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How Deep is Your War Chest?

by James Dunnick MD FACC, CPC,CHCQM

Everyone is aware of the affordable care act popularly called Obama care. The health care industry is well aware of ICD 10 and its implementation date of 10/01/14. Most hospitals are in some stage of readiness, most determining now that they are not quite as prepared as they had hoped.

The problems are at several levels.

First, teaching ICD 10 to coders requires qualified and experienced instructors. But at least coders are certified with ICD 9 and have a basis of understanding. Teaching ICD 10 to physicians requires qualified and experienced instructors (preferably physician instructors for audience acceptance). But the physician teaching of ICD 10 is complicated by their absence of a basic understanding of ICD 9.

Second, electronic health records are becoming mandatory, but electronic health record systems have not yet matured to becoming error free, being user friendly, or provider time conserving rather than time expending.

Our third problem is that administrators, being neither coders, providers, nor electronic health record users, do not understand how difficult the tasks facing their team truly are.

Payers represent our fourth area of concern. They too must have internal education and staffing changes to be prepared for this transition. They will not all be ready on time and their system problems will surface in October as they go live.
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Coordinating Care In (and Outside) Your Practice

by Tom Ludwig, RN, MBA, FACMPE

According to a recent report of the Agency for Healthcare Research and Quality (AHRQ), the top 5% of users of healthcare services in the US account for 50% of all healthcare expenditures. Many of these people have chronic diseases, multiple medications and behavioral health issues. It shouldn’t be surprising that they receive care from many points across the continuum – inpatient, outpatient, and in the community. This sets the stage for potential problems before, during and after each episode of care. Such problems are related to poor communication of appropriate (and necessary) healthcare information, missed appointments and the lack of follow-up on test results and referrals. Not only does this impact the overall cost of care, it can also have a direct effect on outcomes.

How can physician practices effectively work with this population of patients? One of the answers is by providing care coordination. In the MGMA Connexion article “New to the Scene” (March 2012), Dr. Marjie Harbrecht explains that care coordinators ensure patients get needed services, track diagnostic test results and referrals, and manage the flow of medical information in and out of the office. The National Committee for Quality Assurance (NCQA) 2011 Patient Centered Medical Home Standards can be used as a reference for what a care coordinator can do. The Track and Coordinate Care Process Measures outline specific needs for test tracking and follow-up, referral tracking and follow-up, and coordinating with facilities and care transitions – especially hospital admissions and emergency department visits. (The NCQA process measures can be found at www.improvingchroniccare.org, care coordination tools and resources.)
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HIPAA Audits 2014 – Auditing is to Increase; Increased Contractors; Business Associates at Risk

By: Brian L Tuttle, CHP, CHA, CPHIT, CBRA, CCNA, CISSP

 

Well D-Day in the HIPAA world (September 23rd   2013) has come and gone and we are all still here, the world hasn’t ended, the Feds still haven’t kicked down your doors demanding to comb over your practice or business……yet.    As of now the Federal government has a heavy workload in terms of who, what, when, and where will be affected by their new enforcement efforts.   Their progress was stunted a bit by the recent government shut down, but as of this writing (November 14th, 2013) they are back in business.

As you may or may not know the enforcement wing of the Health and Human Services (HHS) which is the Office of Civil Rights (OCR) began a pilot campaign of audits in the summer of 2012.  http://www.hhs.gov/ocr/privacy/hipaa/enforcement/index.html

 This pilot campaign is to become a full time heavily enforced effort with many more facets involved.  Based upon the findings there are many areas that need to be addressed chiefly dealing with the HIPAA Security Rule (65% of fines levied) in comparison with the HIPAA Privacy Rule (26% of fines levied) and the Breach Notification Rule (9% of fines levied).   Going forward the OCR plans to evolve this process and give sharp teeth to what’s already going on.  Originally the law firm KPMG was given the contract to conduct these pilot audits.   According to www.hhs.gov the government plans to bring in many more firms (and subcontractors of those firms) to enforce and audit.  Leon Rodriguez, director for the Office of Civil Rights (OCR), stated at the HIMSS Privacy and Security Forum in Boston on September 23rd, 2013 “We hope to be off and running in the next calendar year “.    Additionally Mr. Rodriguez stated that OCR “will leverage more civil penalties” but more concerning is that fines levied are expected to pay for the audit program and be a revenue generating process for the Feds.

