Consultant Donna Izor: Ten Tips To Make the Patient Schedule Work for Your Practice

by Mary Pat Whaley http://www.managemypractice.com/

Many practices and providers take their patient schedule for granted. They overlook the opportunity to improve both productivity and effectiveness by managing their schedule. Here are ten tips for office managers to make sure that the patient schedule works for you and for your practice.


1. Evaluate the schedule template with the providers and nurse manager quarterly.

By using actual issues from the previous period, discuss what has worked and what has not. Have providers share their concerns and discuss their recommendations for change. Nursing often has many ideas to improve the flow of patients through the practice and is a valuable source of information. Keep track of changes made and evaluate their effectiveness at the following meeting.


2. Standardize visits types.

There are many reasons an individual provider likes their “own” schedule. As managers, we know that this makes it very difficult for the front desk staff to do their jobs. Standardization reduces the potential for errors and disruption that proprietary schedules may cause. Your role in the discussion with providers will be that of facilitator, staff advocate, and coach.

Bring forward options for standardized visit types. Many practices use a block template based on 10, 15 or 20-minute blocks of time. The number of blocks used per visit type are agreed to and used to fill the schedule. There may be additional restrictions placed on the schedule such as no more than one new patient per half-day session. Minimize the number of restrictions or ideally eliminate them to assure your days are as flexible as possible to meet your patient needs. You may also want to consider open access scheduling. Moving to this system often takes time and effort to eliminate the backlog of booked patients but once fully in place can be very successful.


3. Track scheduling errors and issues perceived to be scheduling errors monthly.

Errors in scheduling cause patient dissatisfaction, back up your waiting room, and lead to stress and possibly short tempers. Ask providers and staff to tell you when they think patients are scheduled incorrectly. Track this over time to determine if changes in the system are needed, how visit type use can be improved, and what training may be needed.


4. Know where scheduling bottlenecks are.

What is your average wait time in the office per provider? Do a time study on each provider and measure how long it actually takes for a patient to get through an office visit. Note the time they arrive for check in and registration functions, their time in the waiting room, when the nurse completes check in functions in the exam room, when the provider enters the exam room, when the provider leaves the exam room and when the patient exits the office. Overlay this on your schedule. The information you gather will help you identify bottlenecks and provide meaningful data to share with your providers when recommending a change in the schedule template.


5. Know how much a visit is worth in revenue.

Adding one visit per day by addressing schedule gaps, clinical start times, no-show appointments or changing the length of visits will increase your revenue. If your provider works four days per week and 48 weeks per year at an average visit reimbursement of $75, one additional visit per day will add $14,400 in annual revenue to the bottom line!


6. Train your scheduling staff and update the training regularly.

Training a new staff member often brings up questions the entire staff can benefit from. Be sure to keep track of questions and include answers in future written training materials as well as in staff meeting discussions. Develop a training checklist for scheduling staff and have both the trainer and new employee initial when each area is mastered. This checklist can also be used for annual performance reviews. For current staff, take a look at their computer terminals and see what “sticky notes” are posted there, indicating areas that need special consideration or additional training.


7. Have the schedule be a frequent agenda item for staff meetings.

Get the staff perspective on what is working and what is not on a regular basis. You may find that nursing can provide a great deal of information on how the schedule impacts patient flow from their perspective. Take time for staff to discuss “what if” scenarios and how they would handle a particularly difficult situation. The goal is to have a schedule that staff understands, is user friendly and is consistently used.


8. Have a policy on the number of providers out at one time for vacation or holidays and follow it.

Everyone deserves time off but having many providers out at once can lead to a very hectic week for those remaining. Plan as much in advance as possible for time away. If you do end up with a number of providers out at once, remember that the person remaining will also be responsible for reviewing lab and radiology results for their colleagues as well as answering questions regarding patients that they may not know. Allow extra time in the schedule for this.


9. Know what changes in demand to expect during the year and plan for it.

Do you have more requests for acute visits in January, camp physicals in April, or school sports physicals in August? Minimize last minute adjustments to your schedule by knowing any seasonal trends in scheduling. Take a look at the schedules from past years to predict when you need more or less acute slots and adjust your schedule template for this. Manage the time you’ve allotted by marketing efforts in the office and local papers reminding your patients to schedule in advance.

