JOURNALThe Medical BusinessThe Monthly Newsletter for the Informed Health Care Professional

Brought to you by the Medical Management Institute | June 2013 | Issue 5 Volume 4

mmiclasses.com

Inside this IssueCMS News Updates

If You Don’t Have Cataracts Now...You Will

How Do Your Claims Get Paid At Your Medical Practice?

Ophthalmology Checklist

Maximize Cash Flow & Reduce Tax Payments

Top Ten Tips to Improve Collections

Coding for Incomplete Colonoscopy

MMI Member Updates

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mmi news updates

Hospital Coding Conference in Atlanta, GABecome a Registered Hospital Coder!Please join us July 15-19 for our Hospital Coding Conference in Atlanta, GA, and become a Registered Hospital Coder (RHC)!

The first 3 days will cover Facility Coding (Inpatient & Outpatient), and the last two will cover Facility Billing. For more details, visit mmi-classes.com/collections/hospital-coding.

*Note: This conference will be recorded, so if you can’t make these dates you can purchase an online version and become certified upon passing the online exam!*

ICD-10-CM Certification ProgramCompletely OnlineEffective October 1, 2014, the ICD-9-CM code sets used by medical coders and billers to report health care diagnoses and procedures will be replaced with ICD-10 codes. ICD-10 will be a radical change, requiring extensive planning and training.

That is why the amazing instruction team at the Medical Management Institute has put together a fully customizable ICD-10-CM certification training program, completely online! This program even includes ‘Implementation Insurance,’ guaranteeing no additional charges for continuing education should ICD-10 not be implemented on October 1, 2014.

A complete training program is available for each of the following fields: Coder, Manager, Provider, Clinical Staff, Biller. Visit mmi-classes.com/collections/icd-10 for more details.

HIPAA Training For Your OfficeAre You In Compliance? $29.99 CourseHIPAA Privacy Rules require the adoption of specific practice policies to address patient privacy

issues. In addition, the Security Rules require you conduct a risk assessment and have written policies on handling protected patient information. In addition, both rules require annual and ongoing training efforts for all physicians and staff.

This 30 minute video offers real world examples and provides flash cards to aid in preparing for the final exam. Your employees can access it through any web browser.

Course features: • Video & webinar instruction in the basics of both

the Privacy & Security Rules• Real world examples of breaches & how to avoid

them• Copy of the HHS & Office of Civil Rights HIPAA

summary for easy access• Certificate of completion for each staff member• One year access to HIPAA trained instructors• HIPAA updates emailed to you for one year

Enroll online today by clicking here.

What’s Different About Hospital Coding?Learn What’s Different for $29.99!Are you thinking about adding hospital coding to your “coding tool kit”? This $29.99 course will give you a general overview of what’s different about hospital coding, as well as what it will take to become certified as a Registered Hospital Coder. Course features: • Completely online and work at your own pace• Complete instructor support via phone & email• Interactive learning tools to further engage the

user• Pre-recorded videos & online study material to

follow along with• Practice exams to test your knowledge

Enroll online today by clicking here.

MMI news updates

mmiclasses.com | info@mmiclasses.com | 866-892-2765

facebook.com/MMIfan | twitter.com/MMIclasses

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Administration Offers Consumers an Unprecedented Look at Hospital ChargesMay 08, 2013As part of the Obama administration’s work to make our health care system more affordable and accountable, Health and Human Services (HHS) Secretary Kathleen Sebelius announced a three-part initiative that for the first time gives consumers information on what hospitals charge. New data released today show significant variation across the country and within communities in what hospitals charge for common inpatient services. Also today, HHS made approximately $87 million available to states to enhance their rate review programs and further health care pricing transparency. In an example of how these data might be used, the Robert Wood Johnson Foundation (RWJF) is planning a data visualization challenge which will further the dissemination of these data to larger audiences.

Administration Announces $1 Billion Initiative to Launch Health Care Innovation AwardsMay 15, 2013Administration announces $1 billion initiative to launch Health Care Innovation Awards to provide better health care and lower costs

Health and Human Services Secretary Kathleen Sebelius today announced a nearly $1 billion initiative that will fund awards and evaluation to build on the Obama administration’s work to transform the health care system by delivering better care and lowering costs.   This second round of Health Care Innovation Awards will fund applicants that have a high likelihood of driving health care system transformation and delivering better outcomes.

