Consider the Total Relationship for Banking Services

2018 Alliance sponsor article courtesy of First Citizens Bank

As a medical practitioner, you can benefit from treating banking as a total relationship rather than a series of small transactions, especially in the current economic environment.

Your time is better spent running your practice, rather than shopping for the best bank value. When you have a good relationship with a bank, the financial institution has an incentive to offer you better deals. Bankers want to see your practice grow. When they know your goals and understand your needs, they can offer the products and services that will help you accomplish your goals faster and much more efficiently.

So how do you decide which bank gets to have this important relationship with you and your business?

Start by examining what you want in a banking relationship. All businesses require different services from their banks. Medical businesses are no different. Your greatest need might be standard transactions like checking accounts or credit card processing. But you may also need a financial institution that offers a variety of options for raising capital or that provides electronic services.

Once you’re comfortable with the traditional features banks offer, dig a little deeper. Ask the following questions:

  • Does the bank truly understand the distinct banking needs of busy medical professionals? First Citizens, for example, has a long history of serving small to mid-sized businesses and specializes in managing the complex financial needs of new, established and expanding healthcare businesses.
  • Will the bank help you save and earn money by maximizing options for handling your funds? Medical practices and other healthcare businesses often deal with the complexities of collecting payments from patients and insurance companies on a timely basis. Managing cash flow can be a real challenge. Look for deposit accounts that meet your needs or cash management features that make the most of your resources.
  • Does the bank offer a variety of services, like trust or leasing, providing you with more choices and flexibility in financial services?
  • Does the bank provide a variety of financing options? Maybe you need a real estate loan for a new medical building or a lease to finance a medical equipment upgrade. It might be time to finance a “buy-in” or start up of a practice. For short-term operating needs, a business equity line of credit may be the right move. Whatever your financial goals and objectives, your banker can serve as a trusted advisor and help you map out a successful course of action. Make sure your bank can provide timely, convenient access to these types of loans and credit services.
  • Can the bank meet your personal banking needs? Your financial institution should provide a full spectrum of personal banking products — residential mortgages, residential equity lines of credit, premium service checking accounts and even wealth management services to maximize the effect of your financial assets, minimize taxes and plan for the future.
  • Do you receive individual service and attention you require? Your banker should be willing to meet with you when it’s convenient for you – whether at lunchtime, after hours or on weekends. A banker should also work in close cooperation with attorneys, accountants or other professional advisors to provide proper integration of financial, legal and other matters of importance. It’s important that bank customers receive the same high level of attention and service that you provide your own patients.
  • Finally, is the bank stable and solid? Has it stood the test of time? Does it make sound business decisions? Is the stewardship of customers’ money among its highest priorities? First Citizens Bank, for example, has been around 120 years and is the largest family-controlled bank in the United States. First Citizens brings a special understanding to the challenges and opportunities faced by medical professionals, company owners and managers.

Whether you are just starting out, looking for a new bank for your established practice or simply wanting to evaluate how well your current bank is meeting your needs, asking some questions from these areas can produce a clear picture of what you need from a bank, even in these challenging economic times.

For more information, contact Andy Shene, Charlotte Metro Area Executive for First Citizens Bank, 704.338.3926. First Citizens Bank. Forever First. ® Member FDIC.

Billing Under Another Provider’s Number Can Land Physicians in Hot Water

By Emma Cecil, JD, October 31, 2017

2018 Alliance sponsor feature article courtesy of MagMutual

An Oklahoma physician agreed last August to pay the government $580,000 to resolve allegations that he violated the False Claims Act (“FCA”) by causing false claims to be submitted to Medicare for services he did not provide or supervise. According to the government, the physician allowed a company that employed him and in which he had an ownership interest to use his national provider identification (NPI) numbers to bill Medicare for physical therapy evaluation and management services furnished by other providers.