You may also want to consider adding additional clinical hours during this time to make sure you can meet demand. Consider asking part time providers for extra hours per week or using per diem staff.


10. Deal with your patient no-shows.

Consider writing a policy on no-shows if you do not have one. If you have one, follow it. Make sure that your policy follows any state regulations to avoid patient abandonment claims.

Educate your patients. Develop a set of professional communications about your visit cancellation and no-show policy that begin with your welcome to the practice letter. Post a notice of your policy in your waiting room. Send letters following each no-show and then the termination letter stating the reason for the termination and that the patient is still responsible for their account balance. Be the contact person on the letter so that if the patient calls with questions, they speak with you rather than take up provider time or that of your staff.

If you have a patient that consistently no-shows but the providers do not want to terminate them from the practice, determine what other help you can provide to get the patient to the visit on time. Consider additional reminder calls, assistance with other services such as transportation, or offering the ability to come in and wait without a scheduled time. Though this may take more staff time, the revenue from the appointment should make it worth your while.

Donna Izor, MS, FACMPE is founder of West Pinnacle Consulting, LLC. Her 20 years of experience as a medical practice executive lends her special expertise in the areas of primary care and specialty practices, employed inpatient physicians, regulatory oversight, facility design, physician compensation and relations, and new program development. She has worked with academic, community hospital, and private practices. You can contact Donna at donna.izor@gmail.com.



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CMS and ONC Will Announce Final Rules on Meaningful Use, Standards & Certification 7/13/2010

U.S. Department of Health and Human Services
by Mary Pat Whaley http://www.managemypractice.com/

WHAT: CMS and ONC will host a press briefing to announce the final rules on Meaningful Use and Standards and Certification under the HITECH Act’s Electronic Health Records (EHR) incentive program.

WHO: Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services Donald Berwick, M.D, Administrator, Center for Medicare & Medicaid Services David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology Regina Benjamin, M.D., M.B.A., Surgeon General

WHEN: Tuesday, July 13, 2010 10:00 a.m. EDT

WHERE: Great Hall, Hubert H. Humphrey Building 200 Independence Avenue, S.W., Washington, D.C. 20201
Call in: 800-857-6748 Verbal Passcode: HHS

Watch the webcast live here.


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Independent Diagnostic Testing Facilities (IDTFs) Can Expect Quarterly Letters From Medicare A/B MACs About January 2012 Accreditation Requirement

by Mary Pat Whaley http://www.managemypractice.com/

Medicare Learning Network (MLN) just released MM6912, effective August 2, 2010: Mailing To All Individual Practitioners, Medical Groups and Clinics and Independent Diagnostic Testing Facilities (IDTF) Who Are Billing or Have Billed For The Technical Component of Advanced Diagnostic Imaging Services.

What exactly is an IDTF?

Some suppliers that perform diagnostic tests, other than clinical laboratory or pathology tests, are required to enroll with Medicare as an Independent Diagnostic Testing Facility (IDTF). Not all suppliers that perform these diagnostic tests are required to enroll as an IDTF. Generally, entities can bill for the technical component of the diagnostic tests without an IDTF enrollment if it has the following characteristics:

• A physician practice that is owned, directly or indirectly, by one or more physicians or by a hospital.
• A facility that primarily bills for physician services and not for diagnostic tests.
• A facility that furnishes diagnostic tests primarily to patients whose medical conditions are being treated or managed on an ongoing basis by one or more physicians in the practice.
• The diagnostic tests are performed and interpreted at the same location where the practice physicians also treat patients for their medical conditions.
• If a substantial portion of the facility’s business involves the performance of diagnostic tests, the diagnostic testing services may be a sufficient separate business to require enrollment as an IDTF. In that case, the physician or physician group practice can continue to be enrolled as a physician or physician group practice but are also required to enroll as an IDTF. The physician or group can bill for professional fees and the diagnostic tests they perform on their patients using their billing number. Therefore, the practice must bill as an IDTF for diagnostic tests furnished to Medicare beneficiaries who are not regular patients of the physician or group practice.