CMS & Virginia Partner to Coordinate Care for Medicare-Medicaid EnrolleesMay 21, 2013On May 21, 2013, the Centers for Medicare & Medicaid Services (CMS) announced that the

Commonwealth of Virginia will partner with CMS to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience.  

Under the Demonstration, Virginia and CMS will contract with Medicare-Medicaid Plans to coordinate the delivery of and be accountable for covered Medicare and Medicaid services for participating Medicare-Medicaid enrollees.

Doctors & Hospitals Use of Health IT More Than Doubles Since 2012

May 22, 2013HHS Secretary Kathleen Sebelius announced that more than half of all doctors and other eligible providers have received Medicare or Medicaid incentive payments for adopting or meaningfully using electronic health records (EHRs).

HHS has met and exceeded its goal for 50 percent of doctor offices and 80 percent of eligible hospitals to have EHRs by the end of 2013.

Small Business Health Options Program Will Be Ready for Open Enrollment on October 1

May 31, 2013The Centers for Medicare & Medicaid Services (CMS) moved forward with the release of a final rule and the application that provides small employers with easy-to-understand access to health insurance options for their employees.

Trustees Report Shows Reduced Cost Growth, Longer Medicare Solvency

May 31, 2013The Medicare Trustees today projected that the trust fund that finances Medicare’s hospital insurance coverage will remain solvent until 2026, two years beyond what was projected in last year’s report.

cms news updates reprinted from cms.gov

CMS news updates

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f you don’t have cataracts now, you will...if you live long enough. Cataracts are not a “growth” or “film” growing over the eye, but rather a change in the clarity of the natural “crystalline lens” of the eye which is positioned immediately

behind the pupil. Even though cataracts can develop as a result of ocular trauma or from the use of a certain medication, cataract formation is typically part of the aging process and, most of the time, is a slow, progressive, painless process often taking years before compromising your vision.

And the latter is why cataracts are a serious concern to your well being. It can compromise your safety and the safety of others.

The earliest sign of the development of cataracts is generally not blurry vision, but rather glare from light projected toward the eyes. Driving in the direction of the sunrise or sunset, headlights from an on-coming car at night or sometimes even light shining towards you from the TV set in a darkened room are common causes of glare. You don’t think much about it at first, since the vision is still fairly clear. When sunlight and other lights are coming from behind you the vision seems nearly perfect.

The next signal that cataracts are progressing is generally more subtle. Everything seems to be a little “dimmer”. The discoloration and “clouding” of the lens cuts down on the light entering the eye. You may not make any correlation to cataracts “maturing,” but you may find yourself changing the light bulb in your reading lamp from 75 watts to a 100 watt bulb. More light on the page suddenly makes reading less difficult. Trying to function in low light situations, however, becomes much more difficult.

Finally you start to notice that things aren’t as clear. It’s harder to see the road signs and you may be unable to recognize who is entering the room until they get closer. Often times, merely changing glasses or contacts may improve the vision, not to 20/20, but to an acceptable level, and if so, cataract surgery may not be required.

But if the vision cannot be improved satisfactorily with a new optical prescription, then the only way may be to remove the cataract.

Cataract surgery is easier than ever before. You don’t have to be placed under general anesthesia.

You don’t have to stay overnight in the hospital, and you don’t have to remain immobile after completion of the surgery.

You merely go to the hospital or surgery center, have the surgery under local or topical anesthesia with mild sedation and go home immediately afterwards. Often the protective eye cover placed over the operated eye has an aperture to see through so that you can see out of the operated eye almost immediately.

During surgery, the cloudy and discolored lens is removed through a tiny incision and an artificial intraocular lens implant is inserted in its place. Traditionally this lens improves the clarity of distance objects so that only reading glasses may be needed for close work. However, there are now lenses available which can allow you to see more clearly for distance and near so that no glasses may be needed at all.

Now that longevity is increasing, more individuals will eventually benefit from cataract surgery.

The good news is that the procedure is generally painless with rapid recovery and virtually no down time. If you are starting to notice some glare, blurry vision, or more difficulty functioning in low light, now is the time to visit your eye care professional.

