you cover each day is the distance between your office and the exam rooms. You staff should expect that you are going to know each one of their functions and that means the functions for every department. Ask intelligent questions. Solicit opinions in order to promote positive change and remember that these people are showing up every day For YOU... and that they have the power to make or break your organization. Consider them your colleagues, not just your staff. Provide positive feedback for a job well done, expect only the best and reward such behavior appropriately. Create a team mentality and don't be afraid to challenge anyone who is not actively working to be an essential part of your team.
Every practice needs a "go to" person, aside from the physician, to handle the dozens of decisions that need to be made on a daily basis. The administrator or office manager can save the physician hours of valuable time and help assure practice organization and growth. In many practices, the office manager functions as both patient and employee advocate and their influence on the practice reputation can be formidable. The very best administrators know every function in your practice. They often have a past history in a front office or billing setting and should be able to function in any of the clerical or administrative positions with skill and ease.
Managers are responsible for providing the employees with all the necessary tools and training to assure they have the greatest chance for success in their assigned roles. Their own role requires visibility and accessibility to patients and staff. One of the most familiar employee gripes is often " I was not trained properly," so your managers must devote the time and attention it takes to make the staff an expert in their job function. It is a great idea to have the employee sign off after each training session and to test the employee on their newly learned skills during the training process.
When choosing an administrator for your practice you will want to find an individual with the ability to motivate others and to understand the mission of your practice. Provide them with the ability to make decisions and make it clear to your staff exactly where the managers role fits into your chain of command. If you want your managers to succeed, the staff must know that their decisions meet with your approval and that you are ready to back them up.
A weekly meeting should be scheduled with your management staff, where you review the progress and problems that have cropped up in any department. Request suggestions, reward problem solving skills, and make it clear that the management staff must interact with employees with mutual respect and consideration and that this is a mandatory requirement for continued employment.
Physicians often seek management staff with advanced degrees in health care administration or nursing. This works if the individual has prior knowledge of the inner workings of a medical practice and the experience to supervise various departments. Often this is not the case, and unfortunately for these practices, an individual armed with only their degrees can become overwhelmed by the daily tasks that are an integral part of medical management. You need to make a careful evaluation of any office manager candidate because you will be entrusting them with the care and growth of your practice. Consider promoting a staff member that has shown dedication and problem solving skills as part of their daily routine. In so many cases, these employees are already aware of the problems in your arena and may have unvoiced opinions on how to solve them. Don't be afraid to give a great employee a chance to grow into a management position, especially if you are willing to provide them with the guidance they will need to succeed.
Tomorrow: Building A Team Mentality
Unfortunately, too many practices are structured where the physician operates on one plane and the employees may as well be functioning in a foreign country ! Consequently, employees are not challenged, they never practice their problem solving skills; their day becomes one boring set of routines. Eventually, the practice transmits a "who cares" attitude that is quickly passed on to any new employee who joins the staff. Patients become aware that the practice operates on a drudgery bandwagon and will leave the office with a negative impression that they will only be too happy to share with family and friends.
If this scenario is at all familiar to your practice, you had better make some changes and make them fast. The attitude of your staff and the feelings that they send the patient's way is often the first clear sign that your practice is in deep trouble. If your staff is not engaged or challenged and have not been geared to prioritize your expectations, if indeed they don't even have an idea of what your expectations are, you will soon begin to wonder where all your patients went.
Face the fact that every employee in the world would like his or her day to be as simple as possible. Without a vested interest or a clear set of goals, you can expect that your staff will actively pursue "doing nothing" whenever possible. Certainly, six appointments are easier than ten. Leaving the office early is preferable to working late. If no one notices, why knock yourself out!
You will not have a successful growing practice if the only area you cover each day is the distance between your office and the exam rooms. You staff should expect that you are going to know each one of their functions and that means the functions for every department. Ask intelligent questions. Solicit opinions in order to promote positive change and remember that these people are showing up every day For YOU... and that they have the power to make or break your organization. Consider them your colleagues, not just your staff. Provide positive feedback for a job well done, expect only the best and reward such behavior appropriately. Create a team mentality and don't be afraid to challenge anyone who is not actively working to be an essential part of your team.
