San Francisco Medical Society Blog

UMVS Indemnification Clause May Limit Coverage for Malpractice Claims

Thu, 16 May 2013 15:58:28 GMT

SFMS/CMA has recently become aware that a broad "indemnification" clause in the UnitedHealth Military & Veterans Services (UMVS) TRICARE provider contracts is causing some professional liability carriers to exclude coverage for services provided to TRICARE beneficiaries.

Although California's Knox Keene Act prohibits indemnification clauses in physician contracts, the contract in question is governed by federal law. Indemnification clauses are not uncommon, and usually are used to restrict liability in the case of willful misconduct. The clause in the UMVS contract, however, is so broad that at least two professional liability carriers have indicated that they would not defend or indemnify the physicians in the event of a claim brought by a TRICARE beneficiary.

SFMS/CMA has escalated this issue to high level contacts at UMVS. We will provide additional information as it becomes available. In the meantime, physicians are urged to reach out to their liability carriers to determine if they are covered when treating TRICARE patients.

SFMS members with reimbursement questions can contact our Member Helpline for one-on-one assistance at (800) 786-4262.

“Pause Before Posting”: New Ethical Guidelines for Physicians and Social Media Usage

Fri, 12 Apr 2013 14:52:04 GMT

Physicians should exercise caution—and “pause before posting”—when interacting in online settings in order to preserve professionalism and maintain appropriate patient-physician relationships, according to a policy paper released today by the American College of Physicians and the Federation of State Medical Boards.

“Online Medical Professionalism: Patient and Public Relationships” addresses the use of online and social media and electronic communication between physicians and patients. The two organizations looked at opportunities and challenges created by new technologies and online forums, and provided recommendations and strategies for physician behavior in these areas.

Digital communications and social media use continue to increase in popularity among the public and medical profession. The ACP policy paper discusses best practices to inform standards for the professional conduct of physicians online and includes a chart of online activities, potential benefits and dangers, and recommended safeguards for physician behavior.

Notable recommendations from ACP and FSMB include:

Physicians should keep their professional and personal personas separate. Physicians should not “friend” or contact patients through personal social media.
Physicians should not use text messaging for medical interactions even with an established patient except with extreme caution and consent by the patient.
E-mail or other electronic communications should only be used by physicians within an established patient-physician relationship and with patient consent.
Establishing a professional profile so that it “appears” first during a search, instead of a physician ranking site, can provide some measure of control that the information read by patients prior to the initial encounter or thereafter is accurate.

The paper will be published in the April 16 issue of Annals of Internal Medicine, and is authored by ACP’s Ethics, Professionalism and Human Rights Committee; ACP’s Council of Associates; and FSMB’s Committee on Ethics and Professionalism.

Click here to view the complete policy paper.

Click here for the ACP press release.

What Providers Need to Know about EHR Audits

Wed, 10 Apr 2013 13:59:47 GMT

All eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) attesting to receive an incentive payment for either the Medicare or Medicaid Electronic Health Record (EHR) Incentive Program may be subject to an audit.

Pre- and Post-Payment Audits

CMS and its contractor, Figliozzi and Company, perform audits on Medicare and dually-eligible (Medicare and Medicaid) providers who are participating in the EHR Incentive Programs. States perform audits on Medicaid providers participating in the Medicaid EHR Incentive Program.

In addition to the post-payment audits that have been conducted since 2012, CMS began pre-payment audits this year, starting with attestations submitted during and after January 2013.

New Resources to Prepare for Audits

For those providers selected for pre-payment or post-payment audits, CMS and its contractor will request supporting documentation to validate submitted attestation data. To help providers prepare for a potential audit, CMS created the new Supporting Documentation for Audits Fact Sheet. The fact sheet and a sample audit request letter for both EPs and eligible hospitals are also available on the Educational Resources page of the EHR Incentive Programs website.

Additional Information About the EHR Incentive Programs?

Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

Click here for additional resources from CMS regarding audit information and guidance.

Questions or request for more information? Please contact the CMS San Francisco Regional Office at (415) 744-3658 or rosfofm@cms.hhs.gov.