Dr. Marmer has been a medical advisor and on the board of The Myasthenia Gravis Foundation of Georgia. He is the past president of the Retinitis Pigmentosa Foundation (Atlanta Affiliate) and board member of the Foundation Fighting Blindness. He has a faculty appointment as Clinical Professor of Surgery at Morehouse School of Medicine, Atlanta, GA: Dr. Marmer has had the privilege of being the official team Ophthalmologist for the NBA Atlanta Hawks for over 30 years and was also selected as the IHL Atlanta Knights and the ABL Atlanta Glory team Ophthalmologist. He was selected as the ophthalmologist for the 1996 Olympics and the 1998 Maccabee Games held in Atlanta, Georgia.

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If You Don’t Have Cataracts Now...You WillRobert H. Marmer, M.D.

If you don’t have cataracts now...you will

5Ophthalmology Checklist

oding and documenting for Evaluation and Management Services is one of the most dreaded hills to climb as a new medical coder. As a bi l ler , mastering the

complexities is a requirement. It is also challenging for physicians. Physicians worry about ‘overcoding’. They also worry about not maximizing the revenue for the work they do. The standards for coding and documentation are a complex mix of rules and options that tend to encourage under billing or down coding. The emphasis on comparing your levels to the ‘norm’ or average for your specialty and the penalties make physicians wary of deviating from the average 99213 E&M code. Some physicians do not want to worry about all of the detailed nuances of what makes a level 3 versus a level 4, etc. They tend to code the E&M visit by ‘feel’.

I was recently working with a general ophthalmologist that was struggl ing to understand the E&M level that he could assign for a medical visit with a patient. The majority of his patients are glaucoma, cataract, diabetes and eye trauma patients. Because most of his patients are there for medical eye conditions, he normally bills the medical E&M codes for their visits. The checklist attached is what he uses to ‘verify’ that he indeed has a level 4 established patient visit for his patients. The section on History is applicable to almost every specialty with the “EYE” past medical history being replaced with the specialty area.

I know this physician well and have worked with him on his encounter forms and documentation for several years. Even with that background with him, it was still difficult to get him to understand the complexities of each of the levels. This led to the creation of the form below so that he can be sure, before selecting his favorite level 4 medical

E&M code that it qualifies as a level 4 visit for his established patients.

As with any checklist, there are some assumptions of ‘requirements’ in my checklist that were made to make it less confusing and may actually overstate the requirements. However, when simplifying (or streamlining) the E&M Level assessment process, being sure that you have

overstated the requirements typically is better than going into the many permutations that could end up making a visit qualify for a level. It is true that only 2 of the 3 areas of assessment levels [History, Exam , Medical Decision Making] need to be met to qualify for a level 4 visit. However, I find that it is easier to just make them absolutes for some physicians, where the documentation to support some of the Medical Decision Making , or assessment and plan might not be as strong as an auditor would like.

Take a look at this physician checklist, which my physician found easy to understand and gave him confidence when determining if he could charge a level 4. It is not intended to be the answer to auditing charts. It is one guideline to help a physician through the few minutes he has to document and indicate the level of an E&M visit.

Let me know how you t h i n k i t c o u l d b e improved or if you have other approaches that have worked for you. I look forward to your feedback.

Kathy Dyson, MMI Learning Director

Ophthalmology ChecklistKathy Dyson, MMI Learning Director

“The checklist attached is what he uses to ‘verify’ that he

indeed has a level 4 established patient visit for his

patients.”

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“Some physicians do not want to worry about all of the

detailed nuances...they tend to code the E&M visit

by ‘feel.’”

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'

Level'4'Established'Patient'visit'for'Ophthalmology'

History:'

Chief&Complaint&and&History&of&Present&Illness:&&Need$4$or$5$of$these:$$$

Quality''''' Location''' Duration''' ' Severity''

Timing'' Context'''' 'Modifying'factors''''Associated'S/S'

ROS:&&Need$2$or$MORE$of$these:$$$

Constitutional'''''''''''''ENT''''''''''''Eyes'''''''''''''''CardioVascular''''''''''''''''Skin/Breasts''''''''''''''Respiratory'

ENDO'''GI'''GU'''''Heme/Lymph''''MS'''''''Neuro'''''''''''Psych''''''''''''''Allergy/Immunology'

