Medical Solutions

VERIFY ! VERIFY! VERIFY! The new insurance enrollments spawned by the Affordable Care Act begin to go into effect in January. At about the same time, the rule regarding Medi-Cal eligibility will change; many people who may have previously been denied Medi-Cal benefits because their income was too high will now qualify. Physicians should monitor their patient mix to see if there is an increase in their Medi-Cal patients. The full impact of the Affordable Care Act on insurance ...companies is still unknown with the rates and timing of reimbursements still being worked out. Nevertheless, it is essential for physicians to remain vigil and determine who’s going to pay them, when, and how much. Compounding the uncertainty of 2014 is the future of the doc-fix, a law passed by Congress that allocates the money needed to ensure Medicare reimbursements to doctors is at least maintained. The current doc-fix expires Dec. 31, 2013. If it is not extended, Medicare providers could see cuts of as much as 27 percent. And lurking in the background is the possibility that commercial reimbursements would also be cut. If you need help working with payers or staying on top of your accounts receivable, give me a call at 916.452.6682. Or send an email to [email protected].

MAKE SURE ICD-10 IMPLEMENTATION IS IN YOUR 2014 BUDGET At the top of your list of New Year’s resolutions should be Prepare for ICD-10. ICD-10 represents a complete overhaul of the codes used for medical billing. All HIPPA entities are required to adopt the new, more complex codes which go into effect October 1, 2014. As physicians prepare their 2014 budgets they should be taking into account the costs associated with implementing ICD-10. Those costs could range from minimal... to significant depending on the size of the practice, the strength of the staff and the quality of the technology being used. Some of the issues physicians should consider include: -- Will your EMR software accommodate the complexity of ICD-10 or will you need to upgrade it? -- Will your billing software need to be upgraded? -- Do you plan on integrating EMR and billing or run them as separate entities? -- Are you tech-savvy enough to review your systems or will you need to hire a technology consultant to vet your options? -- Will the software you employ have any new use or maintenance fees that should be in your budget? Need help preparing for ICD-10? Medical Solutions has put together a team of experts that can assess your situation and give you a written plan for implementing the new codes. Give me a call at 916.452.6682 or send an email to [email protected].

TIME IS RIGHT FOR PHYSICIANS TO REVIEW THEIR FINANCIALS As the year draws to a close, it’s important for physicians to assess the health of their practices. The best starting point is probably taking a second look at your accounts receivables to make sure you are being paid fairly and in a timely manner and not allowing unpaid claims to drag on. Physicians should also thoroughly analyze their assets, insurance coverages and tax liabilities to ensure maximum profits. In add...ition to reviewing the past 12 months, this also an excellent time to look ahead. Physicians should update their business plans, making revisions based on events of the past year and your practice’s performance. Especially important is re-doing your financial goals and projections for the next three years. It is also prudent to analyze and consider negotiating new terms with your outside vendors such as telephones, office supplies and janitorial services. If you need help with your business plan or would like a second set of eyes to review your financials for missed opportunities, send an email to [email protected]. Or give me a call at 916.452.6682.

DESIGNATE A LEADER FOR ICD-10 IMPLEMENTATION As the holidays and flu season approach your practice is likely to be busier than any other time of year. But regardless of how busy you may be, you still need to find the time to begin preparing for the transition to the new ICD-10 codes. ICD-10 represents a complete overhaul of the medical billing system and beginning October 1, 2014 all HIPPA entities have to be in compliance. If you haven’t done so already, you really shoul...d begin to prepare for the change which will be complicated and time consuming. The first step is to designate an individual or a team (depending on the size of your practice) to lead and manage the implementation. Either you or the team leader should then educate the rest of the staff about ICD-10 what it means, who will be affected and how it will change the way you do billing. Once the staff is up to speed, the next step is to create an implementation plan with key milestone dates, deliverables and responsibilities. This is a crucial step because it will guide your efforts going forward. Check back with this blog regularly for tips on building an implementation plan. If you need help preparing for ICD-10 send an email to [email protected] or give me a call at 916.452.6682. -- Larry Poore