SGR Advocacy Alert

Wed, 19 Dec 2012 14:47:46 GMT

The negotiations between Speaker Boehner and President Obama on the Lame Duck tax and deficit reduction package are at an impasse. There is a very real threat of the 26.5 percent Medicare physician payment cut taking effect on January 1, 2013, at least temporarily.

If Congress does adjourn without addressing the payment cut being induced by the sustainable growth rate (SGR) formula, the Administration announced today that the Centers for Medicare and Medicaid Services will follow normal claims processing procedures. That is, claims will not be held and Medicare carriers will process payments for physician services provided after December 31 under the normal 14-day cycle required by law. Payment for these claims would be based on the new, lower fee schedule conversion factor of $25.0008, as opposed to the current rate of $34.0376.

At this time, it is impossible to predict whether the 112th Congress will find a way to pass a stop-gap measure before adjourning, how long such a measure would last, or how long payment cuts will be in effect before legislation can be passed after the 113th Congress convenes in January. It is highly unusual for a new Congress to enact significant legislation in the first month of its session, but the circumstances facing our nation today are far from typical.

It is inexcusable that Congress is once again putting the 47 million Medicare patients and the practices of physicians who provide them needed health care at significant risk. The Medicare program has become unreliable and its instability undermines efforts by physicians to implement new health care delivery models that stand to improve value for seniors and other beneficiaries through better care coordination, chronic disease management, and keeping patients healthy.

We believe that the financial disruption this situation will cause for physicians and their practices is unacceptable, and we will continue to fervently convey this message in the strongest possible terms to Congress and the Administration, as we have for the past several weeks. We are working with CMA and AMA physician grassroots networks, and are seeking your voices to tell Congress just how deeply its inaction will affect you.

Despite these efforts, at this time we feel compelled to advise physicians to start making plans for steps they can take to mitigate this disruption and meet their own financial obligations in January, in case the 26.5 percent cut actually takes effect. Given the potential impact on practice revenue in early January, physicians should be certain adequate arrangements are in place to sustain their practices. For those physicians who are forced into the untenable position of limiting their involvement with the Medicare program because it threatens the viability of their practices, we urge that patients be notified promptly so that they, too, can explore other options to seek health care and medical treatment.

We will remain engaged throughout the holidays and keep you informed of any new developments.

ICD-10: Everything You Know Is About To Change

Mon, 12 Nov 2012 15:23:56 GMT

The transition to ICD-10 is one of the most daunting regulatory requirements ever imposed on physicians. Not only will the number of diagnosis codes dramatically increase from 16,000 ICD-9 codes to 68,000 ICD-10 codes, new formatting and documentation requirements will impact numerous medical office processes and personnel. While the compliance date for ICD-10 implementation of October 1, 2014 may seem far away, physicians are encouraged to start planning for ICD-10 and 5010 transition immediately.

About ICD-10

ICD-10-CM/PCS (International Classification of Diseases, 10^th Edition, Clinical Modification/Procedure Coding System) consists of two parts:

ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.

ICD-10-PCS is only for use in all U.S. inpatient hospital settings. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.

Who Needs to Transition

ICD-10 will affect diagnosis and inpatient procedure coding for all health providers covered by HIPAA. Everyone covered by HIPAA who transmits electronic claims must also switch to version 5010 transaction standards. The change to ICD-10 does not affect CPT coding for outpatient procedures.

ICD-10 diagnosis codes must be used for all health care services provided in the U.S. on or after October 1, 2013. Claims with ICD-9 codes for services provided on or after October 1, 2014 cannot be paid.

Training

SFMS/CMA have partnered with AAPC, the nation’s largest medical training and credentialing association, to offer ICD-10 training to our members. Join us on December 5, from 12:15 pm to 1:45pm, for a free webinar about ICD-10 and how it will impact your practice. Topics covered include:

Key differences between ICD-9 and ICD-10
Scope of ICD-10 transition in a typical medical practice
Key steps in planning a successful transition
Resources to assist you

Click here to view the list of ICD-10 webinars/workshops available to members.