Why the delay?  The Federal Government appears to be a little overwhelmed with the task at hand especially with the influx of over 5 million business associates now in the fray with the omnibus changes of September 23rd 2013 (hence why they are aggressively ramping up their enforcement efforts and their own training).   According to Rachael Seeger, spokesperson for the Office of Civil Rights, she states: “For OCR, September 23rd is business as usual as we have not paused in our compliance efforts.  We will, however, begin looking at investigations in a post-omnibus era (September 23rd 2013) with a new lens with respect to compliance responsibilities of covered entities and now business associate liability”.   No specifics were given in the particular quote but based upon information from the pilot program (and true enforcement is guaranteed to be much more vigorous) the audits should be similar to that used by OSHA.  For example:  In the past with HIPAA you were only fined for a reported complaint or a blatant wrongful disclosure.  Now it appears you will be fined for not having proper protocols and policies in place to prevent a possible “future” wrongful disclosure.  Think of it in terms of OSHA.  If a wire is laying on the ground but no one has yet tripped over it, you would be fined.   Same concept will be in place with HIPAA. 

Let’s not kid ourselves folks I’m going to call a spade a spade here.  One doesn’t have to be a news junkie to know that our government is broke and healthcare is a sinking ship hemorrhaging cash that’s just not there.  One way for the Feds to mitigate their losses is to quickly ramp up the enforcement of HIPAA and start rendering massive fines upon covered entities (health care providers, health plans, and clearinghouses) and NOW 5 million business associates (those doing business with covered entities and privy to protected health information).  That’s exactly what appears to be happening.   In the governments defense they have been saying for years that this confusing not very well explained enigma known as “HIPAA” be fully operational at your practice or business..  And of course ignorance of the law is never an excuse. 

Scared yet?   What can you do?  The absolute #1 thing you need to do for your practice or business (if you qualify as a business associate) is a Risk Analysis.  The lack of a Risk Analysis was the #1 area of non-compliance based upon the findings of the pilot audit program the Feds began back in 2012.  This followed closely by lack of written policies consistent with your business, lack of proper system auditing, lack of staff training, and a non-existent contingency plan.   Based upon conducting over 300 national HIPAA audits I find the same to be true.  It’s not enough to do a risk analysis on just one part of HIPAA, you need to dot your i’s and cross your t’s for all of it.  The assessment should cover every facet of the rule and written policies need to be in place for every single implementation specification of the rule.  Even aspects that aren’t required must still have a written policy in place indicating why you “don’t” need to implement.  I know.  Such a pain but doable.

In conclusion we are now in a new world in terms of healthcare.  It’s getting more difficult to conduct a business and especially a medical practice under more and more burdensome regulations.  But it’s not anything that cannot be worked through with some extra due diligence and entrepreneurial spirit that made this country what it is. 

If you have any questions please feel free to email me directly at: brian.tuttle@ingaguehsi.com

ICD-10-CM and Coding for Severe Sepsis

by Steve Adams, InGauge Healthcare Solutions

Recently we looked at how to use the ICD-10-CM Book by using the “chapters, blocks and rubrics” provided for all 21 chapters of the book.

Today I thought we might take one of the 21 chapters and list some of the common ICD-10-CM codes we might use from that specific chapter of ICD-10-CM beginning in October of 2014.

Within chapter 1 of the ICD-10-CM manual we are provided with codes for “Certain Infectious and Parasitic Diseases (A00-B99).

Within this chapter we are taught how to code for HIV, AIDS, Sepsis and MRSA to mention only a few.

One of the more complex scenarios providers face in the hospital setting is the proper coding for severe sepsis.  This article will talk about the future codes we might use and the sequencing of those codes under the ICD-10-CM matrix.  Remember, the articles we write are specific to how a service would be billed to Part B for physician services.  Information from the Part A hospital might differ from the information provided here – but whenever in doubt you can always reach out to your coding department to clarify documentation and sequencing of codes for proper, compliant reimbursement.

With Severe Sepsis you will always use a minimum of two ICD-10-CM codes, sometimes three:

  1. A code for the underlying systemic infection and
  2. A code from subcategory R65.2, Severe sepsis.
  3. In the event there is also an associated organ dysfunction, a code for that condition should also be used along with the first two.

So, basically, we are going to code:

  1. What’s causing the sepsis
  2. That the patient has sepsis (with or without septic shock)
  3. Any underlying organ dysfunction

Now, in the event you are unaware of the causal organism, you are allowed to indicate that using code A41.9 – sepsis, unspecified organism.

