Monday Sep 18, 2017
As I announced in June, the Centers for Medicare & Medicaid Services plans to issue new Medicare identification cards that no longer carry Social Security numbers as a way to prevent fraud and fight identity theft. Last week, CMS unveiled the new cards.
Posted at 02:45PM Sep 18, 2017
by Kent Moore
Friday Sep 01, 2017
Physician offices in the U.S. have cut visit wait times for patients by five minutes in the past year, according to a new survey.
Posted at 10:45AM Sep 01, 2017
by David Twiddy
Wednesday Aug 23, 2017
Physicians who have been confused or concerned about health plans wanting to use virtual credit cards to pay them for patient care are learning they have more say in the matter than they thought.
Posted at 04:14PM Aug 23, 2017
by Kent Moore
Tuesday Mar 14, 2017
The 2016-2017 influenza season is winding down, and hopefully you have used up all your influenza vaccine supply. Right?
As a former office manager, I realize that answer is probably no, and you actually have a lot of leftovers. An essential part of running a medical practice is using your electronic health record or billing system to find the correct number. Determining the amount of flu vaccines you billed over the past two or three flu seasons should help you estimate the number you should order for the 2017-2018 season. Be sure to take into account if your patient panel has grown or decreased. Not only will you be better prepared for the next season but also you can take advantage now of the prebooking options offered by various vaccine manufacturers and distributors.
Prebooking is when you turn in your vaccine order for the upcoming flu season order in advance, typically by the end of March. Admittedly, it is difficult to manage this number effectively because you are doing it an average of five to six months ahead of when you will need the vaccine in your clinic. The manufacturers and distributors have programs available that can help you manage your inventory as well as keep your costs down. Some prebooking programs have matrixes to help determine the number of vaccines to order, staggered shipping, order forgiveness, and volume discounts. These factors can lead to diminished costs, which, of course, can lead to greater profit margins.
You are encouraged to contact the major manufacturers and distributors directly to see what their individual prebooking programs offer. These will vary based on your practice size, patient panels, and volume discounts. Here is contact information for some of the manufacturers:
• Sanofi Pasteur (www.VaccineShoppe.com(www.VaccineShoppe.com)) 800-822-2463
• GlaxoSmithKline (www.gskdirect.com(www.gskdirect.com)) 866-475-8222
• Seqirus (www.flu.seqirus.com(www.flu.seqirus.com)) 855-358-8966
• Protein Sciences (www.flublok.com(www.flublok.com)) 203-686-0800
– Barbie Hays, CPC, CPMA, CPC-I, CEMC, Coding and Compliance Strategist for the American Academy of Family Physicians
Posted at 06:27PM Mar 14, 2017
by David Twiddy
Friday Dec 16, 2016
Update: After this blog item was originally posted, the DEA announced that it had reversed its decisions to eliminate a second registration renewal notice to prescribing physicians and eliminate the grace period for renewals after Jan. 1. Instead, the DEA said it would retain its current policies and procedures for renewing DEA registration although registrants will now receive the second renewal notification at the email address associated with their registration instead of through the mail.
There are many moving parts to practicing as a family physician and one of those is being able to prescribe needed medications for your patients. That depends on having a valid, current registration with the U.S. Drug Enforcement Administration (DEA).
The DEA recently announced significant changes to its registration renewal process(www.deadiversion.usdoj.gov). Effective Jan. 1, the DEA is eliminating the informal grace period that the agency had previously allowed for registrants to renew their registrations. The DEA will send only one renewal notice to each registrant’s “mail to” address approximately 65 days before the expiration date; DEA will provide no other reminders to renew the DEA registration.
The DEA also advises that physicians who fail to file a renewal application by midnight Eastern Standard Time of the expiration date will have their DEA number “retired” and have to apply for a new one. The agency also says after the expiration date physicians won’t be able to renew a DEA registration online and the DEA won’t accept paper renewal applications.
– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians
Posted at 01:24PM Dec 16, 2016
by David Twiddy
Thursday Jun 23, 2016
The Office for Civil Rights (OCR) within the U.S. Department of Health and Human Services recently addressed(www.hhs.gov) patients’ rights to access their protected health information (PHI) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Much of the guidance focuses on the fees that a covered entity, such as your practice, may charge patients requesting copies of their own PHI.