Past&Medical,&Family,&Social&History:&&Need$2$or$MORE$of$these:$$$

Past'Medical' ' 'Past'EYE'MEDICAL' Past'Family'History'

Social$History:$Need$at$least$1$of$these:$

''Smoking/Tobacco''' ' Alcohol' ' Drugs'''

Physical&Exam:''Need&all&eye&systems&checked'or'reason'why'not'indicated'

Test'visual'acuity'(Does'not'include'determination'of'refractive'error)'

Gross'visual'field'testing'by'confrontation'

Test'ocular'motility'including'primary'gaze'alignment'

Inspection'of'bulbar'and'palpebral'conjunctivae'

Examination'of'ocular'adnexae'including'lids'(eg,'ptosis'or'lagophthalmos),'lacrimal'glands,'lacrimal'drainage,'orbits'

and'preauricular'lymph'nodes'

Examination'of'pupils'and'irises'including'shape,'direct'and'consensual'reaction'(afferent'pupil),'size'(eg,'anisocoria)'and'morphology'

Slit'lamp'examination'of'the'corneas'including'epithelium,'stroma,'endothelium,'and'tear'film'

Slit'lamp'examination'of'the'anterior'chambers'including'depth,'cells,'and'flare'

Slit'lamp'examination'of'the'lenses'including'clarity,'anterior'and'posterior'capsule,'cortex,'and'nucleus'

Measurement'of'intraocular'pressures'(except'in'children'and'patients'with'trauma'or'infectious'disease)'

Ophthalmoscopic'examination'through'dilated'pupils'(unless'contraindicated)'of'

Optic'discs'including'size,'C/D'ratio,'appearance'(eg,'atrophy,'cupping,'tumor'elevation)'and'nerve'fiber'layer'

Posterior'segments'including'retina'and'vessels'(eg,'exudates'and'hemorrhages)'

Ophthalmology Checklist

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AND&need:&&BOTH'' Orientation'to'time,'place'and'person'''Mood'and'affect''

'

Medical&decision&making'–'[2'of'3'categories]'

First&Category:&&Number&of&treatments&options:&

='NEED'AS'MANY'DIAGNOSIS'AS'POSSIBLE!''[3'Dx'minimum'for'level'4]'

OR'[all'of'these]'

='Managing&Prescription&Drugs:''MUST'SPECIFY'DRUG'and'NO'CHANGE'TO'DOSAGE'or'CHANGE'TO'DOSAGE'

AND'

Patient'education'conducted'and'documented[topics'specified]'

AND'

Conservative'measures'such'as'rest/ice/washing'eyes'–'changes'to'routine'or'management'of'problem'

Second&&Category:&&Number&of&treatments&options''

Independent'interpretation'of'a'test,'(Optic'Nerve,'Fundus'Photography'or'Visual'Field,'etc.)'–'Need&3&for&Level&4'

Third&Category:&&&Risk&of&Complications,&Morbidity&and/or&Mortality:'

If'you'have:''

Prescription'Drug'Management''

'Minor'or'major'surgeries'or'Elective'major'surgery'

'OR''

Exacerbation'of'a'chronic'problem,'mild'or'severe'AND'

Acute'illness'with'systemic'symptoms''AND'' an'acute'complicated'injury'

'

'

VERIFY'THAT'THE'CHART'IS'SIGNED'AND'DATED'by'the'Physician' Verify'that'the'patient’s'Name'and'the'date'of'visit'is'clearly'documented'

Indicate'the'level'of'visit'at'the'end'of'the'chart'or'dictation'

Ophthalmology Checklist

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ost segregation is a powerful tax planning tool for those who own their building or pay for their own improvements. This approach, used to accelerate depreciation deductions, can

result in significant tax deferrals and increased cash flow.

A cost segregation study is based on a detailed engineering analysis that is used to support the acceleration of depreciation deductions. This process identifies all costs within a property that qualify for faster depreciation. On average, a study performed for a medical building will allocate 40-60% of the depreciable cost basis to 5- and/or 15-year recovery periods. For every $100,000 moved from 39- or 27.5-year, approximately $28,000 in 10-year net present value (NPV) savings can be achieved.

