Newsletters

NJMGMA Newsletter

2015

Spring/2015

Table of Contents
 

  1. Welcome New NJMGMA Members


  2. Who Needs to be HIPAA Compliant?


  3. PMC2015


  4. How to Conduct an Effective In-House Collection Call


  5. Ban the Box


  6. Big Date Offers Practices Big Opportunity for Revenue Cycle Performance


  7. Hiring a New Doctor? Key Provisions for a Medical Practice to Include in Their Employment Agreements


  8. Surviving the Financial Pitfalls of Practicing Medicine in Today's Healthcare Arena


  9. ICD-10: Five Tips On How Your Bank Can Help


  10. Encouraging Small Practices to Preservere with ICD-10


  11. ACMPE Corner


  12. The Road to Being a Certified Patient-Centered Medical Home in Primary Care

 

 

Welcome New NJMGMA Members

NJMGMA would like to recognize and welcome our newest members:

GENERAL MEMBERS

Sharon Austino, South Cumberland Medical Associates
Carol Braun, Weisman Children's Rehabiliation Hospital
Grace Centurion, Dermatology Associates of Central NJ
Odette Cohen, Son Light Medical
Lisa Corblies, Ortho Center
John Craney, WJAA
Ivette Cuevas, Shrewsbury Diagnostic Imaging
Dean Curtis, Randolph Pain Relief & Wellness Center
Kathleen Demytrk, The Cardiovascular Care Group
Kira Feldman, Cedar Bridge Pediatrics
Donna Fitzpatrick, Steven A. Litz MD, F.A.C.A.
Raza Iqbal, Premier Medical Alliance, LLC
Nicole Lee, Monmouth Ocean Pulmonary Medicine
Lisa MacNair, Lake Forest Pediatric Associates
Martin Manzo, Atlantic Medicine & Wellness
Mary Anne Pajel-Sio, Willow Park Medical Group
John Pugh, Medicor Cardiology
Mitchell Richman, Advanced Orthopedics and Sports Medicine
Tammy Ringenary, M.J. Ackerman and Associates
Jamie Shombert, Institute for Personal Growth

AFFILIATE MEMBERS

Bill Algokce, Bridge Financial Group, LLC
Kelly Baur, Kareo
Jonathan Bergman, Vantage Unified Communications
Kathleen Carlyon, Crimson Medical Referrals/The Advisory Board
Rhone Carr, DocuVault Delaware Valley, LLC
Katie Claxton, HealthPort
Darren Crane, DLC Technology Solutions, Inc.
Corie Eisenberg, Chrysalis Digital
Nicole French, Acelleron Medical Products
Vishal Gandhi, ClinicSpectrum Inc.
Peter Hoglund, AEPG Wealth Strategies
Avi Koplowitz, DependaBill Medical Billing Solutions
Carleen Lombardi, ConnectOne Bank
Andrew Politi, Simon's Agency
Albert Rozell, InfoTech Innovators LLC
Nikhil Saha, Medical & Dental Billing Services, LLC
Michael Urban, Holon Solutions
 


Who needs to be HIPAA Compliant?

The HIPAA Security Rule applies to all health plans, healthcare clearinghouses, and to any healthcare provider who transmits protected health information (PHI) in electronic form, or electronic protected health information (ePHI). According to the U.S. Department of Health and Human Services, those that fall under this category are known and referred to as Covered Entities (CE).

The following is a more comprehensive list of who needs to be HIPAA compliant:

  • Covered healthcare providers (hospitals, clinics, regional health services, individual medical practitioners) that carry out transactions in electronic form
  • Healthcare clearinghouses
  • Health plans (including insurers, HMOs, Medicaid, Medicare prescription drug card sponsors, flexible spending accounts, public health authority, in addition to employers, schools or universities that collect, store or transmit ePHI, or electronic protected health information, to enroll employees or students in health plans)
  • Their business associates (including private sector vendors and third-party administrators)

Note: 'HIPAA certified' is not the same as 'HIPAA compliant.' No third party can make your organization HIPAA compliant. There is also no certification program recognized by the federal governing body of the HIPAA standard, the Department of Health and Human Services (HHS) and the Office of Civil Rights (OCR).  

Performing the required HIPAA Security Risk Analysis is a mandatory component toward HIPAA compliance. HIPAA violation penalties can be severe if your organization is found non-compliant as the result of an HHS-OCR audit. Whether for overall HIPAA-HITECH compliance or for meeting Meaningful Use requirements, completing a formal HIPAA Security Risk Analysis is necessary compliance step and requirement for both.

Author:  Al Rozell, President / CEO - InfoTech Innovators LLC
Certified Open Group Distinguished IT Specialist, HIPAA CHSP, PCI-DSS CPCIP

arozell@infotechinnovators.com  - 877-234-5511

InfoTech Innovators is a full service IT consulting firm that specializes in providing IT support services for healthcare providers and providing HIPAA Security Risk Assessment services. 