Additional Resources

General ICD-10 Information

CMS-0013-P—HIPAA Administrative Simplification: Modification to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PMS

Transactions and Code Sets Regulations

ICD-10 Basics for Medical Practices

Talking To Your Vendors about ICD-10 and Version 5010 - Tips for Medical Practices

ICD-10 Transition FAQs

Ensure Your Practice is Prepared for New Workers' Comp eBilling Requirements

Thu, 19 Jul 2012 16:35:24 GMT

On October 18, 2012, payors in California will be required to accept workers’ compensation claims electronically. California is one of the first states in the country to require payors to accept electronic billing (e-billing) of workers’ compensation claims.

While e-billing is currently optional for physicians, the California Division of Workers’ Compensation (DWC) has adopted new regulations for standardized paper billing forms and e-billing standards, which encourage both workers’ compensation insurers and medical providers to transition to e-billing. The DWC website contains information on the updated regulations, a frequently asked questions summary and a link to the “Electronic Medical Billing and Payment Companion Guide 2012.”

SFMS/CMA have partnered with the California Orthopedic Association, American Medical Association, and the California Department of Industrial Relations to a offer a four-part California e-billing webinar training program presented by DWC, Jopari Solutions, and other industry experts. The four webinars are as follows:

Registration for this series of webinars is free to SFMS physician members and their staff. For more information or to register for these or any CMA webinar, please click on the individual webinar names above or visit www.cmanet.org/events.

Expand Your Referral List with sfms.org

Thu, 31 May 2012 11:53:43 GMT

SFMS physician members: Help expand your patient base and promote your practice with your customizable physician member page on the SFMS website. SFMS makes more than 6,000 referrals each year with our Physician Finder tool.

Highlight your practice by updating your profile today.

Other new website features include:

Advocacy Section with regional, state, and national updates on priority bills and key wins.
Online event registration and membership renewal.
On-demand member-only resources available for immediate download (e.g., 5010 update, new California law update for physicians, etc.).

Blue Shield of California Fee Schedule Changes Effective June 2012

Mon, 14 May 2012 11:21:47 GMT

SFMS/CMA has learned that Blue Shield has notified physicians of changes to its physician fee schedule that will go into effect June 1, 2012. In the notice, Blue Shield informed physicians that it would be increasing payment for some Evaluation and Management (E/M) services.

Blue Shield also reports that it will continue reimbursing for inpatient and inpatient consultations and will not follow Medicare’s 2010 policy change.

The new rates are available at the Blue Shield website. Physicians can also request a copy of the new fees by completing the allowance review form enclosed with the notice, or by calling the Blue Shield Provider Services Department at (800) 258-3091.

Physicians are encouraged to carefully review all proposed amendments to health plan or medical group/IPA contracts. Physicians who do not agree with the proposed change have the option to terminate the contract by providing 60 days written notice to Blue Shield. The termination notice must be received by Blue Shield within 45 days of receipt of the notice. It should be noted that if a physician terminates the contract according to these terms, the change will not apply to that physician during the termination notice period.

SFMS/CMA has developed an action guide for physicians on contract amendments to help our members understand their rights when a health plan has sent notice of a material change to a contract. SFMS members can access this tool by logging into the SFMS website and click on the “For Physicians” --> Practice Management (http://www.sfms.org/ForPhysicians/PracticeManagement.aspx). The guide includes a discussion of options available to physicians when presented with a material change to a contract. The guide also includes a financial impact worksheet that can be used to calculate the net impact of the fee schedule changes to a practice.

How to Reduce EMR Liability

Tue, 20 Mar 2012 13:54:29 GMT

As the number of electronic medical records increases, so do certain legal risks, medical liability experts say. Here are some common mistakes doctors make with EMRs and how attorneys recommend that physicians reduce their liability risks:

Mistake: EMRs allow users to move quickly through patient records, but cutting and pasting information makes it easy to paste incorrect information.

Recommendation: Refrain from copying and pasting EMR data, and be cautious when moving from one patient’s record to the next.

Mistake: Computer programs can help doctors make a differential diagnosis, but the templates don’t often include every possible symptom and corresponding medical condition.

Recommendation: Doctors should not become overly dependent on electronic diagnosis aids. Electronic systems are no substitute for hands-on diagnosis.