Every practice needs a "go to" person, aside from the physician, to handle the dozens of decisions that need to be made on a daily basis. The administrator or office manager can save the physician hours of valuable time and help assure practice organization and growth. In many practices, the office manager functions as both patient and employee advocate and their influence on the practice reputation can be formidable. The very best administrators know every function in your practice. They often have a past history in a front office or billing setting and should be able to function in any of the clerical or administrative positions with skill and ease.
Managers are responsible for providing the employees with all the necessary tools and training to assure they have the greatest chance for success in their assigned roles. Their own role requires visibility and accessibility to patients and staff. One of the most familiar employee gripes is often " I was not trained properly," so your managers must devote the time and attention it takes to make the staff an expert in their job function. It is a great idea to have the employee sign off after each training session and to test the employee on their newly learned skills during the training process.
When choosing an administrator for your practice you will want to find an individual with the ability to motivate others and to understand the mission of your practice. Provide them with the ability to make decisions and make it clear to your staff exactly where the managers role fits into your chain of command. If you want your managers to succeed, the staff must know that their decisions meet with your approval and that you are ready to back them up.
A weekly meeting should be scheduled with your management staff, where you review the progress and problems that have cropped up in any department. Request suggestions, reward problem solving skills, and make it clear that the management staff must interact with employees with mutual respect and consideration and that this is a mandatory requirement for continued employment.
Physicians often seek management staff with advanced degrees in health care administration or nursing. This works if the individual has prior knowledge of the inner workings of a medical practice and the experience to supervise various departments. Often this is not the case, and unfortunately for these practices, an individual armed with only their degrees can become overwhelmed by the daily tasks that are an integral part of medical management. You need to make a careful evaluation of any office manager candidate because you will be entrusting them with the care and growth of your practice. Consider promoting a staff member that has shown dedication and problem solving skills as part of their daily routine. In so many cases, these employees are already aware of the problems in your arena and may have unvoiced opinions on how to solve them. Don't be afraid to give a great employee a chance to grow into a management position, especially if you are willing to provide them with the guidance they will need to succeed.
Tomorrow: Building A Team Mentality
Thursday, July 7, 2011
Essential Features For Your EHR
The following features should be available in any practice software you may consider :
Claims Transmission - The transmission of your electronic claims should go through as few channels as possible between your office and Medicare or the commercial insurer. If your software vendor uses a clearing house for claims, you must make sure that the house is recognized by both CMS and the private insurance companies. You should have a claim editing feature that will advise you of errors in coding and provide a daily listing of your transmissions that will allow you to view the total number of claims transmitted, those accepted and any rejected claims as well. This transmission log should be examined each day and rejected claims should be carefully reviewed before the claim is re-transmitted. Store your transmission logs in a binder in your billing office and do a quarterly audit to assure that none of the commercial insurers are making an error in payment month after month. Occasionally, you should print out a paper claim for each provider to assure that their provider ID numbers are entered into your system correctly. I have seen practices who were not paid for their Nurse Practitioners for months because they were entered into the system with their social security numbers rather than the practice Tax ID. Before you transmit your first electronic claim with your new software, you must go to the data base and assure that Tax ID, NPI and insurance ID are correct for each physician in your group. You should also assure that the descriptions for certain testing or isotopes are transmitting according to CMS requirements, or these claims will be denied.
One important word of caution for obtaining your CPT and diagnosis codes for transmission. Many new systems will prompt you to use codes that they consider more appropriate for your claim and to obtain the highest reimbursement rates. This is fine if your patient's list of complaints is aligned with the coding recommended. However, if there are glaring discrepancies in patient notes or medical tests or records, you will find yourself the target of perpetual audits and may be subject to penalties when coding seems to generate from your system rather than your physicians. Use your software appropriately.
Data Change - Some of the software programs available today have glaring problems, and this is especially true with the software that is internet based. One of the more serious issues is a lack of communication between the different task modules. These internet systems are often created as a series of independent books. A book for demographics, one for coding, one for billing etc... Very often, data changes entered in one of the books does not communicate with the system as a whole requiring staff to navigate between screens to make changes in each task module. This may be especially true in systems that were developed for use by single practitioners. Make sure that the changes you need to make in your systems are noted and saved in each of your patient screens.