PMC2015

NJMGMA has put the final pieces into place for what promises to be an event you won't want to miss.  Building on the success of the past, this year's schedule focuses on core elements essential to a successful practice in today's healthcare environment while preparing you for what's ahead.

PMC2015, Focus on the Future, offers attendees two and a half days of essential education, paired with exciting networking events to mingle with our exhibitors and your peers.

Check out this year's conference schedule here and start planning to be at NJMGMA's PMC2015!

Reserve your spot and REGISTER TODAY!
(Member rate $299, Non-Member $499)

*Select the Preconference events you wish to attend during the registration process.  If you have already registered and would like to add a Preconference event to your experience please contact us at staff@njmgma.com.

Affiliate Members:  Your target audience will be at PMC2015 and so should you!  

Our Program is packed full of education, networking and fun!  And most importantly for our exhibitors, the fantastic floor plan and an agenda full of face to face exhibitor time puts your organization front and center with our attendees. 

CLICK HERE TO RESERVE ONE OF OUR LAST 3 BOOTHS TODAY!

(Member price $1950, Non-Member price $2100)

TO ENHANCE YOUR VISIBILITY, DON'T FORGET TO CHECK OUT OUR SPONSORSHIP OPPORTUNITIES! 

 


Please use code HNJMGMA when booking your freshly renovated room at the Tropicana Casino and Resort at the group rate of $69, 1-800-247-8767.
 


How to Conduct an Effective In-House Collection Call

So you have some patients who haven’t responded to bills and you feel the need to call them and resolve their balances.  How do you prepare for the calls and what should you say?  Here are excerpts from the training that is provided to professional collectors.

First, prepare yourself mentally to expect a successful outcome from your calls.  If you start with the attitude that you just need to get through these calls to check it off your “to do” list, you won’t have as successful an outcome as if you went in with the attitude that you were going to have productive conversations with patients and get most of them resolved.  Your attitude definitely controls what comes out of your mouth, so an expectation of success will come across in your speech and will therefore yield a greater amount of success. 

Having the money conversation is a 3 step process after your opening request to be paid.  “Mrs. Smith, I’m calling about your outstanding balance owed to our practice of $300.  I can take a credit card over the phone today to clear it up for you.”

The patient then responds with… {insert your favorite excuse here} and you start the 3 step process:

Empathize – Acknowledge what you just heard “I know how you feel, that happens sometimes”.  Acknowledging what they just said will make you more human and compassionate to them, helping you to build rapport.

Remind of the Obligation – “We provided services for you on ___ date and we’ve sent you ___ bills.”  This is designed to make them feel guilty that sufficient time has elapsed and that you are correct in asking to be paid.

Ask for the money again – “It’s my policy that balances are paid within 30 days of the first bill.  What type of credit card will you be using to take care of your balance?”

Now, if the patient says they can’t pay off the full amount today, respond with “How much are you short?” rather than “How much can you pay?”  While the difference is subtle, psychologically, the first phrase conveys an expectation that they can afford to pay most of the balance due while the second phrase conveys an expectation that you’re willing to accept a token, like $5 or $10.  Avoid questions that indicate that you’ll take whatever they offer.

Once they’ve agreed to pay a portion of the balance, don’t stop there.  Maintain control of the conversation and get a commitment for payment of the remainder or you’ll likely never see it.  “Can you pay off the remainder in 14 days?” Or, “Let’s set up a 2 month payment plan” or “how much time do you think you’ll need?”

If the conversation isn’t resulting in payment and the patient wants to discuss their personal problems further, you want to use a technique called Bridging.  Bridging is a technique that professional collectors use to help retain control of a call, acknowledging the human need, and moving the patient back to the business need.  Verbal bridges allow the collector to steer a debtor back to relevant topics if he or she loses focus or seems off on an unimportant tangent

Here are some examples:

  • “What’s most important is that we get you into a payment plan that keeps you out of collections without jeopardizing the needs of your family.”
  • “The real issue here is money; not so much an insurance issue, correct?”
  • “Let me answer you by saying that it is frustrating to get calls from a collection company. Now I’m willing to work with you on a payment plan that will work for both you and our office.”
  • “Another thing to remember is that we’re willing to work with you during this difficult time.”

 

If a patient is completely uncooperative in establishing a payment plan, then simply tell them, “I’m sorry I am unable to help you,” and realize that it’s time to use a third party because you’ve done all you can.  Sending more bills, warning letters etc. will just cost you more money and since patient A/R over 90 days old depreciates in recoverability at a rate of 15% per month*, holding onto it longer is very costly.

*Source: US Dept of Commerce Study

Karen Cooper, MBA
District Sales Manager
Transworld Systems Inc.
621 Shrewsbury Ave, Suite 252
Shrewsbury, NJ 07702
732-704-7626 x101
Karen.Cooper@transworldsystems.com
www.web.transworldsystems.com/kcooper
 


Ban The Box 

On August 11, 2014, Governor Christie signed the “Ban The Box” bill (S2124) which will require companies that employ 15 or more employees to interview job applicants first before asking them if they have ever been convicted of a crime. This includes job applications as well as during interviews leading up to a formal job offer.