According to OCR, you can charge patients for:
1. labor costs (including preparation of an explanation or summary when agreed to by the individual)
2. supply costs related to the creation of either the electronic or paper copy (e.g., paper, toner, CD, or USB drive)
3. postage costs when the individual requests the information be mailed
The OCR guidance indicates that permissible labor costs may include only the labor “for creating and delivering the electronic or paper copy in the form and format requested or agreed upon by the individual, once the PHI that is responsive to the request has been identified, retrieved, or collected, compiled and/or collated, and is ready to be copied.” (Emphasis added) That means you cannot charge for reviewing the request or searching for and retrieving the information.
The OCR also emphasizes that you may not charge individuals for system maintenance, data storage and maintenance, or the administrative costs associated with outsourcing your office’s response to requests for PHI. OCR further notes that if you use systems that allow individuals to access their PHI through electronic health record technology, you may not charge labor or supply costs.
The OCR guidance says that when calculating the fees you charge, they may reflect your actual costs, your average costs, or a flat fee. If using actual costs, they must be reasonable and calculated upon each request. OCR says that you can charge average costs as a standard rate (e.g., a per-page fee if you maintain the requested PHI in paper form and the individual requests a paper copy). The OCR adds that “per page fees are not permitted for paper or electronic copies of PHI maintained electronically.” Finally, you can charge a flat fee but only for electronic copies of electronically maintained PHI, and the flat fee cannot exceed $6.50.
Regardless of the fee method used, you must notify individuals in advance of any fees that could be charged for their requests for PHI at the time the details of the request are being arranged. Failure to provide such notice could potentially be a HIPAA violation.
If a patient requests that you send their PHI to a third party, you must treat that request the same under HIPAA as if the patient were requesting it be sent to them directly. However, if a third party initiates the request for PHI, the limitations on copying fees do not apply. So, you should ask whether the request was a direction from the patient or a request from a third party.
Finally, the OCR guidance discusses the relationship between HIPAA and state law. Specifically, when it comes to an individual's right to access his or her own PHI, HIPAA trumps state law if HIPAA provides individuals with greater access to their PHI. That means if your state law allows you to charge higher fees or to limit an individual’s access, HIPAA will preempt that state law.
Needless to say, now may be a good time to review your policies and procedures for granting access to individuals’ PHI, including whether and how you charge for copies of that information.
Posted at 12:37PM Jun 23, 2016
by David Twiddy
Wednesday Mar 30, 2016
Almost 350 physicians, practice administrators, and other health care leaders met in Colorado Springs, Colo., March 20-22 for the inaugural Collaborate in Practice Conference, sponsored by the Medical Group Management Association (MGMA) and the American Medical Association.
The event was billed as a way to help practices better handle the many challenges facing medicine through better teamwork, leadership, and collaboration among physicians, other clinicians, managers, and other partners.
Halee Fischer-Wright, MD, president and CEO of MGMA, said that health care can’t just confront change but needs to control it or, better yet, lead the way.
Breakout sessions focused on such topics as making team meetings more effective, refining and reinforcing your practice’s culture, finding ways to give patients more access so they don’t gravitate to other providers, and increasing physician engagement to fend off burnout.