This case is merely another example of government enforcement action against providers who submit or cause to be submitted claims for services using the name and NPI of a physician who did not personally furnish the services. Back in 2011, the University of North Texas Health Science Center paid the government $859,500 to resolve allegations it had for submitted claims for physicians’ services provided to Medicare and Medicaid beneficiaries using the NPI numbers of physicians who neither provided nor personally supervised the services rendered. Other examples include Towson University Speech Language & Hearing Center, which paid $10,000 for submitting claims for audiology services with an NPI that did not correctly identify the provider who actually rendered those services; a family practice physician who paid $133,880 for submitting claims to Medicare for nurse practitioner services as though he had personally performed the services; a hospital that paid $706,090 in penalties for submitting claims for physicians’ services provided by a doctor to Medicare beneficiaries using the provider identification numbers of another doctor who did not furnish the services; and a medical school practice that paid $138,321 after it submitted claims for services provided by physicians to Medicare beneficiaries using the provider identification numbers of two physicians who did not furnish the services.

As a reminder, services generally must be billed under the name and NPI of the provider who actually performed the services. Billing under one provider’s name and NPI for services that are furnished by another provider may be fraudulent if the identity of the person performing the service would be material to the government’s decision to pay the claim.

The government does, however, permit the services of one provider to be billed under the name and NPI of another provider in certain limited circumstances, including where the services of auxiliary personnel (including both physicians and non-physician practitioners) are billed “incident-to” the professional services of a physician, and where the services of a substitute physician are billed under the regular, but unavailable, physician’s name and NPI on a temporary basis (“locum tenens” and “reciprocal billing” arrangements). These billing practices have very specific and stringent requirements, and failure to strictly comply with those requirements could subject providers to significant liability under the False Claims Act.

Importantly, the incident to, locum tenens, and reciprocal billing rules are Medicare rules and may not apply in the context of private payor billing. Many commercial plans specifically prohibit billing the services of one provider under the name and NPI of another provider and explicitly require that all services be billed under the name of the rendering provider. Providers billing private payors must therefore review their provider contracts and health plan rules to determine whether billing the services of one provider under the name and NPI of another provider is ever allowed, and if so, under what circumstances. If prohibited, knowingly billing under another provider’s name and NPI could potentially lead to criminal liability under the federal health care fraud statute, which makes it a crime to knowingly and willfully obtain by means of false or fraudulent representations money or property owned by any health care benefit program in connection with the delivery of or payment for health care services.

Key Takeaway

Before submitting bills for services furnished by one provider under the name and NPI of another provider, practices must be intimately familiar with the rules under which such billing is appropriate and allowed. Although practices that are under pressure to pay non-credentialed physicians may be able to bill the non-credentialed physician’s services under a credentialed physician’s NPI pursuant to Medicare incident to rules, such billing may be prohibited by commercial payors. Commercial payors also may not recognize locum tenens or reciprocal billing arrangements. In sum, billing under another provider’s name and NPI without strictly complying with CMS’s stringent incident-to or reciprocal billing rules, or in violation of private payor contracts, can spell big trouble, including treble damages under False Claims Act where claims are submitted to the government, and even criminal liability under the federal health care fraud statute.

Data Show Independent Physicians are More Productive

2018 Alliance sponsor article courtesy of Athena Health

By Chris Hayhurst | July 11, 2018

Primary care physicians who are owners or partners in independent practices are more engaged and more productive than PCPs who work as employees.

That’s one of the key findings from a recent survey of 1,029 physicians on the athenahealth network. The survey asked PCPs a variety of questions to assess their engagement and their perceived “capability“— that is, their determination of whether they have the tools, resources, and latitude to properly care for patients.

That information was then combined with athenahealth data on productivity, including the work Relative Value Units (wRVUs) physicians generate each day.

Within independent medical groups, the survey found, PCPs who are owners or partners are 11 percentage points more likely than those who are employed to report being engaged in their jobs (37.5 percent vs. 26.3 percent).

And independent owners and partners are nearly 20 percentage points more likely to feel engaged than physicians employed by health systems. (Engaged physicians are those who agree or strongly agree that they are willing to go above and beyond in their jobs and to recommend and stay with their organizations.)

On the productivity front, it’s a similar story: On average, the data show PCP owners and partners generate 16 percent more wRVUs per day on average than their employed counterparts (26.9 wRVUs per day vs. 23.1 wRVUs). Likewise, owners and partners generate 29 percent more wRVUs than doctors employed by health systems, who logged an average of 20.8 wRVUs per day.

When it comes to physician burnout — defined as frequent or very frequent feelings of emotional exhaustion or depersonalization — the numbers flip slightly. Physicians employed by independent practices reported the least amount of burnout, at 40 percent, followed by owners/partners of independent practices, at 42.9 percent. Doctors employed by health systems were the most likely to report symptoms of burnout, at 45.5 percent.

