Charging for Missed Appointments

Does your practice have a policy in place for billing patients who miss their appointments?

Many practices already do reminder calls for upcoming appointments as well as follow-up calls on no-show appointments.

One solution for billing patients who missed their appointments was developed by the Healthcare Underwriters Group of Ohio. They suggested the following five necessary components to bill the patient for a missed appointment:

1. There must be evidence that the patient was informed of the physician's policy on missed appointments
2. The patient failed to cancel more than 24 hours in advance
3. The physician must have a 24 hour messaging service by which the patient can cancel their appointment (during and after office hours)
4. The physician must have been available at the intended appointment time
5. The charges must reflect the actual costs incurred

To download the full article, please click the following link: Charging for Missed Appointments

For additional billing and coding resources, please click the following link: Medical Reimbursement Billing and Coding Resources

Improving Patient Care

Need solutions on how to improve your patient no-shows?

In an article published by Family Practice Management, they offered tips on how to improve patient care as well as how to manage the "habitual" no-show patient.

Many practices do not have a policy to address the problem of missed appointments and cancellations. According to the article, only 46% had policies in place to address missed appointments and cancellations.

Some solutions mentioned in the article were as follows:

• Double booking patients
• This is not always the best solution
• "First-come, first-served" models
• Negative about this is the long wait
• Not a good solution for many of the problem patients
• Added a "new doctor" named Virtual Physician ("Dr. VP") 
• If they are a "habitual" no-show patient and schedule an appointment they were added to this doctors queue
• By doing this they do not effect the regularly scheduled patient
• 6-month alternative scheduling probation
• Contacted the patient by letter and phone
• If they made their scheduled appointments, they would return to the normal scheduling (and not Dr. VP)
• They could only see their primary care physician - unless their needs are for acute care
• If they did not make their appointments after 6-months, they could be terminated from the practice

To view the full article, please click the following link: Managing No-Show Patients

For additional billing and coding resources, please click the following link: Medical Reimbursement Resources Page

Hospital Medicine and the Health Care Crisis

Today's Hospitalist published an article on Hospital Physicians and management of their flat reimbursement from the CMS.

The article highlighted the following:

Medicare:

• Out-of-Pocket Increased 64% from 1997-2005
• One-quarter of people on Medicare spend 31% of their income on health care
• Analysis says Aging  will be responsible for 37% increased spending by 2035
• 46% of projected spending was attributed to "excess cost growth"

Hospital Care:

• Americans spent $2.6 trillion on health care in 2010
• Hospital care accounted for $814 billion (not including physician fees)
• Medicare and other fees accounted for 

Solution: 

• Control costs
• HCAHPS - Hospital Consumer Assessment of Healthcare Providers and Systems
  

To view the full article, please click the following link: Disappearing Dollars? Hospital Medicine and the Health Care Crisis

For additional billing and coding resources, please click this link: Medical Reimbursement Billing and Coding Resources

Meaningful Use: Stage 1, Stage 2 Comparison

EHR Intelligence published an article titled: "Meaningful Use: Stage 1, Stage 2 Comparison".  In the article they discussed the differences among Meaningful Use Stage 1 and Stage 2.

• Timing 
• Those beginning Stage 1:in 2011 have an additional year to prepare for 2014
• 2 Full years to manage technological and administrative requirements for Stage 2.
• Stage 3 Meaningful Use should begin in 2016.
• Objectives
• 20 and 19 Objectives
• Clinical Quality Measures: 
• Exclusions
• Can claim exclusions as long as they are applicable
• Reporting Period
• Stage 2: 3 Month Reporting Period
• Hospitals cannot choose their own 3-month period
• Batch Reporting
• Stage 2: Single File for eligible professionals

To view the full article and additional differences among Stage 1 and Stage 2 Meaningful Use, please click the following link: Meaningful Use Stage 1, Stage 2 Comparison

For additional billing and coding resources, please click the following link: Medical Reimbursement. Inc. Resources Page

Unclogging Patient Flow in the ED and Beyond

In an infographic published the HFMA (Healthcare Financial Management Association) offered the following tips on how to manage patient flow:

• Pre-arrival
• Reduce unnecessary volumes
• Avoid overcapacity/diversion
• Arrival
• Reduce wait times
• Enhance patient experience
• Triage
• Employ team-based, rapid assessment
• Segment patients for specialized care 
• Diagnostics/Procedures
• Synchronize/standardize steps
• Reduce hand offs/waste
• Bring care closer to patients
• Admission
• Commit to improving hospital wide flow
• Pull ED admissions
• Establish surge capacity tactics
• Discharge
• Avoid clogging ED with patients waiting to leave
• Prevent unnecessary future ED visits

To download the infographic, please click the following link: Unclogging Patient Flow in the ED and Beyond

For additional billing and coding resources, please click the following link: Medical Reimbursement Coding and Billing Resources

Ten Activities to Safeguard Patient Privacy in Urgent Care

The following tips were published in an article titled: "Ten Activities to Safeguard Patient Privacy in Urgent Care" from the Urgent Care Association of America.  The article was written for Urgent Cares, but could apply to any medical practice.