Who will receive a mailing?

Enrolled physicians, non-physician practitioners, including single and multi- specialty clinics, and IDTFs who have billed the Medicare program for the technical component of advanced diagnostic testing services within the preceding six month period and who continue to have Medicare billing privileges with Medicare contractors (carriers and Part A/B Medicare Administrative Contractors (A/B MACs)) are affected.

If you have billed the Medicare program for the technical component of advanced diagnostic testing services within the preceding six month period and continue to have Medicare billing privileges with Medicare contractors, you will receive a letter from your Medicare contractor advising you of the need to become accredited by January 1, 2012, in order to continue to provide these services and bill Medicare.

When more than one physician or non-physician practitioner is operating within a group, such as a single specialty or multispecialty clinic, only the group will receive the letter, not each of the individual physicians or non-physician practitioners working for the group.

What will the mailing say?

You must be accredited by one of the three Centers for Medicare & MedicaidServices (CMS) approved national accreditation organizations by January 1, 2012,in order to be eligible to continue to furnish the technical component of advanceddiagnostic testing services to Medicare beneficiaries and submit claims for thoseservices to your Medicare contractor.

Your contractor will be mailing the letter quarterly beginning with July 2010 through July 2011. If necessary, follow the instructions in the letter to become accredited by January 1, 2012, in order to continue billing for the technical component of advance diagnostic imaging services. Make sure that your office staffs are aware of these new accreditation requirements and begin the accreditation process as soon as possible to protect your Medicare billing rights for these services.

Why do IDTFs have to become accredited now?

Section 135(a) of the Medicare Improvements for Patients and Providers Act of2008 (MIPPA) amended section 1834(e) of the Social Security Act and requiredthe Secretary, Health and Human Services, to designate organizations to accreditsuppliers, including but not limited to physicians, non-physician practitioners andIndependent Diagnostic Testing Facilities, that furnish the technical component(TC) of advanced diagnostic imaging services.

What qualifies as an advanced diagnostic imaging procedure?

MIPPA specifically defines advanced diagnostic imaging procedures as including:

• Diagnostic magnetic resonance imaging (MRI),
• Computed tomography (CT), and
• Nuclear medicine imaging, such as positron emission tomography (PET).

MIPPA expressly excludes from the accreditation requirement x-ray, ultrasound,and fluoroscopy procedures. The law also excludes from the CMS accreditationrequirement diagnostic and screening mammography, which are subject to quality oversight by the Food and Drug Administration under the Mammography Quality Standards Act.

How long does it take to become accredited?

Since CMS expects that it may take as much as nine months from the time you initiate the accreditation process to completion, you should begin the accreditation process for advanced diagnostic imaging services as soon as possible, but not later than March 2011.

Who are the accrediting organizations?

CMS approved three national accreditation organizations — the American Collegeof Radiology, the Intersocietal Accreditation Commission, and The JointCommission — to provide accreditation services for suppliers of the TC of advanced diagnostic imaging procedures. The accreditation will apply only tothe suppliers of the images themselves, and not to the physician interpretingthe image. All accreditation organizations have quality standards that address the safety of the equipment as well as the safety of the patients and staff.

If you have questions, contact your Medicare carrier and/or A/B MAC attheir toll-free number, which may be found here (zip file.)

The letter will look like this:

[DATE]

[Supplier Name and Address]

Dear Physician/Non-Physician Practitioner/IDTF owner:

In accordance with Section 135(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), suppliers, including but not limited to physicians, non-physician practitioners and Independent Diagnostic Testing Facilities that furnish the technical component (TC) of advanced diagnostic imaging services must be accredited by January 1, 2012 in order to continue to furnish these services to Medicare beneficiaries.

Our records indicate that you have furnished advanced diagnostic imaging procedures such as diagnostic magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging such as positron emission tomography (PET) within the last six months. If you are not accredited by one of the organizations shown below by January 1, 2012, you will not be eligible to bill the Medicare program for advanced diagnostic imaging services. This letter requests that you take the necessary action to become accredited by the January 1, 2012 deadline. Since we expect it can take up to nine months from the time you initiate the accreditation process to completion, we urge you to begin the accreditation process for advanced diagnostic imaging services as soon as possible.