Multiple Location Features - In a large practice with multiple locations, you will want a system that allows you to designate the different locations by short name rather than by creating separate entities. This will allow you to enter charges and payments by location rather than making it necessary to switch entities and allows you to report your billing and demographics as one bulk or by location. Billing should be separated by location and entered under the short name.
Auto Population - Most systems will offer features to streamline demographic and billing data entry. A zip code feature will populate city and state . Guarantor information and insurance mailing address and phone numbers are also possible auto population features you may want to consider.
Report Modules - You will want a system reporting module that gives you several options for reporting practice financials. Charges and payments should be geared to report financials for any physicians, locations, or procedures and to compare these statistics each month and quarter. Better systems will allow you to plug in your own choice of desired options for reporting so that your examination of your practice is comprehensive and less time consuming. This data can then be converted automatically into an Excel spreadsheet for meetings and quarterly comparison. Accounts receivable reports should always contain the patients name, date of birth and both primary and secondary insurance coverages as well as insurance ID numbers to make it easier to communicate with the insurance providers by phone regarding aged claims.
All systems will require you to make a commitment to assure your system functions at maximum efficiency. While the software vendor will assist you in obtaining transmitted identification numbers for Medicare and the commercial carriers, you will need to make certain that each physician's information is correct. You staff will require comprehensive training and a clear understanding of each feature of your software so that its use will allow maximum performance and job description.
Tomorrow : Your Employees - the key to you success...
Claims Transmission - The transmission of your electronic claims should go through as few channels as possible between your office and Medicare or the commercial insurer. If your software vendor uses a clearing house for claims, you must make sure that the house is recognized by both CMS and the private insurance companies. You should have a claim editing feature that will advise you of errors in coding and provide a daily listing of your transmissions that will allow you to view the total number of claims transmitted, those accepted and any rejected claims as well. This transmission log should be examined each day and rejected claims should be carefully reviewed before the claim is re-transmitted. Store your transmission logs in a binder in your billing office and do a quarterly audit to assure that none of the commercial insurers are making an error in payment month after month. Occasionally, you should print out a paper claim for each provider to assure that their provider ID numbers are entered into your system correctly. I have seen practices who were not paid for their Nurse Practitioners for months because they were entered into the system with their social security numbers rather than the practice Tax ID. Before you transmit your first electronic claim with your new software, you must go to the data base and assure that Tax ID, NPI and insurance ID are correct for each physician in your group. You should also assure that the descriptions for certain testing or isotopes are transmitting according to CMS requirements, or these claims will be denied.
One important word of caution for obtaining your CPT and diagnosis codes for transmission. Many new systems will prompt you to use codes that they consider more appropriate for your claim and to obtain the highest reimbursement rates. This is fine if your patient's list of complaints is aligned with the coding recommended. However, if there are glaring discrepancies in patient notes or medical tests or records, you will find yourself the target of perpetual audits and may be subject to penalties when coding seems to generate from your system rather than your physicians. Use your software appropriately.
Data Change - Some of the software programs available today have glaring problems, and this is especially true with the software that is internet based. One of the more serious issues is a lack of communication between the different task modules. These internet systems are often created as a series of independent books. A book for demographics, one for coding, one for billing etc... Very often, data changes entered in one of the books does not communicate with the system as a whole requiring staff to navigate between screens to make changes in each task module. This may be especially true in systems that were developed for use by single practitioners. Make sure that the changes you need to make in your systems are noted and saved in each of your patient screens.
Multiple Location Features - In a large practice with multiple locations, you will want a system that allows you to designate the different locations by short name rather than by creating separate entities. This will allow you to enter charges and payments by location rather than making it necessary to switch entities and allows you to report your billing and demographics as one bulk or by location. Billing should be separated by location and entered under the short name.
Auto Population - Most systems will offer features to streamline demographic and billing data entry. A zip code feature will populate city and state . Guarantor information and insurance mailing address and phone numbers are also possible auto population features you may want to consider.