In New Jersey though, employers can still run background checks on a qualified applicant before giving them a formal offer, which is not the case in some other jurisdictions. So as an employer, you do still have the ability to find out about their criminal record before offering them a spot on your team.

This new bill creates an exposure for employers that aren’t difficult to cover, but can’t be overlooked or brushed aside.

You can easily keep your company compliant by making sure you toss the old job applications that still have the checkbox for being convicted of a crime and replace them with the new applications. (Download them free at the end of this article)

By March, companies with 15 or more employees will additionally be prohibited from promoting on job postings that those with a criminal record will not be considered. So make sure your job postings (online and offline) are adjusted accordingly.

Be mindful during your interviews that if you inquire about an applicant’s criminal history during the initial screening process you can be fined if it’s reported.

Penalties for violations include civil penalties of $1,000 for the first violation, $5,000 for the second, and $10,000 for each violation after that.

Steps To Ensure Compliance:

  • Train anyone who might conduct a first interview on the new law, so they understand what they can and can’t ask.
  • Update job applications if they include questions about a candidate’s criminal history.

While you’re at it, now is a great time to take make sure the application includes:

  • Language around the Americans with Disabilities Act (ADA)
  • Verification of citizenship (I-9)
  • Permission for reference checks

A thorough job application is an important tool in the hiring process, it’s worth the time to make sure it’s perfect!

Balance Point Payroll Solutions


BIG DATA OFFERS PRACTICES BIG OPPORTUNITY FOR REVENUE CYCLE PERFORMANCE 

You’ve heard of big data and its potential to support better patient care and information sharing. But did you realize that all practices, whether independent physicians, large practices or hospital-owned enterprises, have a wealth of big data that holds potential for boosting revenue cycle performance and payoff? The opportunity to examine denial data to reveal key issues that can be translated into actionable items is yours already – no matter the systems you utilize, there is a way to capture, integrate, manipulate, illustrate and act.  Simply put, the variety, sophistication and accessibility of big data is transforming denial management, allowing physicians to see their performance on a granular level and to respond on target!               

Big data will fundamentally change the way we can look at denial information; to use this to our advantage, we must first shift our mindset.  Historically, offices have looked at charges/denials as individual events. However, big data will allow us to move beyond isolated concerns to detect the trends, commonalities and issues the types of denials represent, allowing assignment of protocols and fixes that will have predictive, widespread results categorically. This shift will positively affect denials exponentially. 

Every practice has the ability to use its big data as a powerful management tool now.  Here is a simplified plan of action:

  • Track denials - from manual billing to the most sophisticated combination of systems, your 835 remit data is available.
  • Build a methodology to pull data together – sort and prioritize like issues. 
  • Display/report – in a meaningful way, specific to your practice (by physician, department, location, service, codes, carrier, etc. by graphing, charting, listing, etc.)
  • Identify issues and trends – start by highlighting at least the top 3 issues.  Some examples could be credentialing, non-payable coding combinations or eligibility issues. Whatever your issues, they likely account for a disproportionate percentage of your unrealized income.
  • Evaluate – what do this data and these results mean? Research solution, seek expert advice or obtain training.
  • Action – results in enhanced denial management, tools, protocols. 

Imagine affecting change efficiently to hundreds or thousands of like issues with one learned fix or pulling 200 records for auditing risk management instead of 20,000 and getting more effective results.  Big data can simply make production more profitable, decision making more informed and management more focused. 

As healthcare professionals, your primary focus is on your patients, but big data will do more than enhance treatment for your practice.  Big data will support your most productive and prosperous practice and this will benefit everyone.     

Case Study 

Big data evaluation helped this organization understand their denials in a way that led to greater productivity and profitability. Learn from their experience with data capture, integration, manipulation, illustration and action. 

Physician Practice: Understanding operational gaps in the practice

Having been in practice for more than 20 years, a rural specialty surgeon whose practice was also licensed as an ambulatory surgical center (ASC) and lab facility, realized that his practice was not performing at the desired and expected level. With denial percentage rates hovering in the teens, he suspected that the lagging financial performance of the center was likely the result of challenges with one of his largest insurance payer.  In order to validate his suspicions, the surgeon engaged The Business Side for its Denial Analysis Report. 

Using big data from the ASC, it was quickly determined that 70% of denials resulted from his two top insurance carriers.  However, upon closer examination of the top five insurance carriers, a common set of clerical inconsistencies emerged, highlighting a need for improvement in the operational practices of the center.  Specifically, it was noted that three functions were primarily responsible for the majority of denials, those being coding, documentation, and patient eligibility.  Instead of denials emanating from the payers as the surgeon had thought, it became clear that the root of his issue lay with his front desk and coding staff.  Remediation of denials lay in revamping operational practices, retraining personnel, or potentially finding replacements. 