MIPPA expressly excludes from the accreditation requirement x-ray, ultrasound, and fluoroscopy procedures. The law also excludes from the CMS accreditation requirement diagnostic and screening mammography which are already subject to quality oversight by the Food and Drug Administration under the Mammography Quality Standards Act.

The Centers for Medicare & Medicaid Services (CMS) approved three national accreditation organizations – the American College of Radiology, the Intersocietal Accreditation Commission, and The Joint Commission – to provide accreditation services for suppliers of the TC of advanced diagnostic imaging procedures. The accreditation will apply only to the suppliers of the images themselves, and not to the physician interpreting the image. All accreditation organizations have quality standards that address the safety of the equipment as well as the safety of the patients and staff. The accrediting organization that issues your accreditation will notify Medicare once your accreditation is complete and approved.

To obtain additional information about the accreditation process, please contact the accreditation organizations shown below.

American College of Radiology (ACR)

1891 Preston White Drive

Reston, VA 20191-4326

1-800-770-0145

Intersocietal Accreditation Commission (IAC)

6021 University Boulevard, Suite 500

Ellicott City, MD 21043

1-800-838-2110

The Joint Commission (TJC)

Ambulatory Care Accreditation Program

One Renaissance Boulevard

Oakbrook Terrace, IL 60181

1-630-792-5286

If you have questions about this letter, contact [carrier or A/B MAC phone number/contact person].

Sincerely,

[Name of carrier or A/B MAC]

******************************************************************

Supplier Billed Advanced Medical Imaging CPT codes for Section 135 (a) of the MIPPA to Receive Accreditation Requirement Notification Letter

70336 70540 71250 72125 73200 74150

70450 70542 71260 72126 73201 7416

070460 70543 71270 72127 73202 74170

70470 70544 71275 72128 73206 74175

70480 70545 71550 72129 73218 74181

70481 70546 71551 72130 73219 74182

70482 70547 71552 72131 73220 74183

70486 70548 71555 72132 73221 74185

70487 70549 72133 73222

70488 70551 72141 73223

70490 70552 72142 73225

70491 70553 72146 73700

70492 70554 72147 73701

70496 70555 72148 73702

70498 70557 72149 73706

70558 72156 73718

70559 72157 7371972158 73720

72159 73721

72191 73722

72192 73723

72193 73725

72194

72195

72196

72197

72198

72200

75557 76360 77011 78000 78811

75559 76376 77012 78001 78812

75561 76377 77021 78003 78813

75563 76380 77058 78006 78814

76390 77059 78007 78815

76497 77078 78010 78816

76498 77079 78011 78891

78015

78016

78018

78020

78070

78075

78099

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Medicare Changes Fee Schedule Mid Year...

As you are probably aware, Congress has changed the Medicare Fee schedule effective with dates of service on and after June 1, 2010. This represents a 2.2 % increase in the conversion factor.

We are aware of these changes and are working to get the new fee schedules loaded so you can make the necessary corrections to your contacts.

There are a few things you need to do before hand if you are using the contracts and fee schedules modules. If you do not use these modules, you may disregard this message.

1. For your Medicare 2010 Fee schedules that you have already created, change the contract stop date to May 31, 2010. Doing this will prevent showing false positives in your payment audit system. Any underpayments already in your payment audit system showing underpaid, will be automatically removed on your next update.

2. We will notify you by email, once we have made the new data available on our webservice, this could take some time, but we are working hard on the update.

3. Once you receive the email from us, stating that the new data is available, you will need to run the check for CMS updates from the Utilities menu, and then create new Medicare contracts with a start date of June 1, 2010. Please DO NOT simply delete, or update the current Medicare 2010 contracts with the new fee schedule amount! Our Payment Audit System looks at the date of service in order to apply to correct fee schedule amount, so you must have two Medicare Fee Schedules for 2010 for every payment type you currently use.

4. Once the new contracts are loaded, DataPlus will then go backwards and identify any new underpayments based on the new fee schedule.