Mistake: Because EMRs allow physicians to move through patient charts much more quickly than paper charts, attorneys are noticing that some doctors are not being thorough when writing notes electronically.

Recommendation: Physicians should keep meticulous electronic notes on each patient and take time to document each chart.

Mistake: Some practices can fail to safeguard electronic patient data.

Recommendation: Practices should encrypt all information on computer devices and have policy that discourages employees from taking portable devices out of the office.

Mistake: A system may not clearly indicate changes to records.

Recommendation: Physicians should install systems that show transparency when modifications are made and/or have a program lockout period where no more modifications can be made to a record.

Mistake: Doctors may fail to follow notification requirements in the event of a data breach.

Recommendation: Be clear on what your state law requires when a data breach occurs, and make sure employees follow the rules immediately.

Mistake: Doctors may destroy or delete electronic records when a lawsuit is possible.

Recommendation: If doctors suspect they are being sued, they must preserve all electronic data related to the patient in question, including emails, phone messages and computer records.

Source: Attorneys Catherine J. Flynn and Michael Moroney of Weber Gallagher Simpson Stapleton Fires & Newby LLP in New Jersey; Reprinted from American Medical News, March 5, 2012.

Medicare FFS Version 5010 Requirement Changes for Non-Specific Procedure Codes

Tue, 24 Jan 2012 14:40:54 GMT

Medicare Fee-for-Service (FFS) has amended the Not-Otherwise-Classified (NOC) code set listing effective January 16, 2012.

Anesthesia codes that include the phrase “not otherwise specified” in their code descriptors (procedure codes 00100 through 01996) do not meet the criteria of a non-specified procedure code and do not require a description to be supplied in the SV101-7/SV202-7 data elements.
Anesthesia procedure code 01999, “Unlisted anesthesia procedure(s)” meets the requirements of a non-specified code and continues to require additional information to be supplied in the SV101-7 data element.
Some pathology and laboratory codes identified in procedure code section 8800 and a variety of other NOC codes have been removed. These codes do not meet the criteria of a non-specified procedure code and do not require a description to be supplied in the SV101-7/SV202-7 data elements.

Medicare FFS’s complete listing of the NOC codes can be found at http://www.CMS.gov/ElectronicBillingEDITrans/40_FFSEditing.asp. Medicare will be updating the code set, at minimum, on a quarterly basis (January, April, July, and October) as the NOC list is refined and the parent code sets are updated. For more information on Version 5010 and D.0, please visit http://www.CMS.gov/Versions5010andD0.

An Unfolding Success Story: Electronic Medical Records Transition Moves Ahead

Mon, 28 Nov 2011 13:30:27 GMT

It’s hard to think of any major portion of President Obama’s health policy that hasn’t engendered intense argument. But one at least comes close: the provision of the 2009 federal stimulus law that pushes medical practices to update their record-keeping for the 21^st century. The aim is to ensure that all of the nation’s medical records are computerized by 2014. There seems to be a broad consensus that increased use of electronic data will improve the quality of health care in the country and ultimately lower costs. And here’s why. In roughly three out of four doctors’ offices in the country, patient charts are still updated by hand and stored in vast, color-coded filing cabinets. If a patient changes doctors, the file has to be mailed or faxed and the new doctor often has trouble reading the previous doctor’s hen scratching. Patients walk out of a medical office with one or more tiny pieces of paper to get prescription drugs filled. When they come back for a follow-up, they have to bring a bag full of drugs so the doctor will know what the patient is taking. Given such cumbersome procedures, few would argue that computerization isn’t needed. But the federal program did lead to complaints in the beginning. Critics warned that doctors who serve mostly low-income patients would lack the time or inclination to make the painstaking switch to electronic records. They worried that the nationwide push would widen the so-called “digital divide” that already exists between doctors in affluent parts of the country and those in underserved urban and rural areas. So far, that hasn’t happened. The $19 billion medical records law—which pays doctors to switch to an electronic system or upgrade one they’re already using—is having an impact on the entire health care industry. And small primary care practices that treat Medicaid patients are no exception. As of last week, the U.S. Department of Health and Human Services reported, more than 100,000 primary care doctors across the country had taken advantage of federal incentives to adopt a certified electronic medical record system. Half of the doctors were members of small practices that serve Medicaid and Medicare patients, and the rest worked in community health centers, public hospitals, rural health clinics and other public settings.

