January 26, 2012
Collecting deductibles and co-pays once a patient leaves your office is time-consuming, costly and makes practice cash flow inconsistent and unpredictable. If you’re like most practices, during the latter half of a calendar year, many of your patients have met their deductibles and insurance covers the majority of their office visits and medical needs. As we turn the calendar over on 2012, it’s a good time to remind your front desk team that a new benefit plan year has begun and reinforce your collection procedures.
A well-trained medical biller on your team is your best weapon in keeping your practice revenue flowing smoothly. Proper use of CPT codes and knowledge of a variety of your local insurance companies and major health plans will help you establish a database of knowledge to employ in creating effective collection policies for your practice. Additionally, a few simple techniques will help you to begin 2012 with a strong collections process in place.
- Develop and Communicate an Upfront Collections Policy
It’s important to have current benefit plan information on file for each patient so that you can accurately calculate any co-pays or deductibles for your patients. It’s a good policy to check your patients’ insurance coverage during their initial visits each new plan year. If the patient has a co-pay or deductible, collecting it at the time service is rendered significantly reduces the number of potentially uncollectible accounts. Review your new patient paperwork to ensure that any changes in policies or procedures have been accurately incorporated into these forms. Data collection is half the battle in ensuring efficient claims processing for services.
- Train Staff on Proper Collection Techniques
Make sure that your staff understands your collections policy and is comfortable enforcing it. Use role-playing techniques until your front desk team members are confident in talking with patients about their financial responsibilities.
- Educate Patients on Their Financial Responsibility
If you clearly communicate your payment policies and are consistent in enforcing them, then patients know what to expect when they visit your office. Give them multiple ways to pay their bill by offering cash, check and credit card options.
- Offer Financial Assistance
With the growing number of uninsured or underinsured patients in our country, it’s important to have a financial aid policy to assist patients in need. You can also offer assistance to patients in finding community or government programs to help with medical expenses. Lastly, low or no interest financing will allow patients in need to receive necessary medical treatment.
Another technique that’s on the rise is for medical practices to establish a line of credit from a financial institution to manage cash flow inconsistencies, particularly during the first quarter when deductibles must be met before insurance company payments begin. As practices convert to the ICD-10 Version 5010 HIPAA transaction standards, which went into effect on January 1, 2012, some experts are advising that a line of credit will help to minimize cash flow disruptions that may result from this conversion. Information about ICD-10 Version 5010 can be found on the Centers for Medicare & Medicaid Services website at https://www.cms.gov/ICD10/.
In summary, it’s important to understand the intricacies and complexities of insurance plans, medical billing, as well as government programs and regulations covering the payment of insurance claims. With this knowledge in hand, you can create the business processes and policies to support the efficient operation of your medical practice and maintain a steady revenue stream.
Topics: Solution Blog | No Comments »
January 19, 2012
Did you know that you can register, start attesting and then save and continue later on the CMS attestation site? Well, you do now. It is always a good idea to take your time when filling out critical forms and in this case, it involves your provider’s incentive bonus. You can register here and fill out the information you have gathered so far, save and continue more later: https://ehrincentives.cms.gov/hitech/login.action.
Keep in mind that you will need numerators and denominators in order to completely attest, so I recommend having those numbers handy or at least access to a dashboard or reporting tool that has that information easily accessible. What is a numerator? It is the satisfying number to meet the requirement. What is the denominator? It is the complete grouping that was considered for the measure. There are also denominator exclusions for many of the measures. This specific exclusion type means the patients who were not eligible for some medical or non-medical reason for the particular measure even though they may have been in the denominator grouping for that measure.
And….if you are looking for even more links, tools and assistance with Meaningful Use, feel free to check out the Meaningful Use section of our blogposts for more information.
Topics: Solution Blog | No Comments »
January 12, 2012
Patient privacy and confidentiality of medical records is protected by the department of Health & Human Services through the HIPAA Security Rule. And, if your practice is using Electronic Health Record technology (EHR) and/or attesting to Meaningful Use, well-documented Policies and Procedures are at the heart of the HIPAA Security Rule Administrative Guidelines.
The very first Administrative Standard refers to the prevention, detection, containment and correction of any security violations. As we’ve discussed over the last few weeks, if you are attesting to Meaningful Use, Measure 15 outlines the requirement of a security risk analysis that addresses potential security gaps and provides clear direction on managing and preventing security risks. Furthermore, this security management process must be documented and contained within the practice’s P&Ps. These P&Ps will assist you in meeting compliance standards and protecting you in the event of an audit.