This analysis allowed the surgeon to use the big data already on hand to gain a true understanding of his ASC’s operations and to make adjustments in order to improve financial performance and operational efficiency. 

Brad Dugai
Director, The Business Side, Inc.


Hiring a New Doctor? Key Provisions for a Medical Practice to Include in Their Employment Agreements

For a medical practice, figuring out the appropriate contractual language to insert in an employment agreement could be overwhelming and tedious.  In order to make the process simpler, a practice should take the time to understand certain key employment provisions and have them inserted into the practice’s physician employment agreements.  This due diligence will save the practice time and assure the practice and it’s physician owners that they are protected from avoidable pitfalls, or at least assure that such pitfalls be ameliorated.  Since employment agreements initially tend to be weighted in favor of the party who prepares the initial draft, the practice should take advantage of the opportunity to prepare a user friendly and tightly constructed employment agreement.  The following are just a few of the key provisions that practices should consider incorporating into their employment agreements when hiring a new physician:

Termination.

Most medical practices include a “without cause” termination provision in the employment agreement.  “Without Cause” termination permits the practice to terminate the physician’s employment without stating a specific reason; therefore, if the practice is unhappy with the physician for whatever reason, or no reason, the practice can terminate the physician.  Although New Jersey is an employment “at will” state, most employment agreements for physicians provide that written notice shall be given prior to termination without cause on an agreed upon number of days, such as 30, 60, 90 days or longer.  When deciding on how many days a practice would prefer, the practice generally considers the time it will take to find a suitable replacement or how long the practice is willing to keep the physician employed (or pay for such employee) when the practice no longer wants to continue the employer-employee relationship.  Typically the right to terminate the employment agreement without cause and provide notice on an agreed upon number of days in advance thereof is made to be reciprocal.  Also, keep in mind that even if the employment agreement sets out a specific term, such as two years, the “without cause” termination provision essentially makes the real term whatever the “without cause” notification period is.  

A “for cause” termination provision should also be included. This will enable the practice to terminate the physician immediately (with or without written notice) upon the occurrence of one or more specific “for cause” events, like the physician’s: loss or suspension of medical license, certifications, or CDS or DEA registrations; failure to become timely board certified;  disability; failure to follow rules, regulations and bylaws of the offices and hospitals where services are performed; or failure to maintain privileges at the required hospitals.  The physician may request that he or she be given notice and a reasonable opportunity to cure for certain “for cause” events.  The practice should clearly review each of these and determine for which events they are willing to permit a cure. 

Malpractice Insurance.

A practice will typically provide for and pay for the physician’s professional liability insurance, which may be an occurrence based policy or a claims-made policy.  An occurrence based policy is a type of malpractice insurance that protects the physician and practice from any covered incident that “occurs” during the policy period, regardless of when the claim is filed.  A claims-made policy is an alternative type of malpractice insurance that provides coverage for claims only when BOTH the alleged incident AND the resulting claim happen during the period the policy is in force.  In the event the policy is a claims-made policy, the practice should stipulate who is responsible for payment of the tail insurance upon the physician’s separation from the practice.  It may be in the practice’s best interest to shift the burden of payment of tail insurance (or a portion thereof) to the physician.  Ultimately though, this is a negotiation point to be agreed upon by the parties.  Since occurrence based polices are more expensive than claims made policies, if the practice initially provides an occurrence-based policy for its physicians, it may want to reserve the right to change policies at its sole discretion during the term of the employment agreement.  

If the practice permits the physician to moonlight, the practice should make sure that the employment agreement provides that the physician is obligated to obtain and pay for (at his or her sole cost) separate professional liability insurance which covers such outside work.   

Restrictive Covenant.

Most practices include a restrictive covenant in their employment agreements to protect the practice from having their physicians compete against the practice by setting up a competing practice down the road or taking with them the practice’s patients, during employment or upon the physician’s termination.  A restrictive covenant seeks to prohibit the physician from practicing medicine or a specific specialty for a specified period of time in a specific geographical area upon the physician’s separation from the practice.  A restrictive covenant also typically includes a non-solicitation clause by which the physician is prohibited from soliciting former patients, employees, and referral sources for a certain time frame after his or her separation from the practice.  Most importantly, the agreement should also address the specific remedies for violating a restrictive covenant or non-solicitation clause.  One remedy that the practice could stipulate is that the practice be entitled to preliminary and permanent injunctive relief without having to prove actual damages or immediate or irreparable harm and an equitable accounting of all earnings, profits and other benefits received by the physician arising from such violation.  The practice can also include language that the violated restrictive covenant time-period be extended by a period of time equal to that period beginning with the commencement of any such violation and ending when such violation shall have been finally terminated in good faith.  An alternative remedy for the practice is to require the physician to pay specified monetary (or liquidated) damages if the physician breaches.  The specific amount of the monetary damage should be reasonably related to the potential harm.  It is recommended to consult and discuss with legal counsel specifics of a restrictive covenant, to ensure that it will be enforced to the maximum extent.  Also, please note that if the medical practice seeks monetary (liquidated) damages, a preliminary or permanent injunction most likely will not be able to be obtained.  

