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Department: Practice Management

Online Clearinghouse Reduces Claims Denials, Boosts Cash Flow
Only about 20% of the 12 billion health care claims submitted annually to commercial and government health care payers are paid correctly, according to a report last month by the American Medical Association. The rest—a staggering 80%—are paid inaccurately, the AMA said. When payments are made incorrectly, particularly if payments are denied or delayed, cash flow and profits for physicians suffer.

Stimulus Encourages HIT Adoption
The federal stimulus plan that Congress enacted and was signed into law in February includes $19 billion to reimburse physicians for investing in certified electronic health record (EHR) systems. Organizations representing physicians hail the funding as a significant step toward helping physicians adopt these systems, but they also say they have questions about how physicians will be reimbursed for their EHR investments.

Multiple Strategies Boost Efficiency
Many nephrology practices are making significant efforts to enhance practice efficiency. “In today’s medical practice environment, which is characterized by decreasing reimbursement and increasing overhead, nephrologists must maximize any revenue generating or cost-savings opportunity that exists,” says Lisa Simonton, executive director of Renal Endocrine Associates, a nine-physician, three-location practice in Pittsburgh. “Strategies to enhance efficiency can help maximize patient flow and reduce practice costs.”

While these strategies are important, nephrologists also are recognizing that clinic-based care is costly because the clinic generates most of a practice’s overhead costs. Therefore, some nephrologists may try to limit the number of patients they see in the office. The trend in the specialty, however, is toward the development of CKD clinics, which may be driving a greater focus on office-based care. This factor is causing nephrologists to focus more closely than ever on increasing efficiency.

Survey Reveals State of Primary Care
In November, the Physicians’ Foundation, a charitable foundation in Boston that represents members of state and local medical societies, including most of America’s 900,000 physicians, released the results of a survey of 270,000 primary care physicians and 50,000 specialists (at www.physiciansfoundations.org). Titled The Physicians’ Perspective: Medical Practice in 2008, the report on the survey revealed a widespread loss of morale, and pointed out that many physicians are sufficiently overworked and demoralized that they wish to quit or reduce their practice hours. The results of the survey were reported on CNN and other major media outlets.

Annual Kaiser Survey Shows Growth Among Workers Using HSAs
Enrollment in consumer-directed plans continues to grow, rising to 8% of all workers from 5% last year, according to a recent survey by the Kaiser Foundation. This finding is one of the key results from the 2008 survey. Other key findings from the survey include increases in the average single and family premiums and an increase in the percentage of workers enrolled in high-deductible health plans with a savings option (HDHP/SO). Cost sharing for medical services has also increased in recent years. The percentage of employers sponsoring insurance and the percentage of workers covered by employer-sponsored insurance remained stable over the past year.

Boost Revenue Without Breaking Rules
The mid-level providers (MLPs) in physicians’ offices can save physicians a lot of time at the end of the day. But, they can also help increase the practice’s bottom line. Physician assistants or nurse practitioners can see patients, they can follow patients with chronic illnesses, and, depending on the state licensure rules, some have prescriptive authority.
The question regarding these staff is: How can physicians use these providers most effectively without spending more time supervising them than one does seeing patients, documenting, and handling other tasks in the practice? Mid-level providers can see patients on their own and bill Medicare directly with their own provider numbers. This can occur in the hospital as well as in an office. Medicare assigns non-physician practitioners their own numbers and it is highly recommended that physicians get a number for each nurse practitioner and physician assistant in the office. Their National Provider Identifiers (NPIs) will then be connected to your practice and their services can be billed out directly with a 15% discount to the reimbursable amount. This option might be worth considering depending on the availability of the physician.

Report: Large Groups Are More Efficient
A recent analysis of medical research on health care organizations suggests that larger and more organized physician groups offer the most efficient care. In essence, the analysis concludes that physician groups need to be larger, more cohesive, and more closely affiliated with each other than they are now. In other words, the cottage industry of having largely disparate physician groups of all sizes is inefficient and contributes to some of the most difficult problems inherent in the health care system today, such as overuse, underuse, and misuse of care, the analysis shows. The analysis is contained in a report, Physician Organization in Relation to Quality and Efficiency of Care: A Synthesis of Recent Literature, by Laura A. Tollen, MPH, a senior health policy leader at the Kaiser Permanente Institute for Health Policy, in Oakland, Calif. The report was published by The Commonwealth Fund in New York (at www.commonwealthfund.org).

Appraisals Help Boost Reimbursement
Physicians are all too familiar with the problems inherent in trying to collect from health insurers. To maximize reimbursement from health insurers, they have learned to file thorough and accurate claims. The same is true when seeking reimbursement from property and casualty insurers. Being well prepared with all the right information is the best way to get reimbursed in the event of a property and casualty disaster. Most physicians believe they will not face the types of disasters others have experienced over the past several years. They may be right but clearly it is better to be prepared. Or, as some consultants advise, “Hope for the best but plan for the worst.” Disasters take many forms and can occur at any time. Hurricanes, tornadoes, fire, flood, earthquakes, and land-slides are just a few of the various types of disasters that can strike. Are physicians prepared for every contingency? In 2005 nearly every medical facility in New Orleans and along the Gulf Coast felt the effects of Hurricane Katrina. Charity Hospital, Memorial Medical Center, and the Tulane University Hospital each suffered extensive damage, affecting their ability to provide adequate medical care. Many physicians were dislocated. More than two years later, some of these practices and institutions are still recovering.

OIG Begins HIPAA Compliance Audits
The federal Department of Health and Human Services (HHS) Office of Inspector General (OIG) has initiated patient-information security compliance audits of health care organizations. Compliance revolves around a broad set of security requirements that took effect in 2005 under the federal Health Insurance Portability and Accountability Act (HIPAA). Although hospitals have been the early targets of these audits, medical practices could be next. In light of a possible OIG audit, and given the potentially disastrous financial consequences of a major security breach, practices should review their internal policies and procedures regarding security compliance. Protecting the security of patients’ clinical, administrative, and financial data also protects the group’s ability to see patients and conduct business. To do so, practices must limit the availability of these data only to those in the practice who need to see the information. The foundation of any security initiative is the risk assessment and analysis. A risk assessment is a required element of sound security procedures. It allows a medical practice to identify potential threats and vulnerabilities. CMS has included a matrix at the back of
the HIPAA security regulation (www.cms.hhs.gov/SecurityStandard/02_Regulations.asp) that lists the requirements. It is likely that the OIG would use this same list for any audit of a hospital or physician practice.

5 Keys to Hiring Billers, Coders
Hiring qualified billers and coders is one the most challenging endeavors in a practice. Employing an effective medical billing and coding team can greatly affect practice success. Mismanaging claims, denials, and aging receivables can result in delayed reimbursement, affecting the practice’s ability to meet payroll and pay expenses. Coders are obligated to code all procedures and services accurately and confirm that provider documentation supports the charges submitted. Federal fines can be as much as $25,000 per line of incorrect coding or documentation and violations can result in jail time and sanctions against a practice. The medical coder assigns alphanumeric codes to the services a physician renders during each patient visit. The biller uses the codes to bill insurers and is often considered the practice’s income manager. The size of one’s practice determines the type of coding and billing staff the practice should hire. Large offices tend to divide accounts receivable by payer, meaning coders and billers are assigned to individual payers, such as Medicare, Medicaid, and commercial insurers. In smaller offices, one person may do both billing and coding for all types of claims. Billers prefer to specialize by payer type, but it is important for a medical biller to understand how to process claims for all payers.