1. Conduct a Privacy Audit
• Verify a Notice of Privacy (NOP) is provided to every patient and it is posted in plain sight by the front desk.
2. Train Your Staff on HIPAA
• Provide refresher training every year after their initial training
3. Consider the Patient Sign-In Sheet
• Cross off checked-in patients with a black marker or keep the list behind the counter
4. Designated Staff-Escort and Staff-Only Areas
• To ensure patient privacy all workstations, file rooms, etc. 
5. Keep Patient Records, Papers and Computer Monitors Out of View
• To ensure patient privacy have computers and fax machines should be in a separate room with a sign that is "restricted area"
6. Have Electric Shredder of Locked Shred Bins Available
• Necessary so patient privacy is not recovered by "dumpster divers"
7. Limit Conversations About Patient Health Information (PHI)
• Don't "discharge" patients in the halls or talk about their account at the front desk
8. Verify Telephone and Fax Numbers; Mail and Email Addresses
• Allows improvements to billing and collection successes
9. Require Individual Passwords and Activate Screen Savers
• To prevent unauthorized use only give the password to the user of that particular computer
10. Consider and Act Upon Patient Comments
• If a patient has a complaint about their privacy, make the appropriate changes to your system

To view the full article, please click the following link: Ten Activities to Safeguard Patient Privacy in Urgent Care

For additional billing and coding resources, please click the following link: Medical Reimbursement Billing and Coding Resources

Collecting Copayments Can Generate High Returns

According to an article published in Emergency Medicine News - If Handled Sensitively, Collecting Copayments Can Generated High Returns, there are a variety of ways that hospitals have improved the collection of copayments.  The following bullets give some guidance on what Inova Fairfax Hospital in Falls Church, Virginia and St. John Northeast Community Hospital in Detroit, Michigan has done to increase copayments and revenue:

• Implement a discharge process
1. Employee verifies patient information (statistics show that 22% of patient records have the wrong information)
2. Asks if person wants to take care of copay or put a deposit down

• Have various payment options available to increase payments:
• Have an ATM available in the Emergency Department for copayments
• Accept credit cards
• Give patients self addressed envelopes to mail their payment in
  
• Be up front with your copayment collection process
• Having a sign such as "Your insurance requires $50 copayment" will cover any misunderstandings that patients may have

To view the full article, please click the following link: If Handled Sensitively, Collecting Copayments Can Generate High Returns

For additional billing and coding resources, please click the following link: Medical Reimbursement Billing and Coding Resources

Fewer Emergency Rooms Available as Need Rises

According to the article, "Fewer Emergency Rooms Available as Need Rises" published in the New York Times, many hospital emergency rooms are closing even though emergency room visits are increasing.

Some reasons for Emergency Rooms closing were a result of the following:

• They served large numbers of the poor
• Were commercially operated hospitals
• Were at hospitals with "skimpy profit margins"
• Operated in competitive markets

Closing other emergency rooms have an impact on the emergency rooms that are open as well. The following could effect the patient in a negative way:

• Take longer to get to another hospital
• There may not be enough beds
• Long waits to be admitted

To view the full article, please click the following link: Fewer Emergency Rooms Available as Need Rises

For additional billing and coding resources, please click the following link: Medical Reimbursement Billing and Coding Resources Page

Reduced Wait Times, More Efficient Emergency Departments

In an article published by New York City Health and Hospitals Corporation, Kings County Hospital Center implemented a reorganization of their emergency department.

Some of the changes to their emergency department were the following:

• They changed the greeter at the front door to a nurse instead of a security guard
• Triage nurse interviews a patient, performs an assessment, and identifies patient level of urgency - after this is complete their vital signs and a complete assessment are taken.
• They changed their department from staff-centered to patient-centered

Overall, the following improvements occurred at King County Hospital Center:

• Wait time had an improvement of 50% (from 31 minutes to only 15 minutes)
• Pediatric wait time dropped to 20 minutes from 52 minutes
  
• The article also shows success stories from 3 other hospitals in the New York area.

To view the full article, please click the following link: Reduced Wait Times, More Efficient Emergency Rooms

For additional resources, please click the following link: Medical Reimbursement Billing and Coding Resources

Screening for Alcohol and Drug Problems in EDs

Published by the Physicians and Lawyers for National Drug Policy, "Screening for Alcohol and Drug Problems in Emergency Departments and Trauma Centers" highlighting the need for alcohol screenings in primary cares, emergency departments and trauma center visits.