Before we look at an example, this is what the coding department would need from a provider in order to properly bill for a patient with Severe Sepsis on your hospital rounding sheet:

  1. The cause of the severe sepsis – if unknown state causal organism unknown
  2. The words, severe sepsis (with or without septic shock); and
  3. Any organ dysfunction the patient might have resulting from the severe sepsis.

For example, you have a patient in the ICU with bacterial meningitis that is in respiratory failure and has severe sepsis, without septic shock.

The billing staff would code in the order above:

  1. Bacterial meningitis (G00.9)
  2. Severe Sepsis w/o septic shock (R56.20)
  3. Respiratory failure ( J96.00)

As you can see, your documentation for Part B physician payment really won’t change much, just that you would want to write more than (respiratory failure) on your daily hospital rounding sheet.

The more information you provide in your note will allow the billing department to increase the turnaround time in the revenue cycle and therefore help ensure proper, compliant, efficient turnaround time in the conversion of your work into money.

Now let’s say you have a patient with severe sepsis that has an unknown causal organism.

Your notes should indicate that the patient has severe sepsis w/o septic shock, due to unknown organism and patient has acute kidney failure.

The coding staff would then code as follows – remember: Cause, Severe Sepsis and Organ Dysfunction (if applicable):

A41.9:  Sepsis unspecified organism

R65.20: Sever Sepsis w/o septic shock

N17.9:  Acute Kidney Failure

 

ICD-10-CM Introduction

by Steve Adams

As we begin to draw closer to that October 2014 date we wanted to introduce you to the make up the ICD-10-CM book and some of the ways you can find the 3-7 character codes that represent the more than 69,000 diagnostic services within the ICD-10-CM manual that you will use every day.

The National Center for Health Statistics (NCHS) is the Federal agency responsible for the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) in the United States and has developed a clinical modification of the classification for morbidity purposes.  In essence, they take the World Health Organizations (WHO) ICD-10 and convert it into what we will begin using in the United States in October of 2014 – ICD-10-CM.

Today we thought we might look at the some of the terms we will need to know in order to locate diagnosis codes within the ICD-10-CM book.

Basically, there are three terms we need to learn in order to find a code: Chapters, Blocks and Rubrics.

Chapters – there are 21 chapters in the ICD-10-CM book.  Each chapter starts with an alpha character that represents various diseases, injuries, symptoms, or causes of the same.

Blocks – each chapter is broken up into blocks that are just a range of codes within a chapter.

Rubrics – once you find the block that contains your range, the rubric will identify the specific code you are looking for in order to file your claim.

Chapter 1 in ICD-10-CM begins with the Alpha Characters A & B and covers “Certain infectious and parasitic diseases.”

So let’s say you want to diagnosis a patient with:

Primary Respiratory Tuberculosis

You know this is an infectious disease so you’d go to chapter 1.  Once there you’d see this:

This chapter contains the following blocks
A00-A09 Intestinal infectious diseases
A15-A19 Tuberculosis
A20-A28 Certain zoonotic bacterial diseases
A30-A49 Other bacterial diseases
A50-A64 Infections with a predominantly sexual mode of transmission
A65-A69 Other spirochetal diseases
A70-A74 Other diseases caused by chlamydiae
A75-A79 Rickettsioses
A80-A89 Viral and prion infections of the central nervous system
A90-A99 Arthropod-borne viral fevers and viral hemorrhagic fevers
B00-B09 Viral infections characterized by skin and mucous membrane lesions
B10 Other human herpes viruses
B15-B19 Viral hepatitis
B20 Human immunodeficiency virus [HIV] disease
B25-B34 Other viral diseases
B35-B49 Mycoses
B50-B64 Protozoal diseases
B65-B83 Helminthiases
B85-B89 Pediculosis, acariasis and other infestations
B90-B94 Sequelae of infectious and parasitic diseases
B95-B97 Bacterial and viral infectious agents
B99 Other infectious diseases

Just to review:

The chapter for Tuberculosis was Chapter 1 – Infectious Diseases.