Asset ManagementAn asset management study is a cost segregation study that focuses on detailing the assets. The idea is to provide a sufficient level of detail so that you can support the disposal of each asset when it is removed or replaced. This becomes critical when scheduled renovations are imminent. Now the IRS has temporary regulations that allow you to deduct even structural c o m p o n e n t o f y o u r building, provided you have the necessary detail.

Does My Property Qualify?Properties acquired, constructed, or renovated as far back as 1987 are eligible for savings—with no need to

amend returns. Medical buildings, for-profit hospitals, dental offices, urgent care centers, imaging centers, senior living facilities, and veterinary clinics are just some of the property types which may benefit.

An ExampleTo illustrate the impact, an owner of a four-story medical office building that was built for $6M and

placed in service in June 2004 had a CSS performed. The building has a total gross area

of approximately 50,800 square feet, located on a 3.26-acre site with an additional remote parking area constructed on a 2.7-acre site.

The CSS rescheduled $1.962 million, or 32.7 percent, of the assets to 5- and 15-year property. As a result, the property owner

saved over $425,000 in tax payments for the current tax year.

It is important to note that a cost segregation study does not increase depreciation, it accelerates it. The bottom-line is the taxpayer benefits from having more cash in hand now that can be put to work in other ways. A dollar today is worth much m o r e than it will be 10 years from now.

It’s the taxpayer’s money; can you think of any reason not to go after it?

Getting StartedFor more information, visit

www.bedfordteam.com or contact Debbie Rodkin at drodkin@bedfordteam.com or

678.204.4770 to request a complimentary estimate of benefits today.

Maximize Cash Flow & Reduce Tax Payments

Keep Money In Your Pocket, Don’t Pay the IRS | Debbie Rodkin

Maximize cash flow & reduce tax payments

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epending on whether you use American Medical Association (AMA)’s CPT® rules or Medicare’s rules for coding colonoscopies, the rules vary.

When reporting to Medicare, if the surgeon takes the scope past the splenic flexure, the colonoscopy is considered “complete” and reporting G0105 for Colorectal cancer screening (colonoscopy on individual at high risk) or G0121 for Colorectal cancer screening (colonoscopy on individual not meeting criteria for high risk, depending on the patient’s risk factors) with no modifier appended. In either case, Medicare will reimburse for the coded procedure.

Likewise, if the physician preps the patient for the screening but cannot take the scope past the splenic flexure due to obstruction, discomfort, or complication, CMS instructs modifier 53 is to be appended to indicate the procedural service was reduced, per transmittal AB-03-114, C 2822. Although per CPT, this modifier is to be appended when a physician elects to terminate a surgical or diagnostic procedure due to extenuating circumstances. Of course, the patient’s medical record must contain adequate information to support the incomplete procedure.

The transmittal further assures that, “...it is not appropriate to count the incomplete colonoscopy because that would preclude the beneficiary’s being able to obtain a covered completed colonoscopy.” This meaning that reporting an incomplete screening should not affect your ability to collect appropriate reimbursement for a subsequent complete exam as Medicare’s frequency limitations should not be triggered from an incomplete procedure. The transmittal concludes that if coverage conditions are met, Medicare pays for both the incompleted colonoscopy and the completed one whether the colonoscopy is screening in nature or diagnostic.

On the other hand, CPT instructs that, “...for an incomplete colonoscopy, with full preparation, use a colonoscopy code with modifier 52 for reduced services and provide documentation”. Modifier 52 is used to describe circumstances in which services provided were reduced in comparison to the full description of the service.

To insure appropriate reimbursement, consult your payer contracts and check with your third-party payers for their recommendations as some non-Medicare payers may follow CMS guidelines and some may adhere to CPT instructions.

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Coding for Incomplete ColonoscopyWhen how far you go depends on what you code

Coding for incomplete colonoscopy

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It’s a problem faced by virtually every business and medical practice – how to deal with patients who pay their bill late, or not at all.  While patients expect prompt and professional service, they don’t always meet the same standard when it comes to paying their bill.

Accounts not paid promptly can severely impact the cash flow of a practice.  A clearly defined and carefully communicated, yet diplomatic, payment policy, may help avoid difficult collections situations.

1. Have a defined Credit Policy

The first step is to clearly define when accounts are to be paid.   If patients are not informed that accounts are to be paid on time, chances are they will pay them late, or sometimes not at all.  Make sure that your payment terms and expectations are clearly stated in writing to each person.