Report Modules - You will want a system reporting module that gives you several options for reporting practice financials. Charges and payments should be geared to report financials for any physicians, locations, or procedures and to compare these statistics each month and quarter. Better systems will allow you to plug in your own choice of desired options for reporting so that your examination of your practice is comprehensive and less time consuming. This data can then be converted automatically into an Excel spreadsheet for meetings and quarterly comparison. Accounts receivable reports should always contain the patients name, date of birth and both primary and secondary insurance coverages as well as insurance ID numbers to make it easier to communicate with the insurance providers by phone regarding aged claims.
All systems will require you to make a commitment to assure your system functions at maximum efficiency. While the software vendor will assist you in obtaining transmitted identification numbers for Medicare and the commercial carriers, you will need to make certain that each physician's information is correct. You staff will require comprehensive training and a clear understanding of each feature of your software so that its use will allow maximum performance and job description.
Tomorrow : Your Employees - the key to you success...
Wednesday, July 6, 2011
Hardware and Phones
In light of the enormous changes affecting medical practices throughout the United States, many physicians are updating or replacing their practice software. The age of total conversion to EHR is upon us and can pose a financial burden on physicians who suddenly find themselves having to adapt to a new style of medicine. In many cases, computer hardware will need to be replaced as well and you want to find some areas where your practice can realize some cost savings. Often, your software vendor will offer pricing for accompanying hardware in their estimate for updates to your computer programs. In most cases, these prices are not at all competitive and I believe that you can get a better deal by making a separate hardware package yourself.
Find out the specs that are required for your new program and shop around until you make the best deals. Hewlett Packard and Dell can offer bulk purchase discounts and will work with your software vendor to insure compatibility. They will also customize your systems for additional programs such as Word, Excel, Outlook and Power Point. Do a careful check of your warranty coverage and consider additional warranties that cover the machines as these systems are often subject to more use than a personal computer.
Servers should be chosen to expand with practice growth and should be stored in an air-cooled space to avoid overheating. Allow for the space for your servers prior to the completion of your build out or renovation and one that allows for the addition of programs without overtaxing the system. The servers should be housed in a locked room and should also be covered by an extended warranty.
Your phone systems should be uncomplicated and contain enough memory to add additional lines and hardware for new workstations, along with the capability to store a number of practice messages and the ability to retrieve messages from any work station. If you need a large number of incoming lines, you will want to have an employee from the phone company assigned to your account. They will be able to monitor your charges, make changes to your lines and answer any ongoing questions regarding your system. Local phone companies will also be able to offer you packages that include both phone services as well as the hardware for your office. Often their phones are more durable, so look at samples from independent vendors and your local carrier before making a final decision.
Software : It almost seems as if every computer programmer is busy developing medical practice software and the rush to develop systems for electronic medical records is being done at warp speed. Many of these programs have the same or similar features and are either hardwired into the servers directly or are internet based and the manufacturer of the software controls the hardware off site. There can be a tremendous variation in prices however and don't be surprised to find that every additional feature you may want will ultimately carry an additional price.
Many practices are already at full implementation of electronic medical records and are delighted with both their purchase and their use. Inevitably CMS and the commercial insurances will require that all practices convert to an electronic system, but EMR's are not without their own set of problems. Once all systems are paperless, what features will allow the various softwares to communicate with each other to provide a uniform patient health record? How can we guarantee privacy for medical records in systems that are internet based? What impact will the cost of conversion to EHR pose for some smaller, less financially successful practices? It often seems as if the cart is well ahead of the horse in this issue and I have to wonder about additional costs when CMS eventually requires a uniform system for health care records.... The future is certainly fraught with concerns that will shape a new face for medicine in the years to come....
In many cases, physicians who are using electronic systems will utilize some form of tablet computer, where they enter patient symptoms and treatments. Of course, in 2013 their systems will have to be updated to handle the new ICD-10 codes. A stylus is used to tap a series of pull down menus that the physician completes during the course of the exam. The tablet is especially useful during hospital visits and as long as these computers have long range capacities they can help assure that hospital charges are made at time of visit or directly after.