 The block for Tuberculosis is:

 A15-A19          Tuberculosis

 When we go to that block we would see more specific diagnosis codes that relate to different forms of Tuberculosis.  For Respiratory Tuberculosis we want to look at A15:

 A15 Respiratory tuberculosis

 A15.0    Tuberculosis of lung

Tuberculous bronchiectasis

Tuberculous fibrosis of lung

Tuberculous pneumonia

Tuberculous pneumothorax

A15.4    Tuberculosis of intrathoracic lymph nodes

Tuberculosis of hilar lymph nodes

Tuberculosis of mediastinal lymph nodes

Tuberculosis of tracheobronchial lymph nodes

Excludes1: tuberculosis specified as primary (A15.7)

A15.5    Tuberculosis of larynx, trachea  and bronchus

Tuberculosis of bronchus

Tuberculosis of glottis

Tuberculosis of larynx

Tuberculosis of trachea                      

A15.6    Tuberculous pleurisy

Tuberculosis of pleura Tuberculous empyema

Excludes1: primary respiratory tuberculosis (A15.7)                      

A15.7    Primary respiratory tuberculosis

So for this patient with primary respiratory tuberculosis we would use ICD-10-CM: A15.7

The key to understanding ICD-10-CM is knowing your Chapters, Blocks and Rubrics.

EMR Interoperability – You Can Stop Holding Your Breath Now

By Mike Jenkins, PMP

Over the past month, I have seen nearly a dozen tweets talking about lack of interoperability and sharing of information between physicians.  Cheer up, this is about to change in some big ways.

Starting January 1, 2014, ALL physicians attesting for Meaningful Use stage 1 and stage 2 must do so using EHR technology certified under the ONC 2014 requirements.  The 2014 requirements raise the bar significantly for all EMR vendors and will force those with a reputation for being closed systems, to play nicer with all others.  Recent press releases validate this.  Yet, the real news here is where Meaningful Use in 2014 is forcing EMR vendors to share information between systems.

The ONC 2014 requirements are summarized in this document. Specifically, the following EMR requirements promote interoperability:

  • §170.314(b)(1) Transitions of care – receive, display, and incorporate transition of care/referral summaries.
  • §170.314(b)(2) Transitions of care – create and transmit summary care records.
  • §170.314(e)(1) View, download, and transmit to 3rd party.
  • §170.314(e)(2) Clinical summary – ambulatory setting only.
  • §170.314(e)(3) Ambulatory setting only – secure messaging.
  • §170.314(f)(2) Transmission to immunization registries.
  • §170.314(f)(3) Transmission to public health agencies – syndromic surveillance.
  • §170.314(f)(4) Inpatient setting only – transmission of reportable laboratory tests and values/results.
  • §170.314(f)(5) Optional—ambulatory setting only—cancer case information.
  • §170.314(f)(6) Optional—ambulatory setting only—transmission to cancer registries.

These standards, in one form or another, force EMR vendors to build into their systems the ability to securely package, send, and receive patient data in a standardized format.  There are several key technologies specified in these standards.  These are C-CDA, the Direct Project, and Blue Button. 

Consolidated – Clinical Data Architecture (C-CDA) is a document markup (XML) standard that specifies the structure and semantics of “clinical documents” for the purpose of exchange between healthcare providers and patients.  A C-CDA can contain any type of clinical content including discharge summary, imaging report, admission & physical, pathology report, and more.  More details can be found here

The Direct Project specifies a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the internet.  Direct messages, when sent, validate the sender and receiver are trusted, digitally sign the message, encrypt the message, send the message over SMTP (email) protocol.  The receiver reverses the process.  It decrypts the message, verifies the signature, then delivers it to the recipient.  All of this uses readily available technology and infrastructure.  More details are here.

Blue Button is the symbol for a patient’s access to their own data.  It offers patients the ability to retrieve records in both human readable and machine readable formats, and to send them where they choose.  Meaningful use refers to this as View, Download, and Transmit (VDT).  More details are here.  

All of these technologies are in use already.  Health Information Exchanges and Cancer registries are using C-CDA and The Direct Protocol.  Blue Button has been offered to patients for several years by some EMR vendors.  It is simply a matter of adoption for this interoperability to become ubiquitous.

The most immediate and profound benefit will be the reduction in the need to fax healthcare documents.  Once the direct trusts are configured, it can be as simple as one or two clicks for a provider to send all relevant components of a chart as part of a referral request.  On the receiving end, this can be consumed into the patient chart with another click.  This process can be done in seconds and requires NO additional rekeying or resending. 

Providers should learn about these capabilities immediately.  In addition to referrals and provider-provider sharing, this can and should be used to share information with patients.  Imagine a world where patients only have to complete one H&P and it gets consumed electronically by every physician office they visit.  ONC is making this possible next year.  It is up to you, as provider or patient, to take advantage of this.

Shared Visit Documentation

Steve Adams, MCS, CPC, CPC-H, CPC-I

For CMS you cannot bill “incident to” in the inpatient setting under most normal circumstances. However, CMS will allow a Non Physician Provider (NPP) like a PA or NP to see a patient and use the physician’s number to bill for their services under a provision called the “shared visit.”