2. Invoice promptly and send statements regularly

If your practice doesn’t systematically invoice and bill, start now. Many times bills aren’t paid simply because the patient hasn’t been billed or reminded in a timely manner. Monthly statements aren’t enough anymore. Each patient should be reminded at the least every two weeks.  The lack of accomplishing this often occurs in smaller or newer practices where there isn’t enough staff to handle the invoicing and billing properly.  If staffing or the cost of regular systematic, frequent follow-up is an issue in your case, help is available to get it done in a economical manner.  With our economy today, there is no replacement for getting this done one way or another.

3. Use “Address Service Requested”

One of the most difficult collection problems is tracking down a patient who has “skipped” — or moved without informing your practice of the new address. The U.S. Postal Service has a procedure to address this situation. Any statement or correspondence sent from your office should have the words “ADDRESS SERVICE REQUESTED” printed or stamped on the envelope, just below your return address in the upper left hand corner.

If a statement or invoice is sent to a patient who has moved and the words “ADDRESS SERVICE REQUESTED” appear on the business’s envelope, the Post Office will research this information. If they can locate a change of address for that person, they will send you business Form #3547 with the correct new address for a small fee.  This can help keep your address file up to date and eliminate many of your items being returned marked “Forwarding Order Expired,” and leaving you (and your A/R) in the lurch.

4. Contact Overdue Accounts More Frequently

No law says your practice can contact a patient only once a month.  The old adage, “The squeaky wheel gets the grease” has a great deal of merit when it comes to collecting slow pay and delinquent accounts. Contacting late payers every 7-14 days will enable you to diplomatically remind the patient of your terms of payment.

If recent economic conditions have made it impossible, due to reduced or inadequate staffing levels, to make contacts that frequently, never fear.  What used to be a benefit that only the largest practices could afford, there are now VERY inexpensive services available that will do the contacting for you, in your name. This accomplishes the level of frequency you need, without spending more money (often even less) than it would cost you to do the contacting in-house.

5. Use your aging sheet, not your feelings

Many practices (or some well-meaning people on their staff) have let an account age beyond the point of ever being collected because he or she “felt” the patient would pay eventually, and did not want to offend or alienate them.  While there are certainly isolated cases of unusual situations, the truth is that if your practice is not being paid, someone else probably is.   So stick with your systematic plan of following-up on slow pay and delinquent accounts.   If it is done systematically and early in the process, it will soon be apparent who intends to really pay and who doesn’t.  Appropriate action can and should be taken once you know where your practice stands.

Top 10 Tips to Improve CollectionsDavid Wiener, “Mr Cash Flow”

Top 10 tips to improve collections

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6. Make sure your staff is well trained

Even “experienced” staff members can sometimes become jaded when dealing with past-due accounts.  This usually happens when the patient has made and broken promises for payment.  Make sure the staff is firm, yet courteous when dealing with them.  Your practice’s collection staff may benefit from customer service training because, in effect, they must “sell” your patient on the idea that your practice expects to be paid.  Make sure that your staff is trained to not only bring the account current, but to also maintain good will.

7. Admit and correct any mistakes on your part

Sometimes patients don’t pay your bill because they think your practice has made a billing error.  If that is the case, quickly admit it and correct the error.  Generally, patients realize that mistakes happen sometimes in business.  Unfortunately, some patients believe that the doctor “doesn’t need the money.”  Denying an obvious error on your part only feeds the fire of resentment your patients already feel.

8. Ensure you are compliant with federal, state and local laws

Collections, both in-house and outsourced, are governed by federal, state, and local laws and regulations.  In many cases, medical practices are governed by the same laws as are collection agencies.   Ignorance of the laws and regulations that govern your activity is never an excuse, nor a defense, for breaking them.  For example: Calling to collect on an account at an odd hour or disclosing to a third party that a person owes your practice money are just a couple of the collection practices that can cause serious repercussions.  Become familiar with the Fair Debt Collection Practices Act, the Telephone Consumer Protection Act, HIPAA and any state and local regulations pertaining to your location, or partner with someone who can help you remain compliant.

