Should Residents be required to have more training?

 

maxrvu (6).png

75% of physicians in our Health Care Professional Survey would have preferred more training on the Business of Medicine during their residency.

The most important aspect of training is learning how to properly care for your patients, but what happens when you complete training and you’re off in the real world of medicine?

There’s a lot of things they don’t teach you, like how medical billing works, how you will be compensated, and how to track that compensation.

maxRVU Charge Capture helps physicians track patient encounters at point-of-care. This is a pretty easy concept to understand, but what’s so special about our charge capture solution is that maxRVU supports Residents as well. You can learn proper coding techniques that go right along with your specialty, while attending physicians review the codes you submit before they’re handed off to the billing department.

CPT codes will no longer be a mysterious string of numbers, but instead a well-known code describing what procedures and consultation levels you performed. Better yet, you’ll track the Relative Value Units associated with the codes to get an idea of what your reimbursements would look like.

Staying Compliant

Staying on goal is the most important lesson to get out of this series.  You can talk about, plan, and discuss things wonderfully, but if they are not physically being carried out effectively, it is all for nothing.

Internal audits should be performed in a predetermined timeframe – quarterly or every 6 months at a minimum.  These can be very simple checklists to ensure that you are staying on schedule, and also that your office staff is handling the new information correctly.

Also a monthly review of your progress is a good bet. These can be as simple as informal staff meetings where you review goals, provide education and ensure that you are keeping on track. Make sure that your billing program is tight – with no lost revenue and close receivables.  Also, check that you are staying on budget as well.  Hold meetings with your project manager, as well as with any companies you may have hired to do installations or training sessions.  Be sure you are on target for your initial due date, and make any accommodations you may need to, should that date need to be adjusted.

To keep current with compliance issues, you may want to subscribe to newsletters and journals that will keep you informed.  Some are free, but others may charge a subscription fee.  Share the information with your office staff at your staff meetings. Be proactive, plan ahead and stay on top of the regulatory trending patterns, so you can steer your practice towards maintaining compliance and profitability.

Conquering Regulation:Project Initiation Steps

You have assessed your assets, targeted your shortcomings, and initiated a project budget and timeline for compliance.  Now we must determine how you will educate yourself and your employees on the new codes, regulations, and rules that affect your practice.  Small project initiation will offset the grandeur of this task, and make it much more manageable than you may have ascertained.

Just as in any corporate structure, there are always new processes, new tools, new positions, and new compliance issues to deal with.  Structural change occurs frequently, and preparation is the key component to handling these upgrades in stride.

In order to utilize the new software that may have been installed, or to decipher new codes that were developed, education will be a paramount player in this project.  Developing smaller projects within the grand task is the answer.  Small group discussion over the needs of your practice is a great starting point.  Obviously the entire office cannot shut down in order to comply with training needs, so having different small group sessions works best.  There are a variety of e-solutions that offer great knowledge and training sessions regarding all topics of healthcare regulations and compliance.

Supplemental staffing is another avenue that may need to be addressed during this transition period.  During the project initiation itself, or training periods, additional staff may be needed for s specific tenure.  These contract employers are specifically trained to handle this type of workload, and can be an effective hands-on training tool at your disposal.  Many people learn better from these types of trainers.  They can also supplement office personnel should other training methods have been selected.

Job roles may need to be re-evaluated.  With new responsibilities and expectations, job descriptions may need to be updated, or even changed.   Meetings with office management will determine whether or not the current workload can be merged with changing strategies in compliance.

The thing to remember here is to make small, methodical changes geared toward the overall goal.  Rome was not built in a day.

Changing the Medical Field

Change is hard in any industry, and the medical field is no different.  But once you have inventoried where your strengths lie, and where your deficiencies fall, you are already well on your way to assessing what needs to be done in order to manage and implement these changes effectively.  In the previous post, we covered taking inventory of what your practice has, and needs to purchase or update.  In this section, we will relate how effective strategies in your game plan will make the overwhelming task of updating your current systems seem effortless.

A vital component in this change is going to be your current office staff.  A brainstorming session comprised of your key employees that will be effecting the change is mandatory.  While your office manager may be competent at their current daily tasks, the news changes that need to be tackled may be slightly beyond his or her scope.  Discuss this possibility with them and work with what they are capable of handling.  Knowing that you may need to outsource a project manager or enlisting one of the numerous healthcare management companies out there is a realistic possibility.  Trying to push a project onto someone who cannot handle it will only cost more money in the long run.

Make sure you are informed of what actually needs to be done.  There are various media outlets available to us.  Present materials such as videos, on-line training, etc. to not only your staff, but to yourself as well.  You are being held accountable for these changes, and intimate knowledge of them is mandatory.

Formulating a budget and a time-frame for implementation is key.  You cannot begin to transition until you are fully aware of the scope of the project.  Once this has been formalized, stick to your plan.  Ask the project management team for their input on what needs to be done – software, training, documents, devices, etc.  Communication is an invaluable tool here.  Give each initiation its own timeline within the general scope of the project.  Forming mini tasks to be completed gradually gives the project a more graspable aspect, and makes it less daunting.

Schedule internal audits of the progress.  Make sure you stay on top of this.  Don’t just take the word of your project manager.  Hold them monthly, quarterly – whatever timetable works with your establish timelines.  Successful completion of each section of this process is the only way to ensure a reachable goal – and that is to update and embrace the changes in healthcare, not dread them.

