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Issue Date: May 2005
HIPAA Security Rule Catching Many Medical Practices Off Guard
What Is Your Diagnosis? A Look at the Revised ICD-9-CM Guidelines
At this point, you might think that the Health Insurance Portability and Accountability Act (HIPAA) has become the center of a regulatory solar system with so many of your routine tasks now revolving around its many tenets. That ever-present acronym can now be found in still another place: the recently modified ICD-9-CM Official Guidelines for Coding and Reporting. The latest version went into effect on April 1 of this year.
Rounds and Revenue: Billing for Hospital Visits
When selecting a level of service for care rendered to inpatients, you can base your choice on time expended rather than on the scope of history, physical, and medical decision-making. You should consider this option when more than 50% of an encounter is devoted to coordination of care or counseling.
Will Pay-for-Performance Relieve Payment Woes?
Over the next five years, Medicare’s formula for paying doctors will reduce physician reimbursement by 30%. Recognizing that such cuts will have far-reaching implications, the federal Centers for Medicare & Medicaid Services is testing a pay-for-performance program to reward high-performing physicians with increased pay.
Connecting PCPs and Specialists
Given the time pressure they face in managing their own practices, should gastroenterologists make the effort to educate primary care physicians (PCPs) about colorectal cancer screening guidelines and the appropriate care of non-cancerous colorectal problems?
The answer is yes. As advocates for colorectal screening, gastroenterologists should be aware of obstacles PCPs face in making referrals for colonoscopy. In addition, by teaching referral sources about gastrointestinal conditions, gastroenterologists are more likely to receive only those referrals that actually require specialty care. By helping to smooth the path to their door, gastroenterologists can enhance quality of care, improve timely access to their services, and solidify their referral stream.
Program Boosts Billing Accountability
In physician offices that outsource their billing, staff might start to finger point and play the “blame game” when claims don’t get paid or charges are lost. But doing so doesn’t resolve problems or improve the process to prevent the same mistakes from happening again.
Lack of control over the billing process also makes it difficult for staff to assume responsibility and take pride in their work because they can’t see the end result: the claims getting paid. At Miami Pediatrics, a seven-physician, three-location general pediatrics practice in Miami, we noticed staff in the three clinics were developing an “us versus them” attitude, especially when errors occurred.
Asthma Efforts Improve Outcomes
Asthma specialists and primary care physicians are finding that the outcomes of their asthma patients who participate in disease management (DM) programs are better than the outcomes of those who do not participate. The goal of DM programs is to identify enrollees with asthma, educate them about their condition, ensure that they understand their asthma triggers and the treatment plan outlined by their physician, and prompt them to contact their physician when an intervention is necessary. These programs can have significant benefits for physicians as well as patients.
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