by Michelle Dunn

Medical bills aren’t always like other bills, many times they are not planned for and the bill is an unexpected surprise that some people cannot afford. If a patient doesn’t have insurance, this can be a real problem, especially in this economy where as more and more people lose their jobs they also lose their medical insurance.

As a doctor billing patients when they cannot pay in full at the time of service, you must have policies and procedures in place for your office staff to follow in order to successfully get paid for your services. You should look at it as part of your job to help your patients be able to pay your office. 

With that in mind here are my top five tips for helping your patients pay off a balance due.

1. Be realistic when talking with patients about payments. If you aren’t realistic, you won’t get paid. Ask them about their income and monthly bills and set a monthly payment they can realistically make, otherwise they won’t make any payment.
2. Get payments twice a month rather than once a month.  Even if the installment payment is less, if someone is paying twice a month it could be more than one monthly payment, resulting in the bill getting paid quicker.
3. Put it in writing. Whatever you decide with your patient in regards to their bill, put it in writing and send them a copy.
4. Follow up. Any collection efforts you put in go down the drain if you don’t follow up.
5. Offer your patients a couple of solutions. Many people are embarrassed to have a past due balance with you, and want to pay it off as quickly as possible. Offer them a couple of options so they can be part of the decision making process on how they will pay you.

Michelle Dunn, author of The Guide to Getting Paid, is an expert on the topics of credit and collections.  For more information on Michelle, visit www.credit-and-collections.com.  To read more articles like this, visit www.efficiencyinpractice.com and sign up for a complimentary subscription to our Efficiency in Practice enewsletter.

This article can be reprinted freely online, as long as the entire article and this resource box are included.

by Hoyt Torras, MPA, MHA

One of the biggest mistakes a medical practice can make when they receive a request for medical records from a payer, such as Medicare or Medicaid, is to quickly copy some records and throw them into an envelope. Most audits start with the payer, or their audit contractor, providing a list of names and dates of service for which they are requesting copies of medical records.

Here are a Baker’s Dozen worth of tips for those type audits:
1. Before submitting records to the payer or their audit contractor, make sure records are legible and that there are records for each date of service. Further, make sure the documents are well-organized so that auditors can easily find the pertinent records.
2. Designate one person to be responsible for responding to the audit and follow-up.
3. Allow plenty of time to respond. Pay close attention to the deadline for responding in the audit notice. Sometimes you may be granted an extension. Request an extension early, and request it in writing.
4. Read the audit request letter carefully. It usually lists the types of information the auditor expects. Don’t worry if the generic list you’re provided includes information that is not applicable to your patient or the services provided. Just make sure you send a copy of documentation in your records that supports each service billed.
5. Send only copies of the record, not the original, and number the pages.
6. Make at least one copy of the records you submit, exactly as submitted. It is more difficult to appeal an audit when you and your advisors are not sure what was sent to the auditors and used to render their initial decision.
7. Make sure to submit documentation for each date of service requested, but do not fabricate documentation if you do not have it.
8. If your office note for an Evaluation and Management (E/M) code refers to a prior history, you should include documentation related to those aspects. This is especially important for new patient visits where all three elements, History, Exam and Complexity of Medical Decision Making, will be reviewed.
9. If lab tests, x-rays or other diagnostic tests were ordered and billed by your medical practice for the date of service, make sure the report is in the record submission even if the report was not available for several days, after the encounter. Even if the tests were performed or billed by another physician or entity, include them because they may help justify higher levels of E & M services.
10. If you performed a consult, even if it is a payer such as Medicare that no longer recognizes consult codes, include a copy of the report to the referring physician. Again, that helps indicate the extent of work performed on the date of service.
11. If your handwriting is not legible, it may be best to have the records transcribed. Some auditors may deny a service if the records are not easy to read. At other times, auditors may miss important aspects and down code or deny the service. If you transcribe old records, make sure it is clear that the transcription is recent, with the current date prominently displayed. When you submit the record, place the handwritten copy behind the transcription. Usually, you should include a comment about the recently transcribed records in the cover letter you send with the audit submission.
12. Write a cover letter outlining the contents of the package. Provide the name of a contact person at your medical practice along with phone and email address in case the auditor needs additional information.
13. Use FedEx, UPS or mail with return receipt requested so that you have a record of delivery. Some payers allow electronic transfer of records.
Finally, the steps you take to comply with the request will make a difference in how the audit proceeds and how much time and effort it takes to appeal any adverse findings.

Hoyt Torras, MPA, MHA is a Senior Consultant Senior with InGauge Healthcare Solutions and a contributing author to Efficiency in Practice. For more information on Efficiency in Practice and to register for Hoyt’s tele-class, “Practical and Achievable Approaches to Compliance – Tips for Preventing Coding/Billing Audits, and What to Do If You Get Audited” click Here. First time attendees register at no charge.
This article can be reprinted freely online, as long as the entire article and this resource box are included.