Indemnification.

Most practices include an indemnification provision which obligates the physician to reimburse the practice and hold the practice harmless from all liabilities, costs, and expenses that exceed the insurance coverage, which the practice may incur as a result of the physician’s acts or omissions, including court costs and attorneys’ fees, while the physician provided professional services under the employment agreement. 

In summary, the practice should take the time to understand at least the above key employment provisions, as well as other provisions that should be included in an effective physician employment agreement.  The engagement of an experienced attorney, who primarily represent medical practices, should be considered in order to protect the practice’s and it’s physician owner’s interests.

Michael F. Schaff is the chair of the Corporate and Healthcare Departments and shareholder of Wilentz, Goldman & Spitzer P.A.  Mr. Schaff lectures and publishes frequently on physician-related topics.  He is currently on the Advisory Board of BNA’s Health Law Reports and Chair of the Editorial Board of the New Jersey Lawyer Magazine.  Among his many accolades, Michael has been selected for inclusion in Best Lawyers in America, New Jersey Super Lawyers (Top 100 attorneys) and Chambers USA Top Attorneys (Tier 1, Healthcare). 

Lisa Gora is an associate in the Corporate and Healthcare Departments at Wilentz, Goldman & Spitzer, P.A.  She is a member of the Young Professionals Council of the American Health Lawyers Association and is also an active member of the New Jersey State Bar Association’s Health Law Section. 


Surviving the Financial Pitfalls of Practicing Medicine in Today's Healthcare Arena

Lower reimbursements, poor cash flow, especially at the start of the year (due to the high deductible of out and in-network policies as a result of a new product design by the carriers), higher medical practice costs, such as staff salaries, medical insurance  premiums and supplies, even inclement weather as we’ve had to endure this harsh winter – are just some of the constant concerns of our medical practice clients. These - in addition to the complaints about the implementation of EHR, which is distracting them from their focus on the patient and forcing them to capture medical data, slowing their number of patient encounters and negatively impacting cash flow - are challenges faced by the vast majority of medical practitioners today.

Our clients ask, “How can we handle all of these operational issues, including dealing with the co-regulatory issues that are becoming more and more complex?” Physicians must understand the rules and regulations dealing with billing issues, e.g., the Stark Law, the Codey Law, HIPAA, ICD 10, Meaningful Use, Phase II and a myriad of other compliance requirements.

Yes, the business of medicine calls for physicians not only to understand and perform at their highest efficiency and practice quality and cost effective medicine. They must also be innovative to inspire and motivate patients to be engaged in their own healthcare. In fact, the Affordable Care Act calls for patients to participate in their health decisions. Additionally, physicians must be aware of the latest technology along with the most advanced research within their specialty, in order to practice evidence- based medicine.

With so much of their time spent practicing and keeping current with new protocols and modalities in their fields, many have not established their personal or medical practice goals and objectives. They have not taken the time to develop a vision or strategy for the future. Sometimes, I hear, after the fact, that they have joined a mega group because their colleagues have done so. This even though they have not performed their own due diligence, which includes asking what happens if they are dissatisfied with the “new” corporate culture and finding out how they can  unwind.

Yes, there are many options our medical clients have, such as join an existing single specialty group, join an existing multi- specialty group, become a retainer or concierge practice, start a new single specialty group (presently, we are involved with practices in three specialties that are combining to form large single-specialty groups), sell to a national or public company (what many Anesthesia, Pain and Ambulatory Surgery Centers groups are doing in New Jersey) or become part of a hospital - physician alignment. Our firm has been involved in more than 25 alignments with New Jersey hospitals ranging from employment to Professional Service Models. We have educated and coached our clients based upon real life experiences, which has given physicians a greater insight and understanding of the complexity of hospital - physician alignments. By providing this knowledge and insight and also by working in collaboration with our clients’ healthcare attorneys, we have currently been able to create many successful alignments.

Presently, some of our clients are still unsure about how they want to proceed but they now have the tools and understanding to make an informed decision. This brings clarity, less anxiety and the ability to truly develop a strategy and business plan for the future. Many recognize that in order to be successful and stay independent, they have to meet the challenge head- on. Working with all of the stakeholders including partners, office administrators and their experienced healthcare advisors, physicians can develop a well-planned strategy. Many of our physician clients who want to remain independent have set these strategy meetings in  motion.

We recommend that during these meetings physicians should develop a strategic plan:

  • Outline your goals and objectives
  • Develop a vision as well as a mission statement
  • Develop an action plan with a timeline
  • Invest in your staff
  • Develop an organizational chart
  • Invest in informational technology (Data! Data! Data!)

Watchful Waiting is not an Option is our mantra to our physician   clients.