• According to the American Association for the Surgery of Trauma, brief interventions in the trauma center decreased intoxicated driving.
• Alcohol exclusion clause (under the Uniform Accident and Sickness Policy Provision Law (UPPL)
• denies payments to doctors and hospitals that render care to patients
• discourages alcohol screenings in trauma centers and emergency departments.

Alcohol Exclusion Law

• 32 states and Washington DC explicitly allow insurers to use alcohol exclusions
• 9 states prohibit insurers from using alcohol exclusions
• 9 states implicitly allow insurers to use alcohol exclusions
• Many organizations support the real of the Alcohol Exclusion Law

To receive the full article in detail, please click the following link: Screening for Alcohol and Drug Problems in Emergency Departments and Trauma Centers

For additional billing and coding resources, please click the following link: Medical Reimbursement Billing and Coding Resources

In-Network vs. Out-of-Network Care

Fair Health Consumer published an article on "In-Network vs. Out-of-Network Care".  The article discussed the differences between in-network and out-of-network care.:

Out-of-network costs by plan:

• HMO (Health Maintenance Organization or Exclusive Provider Network (EPO)
• The article stated you generally have to pay the full cost of any out-of-network care, except for emergencies.
• Preferred Provider Organization (PPO) or Point of Service (POS) Plan
• Higher deductible
• Higher percentage co-insurance, which is a percentage of the “allowed amount”
• The full difference between the allowed amount and your provider’s actual rate, which could be much higher

The article also has examples of In-Network and Out-of-Network Costs

Reasons for going out-of-network could be because of the following:

• You're referred to a specialist and they are out-of-network
• Providers who are at a hospital that is in-network, but the actual provider may be out-of-network

To view the full article, please click the following link: In-Network vs. Out-of-Network Care

To view addition medical billing and coding resources, please click the following link: Medical Reimbursement, Inc. resources page.

Creating an Efficient - and Effective - RAC Response

HFMA Published an article on "Creating an Efficient - and Effective - RAC Response" and how one hospital has designed an approach on how to manage their RAC audit activity.  The article stated that:

• RAC Spending has Increased from the end of 2011 to the beginning of 2012.  
• Hospitals needed a way to manage their RAC audit activities

The following are ways that Ministry Health in Wisconsin managed their RAC audit activities.

• Dedicate staff to RAC process management
• Manage the data flow related to RAC requests and meet deadlines for appeals with a tracking database
• Use a document management system to convert patient records into electronic files and scan documents for critical information.
• Track the time spent on RAC process management activities.
• Expand the team’s efforts to include review of audits from commercial payers.

To download the full article, please click the following link: Creating an Efficient and Effective RAC Response

For additional billing and coding resources, please click the following link: Medical Reimbursement, Inc. Resources

Obtaining, Uploading and Utilizing Your Contracted Fee Schedules

The American Medical Association (AMA) Published a step-by-step guide on "Obtaining, Uploading and Utilizing Your Contracted Fee Schedules".

The guide listed the following steps on how to obtain, upload and utilize your fee schedules:

1.  Gather your contracted fee schedules from the payers which you contract
2. Run an annual report on each CPT code and how many times it was used in that year
3. Determine your most frequently billed CPT codes from your annual report
4. Load all applicable information into your practice management system
5. Print and review your reports from your practice management system on your contract rates and payments (if applicable)
6. If you don't have access to reports from your own practice management system, create your own in Microsoft Excel.  

To receive the full step-by-step guide with Excel files included, please click the following link: Obtaining, Uploading and Utilizing Your Contracted Fee Schedules

For additional billing and coding resources, please click the following link: Medical Reimbursement, Inc. Resources

Bundled Payment Fact Sheet

A short fact sheet was produced by the Centers for Medicare and Medicaid Services on Bundled Payment Initiative.  The Bundled Payment Initiative allows providers flexibility in:

• Selecting Conditions to Bundle
• Developing the Health Care Delivery Structure
• Determining How Payments Will Be Allocated

The Bundled Payment Initiative consists of 4 separate Models:

1. Model 1 consists of the Inpatient Stay Only
2. Model 2: consists of the Inpatient Stay plus Post-discharge Services
3. Model 3: consists of the Post-discharge Services Only
4. Model 4: consists of the Inpatient Stay Only

To view the full fact sheet as well as a chart with the key features of each model, click the following link: Bundled Payment Fact Sheet (PDF)

For additional billing and coding resources, please click the following link: Medical Reimbursement, Inc. Resources