WHAT IRKS DOCTORS ABOUT THEIR PATIENTS In a recent blog we discussed problem patients and how physicians can deal with them. Now comes a survey that identifies the kinds of patient behaviors that physicians find the most annoying. The number one complaint doctors have about patients is their not arriving on time for their appointments; in a busy office one late appointment can throw off the entire day’s schedule. The other top-five complaints include patients that:... -- Ask office staff for help regarding things that have nothing to do with their health. -- Don’t admit to not taking their medications or not taking them as prescribed. -- Diagnose themselves and tell the doctor how to treat them. -- Begin asking questions just as the doctor has finished the exam. Some of these behaviors are just annoying, but others can impact the doctor’s ability to treat the patient properly. Sharing with new patients a written policy outlining what is expected of them can go a long way toward minimizing those behaviors. For additional tips on how to deal with annoying patients before they become problems send an email to [email protected] or give me a call at 916.452.6682. -- Larry Poore

IT'S OK TO DISMISS A PATIENT EVERY NOW AND THEN From a business standpoint, most physicians especially those just starting out focus on acquiring new patients in order to grow their practices. But regardless of whether your practice is new or well established there will be times when dismissing a patient is the right thing to do. Problem patients are relatively rare but can have a negative effect on your practice and on other patients. These individuals are usually gu...ilty of one or more of the following, each of which could be grounds for dismissal: -- Abusive behavior -- Non-compliance -- Missed appointments -- Non-payment of services Patients who are aggressive or verbally abusive can disrupt the office and make other patients in the waiting room feel uncomfortable. Some routinely miss appointments, taking time away from other patients and making it difficult to run the office smoothly. Still others fail to follow the regimen laid out by the doctor. Many physicians tolerate problem patients rather than dismiss them out of fear that they will be sued for malpractice. Those fears are unfounded. Your practice is a business and you have every right to do what’s best for it. You are on sound footing as long as you follow some basic guidelines. Remember that you can’t dismiss a patient who you are in the midst of treating. When the timing is right and you’ve made the decision to dismiss a patient you should give him or her two to four weeks notice so they can find another doctor. The patient should be told in person about your decision; it should also be put in writing. (The written version should not list the specific reasons for the dismissal.) You should also notify their insurance company so it can assist the patient in finding an alternative. (During the process you are required to continue to provide acute or emergency services.) Dismissing anyone can be very stressful. If you need help dealing with a problem patient, send an email to [email protected] or give me a call at 916.452.6682. Larry Poore

HOW TO MANAGE PATIENTS' EXPECTATIONS One of the keys to rewarding, long-term relationships with patients is clearly communicating what is expected of them. And the process begins with the very first office visit. Patient education is essential to maintaining long-term relationships with patients. Right at the outset even before examining the person -- you or a senior member of your staff should explain your office policies and procedures to the patient. That includes your r...ules regarding insurance and other forms of payment. Policies related to making, keeping and cancelling appointments should be detailed. And patients should understand that all conversations in the office are confidential and should be conducted in a civil, professional manner. It is also important that patients recognize they are expected to follow the doctor’s directions for care and take any prescribed medications as indicated. In order to ensure that new patients understand your protocols, they should be explained in person. The patient should also be given a written copy of the protocols after he/she has acknowledged and signed it. Taking a little extra care up front can avoid problems down the road. If you need help developing patient guidelines, send an email to [email protected] or give me a call at 916.452.6682. -- Larry Poore

NEW CODES WILL ADD TO BILLING COMPLEXITY All the publicity around ObamaCare has overshadowed another important milestone. This month begins the 12-month countdown to when ICD-10 codes will replace ICD-9 codes used to report medical diagnoses and procedures. (The deadline for all HIPPA entities to be in compliance is Oct. 1, 2014.) While codes may be updated each year, ICD-10 represents a complete overhaul of the system. Unlike ICD-9 codes which are mostly numeric with 3-5 cha...racters, ICD-10 codes are alphanumeric and contain 5-7 characters. ICD-9 is more than 30 years old and hasbecome outdated. For more details about why the change is being made, visit www.cms.gov/ICD10. Regardless of the size of your practice, ICD-10 will change the way you do business. And because of the new system’s complexities, now is the time to begin preparing for the transition. That includes working with vendors, payers and other business partners to ensure smooth transitions. It also means extensive training for coders. It is especially important to ensure your software vendor(s) are updating their systems to accommodate the new code sets. If you need help preparing for ICD-10 send an email to [email protected] or give me a call at 916.452.6682.

