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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by Carol Hoppe, CPC, CCS-P, CPC-I

With continuing decline in reimbursement, establishing an internal audit process is critical for physician practices to ensure charges are being billed appropriately and optimal revenue is being captured.  Correct coding is essential to getting paid appropriately and avoiding audits by Medicare, Medicaid and other payers.  Even the best practices can experience billing errors and the only way to minimize them is to have a system in place to monitor the work done by staff and physicians.  

Step #1 – Establish and Follow a Documented Compliance Program

While voluntary for 12 years now, the Healthcare Reform law of 2010 mandates that all physicians participating in Medicare and Medicaid must adopt a compliance program in the near future.  While most large healthcare organizations already have some type of compliance program in place, small physician practices may be unprepared for this requirement.  Although details have not yet been defined, all healthcare providers will need to increase their compliance efforts.  The new regulations will undoubtedly raise the stands but incorporating a model compliance plan now will reduce the risk of liability under the False Claims Act (FCA) requiring providers to prevent and identify improper payment of government funds.
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by Elizabeth Escalante

In today’s medical practices, employee turn-over is a fact of life. Employees who remain with an employer for many years are becoming increasingly few and far between. While managers cannot always stop an employee from leaving the practice, we can make sure that their departure was not due to factors that could have been prevented. Cultivating an environment where employees are happy to come to work and are dedicated to their jobs starts from the first moments of that new hire’s employment. It all starts with their orientation.
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How ironic that the day I set aside to write an article on medical practice customer service, I find myself sitting in our orthodontist’s office. With two children in braces, I’m here often. If you are looking to improve the customer service you provide your patients, consider modeling your office after my orthodontist’s office.

They are the epitome of great customer service. Why? Because they have to be:
• Most insurance plans do not cover orthodontics. Therefore, most patients are self pay. A satisfied patient pays his bill; a dissatisfied patient does not.
• If you enter your zip code and Google “orthodontist,” you’ll get a long list of options in your area. You have many choices and your orthodontist knows this.
• The orthodontist relies on you for patient referrals. Other parents see that my children have braces and they immediately ask who my orthodontist is and if I like him.
• The orthodontist’s best referral? A second (or third) child from the same family. As in my case, many parents choose an orthodontist more than once.
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by Andrea C. Santiago, Health Careers Guide at About.com

Every employer experiences turnover. But how do you determine if your attrition is “normal” or average, or if there is something more serious going on with the staff or work environment?

Turnover can be very costly to a practice. With each employee who leaves, much time and money go out the door with that person. Being short-staffed can be particularly challenging in a medical practice environment, because patients don’t stop getting sick or stop scheduling appointments just because your key staff member(s) quit today.

Sometimes turnover can even have a “snowball” effect – once one or two people leave, others will follow, and then you’re left scrambling to put the staff back together.

Below are a few ways you can assess and engage your staff to help prevent or reduce high turnover in your practice.
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by Michelle Trandel

Four years after its introduction, the PQRS program (Physician Quality Reporting System) continues to frustrate providers and office staffs.  Complaints about a lack of timely feedback and confusion about how to sort through the endless maze of information on the CMS website are just some of the challenges facing practices.  An understanding of the background and benefits of the program is the first step towards successful reporting.  So let’s review some program basics.

1.     PQRS is here to stay

The PQRS program, formerly PQRI (Physician Quality Reporting Initiative), was created in 2006 as part of the Tax Relief and Health Care Act.   This act required the creation of a voluntary program where eligible providers could receive an incentive for reporting on quality health measures with the goal that clinical data would help drive improvement in health care and reduce costs.  Currently, the PQRS program is focused on data collection.  Success is defined as whether providers satisfactorily report the measures; however, it is anticipated that PQRS will transition from a pay-for-reporting system to a pay-for-performance system in the future.
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by Donna Weinstock

If there is one thing we can be sure of in healthcare, it is that things are always changing. This time the change is really significant.

Effective October 1, 2013, ICD-10 codes must be used on all HIPAA transactions. Additionally, effective January 1, 2012, electronic health care transactions must be processed using Version 5010, a format that will accommodate the ICD-10 codes.

While there are always questions and uncertainty surrounding change, one thing is certain: payers and providers who are not prepared will suffer. Providers will face rejected claims and delayed reimbursement. Payers will experience a huge influx of support calls and customer service issues.
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