9. Use a third party earlier in the process

Most practices have trouble keeping up with laws regarding contacting customers/patients regarding their accounts.  Even if they can stay informed enough to ensure their compliance, the additional challenges that the regulations cause means that tactics must change.   In order to collect the accounts, more frequent contacts are necessary (see tip #4).   In a difficult economy, most businesses/practices can not afford to hire the additional staff necessary to effectively and systematically collect before accounts age to oblivion.

Services are available that will accomplish the “in-house” follow up necessary to collect accounts early, while ensuring complete compliance to privacy and collection laws.  These services, like Transworld Systems Accelerator, can actually save the business/practice the internal expenses of doing their own follow-up at avery reasonable price, and without alienating customers/patients.

By the time an account reaches 60-90 days past due, the customer/patient is sending a message.  They either do not intend to pay, or are waiting to see what the business/practice will do to demonstrate their commitment to getting the account paid.   At that point, a third party can motivate a customer/patient to pay in ways that the business/practice cannot, simply because the demand for payment is coming for someone other than your business/practice.  Avoid paying a percentage to a contingency collection agency, using small claims court or hiring an attorney by using a flat-fee collection service such as Transworld Systems Profit Recovery. Using Transworld Systems Profit Recovery can save your business/practice both time and money, without having to pay a high percentage of any money collected.

10. Remember that nobody collects every account

Even with a carefully designed and implemented plan for follow-up and collections, there are a few accounts that will never be collected.  Save your business/practice time and money by identifying these accounts early in the process.  At the same time, your business/practice will benefit from the improved cash flow from the vast majority of accounts that do pay.

Developing and implementing a sound collections policy and strategy is a vital part of running a successful business or medical/dental practice.  Follow these 10 Tips, and watch your business/practice thrive while retaining a good professional relationship with your customers and patients.

David Wiener, known as “Mr Cash Flow” is a speaker, educator, and consultant working with medical

and dental practices across the United States, helping make their

practices more efficient and profitable. His blog, Mr Cash Flow’s

Tips and Tricks provides practical solutions for practice optimization.

It can be found at http://mrcashflowblog.com. To receive a

free, personalized A/R strategy session via phone, contact him at

888-780-1333

Top 10 tips to improve collections

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What happens when the back office doesn’t tell the front office what mistakes they are making? De ja vue! You begin to see the same mistakes over and over again while the practice misses revenue when the billing staff doesn’t correct and resubmit the denied claim. If the staff doesn’t know the problem, it is impossible to correct it, learn from it, and never do it again. In this industry constant education is required to be successful. If one doesn’t stay current with coding additions and changes, this can lead to misuse of modifiers and even inaccurate level assignment.

The best examples to learn from can be found on your denial report. Why was the claim denied? What is the payer rule? Can it be resubmitted? How? Then…do it!

Work the denials and follow throughConsider the denial list the to-do list. When items show up, each must be researched fully and either resubmitted or filed away. Whatever the outcome – work the list; the fewer the items, the better in this case. Look for patterns and areas of opportunities for training or at minimum a memo to either the clinical or administrative staff…or both.

Catch potential problems from the time the patient walks in the door.Don’t just copy the patient’s personal and insurance information. Obtain a copy of the most current insurance card at the time of service and verify benefits each and every time. By making a copy, it can serve as a back-up to incorrectly recorded policy numbers, failed authorizations, misspellings/typos in the patient’s name, address or other personal information.

Subtle changes in the way your front desk asks for information can make a world of difference. Ensure your clinical staff understands the importance of complete documentation.

You can have everything coded and documented correctly, but if the claim is sent the wrong payer or with the wrong information, it simply will not be paid.

Know your modifiersCommon mix-ups are 51 and 59; 52 and 53...The mix could be due to poor documentation or lack of regular training.

Don’t fear change. If you do, you’re in the wrong business.It is not wise to ignore coding changes. You can be leaving money on the table if you don’t have access to the latest code changes and someone who keeps up with them. If you don’t have someone on it all the time, you could lose six months of revenue before the change is discovered, or be mis-reporting something that changed two months ago.

DocumentationWe all know the old, tired adage; “If it wasn’t documented it didn’t happen.” Or as I like to say; “If it wasn’t documented, you can’t bill for it”. Super caution can seriously cost the doc his/her business. When clinical staff does not document accurately enough, the office misses out on potential payments for services that were actually provided.