Because a “shared visit” in the hospital is not the same as an “incident to” service in the office, you have to document more in order to meet the criteria for the inpatient “shared visit.”

According to CMS:
When a hospital inpatient/hospital outpatient or emergency department E/M is shared between a physician and an NPP from the same group practice and the physician provides any face-to-face portion of the E/M encounter with the patient, the service may be billed under either the physician’s or the NPP’s UPIN/PIN number. However, if there was no face-to-face encounter between the patient and the physician (e.g., even if the physician participated in the service by only reviewing the patient’s medical record) then the service may only be billed under the NPP’s UPIN/PIN. Payment will be made at the appropriate physician fee schedule rate based on the UPIN/PIN entered on the claim.

The important part of a shared visit is the documentation required by the MD to meet the criteria of the “shared visit.” Please make sure that as a physician sharing a visit with the NPP that you, the physician:

1.See the patient on the same day
2.Document a portion of the history, exam and decision making
3.Sign off on the note

It is not sufficient to simply document that you’ve seen and agreed with the NPP. I advise physicians to simply write a “mini” history, exam, and some decision making that shows that all three elements above have been met and that you have indeed “shared” the visit with the NPP.

Documentation for Office Consults

Steve Adams, MCS, CPC, CPC-H, CPC-I

CMS no longer allows reimbursement for the consultation codes, so these issues pertain specifically to commercial patients.

CPT defines a “consultation” as:

A type of evaluation and management service provided by a physician at the request of another physician or appropriate source to either recommend care for a specific condition or problem or to determine whether to accept responsibility for ongoing management of the patient’s entire care or for the care of a specific condition or problem.[1]

A consultation is not the same as a transfer of care:

A “transfer of care” is the process whereby a physician who is providing management for some or all of a patient’s problems relinquishes this responsibility to another physician who explicitly agrees to accept this responsibility and who, from the initial encounter, is not providing consultative services.[2]

The AMA gives us the definition of a consult in that your opinion or advice is requested by another physician or other appropriate source. Other appropriate source would be another medical provider like MD/DO/PA/NP/CNM – not from a patient or a patient’s family member.

The decision to bill as an office “consultation” or “transfer of care” is dependent upon whether or not the other provider is seeking your “opinion or advice” or is simply “transferring the patient’s care” to you for management.

If you are going to bill an encounter as an office consult because the requesting provider wants your opinion and/or advice, reference in the note that the request came from the other provider. Mention the provider by name and offer your opinion and advice within the body of the patient’s note.

A proper chief complaint would look something like this – Patient is being seen today in consultation at the request of Dr. Jones for uncontrollable HTN. In the Assessment/Plan consider using Opinion/Advice.

Don’t forget, you are also required to communicate your opinion and advice back to the requesting provider. A letter outlining your opinion and advice must be sent back to the requesting provider unless you share a common note.
If you do not bill one of the outpatient consultation codes (99241-99245) because the requesting provider is transferring the patient’s care to you for a specific problem or there is no request for your opinion and/or advice, use the standard outpatient EM codes 99201-99215 based on if the patient is new or established and also on your documentation.

[1] 2013 CPT Professional Edition – AMA

[2] 2013 CPT Professional Edition – AMA

Transitioning to Meaningful Use Stage 2

By Mike Jenkins, PMP, MBA

On February 17, 2009, the “Stimulus bill” earmarked $19 Billion for the “Health Information Technology for Economic and Clinical Health” (HITECH) Act.  HITECH encourages physicians to migrate to electronic health records (EHR) and to show “Meaningful Use”.  Eligible Providers (EPs) attested with 90-days data before 10/3/2012 could earn up to $44,000 over five years.  After 2012, the total earning decreased.  Those attesting with data captured after 10/2/2013 would be subject to Medicare penalties starting in 2015. 

 

Deadline for

attestation data

Maximum

ARRA Payout

10/2/2012

$44,000

10/2/2013

$39,000

7/1/2014

$24,000

less penalties

10/1/2014

penalties

 

The HITECH program extracts penalties if no MU by 2015.  Penalties are based on prior years reporting with a 2 year lag.  If the EP had MU attestation in 2013, there is no penalty in 2015.  Medicare MU registration and attestation must be done before 10/3/2014 to prevent adjustment in 2015.  This means the 90-day reporting period must start no later than 7/1/2014.  The EP must continue to meet MU requirements annually to avoid adjustments in subsequent years. 