While the survey doesn’t get to the reasons for the differences between the three PCP groups, athenahealth vice president of research Josh Gray notes that ownership or partnership entails a connection to one’s practice that employed physicians are less likely to feel.

“That employee relationship may dilute some of the passion of being an owner or partner,” Gray says. “When you have a personal stake in a practice’s success, you’re probably going to feel more engaged, and that may lead you to be more productive.”

Chris Hayhurst is a writer based in Northampton, Massachusetts.

Which EHR Vendor is Next?

2018 Alliance sponsor article courtesy of Azalea Health

Like the saying goes, the only constant is change. We have come to expect changes in our personal lives, but when it comes to business, unexpected changes can be unwelcomed and disruptive. As the healthcare industry continues to evolve and develop, healthcare executives have sought out mergers and acquisitions as a way of survival. EHR vendor mergers and acquisitions though can be quite disruptive to physician practices. We have seen major EHR vendor transactions in 2018, with the NueMD, AdvancedMD, and Marlin Equity activity being the most recent.

According to a recent Black Book Research report, 30% of physician practices are looking to replace their EHR within 3 years. These EHR replacements happen for various reason, including:

  • existing EHR does not meet ONC standards;
  • current vendor “sunset” or replaced their EHR;
  • current vendor sold or merged company;
  • poor customer service

But not all physicians replace their EHR out of despair. Some are proactively looking for an EHR solution that fits their workflow better and has modern, advanced features to take them into the next decade.

With technology critical to the business functions of your practice, it is important to keep a close eye on these five signals that your EHR vendor is serious about planning for the future:

  1. Cloud-based
  2. Telehealth
  3. Interoperability
  4. Regulatory Upkeep
  5. Patient Engagement

For detailed information on evaluating vendors based on these five factors, download Azalea Health’s eBook, Ensuring Your Future Success: Five Signs Your EHR Vendor Is Sticking Around.

 

Don’t Complicate your Complications

By Marshaleen King, MD

2018 Alliance sponsor feature article courtesy of MagMutual

Case Scenario

A 64-year-old woman presented to the emergency room (ER) with right sided abdominal pain. Her ER evaluation revealed cholelithiasis with thickening of the gall bladder wall. The patient was admitted by the surgical team on call and underwent laparoscopic cholecystectomy. Approximately 12 hours after surgery, the patient developed fever and tachycardia followed by tachypnea and abdominal rigidity. On evaluation by the surgical team, a decision was made to take her back to the operating room (OR) for an exploratory laparotomy. During her exploratory laparotomy the surgeon discovered a transection of her common bile duct and decided to perform a repair. The complication was addressed using a technique that included a choledochoduodenostomy.

Post-operatively, the patient developed septic shock complicated by multi-organ failure and her condition rapidly declined. On hospital day 4, the surgeon had a discussion with the patient’s family and a decision was made to transfer her to a tertiary care center. At the time of transfer, the patient was on mechanical ventilation and required several vasopressors to maintain her blood pressure. Following transfer to the tertiary care center, concerns were raised about breakdown of her common bile duct anastamosis. A second exploratory laparotomy was then performed, at which time she was noted to have separation of her choledochoduodenal anastomosis with leakage of bile and duodenal contents into the peritoneal cavity. A hepaticojejunostomy was then performed, along with placement of a gastrostomy-jejunostomy tube and percutaneous transhepatic cholangiography (PTC) drain. Following surgery, the patient recovered from severe sepsis but her renal failure persisted, warranting initiation of hemodialysis. In addition, she had difficulty being weaned from mechanical ventilation and had to undergo a tracheostomy.

The patient’s family was angry because they were not notified of the surgical complication until the option of transferring her to a tertiary facility was being considered. The family sued, stating that, 1) there was a delay in recognizing and appropriately treating her surgical complication, and 2) the delay in transferring the patient to the tertiary center resulted in her severe sepsis and renal failure.

Discussion

Doctors feel a sense of responsibility to their patients and often want to personally manage complications that arise from the procedures they perform. However, physicians should be cognizant of their capabilities and recognize when the intervention required to address a complication is beyond their scope. In instances where a higher skill level is required to address a complication, the physician should seek to expeditiously transfer the patient to a facility where they can receive the appropriate level of care. Any delay in doing so puts patients at risk for worse outcomes related to their procedural complications and exposes physicians to the risk of litigation.