Sometimes clinical staff lacks the understanding of what is important to the coders and billers. You don’t want to be the family care doc that doesn’t note additional orders for tests provided by your nurse, or the ortho that doesn’t distinguish between a paper report or an x-ray, or the physician that doesn’t document the request for an assistant to remove stitches. All of these things can affect your reimbursement and should be documented.

It would be much easier if each patient’s condition mimicked that of each and every procedure and diagnosis code, but unfortunately each patient is a unique snowflake and each visit is comprised of one or a myriad of different codes; some that are to be reported individually, some that are encompassed within another, some that can only be reported with another, and so on.

This is why documentation is so important. The picture must be complete in order to maximize reimbursement for what was actually done and to make that medical necessity “link” between the procedures performed and the diagnosis.

Be on the LookoutLatest Audit Trigger: Docs are overcoding because they are filling out standard EMR templates which is allowing the system to auto-fill the data fields making it look like they are doing the exact same exam on every patient regardless of the reason for the visit. It has become quite an epidemic. Be aware and make sure this isn’t happening in your practice.

How Do Your Claims Get Paid At Your Medical Practice?Keep your staff engaged and informed to increase revenue

How do your claims get paid at your medical practice?

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Manager

Coder

Biller

Clinical Staff

Provider

ICD-10 Implementation

Planning

ICD-10 Doc Requirements

Assessment of ICD-10 Pre-Requisites

ICD-10 for Office

Managers

Office Readiness for ICD-10

ICD-10 Implementation

Planning

ICD-10 Doc Requirements

Advanced Anatomy & Physiology

Basic Coding for ICD-10

Specialty Coding for

ICD-10

Certification Exam

(Pre-Requisite: Registered

Medical Biller)

Advanced Anatomy & Physiology

Billing for ICD-10

Certification Exam

ICD-10 Doc Requirements

ICD-10 for Office Staff

(Pre-Requisite: Need to be licensed)

ICD-10 Doc Requirements

ICD-10 for Qualified Health

Care Professionals

Specialty Coding for

ICD-10

ICD-10-CM CERTIFIED

Your Guide to Becoming ICD-10-CM Certified Effective October 1, 2014, the ICD-9-CM code sets will be replaced with ICD-10 codes. ICD-10 will be a radical change, requiring extensive planning and training. MMI will be launching a fully customizable ICD-10-CM certification training program in the next coming months, which you can learn more about here: mmi-classes/collections/icd-10.

Your guide to certification is detailed below:

Hospital Coding ConferenceJuly 15-19, 2013 in Atlanta, GA

• Monday-Wednesday: Facility Coding, Inpatient & Outpatient

• Thursday-Friday: Facility Billing

For schedule & hotel accomodations, click here. Or call 866-892-2765.

Facility Coding•Role of Chargemaster in Coding• Identifying the Correct Principal

Diagnosis• Identifying Complications and Co-

Morbidities•Determining Present on Admission

Indicator•Using ICD-9 Volume 3•Using Facility Modifiers•Observation and Inpatient

Challenges

Facility Billing•Learn how to use UB-04•Proper reporting of Condition,

Occurrence and Value Codes•Role of Revenue Codes• Identifying Charging Errors and

Omissions•Procedure/Device Edits•Cycle Billing and Overlap of

Service Dates

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The Medical Business Journal is brought to you by the Medical Management Institute

The Medical Business Journal is a monthly source of up-to-date information on all issues affecting the healthcare industry. Its content ranges from medical coding and billing to healthcare reform legislature and beyond. The MBJ is not affiliated in any way with the Department of Health and Human Services, Medicare, or the Centers for Medicare and Medicaid Services. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting or other professional services, and is not a substitute for individualized expert assistance. The CPT codes, descriptors, and modifiers are copyrighted by the American Medical Association. For more information, please call MMI at 866-892-2765.

Editor in ChiefCarleigh Benscoter

ContributorsKathy DysonJennifer DonovanDavid WienerRobert H. MarmerDebbie Rodkin

Layout & DesignCarleigh Benscoter

MBJ

THE MONTHLY NEWSLETTER FOR THE INFORMED HEALTH CARE PROFESSIONAL

ISSUE 5 VOL. 4