Additionally, if you are a specialty practice, part of your overall strategy should be to become recognized by the National Committee for Quality Assurance (NCQA) as a patient- centered specialty practice (PCSP), under its new innovative program for improving specialty care which maintains a set of standards that describe clear and specific criteria.

We believe the carriers recognize an efficient, cost effective, quality practice. Thus using your resources to become recognized by the NCQA program will lead to improved quality, the elimination of waste, improved coordination and patient outcomes and an excellent patient experience, which should result in an improved financial report card for your medial practice.

These are challenging times with little visibility. However, this is your opportunity. Do not fear it. Plan, strategize

Richard Maglin, CPA
Trinity Business Alliance
628 Shrewsbury Ave.
Red Bank, NJ  07701
732-707-1793
www.trinityba.com


ICD-10: Five Tips On How Your Bank Can Help

As healthcare providers across the nation prepare for the upcoming implementation of ICD-10, planning should factor in the financial impact on your practice. As you prepare for the conversion, the magnitude of the changes on your employees, your patients and your bottom line should not be underestimated. There are practical expenses – as well as potentially hidden costs – you should be planning for today.

These five tips will help you identify items you need to consider and actions you need to take in anticipation of expanding capital and increased cash flow flexibility that will affect your practice both before and following the October 2015 conversion. Like many aspects surrounding the transition, to be fully prepared, it is prudent to address finances three to six months in advance of October.

  1. Understand Capital Needs –The complexity of the ICD-10 implementation will require software upgrades and extensive staff training in advance of the conversion. Your bank can construct term loans to address these capital expenditures. 

  2. Arrange Working Capital – Understand the average time it takes today to collect receivables, and expect the average time to lengthen significantly as practitioners learn the new codes. To backstop a longer receivables cycle, you should have access to three to six months of working capital reserves. Although you cannot control whether your payers will be ready and whether they are fluent in the new codes, an expansion of your working capital line of credit will help your practice manage available cash reserves through a period of delayed receivables. In advance of the conversion, talk to your banker about how to obtain or increase an existing line of credit. 

  3. Before You Meet with Your Banker – Compiling essential documents before meeting with your bank will expedite the credit review and result in a fuller discussion of the practice’s financial needs. These documents should include tax returns for the prior three years for the practice and the principals, year-to-date interim financials, current Accounts Receivable Aging Report and an updated personal financial statement. 

  4. Work with a Bank that Understands Your Needs – As the healthcare industry becomes more complex, it is important to work with a bank that understands the specialized financing requirements of healthcare practitioners. Some banks have specialized units dedicated to the healthcare professional. A knowledgeable banking partner who understands the full scope of your industry and operation – from posting and managing your receivables to establishing loans and lines of credit – can design financing plans that anticipate your short- and long-term needs.
     
  5. Widen Your Cash Flow Window – Rather than writing checks to pay for monthly operating expenses, use a business credit card to stretch out payments. Some banks offer extended 50 day billing cycles which can provide additional cash flow flexibility. To avoid interest payments, pay your credit card bill in full each month.

Lisa M. Enright is a Senior Vice President and Manager of the HealthCare Practice Banking Division for RBS Citizens Financial Banking. She can be reached at (860) 440-4217 or at lisa.m.enright@rbscitizens.com .


Encouraging Small Practices to Persevere with ICD-10

Recent legislation has delayed the implementation of ICD-10 until October 1, 2015. Many payers, hospitals and large practices have already adapted their systems for ICD-10 and are continuing with implementation activities. This delay is a valuable opportunity to start looking at your clinical documentation and speaking with business partners about basic ICD-10 testing. 

Take small steps in preparing for ICD-10

One practical step that will not only help you in preparing for ICD-10 but also has benefits in ICD-9 coding environments is CDI, or Clinical Documentation Improvement. Payment is driven by medical necessity and improving clinical documentation will help to support this. 

With ICD-9, CDI can help to make patients’ medical records more meaningful and improve productivity by reducing coder queries. It can also help lay the foundation for a smoother transition to ICD-10. CDI for ICD- 10 means smarter documentation, not more documentation. Here are some tips to help start improving your documentation for both ICD-9 and ICD-10: 

  1. Select a coding “champion” for your office to help lead your documentation improvement efforts. 

  2. Review a cross-section of your medical records to identify and create a reference sheet of common or specialty-specific ICD-9 codes used in your practice. 

  3. Websites such as icd10data.com provide easy online access to the ICD-10 coding book. Check the site to see what your commonly-used or specialty-specific ICD-9 codes translate to in ICD-10. 

  4. Realistically, ICD-10 is not about having to remember thousands of ICD-10 codes. Most physicians use a limited set of diagnoses on a regular basis, especially specialty providers. Take advantage of tools offered by Centers for Medicare & Medicaid Services (CMS) such as Road to ICD-10. Based on specialty, practice size and vendors / payers you interact with, this tools gives an action plan and guidelines for keywords, commonly used codes and specialty-specific scenarios that can help include more detail in your clinical documentation. CMS’s Road to ICD-10 can be found at roadto10.org

  5. Work with your physicians and nurses to have them start including this increased level of detail in their clinical charts and notes. For star performers, have your coders start coding the ICD-10 code now. This will help to validate that you have enough supporting detail in your clinical documentation and prepare test data should you wish to test ICD-10 with your vendors, clearing houses or payers. 