As always, if you have any questions, please let us know, and we appreciate your business!


Sincerely,


Frank G. Trew
Founder / COO

ftrew@mydataplus.com

:::Holiday Hours Reminder:::

DataPlus corporate and support offices will be closed Monday, July 5th in celebration of Independence Day. Normal office hours will resume Tuesday, June 6th. We wish you a safe and enjoyable holiday!

Deja Vu All Over Again: The Medicare Fee Cut is Pushed Back to November 30, 2010

by Mary Pat Whaley http://www.managemypractice.com/

I don’t know about you but I am emotionally exhausted thinking about and worrying about the on-again off-again cuts in Medicare fees for physicians.

Here’s the scoop: late Thursday evening, June 24, 2010, the House of Representatives passed the ” Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (H.R. 3962)” which includes a delay in the 21+% fee cut. Because the same legislation was already passed by the Senate, it now goes to the President for his signature and it becomes law. It is anticipated that this will happen quickly and CMS will have the MACs start processing new claims with dates of service of June 1, 2010 and later at the 2009 fee schedule plus a 2.2% increase. The MACs will also have to reprocess the claims already paid for dates of service June 1, 2010 and later that were processed with 2010 fee schedule and that big fat cut.

Q: What should we be doing for the next 5 months and 6 days?

A: Have someone in your practice take a video of your providers introducing themselves, telling how many Medicare patients they have and how they can’t afford to see Medicare patients unless the SGR formula is replaced with something that works. The video doesn’t have to be slick – just real. Send it to your senators and representatives. Send it your local TV news. Post it on YouTube. Imagine hundreds of thousands of providers introducing themselves and talking about their patients. It would be powerful.

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CMS Delays Claim Payment Until June 17th, Hoping for Congress Movement to Further Delay or Repeal (?) the SGR Formula

by Mary Pat Whaley http://www.managemypractice.com/

Excerpt From Today’s CMS Announcement (with my bolding):

The Centers for Medicare & Medicaid Services (CMS) is hopeful that Congressional action will be taken within the next several days to avert the negative update.

Given the possibility of Congressional action in the very near future, CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18.

This action will facilitate accurate claims processing at the outset and minimize the need for claims reprocessing if Congressional action changes the negative update. It also should minimize the provider and beneficiary burdens and costs associated with reprocessing claims.

We understand that the delayed processing of Medicare claims may present cash flow problems for some Medicare providers. However, we expect that the delay, if any, beyond the normal processing period will be only a few days. Be on the alert for more information regarding the 2010 Medicare Physician Fee Schedule Update

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Question of the Week: "How do I add a user in DataPlus?"

Follow these simple steps to add a new username and password to DataPlus:

• A user with administrative rights will need to log in to DataPlus.
• Select "Utilities"
• Select "User Permissions"
• Select "New Entry" (the arrow with the asterisk)
• Type in the new User Id (usually first initial and last name)
• Type in the User Name (Full Name)
• Choose whether to give this user Administrative, Read Only or Custom access.
• Select "Save" (the disk with the pencil)

By default all new user's passwords are set to "tennessee". Each user will be prompted to change their password the first time they log in. If a user has forgotten their password you can reset it back to "tennessee" by clicking: "Reset User's Password to Default".

You can also change a user's access level by scrolling to their username and changing the "User Class" and selecting "Save"

To remove a user from accessing DataPlus simply scroll to their name and click "Delete" (arrow with the red X)

ARRA Eligible Providers: Who Is Eligible to Receive Stimulus Money and How Much is Available Per Provider?

by Mary Pat Whaley http://www.managemypractice.com

Medicare Definition of Eligible Provider (EP)

For Medicare, physicians and some hospitals are eligible providers. “Physicians” includes doctors of medicine (MD) or osteopathy (DO), dentists or dental surgeons (DDS or DMD), podiatric medicine (DPM), and optometry (OD) and chiropractors (DC).

For providers, their annual payment will be equal to 75 percent of Medicare allowable charges for covered services in a year, not to exceed the incentives in the table below. Payments will be made as additions to claims payments.