When a physician recognizes that a complication has occurred, it is crucial for him or her to inform the patient, and/or the patient’s family, in a timely manner. Delays in informing the patient/family about the complication may be perceived by the patient/family as an attempt to hide or misconstrue information. In the clinical case presented, the surgeon may have averted litigation had he:

  • Informed the patient/family of the complication at the time it was recognized
  • Discussed the options for handling the complication with the patient/family
  • Involved the patient/family in the decision-making process regarding management of the complication

Instead, the surgeon attempted to correct the complication on his own, even though the ideal approach would have been to transfer the patient to a tertiary care center to address the complication. One of the claims against the surgeon included the allegation that the ideal, more technical, surgical procedure required to repair the common bile duct transection was beyond the surgeon’s scope. Although the surgeon felt confident in his skills because he had used this alternative surgical approach before, his delay in transferring the patient was perceived as an attempt to avoid discovery of the complication. The case was settled for a significant amount of money.

Disclaimer
The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.

NCMGMA News Sponsor

athenahealth-ad-2018aTwice monthly, NCMGMA News will feature a sponsor on our site. Our sponsors are a vital part of our organization, enabling us to provide the high level of products and services our members have come to enjoy from NCMGMA.

Our sponsor this period is athenahealth.

Learn more about athenahealth by viewing their ad on NCMGMA News and on our website. You can also visit their website at https://www.athenahealth.com/.

RCM Success Begins at the Front Desk

2018 Alliance sponsor article courtesy of Azalea Health

According to a CDC study, the number of American adults (age 18-64) with high-deductible healthcare plans (HDHP) has increased from 26.3% in 2011 to 39.3% in 2016. How can you equip your employees to answer price questions and begin the collection process at check-in?

Three Steps to Improve Upfront Collections

Help practice employees understand why patients want upfront information about charges and the portion for which they will have responsibility. Here are three steps to help improve collections and improve your bottom line.

  1. Before the appointment – prior to the patient even showing up for an appointment, get a prior authorization from the insurance company. Whether conducted in house by staff or outsourced to a company like Azalea Health, you and the patient will have a better understanding of what the total amount due from the patient will be.
  2. At the appointment – collect payment from the patient before they see the physician or other medical professional. This allows you to confirm that the patient knows what to expect and to collect the amount without follow-up calls or other collection methods.
  3. After the appointment – are you still sending out snail mail notices? Are they clear and easy to understand? A proven way to get payment – and improve patient satisfaction – is to communicate with the patient in the manner they prefer. For many patients, that communication channel would be electronic.

While the patient is responsible for a growing portion of healthcare costs, insurance still plays a major role in achieving a healthy RCM. Let’s take a look at how your practice can take time for an RCM Tune-Up.

Do You Know Your Financial Benchmarks?

Generate and track financial and performance metrics to determine potential areas for improvement and to measure the success of RCM initiatives.

The Healthcare Financial Management Association (HFMA) has developed MAP Keys for both hospitals/health systems and for physician practices. These detailed, industry-standard metrics can be used to measure your organization’s revenue cycle performance. Among the metrics that you should be closely monitoring are:

  • Net days in A/R
  • Net collection ratio
  • Cost to collect
  • Denials rate
  • Lag Days (for hospitals)

Each metric has an individual impact on your financial well-being.

Do You Know Where You Are Going?

Regardless of whether you choose to DIY or partner with a RCM company to improve your revenue performance, there are certain best practices that will yield higher returns, including:

  • Ensuring integration between your front and back office software to increase efficiency
  • Managing the aging and outstanding A/R report to reduce A/R days outstanding
  • Increasing collections through more efficient A/R management
  • Reducing denials with better claims and fewer errors
  • Regularly reviewing your metrics and billing reports to optimize revenue

If you are seeking a partner for RCM, be sure to look at their performance for other practices around average days outstanding for A/R, how long it takes to submit claims versus the industry average, and how many claims are successfully adjudicated on the first submission. Another determinant should be whether your potential partner has RCM experts on staff and if they are located in the U.S. or are off-shore.

Following these guidelines will help keep your bottom line healthy while you work to keep your patients healthy!