Think about testing basic ICD-10 transactions

Horizon Healthcare Services, Inc. (“Horizon”) continues to work with our providers and business partners to help ensure that we will be fully compliant with all mandated requirements for ICD-10.

We are actively partnering with the vendors and clearing houses listed below for ICD-10 testing: 

Clearing Houses

Vendors

Emdeon

MedAssets

C & S Research

E4 Solutions

Gaffey

Relay Health

COBA

 

If you do not work with any of the business partners listed above, we encourage you to start speaking with your vendors and clearing houses about their ICD-10 readiness, their plans for ICD-10 testing and how they are able to support you in your preparations.

If you submit electronic claims through NaviNet, please note that this online tool is ready to support ICD-10 and will accept ICD-10 codes as mandated by CMS.

If you submit paper claims to Horizon, note that CMS has already released the CMS 1500 Claim Form (version 02/12) that was revised to accommodate ICD-10 codes. Paper claims with ICD-10 codes will be accepted by Horizon as mandated by CMS. 

Horizon’s Approach to coding for ICD-10

The tables below provide information about Horizon’s approach for using ICD-9 and ICD-10 codes for dates of service, or inpatient dates of discharge, before and after October 1, 2015:

Before October 1, 2015, for Date of Service or Inpatient Date of Discharge prior to 10/1/15:

Horizon will Accept

  • Prior authorizations or referrals with ICD-9 codes.1
  • Electronic or paper claims with ICD-9 codes.

ICD-9 codes may be submitted on a CMS 1500 (08/05) or a CMS 1500 (02/12) form.2

Horizon will NOT Accept

  • Prior authorizations or referrals with ICD-10 codes.1
  • Electronic or paper claims with ICD-10 codes.3

Before October 1, 2015, for Date of Service on or after 10/1/15:

Horizon will Accept

  • Prior authorizations or referrals with ICD-10 codes.1

Horizon will NOT Accept

  • Prior authorizations or referrals with ICD-9 codes.1

On and after October 1, 2015, for Date of Service or Inpatient Date of Discharge prior to 10/1/15:

Horizon will Accept

  • Prior authorizations or referrals with ICD-9 codes.1
  • Electronic or paper claims with ICD-9 codes.

ICD-9 codes may be submitted on a CMS 1500 (08/05) or a CMS 1500 (02/12) form.2

Horizon will NOT Accept

  • Prior authorizations or referrals with ICD-10 codes.1
  • Electronic or paper claims with ICD-10 codes.3

On and after October 1, 2015, for Date of Service or Inpatient Date of Discharge on or after 10/1/15:

Horizon will Accept

  • Prior authorizations or referrals with ICD-10 codes.1
  • Electronic or paper claims with ICD-10 codes.

ICD-10 codes may be submitted on either a CMS 1500 (08/05) or a CMS 1500 (02/12) form.2

  • Electronic batches of claims that include both claims with only ICD-9 codes, and claims with only ICD-10 codes (as appropriate based on the claim date of service/inpatient date of discharge).

Horizon will NOT Accept

  • Prior authorizations or referrals with ICD-9 codes.1
  • Electronic or paper claims with ICD-9 codes.3
  • Electronic or paper submissions that include both ICD-9 and ICD-10 codes on a single claim.3

1 Authorizations, referrals and referral fax-backs will display the ICD code as submitted by the provider.
2 CMS 1500 Form 08/05 supports entry of up to four diagnosis codes. CMS 1500 Form 02/12 supports entry of up to 12 diagnosis codes.
3 Rejected claims will need to be resubmitted to Horizon for payment with the appropriate ICD code/s. Providers should not bill the Horizon member until rejected ICD claims have been resubmitted and processed with the correct ICD code/s.

If you have questions about ICD-10, please e-mail ICD10Communications@HorizonBlue.com. For more information, please visit our website at HorizonBlue.com/Providers. Click on Provider Reference Materials, and then click on ICD-10

©2014 Horizon Healthcare Services, Inc. Three Penn Plaza East, Newark, New Jersey 07105


ACMPE Corner

The beginning of each New Year is a time for fresh starts, clean slates and New Year’s resolutions.  Why not make 2015 the year to invest in yourself?

Certification and Fellowship through MGMA is a great way to confirm your expertise in the medical practice management industry.  Not only do these recognitions affirm your professional competency, but they are recognized by physicians, healthcare executives, industry professionals, and your peers.

New Jersey has a rich history of industry professionals who have taken steps toward Certification and Fellowship.  There are currently 64 Nominees, 33 Certified members, and 13 Fellows who work or reside in this State.