We have developed a checklist to guide practices in a review and update of their P&Ps to ensure that they address all of the HIPAA Security Rule Standards. You can download a copy of this document on our website at www.practicemanagersolutions.com.
Beyond the requirements of the HIPAA Security Rule, P&Ps are important in establishing clear expectations of how various stakeholders interact with your practice. They guide you in the day-to-day operation of the practice including instructing staff members on how to perform various functions, establishing patient guidelines for everything from missed appointments to insurance payments, and give the practice manager objective means for evaluating and managing the effectiveness of the practice.
If you haven’t looked at your P&Ps lately, now is a good time to not only incorporate and/or update your security management process, but also determine how effectively they reflect the reality of your practice management. A good P&Ps manual will include at a minimum the following sections:
Patient & Staff Safety
Patient and staff safety is a primary concern in the medical practice. Policies and procedures should exist for:
- Cleanliness of exam rooms
- Sterilization of medical equipment
- Availability of protective gear to prevent the spread of infectious disease
Insurance and Billing Procedures
Effective billing procedures will help ensure the financial viability of the practice. A policy should exist informing patients on how the billing process works, including what their responsibilities are in providing payment for services. The staff requires guidelines on how to process medical procedures for insurance payment through proper coding of procedures and effective interaction with insurance companies. Procedures should exist for the collection of delinquent accounts, resolution of discrepancies and the appropriate write-off of uncollectable debt.
Human Resources Policies
Like any business, your practice has policies that outline employment practices for your staff. Your P&Ps should clearly describe the policies for items such as:
- Vacation time
- Sick days
- Holidays
- Employment reviews
- Pay raises and pay scales
Administrative Functions
Administrative P&Ps define how the front office interacts with patients. It sets the initial tone for the patient experience. They should cover:
- Days and hours of operation
- After hours calls
- Appointment scheduling
- Maintenance of the waiting room
- Office opening and closing procedures
- Proper hand-off of patients to the medical staff
In summary, Policies and Procedures promote consistency in performance of all functions within the practice. They provide effective communication channels with staff and with patients, as well as third-party stakeholders such as insurance companies and labs. Inclusion of a robust security management process protects you in the event of a Meaningful Use audit. Regular review of your P&Ps should include staff to guarantee they accurately reflect the day-to-day realities of running the practice. A P&P review can guarantee that your communication materials, including your website, contain the most up-to-date policies for patients ensuring a calm and efficient patient experience.
Topics: Meaningful Use | No Comments »
January 5, 2012
A security risk assessment is a requirement of Meaningful Use attestation (Measure 15), but what exactly does that mean? A security risk assessment is not a new concept. It is a requirement of the HIPAA Security Rule. But for attestation purposes, you must review your security procedures and ensure that they address current potential, as well as future, risk to your EHR system.
A thorough security risk assessment should include the following components:
- A review of current security procedures related to your EHR. Be sure to include clinicians and management, as well as IT, in the review process.
- Risk management procedures in your practice as well as any third parties who have access to information from your EHR system.
- Threats to not only the confidentiality but also the integrity and availability of protected information.
- Measures to identify future security risks.
- A process for integrating continuing security updates.
- A regular review process to manage future changes.
It’s not enough to merely conduct a security risk assessment, you must also address any security gaps to ensure that your EHRs are fully protected. So, if you’ve identified problems with the security of your EHRs, you should develop a plan and timeline to fix those risks. Only then can you truly meet Measure 15.
Topics: Meaningful Use | No Comments »
December 29, 2011
During this frenetically busy holiday season, it’s easy to focus on others and forget to take some time to reflect on your own needs, wants and goals. Over the next week, give yourself a gift by taking a few minutes to listen to the following audio, and reflect on YOU. It will help you to focus on where you want to go in 2012, AND how to take the steps to get there. Click on my picture below to begin the audio recording.
I’m wishing each and every one of you a very happy holiday season filled with the perfect mix of friends, family, relaxation, fun, self-reflection and time for yourself. I look forward to hearing about your journey throughout the coming year.
Topics: Business Coaching, Thought Processes | No Comments »
Collecting deductibles and co-pays once a patient leaves your office is time-consuming, costly and makes practice cash flow inconsistent and unpredictable. If you’re like most practices, during the latter half of a calendar year, many of your patients have met their deductibles and insurance covers the majority of their office visits and medical needs. As we turn the calendar over on 2012, it’s a good time to remind your front desk team that a new benefit plan year has begun and reinforce your collection procedures.