A national campaign

In addition to cash for doctors—$65,000 for every Medicaid physician and $44,000 for Medicare practitioners—states have been given millions of dollars to set up education programs aimed at helping the medical profession qualify. These advisory groups, called regional extension centers, have the job of translating some 700 pages of complex federal rules on so-called “meaningful use” of electronic health records. Some 22 states have set up regional centers, and several states have exceeded federally set goals for the number of doctors they enroll. For Medicaid doctors — those with 30 percent or more of their patients covered by the federal-state program — qualifying for the first $21,000 federal installment is relatively easy. They simply have to adopt or upgrade a certified electronic records system.

Meaningful Use

For Medicare doctors, who are paid higher rates, the first step is steeper. They must qualify under the meaningful use rules immediately. For example, physicians’ practices must maintain an up-to-date computerized list of medications and allergies for each patient, provide patients with summaries of every office visit, and transmit prescriptions electronically. Ultimately, Medicaid doctors will have to adhere to the same set of rules in order to get subsequent installments of their $66,000 total incentive payment. But they have quite a while to do that. Medicare doctors must be certified by 2012 in order to receive their full incentive. After that, they have until 2014 to qualify for a smaller incentive of $24,000. Medicaid doctors have until 2021 to fully qualify. In the meantime, states are developing what is known as a health information exchange that will allow doctors who convert to electronic systems to access patient records within the state through secure portals, and ultimately transfer records across the country.

Audit Update: Anthem Blue Cross Seeking to Settle Overpayment Refund Requests

Tue, 20 Sep 2011 15:20:58 GMT

CMA has received a number of complaints from physicians that the Anthem Blue Cross Special Investigations Unit (SIU) is requesting refunds outside of the 365-day period allowed by California law. State law allows health plans to pursue recovery of any type of overpayment made to providers within 365 days of the date the claim was paid. For claims older than 365 days, plans can seek to recover overpayments only if the alleged overpayment was “caused in whole or in part by fraud or misrepresentation on the part of the provider.” CMA believes that Blue Cross is using an overly broad definition of “misrepresentation” to seek recoupment on claims older than one year. In June, CMA filed a formal complaint with the Department of Managed Health Care (DMHC) asking that it investigate these potential violations. DMHC subsequently referred CMA’s complaint to its Enforcement Division. Within the past week, CMA has received calls from physicians who report that they have been contacted by Blue Cross SIU, offering to reduce overpayment amounts due if they agree to sign settlement agreements. CMA believes some of the recoupment requests that the SIU is trying to settle may be the same requests that are the subject of our complaint filed with DMHC. Physicians who are approached to sign any type of settlement agreement are strongly encouraged to ask for the offer in writing and to have an attorney review the settlement before signing. Often, these types of settlement agreements require that physicians waive and abandon their legal rights over the moneys at issue. If you are a SFMS/CMA member requiring assistance with the Anthem Blue Cross audit, please call the CMA’s reimbursement help line at (888) 401-5911 or email membership@sfms.org.

What You Need to Know About Audit Letters from Anthem Blue Cross

Tue, 20 Sep 2011 14:56:05 GMT

Physicians are currently receiving three different audit letters from Anthem Blue Cross. This post summarizes the three audits in question and will help physicians understand the issues in play.