CERTIFICATION

Taking the first step is simple.  To become Certified, you must have two year’ s experience as a practice manager with at least six months in a supervisory role.  You must be a member of National MGMA (See Special Note).  The next step is to make application for Certification which requires a $250 application fee and proof of your work history.  Completion of this process makes you eligible to be a Nominee.  As a Nominee, you work at your own pace to prepare for a 175-question objective exam, and a 3-essay question exam.  There are a number of helpful resources available to help you prepare including practice exams, study groups, and work books based on the Body of Knowledge.  Many of these resources are little to no cost. Additionally, there is no time limit on how long you have to sit for your exams once you become a Nominee.  It is designed to be a self- paced process.

Special Notice:  There is currently a program that is in place for this year where State members of MGMA can get their first year’s dues for MGMA National waived if they start the certification process.  The information can be found on the MGMA website at http://online.mgma.org/state-certification-toolkit.  This page should give you all of the information that you need to get started.

FELLOWSHIP

If you have already taken the step to Certification, then resolve this year to take the final step in your journey toward Fellowship.  Fellowship is the highest level of distinction in medical practice management.  There are many thousands of medical practice mangers around the country, but only a small percentage have attained the distinction of Fellowship.  Starting that journey is also simple.  A program application and fee of $250 will start the process.  The program requirements are to author one of three types of papers - exploratory, historical, or focus. This is such a dynamic time to be working in healthcare. There are endless opportunities for topics of interest to anyone working in healthcare.

Commit to making 2015 the year you keep your New Year’s Resolution to achieve Certification or Fellowship.

If you have questions or want to discuss the process further, please feel free to contact me.

Edward Gulko, FACMPE, FACHE
NJ ACMPE Forum Representative
egulko@premierpain.com
732-930-2447


The Road to Being a Certified Patient-Centered Medical Home in Primary Care

NJMGMA recently had an educational event on becoming a Patient Centered Medical Home (PCMH).  Over the next few newsletters, I would like to write about the process from a primary care practice perspective.  Yesterday I clicked the “submit” button on NCQA’s website which was the last step in submitting the PCMH survey.  This survey will get evaluated over the next 4 weeks, with the hope it will result in Certification.

Becoming a certified PCMH means you have shown your practice has guidelines, workflows, reporting abilities, and standards that meet a certain criteria.  Similar to standardized testing, this helps insurance companies and consumers evaluate your practice more objectively because proof needs to be shown of your “inner workings”.  Our practice decided to take this step to better leverage ourselves with insurance companies as well as to push ourselves a little harder to improve patient care.

Many practices already have the workflows and policies in place, but they may not be written down or formalized.  An example of a policy that is required is to have same-day appointments.  You may have certain slots in your schedule for same-day appointments, but do you have a written policy that enforces it or instructs new employees about it?  If you do, that’s one less policy you need to create to qualify as a PCMH.

For this introductory article, I will simply list a few questions that I encourage you to ask yourself and physician leader(s) in deciding if you want to become a certified PCMH.  If you answer “Yes”, it’s time to take action.

1)      Are you interested in differentiating yourself positively from other practice groups?  (Before certification becomes required or common, this could be very helpful when speaking with insurance companies or even patient marketing)

2)      Are there aspects of your practice that could use more standardization and fine-tuning?  (This could be used as a tool to unify your practice and push for progress)

3)       Do you know how to use your EMR’s reporting capabilities, or are you willing and ready to learn them? 

4)      Would you have a leadership team in your practice that would support this project?  (This will take time away from your current workload, and a permanent change in procedures will likely need to take place)

5)      Is your practice willing to invest financially in this project, for long term financial benefit?  (more staff time will likely be needed, possible consultation fees, as well as licensing fees and possible EMR upgrades)

Our practice is still a month away from getting our final score but I would be happy to answer questions from you about the preparation and the process of becoming PCMH Certified, by emailing me at tzeug@tenafypediatrics.com .  In the next article I will discuss some more practical advice from an administrator’s perspective in tackling this certification process.

Tom Zeug, FACMPE
Administrator of Tenafly Pediatrics

 

2681 Quakerbridge Road B2
Hamilton,
NJ 08619
609-208-3279
 
Winter 2014


The President’s Corner

 
        

Thank you for allowing me the honor of holding the office of President of NJMGMA for 2014 and 2015.  Although I have served in several Board capacities over the past 8 years, holding the top leadership role in the state for medical practice managers is quite a humbling experience.  It is reassuring to know that our organization relies heavily on the experience, enthusiasm and dedication of our Board members, both seasoned and newbie participants alike.  And for that we are ALL grateful.

One of my goals during this tenure will be to continue the progress we have already made in making NJMGMA an organization that is strong in both its membership numbers as well our sense of community and volunteerism.  This membership is nothing without YOU… I challenge you each to get engaged, find your niche and make a difference.

I’d like to share with you about some of the things we are already working on for you.

Read more...
 



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