COVERED CALIFORNIA READY TO SERVE SMALL BUSINESSES While the debate over the Affordable Care Act continues in Washington, last week marked the start of open enrollment for small businesses and people who do not have health insurance through an employer. The law mandates that nearly all Americans have health insurance by January 1, 2014. Covered California’s (www.coveredca.com) Small Business Health Options Program is developing a marketplace specifically for businesses with ...fewer than 50 employees. SHOP will offer a range of plans from which to choose and will provide side-by-side comparisons of the plans. Businesses with fewer than 25 employees who are paid an average salary of less than $50,000 per year may be eligible for small-business tax credits up to 35 percent of premium costs. To qualify for tax credits insurance must be purchased through Covered California. Offering health benefits can be a great tool for attracting and retaining high quality employees but small businesses are not mandated to provide it. Businesses that choose not to provide insurance should encourage their staffs to get insurance through Covered California. If you have any questions about what the Affordable Care Act means to you, give me a call at 916.452.6682 or send an email to [email protected].

HEALTHCARE ACTIVITIES POPULAR ON MOBILE DEVICES Smart phones and tablets are becoming increasingly popular ways for consumers to access healthcare information. A recent survey by Manhattan Research showed that 75 million adult Americans use mobile phones for health-related activities, a year-over-year increase of 23 percent. And the number of people using tablet computers to access healthcare information nearly doubled, to 29 million. In today’s marketplace, having a mobile v...ersion of your web site is essential. It’s also an important component to being found in search engines. (Google punishes web sites that do not have mobile versions.) If you’re internet marketing strategy doesn’t include mobile devices you’re missing a significant opportunity to reach potential new patients; you may also be disappointing a number of your current patients. Medical Solutions recently expanded its services to include marketing support. If you need a mobile web site or want help assessing your current internet activities, give me a call at 916.452.6682. Or send an email to [email protected]. -- Larry Poore

OBAMACARE PUBLICITY HEATING UP With enrollment in ObamaCare set to begin October 1, publicity around the health insurance mandate is being ratcheted up. Covered California, the state’s marketplace for getting insurance through ObamaCare, is launching its advertising and marketing campaign this week. The campaign, designed to build awareness and educate consumers about ObamaCare, includes television, radio and digital ads, as well as social media and an expanded web site (www....coveredca.com). The television commercials are being tested in three markets this week, including Sacramento. One of the inaugural television ads introduces viewers to the mission of Covered California with a series of freeway and city signs directing them to the security that having health insurance coverage can bring. A second commercial shows common health scenarios that some Californians could face every day and reminds viewers that they are now eligible for health insurance. Covered California will spend $45 million on media between now and March 31, 2014. The extent of the advertising makes it likely that you will begin to get more and more questions from patients and prospective patients about ObamaCare. It’s a great opportunity to reinforce your commitment to your patients while positioning yourself to acquire new patients who may be getting insurance for the first time. If you have any questions about what ObamaCare means to you and your patients --send an email to [email protected] or give me a call at 916.452.6682. -- Larry Poore

12 INSURANCE COMPANIES PARTICIPATING IN OBAMACARE With enrollment in the new ObamaCare healthcare insurance plans set to begin October 1, Covered California, the marketplace for the state’s Health Exchange, has released the names of the insurance companies that have agreed to participate in the newly created health benefit exchange. Twelve health insurance companies will offer coverage to individuals; six of those companies will also offer plans through the exchange’s Small ...Business Health Options Program (SHOP). The following companies will offer plans to individuals: Alameda Alliance for Health, Anthem Blue Cross of California, Blue Shield of California, Chinese Community Health Plan, Contra Costa Health Plan, Health Net, Kaiser Permanente, L.A. Care Health Plan, Molina Healthcare, Sharp Health Plan, Valley Health Plan, Western Health Advantage. (The ones most likely to serve the Sacramento region include Anthem, Blue Shield, Health Net, Kaiser, Molina and Western Health.) The companies that will be offering health plans to small businesses are: Blue Shield of California, Chinese Community Health Plan, Health Net, Kaiser Permanente, Sharp Health Plan, Western Health Advantage. There is still a lot of uncertainty about how ObamaCare will affect the medical industry and the economy in general. Before accepting too many new patients who have gotten insurance through Covered California it would be prudent to verify how well the claims and payment processes are working for each payer. If you have any questions about preparing for ObamaCare send an email to [email protected] or give me a call at 916.452.6682. -- Larry Poore