Medicare risk adjustment scoring audits

Physicians are receiving letters from Blue Cross requesting records on a handful of Medicare Advantage (Freedom Blue) patients. This records request is part of the Medicare Risk Adjustment Scoring audits. Risk adjustment is how Medicare analyzes and adjusts the capitation amounts paid to Medicare Advantage plans. The risk adjustment audit is designed to identify the health status and demographic characteristics of Medicare Advantage enrollees. Blue Cross is looking to identify conditions/illnesses that demonstrate patients who are at risk for being sicker, which results in higher capitation payments from CMS, or patients who are predicted to be healthier, which nets lower capitation payments from CMS. The Blue Cross Prudent Buyer agreement requires physicians to comply with the request (see exhibit F to the Medicare Advantage PPO Participating Physician Agreement, Article VII, Reporting and Disclosure Requirements). The Blue Cross notice asks for certain patient records within a specified date range. Practices can, however, contact Blue Cross and request that they provide the specific dates of service in question. Additionally, the risk adjustment audits usually involve only a handful of patients per practice, but if the request is voluminous, practices may wish to contact Blue Cross and request that it send a copy service out to the practice. Additional information on risk adjustment audits can be found on the Blue Cross website. (Log in as a provider, click on Medicare Advantage Plans & Benefits, and search “risk adjustment 101.”) Physicians can also contact Blue Cross directly at (877) 489-8437.

Study of physician coding of levels 4 and 5

Physicians are being contacted by Blue Cross about a recent study of physician coding of new and established evaluation and management (E/M) visits, levels 4 and 5 (99204-99205 and 99214-99215). A letter was sent to over 3,200 physicians who, according to Blue Cross, billed 90 percent or more of their claims to Blue Cross at E/M level 4 or 5. The data was collected during a one year period from November 1, 2009, to October 31, 2010. The letter advises physicians that their use of these high-level codes is greater than others in their specialty and asks that they submit medical records on five specific patients so Blue Cross can provide them with feedback and education on this issue. Approximately 600 physicians who reportedly billed 80 to 89 percent of their claims to Blue Cross at E/M level 4 or 5 received a similar letter; however, no records were requested from this group. Participation in the educational program is voluntary, but the notice states that future phases of the program may result in audits of E/M services. Physicians who wish to dispute the Blue Cross findings may do so in writing via email and those who choose to participate in the voluntary program can submit records electronically (see instructions in the Blue Cross notice). Records submitted to Blue Cross will be reviewed by a certified coder or registered nurse and written feedback will be provided within 90 days. Questions or concerns regarding the letter can be directed to Blue Cross at (404) 842-8640.

Special Investigation Unit overpayment refund requests

CMA has heard complaints from several physicians who have received overpayment refund requests from the Anthem Blue Cross Special Investigations Unit outside the 365-day period allowed by California law. As a result, CMA has filed a formal complaint with the Department of Managed Health Care (DMHC) and asked it to quickly investigate these potential violations. State law allows health plans to pursue recovery of any type of overpayment made to providers within 365 days of the date the claim was paid. For claims older than 365 days, plans can seek to recover overpayments only if the alleged overpayment was “caused in whole or in part by fraud or misrepresentation on the part of the provider.” CMA believes that Blue Cross is using an overly broad definition of "misrepresentation" to seek recoupment on claims older than one year.

SFMS to Offer Two Seminars in October

Mon, 19 Sep 2011 16:36:02 GMT

SFMS has partnered with Debra Phairas, MBA to offer two practice management seminars: Creating a Director of First Impressions and MBA for Physicians and Office Managers. Debra Phairas is President of Practice & Liability Consultants, LLC - a nationally recognized firm specializing in practice management and malpractice prevention. Her consulting experience includes over 1,400 practices of all sizes and specialties. She has presented seminars and lectures nationwide for state and local medical/dental associations, management organizations, and specialty societies.

CREATING A DIRECTOR OF FIRST IMPRESSIONS: Customer Service, Patient Relations, and Telephone Techniques for Medical Practice Office Personnel

Friday, October 14, 2011

9:00 am to 12:00 pm; Continental Breakfast/Registration at 8:40 am

Creating a positive first impression is essential to the success of a medical practice. Excellent telephone manners and patient relations techniques are key elements in creating and maintaining that positive first impression. This half-day practice management seminar will provide valuable training for both front and back office staff to handle patients and tasks professionally and efficiently using superlative customer service skills. Interactive role playing and a listening skills quiz are utilized to demonstrate the 'wrong' and 'right' way to interact with patients. Topics covered will include:

Professional phone etiquette – “May I"
Professional language, demeanor and tone of voice
Handling referring physicians, messages or interruptions expertly
Techniques to ensure that patients feel welcomed to your practice
Accurate message taking
Handling angry or difficult patients and complaints
Creating a superlative service-oriented environment
Telephone advice: how much, what type, and how to document
Malpractice prevention with telephone advice, messages and follow-up

Click here to register for SFMS Seminar: Creating a Director of First Impressions.