Doctors can also have the option of using a laptop or office PC where data is entered after the visit and can be placed in every exam room or confined to the physicians private office. Computers in the exam rooms can be utilized by the medical assistants to enter patients vital signs into the system prior to the actual exam. Some doctors feel quite comfortable entering vital data into their tablet or PC during the course of the exam. Others feel that this process detracts from the intimacy of the visit and prefer to wait until the patient is discharged before entering their findings. For simple visits such as a sore throat or cold, the tablet method is easier and poses less intrusion than for more complicated medical exams. In specialty practices, such as Cardiology, where the patient often presents with a complex history and wide variety of symptoms and past treatments, the process of entering data may be too extensive to use during the exam. In these cases, a progress note can be utilized in the exam room and entered at the end of business hours or during the course of the day when the physician has time.
Perhaps the EHR system will eventually eliminate paper and provide a more uniform system for health records, however the time you need to invest prior to implementation of your system is going to be extensive. Your software vendor must customize your package to meet the needs of your daily practice routine. Software should be created with your appropriate diagnosis and treatment options so that you are not constantly searching for a match for your patients symptoms and management. It is surely a good idea to choose a vendor that has worked with other physicians that practice the same specialty or otherwise your initial time investment in setting up your system will be overwhelming.
Exercise extreme caution prior to purchasing any EHR system. Practices can be literally crippled when the features advertised by the software vendor do not function properly post installation. This can be especially true in the present rush to market from start up companies that look great in demonstration and prove disastrous in use. To avoid this risk, it is best to choose a medical software with a significant track record in the industry. These companies have had years of experience in creating software that is user friendly and better geared for use in a specialty practice. Take the time to visit other offices that are using the software and ask how its implementation impacted billing and overall practice statistics. Finally, you must have the support and willingness of all the physicians in your group if you are going to make your conversion a success. Prior to using your new EHR, both your old and new systems should remain in place so that you can make a slow smooth transition and allow enough time for your staff to feel completely comfortable with the software. This will also allow you to evaluate how the new software meets the daily office routine.
Tomorrow: Essential Features For Any EHR System
Find out the specs that are required for your new program and shop around until you make the best deals. Hewlett Packard and Dell can offer bulk purchase discounts and will work with your software vendor to insure compatibility. They will also customize your systems for additional programs such as Word, Excel, Outlook and Power Point. Do a careful check of your warranty coverage and consider additional warranties that cover the machines as these systems are often subject to more use than a personal computer.
Servers should be chosen to expand with practice growth and should be stored in an air-cooled space to avoid overheating. Allow for the space for your servers prior to the completion of your build out or renovation and one that allows for the addition of programs without overtaxing the system. The servers should be housed in a locked room and should also be covered by an extended warranty.
Your phone systems should be uncomplicated and contain enough memory to add additional lines and hardware for new workstations, along with the capability to store a number of practice messages and the ability to retrieve messages from any work station. If you need a large number of incoming lines, you will want to have an employee from the phone company assigned to your account. They will be able to monitor your charges, make changes to your lines and answer any ongoing questions regarding your system. Local phone companies will also be able to offer you packages that include both phone services as well as the hardware for your office. Often their phones are more durable, so look at samples from independent vendors and your local carrier before making a final decision.
Software : It almost seems as if every computer programmer is busy developing medical practice software and the rush to develop systems for electronic medical records is being done at warp speed. Many of these programs have the same or similar features and are either hardwired into the servers directly or are internet based and the manufacturer of the software controls the hardware off site. There can be a tremendous variation in prices however and don't be surprised to find that every additional feature you may want will ultimately carry an additional price.
Many practices are already at full implementation of electronic medical records and are delighted with both their purchase and their use. Inevitably CMS and the commercial insurances will require that all practices convert to an electronic system, but EMR's are not without their own set of problems. Once all systems are paperless, what features will allow the various softwares to communicate with each other to provide a uniform patient health record? How can we guarantee privacy for medical records in systems that are internet based? What impact will the cost of conversion to EHR pose for some smaller, less financially successful practices? It often seems as if the cart is well ahead of the horse in this issue and I have to wonder about additional costs when CMS eventually requires a uniform system for health care records.... The future is certainly fraught with concerns that will shape a new face for medicine in the years to come....