The rules for an Eligible Professional (EP) are very simple. 

Buy a “Certified” EHR + Attest for Meaningful Use = Get incentive payments.

The Meaningful use program is building the foundation to drastically alter the way in which we provide care and referrals for patients.  Stage 1 requires providers to move from paper to electronic data capture.  Stage 2 requires providers share this data with patients and other providers.  Stage 3 is TBD.

Buying a “certified” system today requires providers to purchase a system that is certified by an ONC-ACB company in accordance with the 2011 rules.  Buying and using a system starting January 1, 2014 for Stage 2 attestation AND Stage 1 attestation must be done using a system certified under the 2014 rules.

Stage 1 certification required EPs to show meaningful use of 15 core objectives plus 5 of 10 menu objectives for a total of 20 objectives in order to attest and receive their checks.  Stage 2 makes this quite harder by requiring EPs to show meaningful use of 17 core objectives plus 3 of 6 menu objectives for a total of 20 to continue receiving checks and avoid penalties. 

Stage 2 requires more adoption including patient engagement.  EPs must prove more than 5% of their patients have sent secure message to the EP and more than 5% of their patients have accessed their health information online.  They must produce a Summary of Care for more than 50% of their patients.  They must electronically transmit more than 10% of information, and they must send at least one patient record to a recipient with a different EHR vendor or to CMS.

Stage 1 Clinical Quality Measures (CQMs) reporting required 6 out of 44 where 3 are core or alternate core and 3 are from the menu.  Stage 2 (After January 1, 2014) will require 9 out of 64 CQMs that are pulled from at least 3 of the 6 National Quality Strategy (NQS) domains. 

As of 6/25/2013 there is a stark contrast in the number of solutions certified on the ONC website (http://oncchpl.force.com/ehrcert).

 

Type

2011

2014

Ambulatory

3,217

47

Inpatient

1045

44

 

In conclusion, All EPs MUST use a 2014 certified EHR for 90 days to attest for 2014 starting January 1, 2014.  They must report on data collected no later than October 3, 2014 to avoid penalties.  This means they must have a fully operational 2014 certified system by July 1, 2014 in order to capture 90 days data in 2014.  A 2014 certified system is required for both Stage 1 and Stage 2 attestations.

While completing our own EMR certified for 2014 (Stage 2) we realize this is an order of magnitude harder than 2011 (Stage 1) certification.  Stage 1 has created a false sense of security among vendors and EPs.  The 2014 certification has raised the bar for EHR vendors and every EP who attests.  There will be some consolidation, but there will be vendors who choose to abandon their customers at the 11th hour.  EPs need to solicit their vendors now to get their commitment to finish their certification.  If they do not get a reliable answer, it is time to start considering plan B.

 

Mike Jenkins is the CEO of BuildYourEMR (www.buildyouremr.com), a PMP Instructor and a LEAN Six Sigma expert. He has a deep understanding of Information Technology in Healthcare that comes from serving Managerial and Director position at the most prestigious Healthcare IT companies in the country.

Efficiency in Practice is the free eNewsletter for medical practice managers who want to save time, money and reduce risk.  For more information and to access your FREE report, Patient Collections: It’s Make or Break for Many Practices, visit www.efficiencyinpractice.com 

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

Communication: Let Me Count the Ways

by Donna Weinstock 

When we think of “Communication” we think of words and about saying something to another person. The truth is verbiage is really just a small part of communication. Communication can be tone of voice, inflections and body language. It is so easy to misinterpret a person’s meaning when the communication is not expressed properly.

What we say is as important as how we say it. Here are some examples of how using different words or phrases can have a more positive effect on the communication and the patient you are speaking to:

  1. When we call a patient to confirm their appointment, it is more appropriate to say “confirm” rather than “remind”. When you remind a patient that he/she has an upcoming appointment, you imply they might forget the appointment. Confirming the appointment will suggest you want to verify the date and time.
  2. If the practice needs to change an appointment, it is better to say that you want to “reschedule” or “change” an appointment. By telling the patient you want to “cancel” his appointment, you leave the option of not setting a new time.
  3. When a patient wants to speak with the physician, it is always better to say that the doctor is with a patient, rather than the doctor is busy. It is a much more positive word choice.
  4. If a patient calls and you are not certain if they have been seen before, it is better to ask if they are a “former” patient, rather than an “old” patient. Patients often are touchy about their age. There is no reason to add the word “old” to the conversation. Your goal is to make the patient feel comfortable.
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