“MBA” for PHYSICIANS and OFFICE MANAGERS

Friday, October 28, 2011

9:00 am to 5:00 pm, Continental Breakfast/Registration at 8:45 am

This one-day, hands-on seminar is designed to provide critical business skills in the areas of strategic planning, finance, operations, marketing and personnel management. You will learn the core business elements of managing a practice that physicians don't receive in medical school training. Specialty-specific benchmarking data will be provided. Participants will need to bring their practice financial information which will not be shared. Topics covered include: Finances

Accounts Payable, Accounts Receivable Management
Importance of Profit/Loss Statements as Management Tools
Essential A/R, Staffing, Expense Ratios to Calculate Monthly Status Reports
Cost Accounting Techniques
Contract Evaluation and Management

Operations

Continuous Quality Improvement (CQI) Techniques for Improved Scheduling, Telephone
Service, Medical Records, Patient Flow, EHR
Marketing Technique, Patient and Referral Satisfaction
Risk Management - Medicare Compliance, OSHA, Malpractice Prevention

Personnel Management

Labor Law Essentials, Overtime Laws, Exempt vs. Non-Exempt Employees, Wrongful Termination, Discrimination, Sexual Harassment
Performance Evaluation, Wage Levels, Discipline, Termination
Management and Motivation Skills, How to Increase Productivity

Click here to register for SFMS Seminar: MBA for Physicians.

Be Prepared for New 5010 HIPAA Transactions

Tue, 05 Jul 2011 16:18:44 GMT

The deadline for transitioning electronic transactions to the updated 5010 version of the Health Insurance Portability and Accountability Act (HIPAA) transactions standards is January 1, 2012. Physicians will be required to conduct electronic transactions such as claims submissions, eligibility verification, claims status, remittance advice, and referral authorizations using the updated transaction standards. If physicians’ practice management systems are not up to new standards, they will risk not receiving electronic payments from private insurers and Medicare. The new HIPAA 5010 regulations impact all health care providers who:

Send or receive electronic administrative transactions directly to payers—both private and public; and,
Send electronic data to a billing service or clearinghouse that submits transactions on your practice’s behalf.

What is 5010? The new data standards come out of the Health Insurance and Accountability Act of 1996. It demands for more specificity in what data must be entered and transmitted, with the hope that the claims process will be more efficient and more details will be available about the patient visit. For example, physicians must submit a nine-digit, rather than a five-digit, ZIP code on all claims submissions and submit a street address rather than a post office box. 5010 also allows physicians to distinguish between principal diagnosis, admitting diagnosis, external cause of injury, and patient reason for visit codes. Guidelines for Claims Submission Using HIPAA 5010 Standards Step 1: Impact analysis – Conduct an internal analysis to determine the impact the change to 5010 will have on your practice. Step 2: Vendor, payer, billing service, and clearinghouse connections – Contact your practice management and electronic medical record vendor for details on the installation of upgrades to your system. Contact your clearinghouses, billing service, and payers to find out when upgrades will be completed and when they can accept 5010 transactions. Step 3: Installation of vendor upgrades Step 4: Internal testing and staff training – Once the upgrades are completed, conduct internal testing of your systems to ensure you can generate the 5010 transactions. You will need to train staff during the process of implementing and testing your system. Step 5: External testing with clearinghouses, billing service, and payers Step 6: Making the switch to 5010 – After you have completed external testing with some or all of your trading partners, you may switch to using only the 5010 transactions. You are permitted to begin using the 5010 transaction before the compliance date as long as you and the other organizations agree to the early switch. Step 7: Backup plans – In case transaction is rejected after the switch, make a plan for an interruption in cash flow. Some suggestions: Submit as many transactions as possible before January 1, 2012; decrease expenses before January 1, 2012, to increase cash reserves; establish a line of credit with a financial institution. Source: “5010 Implementation Steps: Getting the Work Done in Time for the Deadline,” AMA. Where Can I Find More Information?