Hospitals include quick-care hospitals (subsection-d) and critical access hospitals and only includes hospitals in the 50 States or the District of Columbia.

Medicaid Definition of Eligible Provider (EP)

Medicaid takes the Medicare definition of eligible providers (physicians) and adds nurse practitioners, certified nurse midwives and physician assistants, however, physician assistants are only eligible when they are employed at a federally qualified health center (FQHC) or rural health clinic (RHC) that is led by a Physician Assistant. Eligible hospitals include quick care hospitals and children’s hospitals.

At minimum, 30 percent of an EP’s patient encounters must be attributable to Medicaid over any continuous 90-day period within the most recent calendar year. For pediatricians, however, this threshold is lowered to 20 percent.

The first year of payment the Medicaid provider must demonstrate that he is engaged in efforts to adopt, implement, or upgrade certified EHR technology. For years of payment after year 1, the Medicaid provider must demonstrate meaningful use of certified EHR technology.

Change 1:
The definition of “hospital-based physician” was recently clarified to include physicians working in hospital outpatient clinics (employed physicians) as opposed to the inpatient units, surgery suites or emergency departments. This still excludes pathologists, anesthesiologists, ER physicians, hospitalists and others who see most of their patients in the ER as outpatients or as hospital inpatients.

Possible Change 2:
The Health Information Technology Extension for Behavioral Health Services Act of 2010 (HR 5040) is a bill in the US Congress originating in the House of Representatives that would amend the Public Health Service Act and the Social Security Act to extend health information technology assistance eligibility to behavioral health, mental health, and substance abuse professionals and facilities, and for other purposes. You can track the bill here.

For more information on stimulus money for meaningful use of an EMR, read my post here.

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What is the Difference Between Fixed and Variable Expenses in a Medical Office?

by Mary Pat Whaley http://www.managemypractice.com/

Operating expenses fall into two categories: fixed and variable. Your fixed expenses are the same from month to month regardless of whether you are seeing patients or not. Your variable expenses change from month to month based on the volume of business you do and what is needed to support that volume of business. Purchases that fall under the operating expense category are less than a pre-determined amount – maybe less than $500 in a practice or less than $1000 in a hospital. Any purchase over that amount will be a capital expense (defined as having a usable life of more than one year) and will appear on your monthly expense statement as depreciation.

Fixed Expenses

• Rent/Mortgage


• Utilities: electricity, water, garbage, cable, alarm system


• Janitorial and Groundskeeping


• Computer System: monthly maintenance


• Phones: monthly maintenance


• Leases: copiers, transcription equipment, some medical equipment


• Malpractice Insurance


• Other Insurance: general, business interruption, directors & officers, umbrella


• Depreciation
  

Variable Expenses – Typically when you are looking at reducing expenses, you will look first at your variable expenses, seeing what you can cut down on or eliminate, or what you can renegotiate.

• Payroll: staff wages, tax match, retirement plan match, bonuses, annual raises


• Benefits: health insurance, life insurance, dental insurance, vision insurance, disability (long term, short-term), worker’s compensation, unemployment


• Computer System: additional licenses, charges for claims, statements, eligibility


• Phones: repair, new lines, new jacks, voice mail changes, cell phone plans, pager plans, answering service, Yellow Pages (hopefully minimal),


• Inside: pest service, plant service


• Medical equipment: small instruments, exam room lamps, Mayo trays


• Laundry: gowns, sheets, towels, shorts, lab coats


• Consumables: (medical – built-in to the price of the service) table paper, syringes, x-ray film, lab supplies


• Consumables: (medical – charged separately to the patient) allergy serum, durable medical equipment


• Consumables: (office) copy paper, toner, kitchen and bathroom supplies, pens


• Printing: encounter forms, appointment cards, Rx pads


• Education: (staff) continuing education, license renewal, CPR, coding updates, dues, subscriptions


• Perks: uniform allowance, parking, lunches, holiday parties, birthday gifts


• Purchased Services: transcription, radiology over-read, accountant, lawyer, consultant, auditor, inspector, outsourced billing, collection agencies


• Marketing: advertising (print, TV, radio, direct), sponsorship of events, meet & greet with referrers, holiday gifts, website

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