4 Steps to Conquering the Burden of Over Regulation

4 Steps to Conquering the Burden of Over Regulation

Healthcare’s current state of flux is causing many physician practices to feel overwhelmed with the cumbersome amount of new regulations and mandates. It is quite stifling, to say the least.  Practices are now dealing with implementing Electronic Health Records, upcoming ICD-10, morphing practice models (ACOs), Medicare quality reporting system……and so on. Where does it all end? How do you keep current, and still have time for patient care? How do you determine what you even need to be compliant, remain solvent and move forward?

In this series of articles, we are going to set up goals to get your practice well on its way to compliance; leaving you to focus on delivering a high standard of care to your patients. It will take work – a lot of work; but by breaking down the process, it will seem manageable and put your practice on a secure path.

There are four steps that we are going to utilize – Take Inventory, Develop a Game Plan, Initiate Projects and Follow Up.

TAKE INVENTORY

Look at your practice and determine what you currently have that is working – do you already have Electronic Health Records?  Perhaps you have a good billing system ready to update to ICD-10 with minimal problems? Once you determine what you have, determine what changes or upgrades that component may need.  Next, ascertain what you do not have.

Utilize project management tools and the entire process will become far less daunting. There are a lot of FREE web based solutions you can consider.  If learning yet another software program is not in your

“time budget”, go to the simple “white board” and list the projects, tasks, timeframe, goals and who is in charge to follow the progress and keep it all organized.

Prioritizing projects can be difficult. You may want to combine some projects, as they can overlap anyway. An example of this is EHR and ICD-10 codes. This can also eliminate redundant staff education in learning the new or updated programs.

Once you have your Inventory completed, it is time to move on to developing your game plan.

Physician Extenders and Charge Capture

The health care workforce is changing, as Non-Physician Practitioners (NPPS), or “Physician Extenders” are providing more services.  NPPS fall into 2 broad categories: Physician Assistants (PAs) and Advanced Practice Nurses (APNs or ARNP’s).

Since 1998, designated NPPs are allowed to submit Medicare Part B claims for services, including procedures, provided in any inpatient or outpatient setting. For billing purposes, these “independent” services do not require physician involvement (e.g. physician initiation of care plan, physician-patient encounter, or physician presence on patient floor/unit) unless otherwise specified by state legislation or facility standards of practice. NPPs do not need to be employed by the physician group. The entity employing the physician group also may employ the NPP.

Physician Assistants

Medicare requires that a PA work a Physician Supervisor who provides both management and direction of the PAs activities. This physician need not be present (although some states may require that) but must be available at all times.

The carrier or A/B MAC will pay for PA services at the lesser of the actual charge or 85 percent of the Medicare Physician Fee Schedule (MPFS). PA assistant-at-surgery services are paid to the employer of the PA by the carrier or A/B MAC at 85 percent of 16 percent of the MPFS.

Advanced Nurse Practitioners

ANPs include Certified Mid Wives, Nurse Practitioners, Certified Nurse Anesthetists, and Clinical Specialists. All 50 states allow ANPs to prescribe medications, while some states allow them to practice independent of a physician.  In general, the NP is paid for covered services at 85 percent of the Medicare Physician Fee Schedule.

Split/Shared E/M Service

In the office/clinic setting when the physician performs the E/M service, the service must be reported using the physician’s NPI. When an E/M service is a shared/split encounter between a physician and an NPP, the service is considered to have been performed incident to if the requirements for incident to are met and the patient is an established patient. If incident to requirements are not met for the shared/split E/M service, the service must be billed under the NPP’s NPI, and payment will be made at the appropriate MPFS payment.

Since services of Physician Extenders are delivered in a variety of settings, (clinics, nursing homes, patient homes, hospitals, etc.) mobile charge capture systems are imperative, utilizing devices such as phones or tablets.  Such programs integrate the CPT and ICD 9 codes and other useful information into one application, allowing the practitioner not only to record medical evaluations, prescriptions, treatments, etc., but also to capture and code the visit enabling an immediate billing.

Sequestration and YOUR Bottom Line

Sequestration came into effect April 1, 2013.  Physicians beware.  As of today, your practice is earning 2% less on your Medicare patients than you did in February.  That’s a big cut and more cuts are on the way every year. Under the current sequester rules; Medicare will be cut by $100 billion over the next 10 years, with $11 billion to be cut in 2013 alone.

How will you compensate for that reduction in revenue?

First, if you have not yet reviewed your 2013 budget, do it now – right now! Determine with your partners and/or practice manager, where you can make cuts, reductions and increase efficiency.

One area to look at very closing and fine tune is your billing system. It’s amazing that even with today’s technology, physicians are still using index cards to record visits; sometimes holding on to them for a month before submitting them – and many times losing some.  This equates to lost revenue AND longer receivable turnaround times.

I just had a routine checkup last week and inquired of my physician (who I have known for years), how he recorded his out of office visits.  He said he was using index cards, even though he had an iPhone and iPad.  I inquired if his practice considered using electronic capture billing software, and he said “What’s that?”

Here’s a practice I can assure you is losing quite a tidy sum – as 80% of his patients are Medicare. As a matter of fact, recent studies indicate that approximately 25%-30% of all medical practice income is lost due to improper billing.

One health system decided to implement a charge capture software program and within three years they recognized:

• Increased charges captured by between 8-17%

• Improved Collection/Realization rates by between 3-5%

• Decreased Denial rates by 4-7%

• Decreased the denied charge write-off rate by 12-17%

Perhaps it’s time for your practice to take a close look at the efficiency of a Charge Capture software billing system.