In many cases, physicians who are using electronic systems will utilize some form of tablet computer, where they enter patient symptoms and treatments. Of course, in 2013 their systems will have to be updated to handle the new ICD-10 codes. A stylus is used to tap a series of pull down menus that the physician completes during the course of the exam. The tablet is especially useful during hospital visits and as long as these computers have long range capacities they can help assure that hospital charges are made at time of visit or directly after.
Doctors can also have the option of using a laptop or office PC where data is entered after the visit and can be placed in every exam room or confined to the physicians private office. Computers in the exam rooms can be utilized by the medical assistants to enter patients vital signs into the system prior to the actual exam. Some doctors feel quite comfortable entering vital data into their tablet or PC during the course of the exam. Others feel that this process detracts from the intimacy of the visit and prefer to wait until the patient is discharged before entering their findings. For simple visits such as a sore throat or cold, the tablet method is easier and poses less intrusion than for more complicated medical exams. In specialty practices, such as Cardiology, where the patient often presents with a complex history and wide variety of symptoms and past treatments, the process of entering data may be too extensive to use during the exam. In these cases, a progress note can be utilized in the exam room and entered at the end of business hours or during the course of the day when the physician has time.
Perhaps the EHR system will eventually eliminate paper and provide a more uniform system for health records, however the time you need to invest prior to implementation of your system is going to be extensive. Your software vendor must customize your package to meet the needs of your daily practice routine. Software should be created with your appropriate diagnosis and treatment options so that you are not constantly searching for a match for your patients symptoms and management. It is surely a good idea to choose a vendor that has worked with other physicians that practice the same specialty or otherwise your initial time investment in setting up your system will be overwhelming.
Exercise extreme caution prior to purchasing any EHR system. Practices can be literally crippled when the features advertised by the software vendor do not function properly post installation. This can be especially true in the present rush to market from start up companies that look great in demonstration and prove disastrous in use. To avoid this risk, it is best to choose a medical software with a significant track record in the industry. These companies have had years of experience in creating software that is user friendly and better geared for use in a specialty practice. Take the time to visit other offices that are using the software and ask how its implementation impacted billing and overall practice statistics. Finally, you must have the support and willingness of all the physicians in your group if you are going to make your conversion a success. Prior to using your new EHR, both your old and new systems should remain in place so that you can make a slow smooth transition and allow enough time for your staff to feel completely comfortable with the software. This will also allow you to evaluate how the new software meets the daily office routine.
Tomorrow: Essential Features For Any EHR System
Tuesday, July 5, 2011
Negotiating the Best Deals
Some price savvy physicians tailor their contractor agreements to end once the walls are sheet rocked and electrical outlets and plumbing are all in place. At this time your build-out will be subject to a preliminary inspection and you will receive a certificate that should be posted in your facility until all work is completed.
At this stage, you can save a bundle of money by doing the finishing work on your own. Wholesale vendors for cabinetry, light and plumbing fixtures and flooring are readily available and sometimes offer free installation with purchase. Check prices at your local Home Depot, Lowes or IKEA. They offer a wide range of choices and their sale prices are often far below retail.
You may want to enlist the help of a local handyman in your area who can complete your finishing work in a reasonable time and for a good price. In light of today's economy, your local papers are filled with talented people who will be only too happy to have this work. Check with your local Better Business Bureau to make sure they hold a valid contractors license. If all is in good order, they will be able to use this license to obtain additional savings on purchases.
Wholesale tile, marble and carpeting vendors are also abundant and the time you spend looking at samples of these products will be worth the savings. When you choose your carpeting for your waiting rooms and professional offices, make sure you pick a fiber that will not thread when chairs are moved back and forth. Spending a little more for good carpeting that will last will not only save you money but will not pose tripping hazards to patients or employees.