After the ARRA (American Recovery and Reinvestment Act) or “The Obama Stimulus Bill” was signed into law in February of 2009 there are many new provisions for HIPAA to be aware of. The section of the bill known as HITECH (Health Information Technology for Economic and Clinical Health Act) is of concern.
What’s different? To begin with, HITECH adds the following requirements to what is already in place for “covered entities”.
• Mandatory annual audits by Health and Human Services to ensure compliance.
• Fines up to $1.5 million for violations.
• Business Associates Agreements are now required for vendors and partners who have access to your patients’ private health information (PHI).
• If there are unauthorized disclosures of PHI it is now mandatory to notify those whose PHI was accessed (patient) , to Health and Human Services and (if large enough breach) the media!
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by Rebecca Umberger

Look who’s searching…

In today’s medicine, the web and social media are important and beneficial tools that should not be ignored.    According to an article from amednews Feb. 21, 2011, “New vital sign:  degree of patient’s online access” by Pamela Lewis Dolan, searching for health information is the third most common online activity behind checking e-mail and using a search engine, with women more likely than men doing healthcare research.   

A Harris survey conducted in January 2011 on behalf of Insider Pages, an online directory that has a “physician finder”; found that most people look for physicians based solely on their location.  Patients starting with a physician finder normally do a query on physicians in a particular geographic area, and once that is generated, the patients will click on the profiles of the physicians they are interested in.   This is then normally followed by the searching the profile page and then the physician’s personal web page if they wanted more information.  The survey also noted that even though not all adults go online, the percentage of online health information seekers is at 59% of the totalU.S.population.
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By Tom Ludwig, RN, MBA, FACMPE

Does your practice receive patient complaints about long waits during the visit? Do you have a physician who is constantly behind schedule? Prolonged waiting times affect your practice in several ways. Patients can become dissatisfied to the point of leaving your practice. Physicians and staff become frustrated with delays that can result in long hours and patient complaints.

There are a variety of reasons for prolonged waiting times. Patients who arrive late, staff who take too much time with patients, providers who try to do too many things at once, and poor communication within the office are just a few of the many possible causes. Are you not sure where the problem lies in your practice? It might be time to measure your office visit cycle time.
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By Donna Weinstock

Healthcare practices often spend time looking at ways to improve patient satisfaction, but how often do they address communication as it relates to improved patient service? I would have to say, not often enough.

Every aspect of patient care involves communication. Whether it is in person, on the telephone or using technology, what you say is as important as how you say it. It is so easy for a patient to misinterpret what is being conveyed. For this reason, practices should look at their communication as a way of improving “the patient experience.”
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By:  Ellen Risotti, BS, CPC, CEMC, CFPC

Annual preventive exams have been a standard of care in the medical industry for many years.  CPT describes these services as a periodic comprehensive preventive medicine evaluation (or reevaluation) and management of an individual.  CPT codes 99381-99387 are the codes used to represent these services and their selection is based on whether the patient is new or established as well as the patient’s age.  CPT goes on to describe the services to include an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures.
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by Bob Healy

Many hospitals and health systems have Physician Liaison and/or Physician Relations Representatives that have the responsibility of visiting physician practices to promote the service lines of the hospital. Similarly many physician practices, in particular   specialty practices, have initiated or have considered initiating such a program as a vehicle to carry their message(s) to the field and ultimately grow their referrals. Some consulting organizations provide the option of outsourcing this role to them (Practice-Reps) while others will provide a Physician Liaison training program for your new hire (Healthcare Success Strategies, Practice Builders).

If you decide that you want to start a Physician Liaison program on your own, where do you start? Let’s examine some of the areas you need to consider:
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by Pat Schmitter CPC, CPC-I

In approximately 24 months the most significant change to the diagnosis coding system will happen.  The Department of Health and Human Services released the final regulation in 2009 to move from the current diagnosis ICD-9 coding system to the ICD-10 coding system beginning October 1, 2013.  If your professional options do not include imminent retirement or a drastic career change, surviving the transition from ICD-9-CM to ICD-10-CM will require a strong foundation. 

ICD-10 is not just a routine annual diagnosis update.  This is a much bigger transition that requires attention devoted to physician and staff education, workflow alterations, clinical documentation, practice management operations and claims management processes and systems which must be reconfigured for ICD-10.  Failure to transition to ICD-10 on October 1, 2013 will result in delayed or denied reimbursement.  Reconfiguring your systems to be ready for implementation is required January 1, 2012 with the conversion to 5010.  While 5010 is a technical conversion where vendors will do most of the heavy lifting, the same is not true for ICD-10. The ICD-10 code set will require action from you and your practice.
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by Bob Healy

Many physician practices often take a reactionary, shot-gun approach when it comes to marketing initiatives. For example, a competitor starts running ads in a local paper so the practice decides they need to do the same. This leads to careless spending and no integration of what you want to accomplish from a branding and messaging perspective.

While practices consistently plan and budget annually for operational expenditures and activities, the same thought process and attention needs to be devoted to marketing. To be successful, efficient and cost-conscious, developing a marketing plan is a necessary and critical element of a practice’s overall strategic process. The marketing plan will serve as a road map to guide your internal and external activities, define your budget and detail your planned strategies and tactics for a twelve month period.
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