Some takeaways from the sessions:
• 71 percent of malpractice suits are tied to miscommunication and poor physician-patient relationships. Practices should focus on fighting dysfunction within teams, defusing toxic relationships that can affect patient care, and create the kind of supportive environment where patients are more likely to share their own personal or social issues that could influence treatment. – Monica Broome, MD
• All team meetings should have a specific purpose and goal. Meetings are a vital sign for your organization, and useless or unsuccessful meetings may reflect a structural problem within the practice. – Steven Bromer, MD
• Practice administrators or physician leaders will have more success changing clinician behavior by appealing to their mastery, autonomy, and sense of purpose. Framing a change simply as a response to regulatory requirements is not helpful. – Stephen Beeson, MD
• To increase patient satisfaction, have nurses call patients the day after a visit, which can either make a satisfied patient even happier or give a dissatisfied patient a chance to complain before it becomes more work for the practice; take advantage of the perceived connection between cleanliness and good care by keeping your office clean; make sure the receptionist always makes eye contact with the patient upon entering; and try to give patients the appointment times they want so you don’t run the risk of the patient showing up late and throwing off your entire schedule. – William Faber, MD
• Leaders should not feel the need to be perfect in all facets of leadership. Instead, they should lead with their strengths, such as execution or motivation, and rely on their team to make up for their weaknesses. – Wayne Guerra, MD
• When done correctly, incorporating health care information technology into your practice can improve patient engagement, physician workflow, and, ultimately, physician happiness. Introduce technology innovations slowly, aim for short-term gains, but ultimately lay the groundwork for big wins down the road. – Lyle Berkowitz, MD
Posted at 09:50AM Mar 30, 2016
by David Twiddy
Friday Dec 04, 2015
of Florida Department of Community Health and Family Medicine has won this
year’s Family Practice Management Award for Practice Improvement. The
department was presented with the award Friday during the Society of Teachers
of Family Medicine Conference on Practice Improvement being held in Dallas,
Editorial Advisory Board member Kenny Lin MD, MPH, presented the award to the department’s
program director, Peter Carek, MD.
The program was
recognized for its inpatient readmission project that addressed high rates of
readmission to the university hospital after discharge. A team that included
family medicine physicians, emergency medicine physicians, pharmacists, nurses,
social workers, and home health providers created and implemented a high-risk
patient discharge plan.
During the 10
weeks before the project started, the family medicine
inpatient service's readmission rate averaged 23 percent. For the 20 weeks following
implementation of the project, the readmission rate decreased to 18 percent, an
absolute reduction of 5 percent and a relative reduction of 22 percent.
– Lindsey Hoover, assistant managing editor, Family Practice Management.
Posted at 02:27PM Dec 04, 2015
by David Twiddy
Friday Dec 05, 2014
A North Carolina primary care clinic has won this year’s Family Practice Management Award for Practice Improvement.
Carolina Medical Center-Elizabeth Family Medicine(www.carolinashealthcare.org), based in Charlotte, was named winner Friday during the Society of Teachers of Family Medicine Conference on Practice Improvement being held in Tampa, Fla.
FPM Medical Editor Kenneth Adler, MD, MMM, presented the award to the clinic’s medical director, M. Quentin Fité, MD.The clinic was recognized for using LEAN efficiency principles over several years to dramatically improve patient satisfaction scores, appropriate care metrics, patient visits, and overhead costs, as well as standardize clinic processes and make more choices based on data rather than gut decisions.
LEAN, first developed by automobile manufacturers, is a systemic approach to improving efficiency by eliminating waste and understanding what parts of the operation create value for the patients and staff.
CMC-Elizabeth Family Medicine is part of the Carolinas HealthCare System and primary ambulatory clinic for CMC’s family medicine residency program. The clinic handles about 25,000 patient visits a year with more than half of its payer mix made up of Medicare and Medicaid patients.
Posted at 12:39PM Dec 05, 2014
by David Twiddy
Tuesday Oct 07, 2014
Physicians are spending more for staff that support the business side of their practices, according to a new survey.
Respondents reported a 4.6 percent increase in spending compared with last year on total business operations staff for each full-time equivalent (FTE) physician. The Medical Group Management Association’s (MGMA) 2014 Cost Survey(www.mgma.com) said multispecialty practices spent a median of $52,009 per FTE on business operations staff. That includes general administration, information technology, accounting, and managed care administrative employees.
Family physicians spent a median of $32,772 per FTE. That's a 17 percent increase from the previous year, but MGMA cautioned that only a third of family physicians taking the survey provided information on this question. The organization noted that business administrative staff costs for family physicians rose 4.59 percent between 2009-2013.
MGMA didn’t ascribe a specific reason for the increases, crediting everything from practices simply wanting to make themselves more efficient and business savvy to offices reacting to regulatory changes in the medical and insurance communities.
The survey involved 2,518 medical groups across the country, including 475 family medicine practices.
Posted at 10:31AM Oct 07, 2014
by David Twiddy
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