Tile or linoleum squares are the best choice for your exam rooms and they are very easy to install. Use additional glue on tiles that come with their own adhesive to avoid future lifting. These tiles are durable, easy to clean and will last for some time. It is advisable to use rubber strips rather than wood molding where the tiles meet the walls. These stay cleaner looking and will not chip or scratch.
Consider chair railings for the walls of the exam rooms where patient or visitor chairs can scrape wall paint and affect the overall clean look you want to maintain.
Local painters in your area will also offer you discounts for painting multiple rooms. Many also have connections will wallpaper outlets as well. Choose paint that is washable so that scuffs and spills are easily remedied, and make sure your choose colors that will blend with your choices in furniture, wall covering and any artwork.
Once again check your patient demographics when it comes time to choose furniture for your waiting room. For elderly patients, chairs should be easy to get in and out of without assistance, and arms are often warranted. Colors and fabrics should be durable and stain resistance and you may want to consider at least one bench for overweight patients or for those with back problems. If you want to add tables to your area, make sure that they are strategically placed to avoid bumps. Have sufficient lighting and reading materials available. Some practices run a series of informative videos in their waiting area that provide patients with health and fitness tips. These can prove a valuable distraction for extended waiting times.
If anyone in your family has a flair for decorating, this is the best time to enlist their help. They can shop around for the best prices and bring you samples of everything from paint colors to artwork. This can be an enjoyable experience where your furnishings can reflect your personal sense of style and purpose, so get involved in the process as much as you can. You will be living with the result of your choices for some time, so you will want to create rooms that you can live with from day to day.
Tomorrow : Hardware and Phones
At this stage, you can save a bundle of money by doing the finishing work on your own. Wholesale vendors for cabinetry, light and plumbing fixtures and flooring are readily available and sometimes offer free installation with purchase. Check prices at your local Home Depot, Lowes or IKEA. They offer a wide range of choices and their sale prices are often far below retail.
You may want to enlist the help of a local handyman in your area who can complete your finishing work in a reasonable time and for a good price. In light of today's economy, your local papers are filled with talented people who will be only too happy to have this work. Check with your local Better Business Bureau to make sure they hold a valid contractors license. If all is in good order, they will be able to use this license to obtain additional savings on purchases.
Wholesale tile, marble and carpeting vendors are also abundant and the time you spend looking at samples of these products will be worth the savings. When you choose your carpeting for your waiting rooms and professional offices, make sure you pick a fiber that will not thread when chairs are moved back and forth. Spending a little more for good carpeting that will last will not only save you money but will not pose tripping hazards to patients or employees.
Tile or linoleum squares are the best choice for your exam rooms and they are very easy to install. Use additional glue on tiles that come with their own adhesive to avoid future lifting. These tiles are durable, easy to clean and will last for some time. It is advisable to use rubber strips rather than wood molding where the tiles meet the walls. These stay cleaner looking and will not chip or scratch.
Consider chair railings for the walls of the exam rooms where patient or visitor chairs can scrape wall paint and affect the overall clean look you want to maintain.
Local painters in your area will also offer you discounts for painting multiple rooms. Many also have connections will wallpaper outlets as well. Choose paint that is washable so that scuffs and spills are easily remedied, and make sure your choose colors that will blend with your choices in furniture, wall covering and any artwork.
Once again check your patient demographics when it comes time to choose furniture for your waiting room. For elderly patients, chairs should be easy to get in and out of without assistance, and arms are often warranted. Colors and fabrics should be durable and stain resistance and you may want to consider at least one bench for overweight patients or for those with back problems. If you want to add tables to your area, make sure that they are strategically placed to avoid bumps. Have sufficient lighting and reading materials available. Some practices run a series of informative videos in their waiting area that provide patients with health and fitness tips. These can prove a valuable distraction for extended waiting times.
If anyone in your family has a flair for decorating, this is the best time to enlist their help. They can shop around for the best prices and bring you samples of everything from paint colors to artwork. This can be an enjoyable experience where your furnishings can reflect your personal sense of style and purpose, so get involved in the process as much as you can. You will be living with the result of your choices for some time, so you will want to create rooms that you can live with from day to day.
Tomorrow : Hardware and Phones
Subscribe to:
Posts (Atom)