What’s Your Ideal Medical Practice Staffing Mix?

Lea Chatham July 22nd, 2014

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By Rochelle Glassman

Tweet this Kareo storyThere is no hard and fast rule on how many staff you require for your practice because each specialty and situation may require something different. It is important to understand your medical practice staffing needs based on the job functions required to efficiently operate and manage your practice. Understaffing can cause breakdown in operations that could result in errors, reduction in revenue, and patient dissatisfaction. Overstaffing may cause a loss of productivity and an unnecessary financial overhead burden.


How Many Staff Should You Have?
Many of the medical associations such as Professional Association of Healthcare Office Management (PAHCOM) and Medical Group Management Association (MGMA) benchmark how many full-time employees you need per full-time provider. A full-time employee (FTE) is an employee who works between 35 and 40 hours per week. A practice’s FTEs may include front desk, billing, office management, medical assistants, nurses, and even scribes.

There are many factors that can influence your staffing like patient volume, specialty, and the use of technology.Tweet this Kareo story

Here are some recommendations from MGMA to use as a guide for your practice.

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Calculating Your Staffing Ratio
Before you calculate your practice’s staff-to-provider ratio, however, it’s essential to know how to do it correctly. It seems simple enough: Count up the doctors in your practice and divide by the number of billing staff, right? Well, not quite.

Rather than count each physician individually—a common mistake—practices must make sure to count physician FTEs. To properly calculate the number of physician FTEs within your practice, divide the total number of patient encounters performed during the past year for your entire practice by the average number of yearly physician encounters, (This number will be between 3,600 and 4,800 depending on your specialty. Primary care tends to be on the high end at 4,800 and single surgical specialists, like orthopedics tend to be on the low side at 3,600). The reason that you want to perform your FTE calculation in this manner is to accurately account for physicians who work part-time, job share, work any other less-than-full-time schedule, or manage their time efficiently and therefore are able to treat more patients.

To calculate the number of billing staff FTEs, you’ll want to define an FTE as an employee who has been compensated for 2,080 hours of work (40 hours/week X 52 weeks/year) during the last year. Like the physician FTE calculation, this will take into account any employees who work any schedules more or less than 40 hours per week. Hours to include in this calculation should be related to any personnel who participate in the physician revenue cycle, including insurance verification, data entry, coding, payment posting, accounts receivable follow-up, patient statement processing, customer service, etc.

Once you know your medical practice staffing ratio, compare it to the chart provided above. If you are much higher, it’s probably time to look at your staffing, processes, and technology. The next blog in this series will review areas where you may find inefficiencies and ways that process changes or technology can help.

About the Author

Rochelle_MG_1811Rochelle Glassman is President & CEO of United Physician Services. Rochelle brings a passionate, very practical “do it today” approach to making medical practices successful and getting physicians paid more.

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Get the Medicare Well Visit Right and Get Paid

Lea Chatham July 18th, 2014

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By Kathy Young

Kareo EHR

 

When the Centers for Medicare and Medicaid (CMS) began to allow for well visits, they sold the idea as an opportunity for the primary care providers to increase their revenue. Many providers were excited about the idea and began performing these well visits. CMS decided not to use the CPT codes for preventative services. Instead, they created their own codes, and with the codes, new requirements for the well visit.

 

It is the requirements of the Medicare well visit that have created ambiguity amongst providers.Tweet this Kareo story

In the first 12 months of being a Medicare patient, seniors are allowed an initial visit, which is the welcome to Medicare visit for preventative care (G0402). Then there is the annual initial visit for those patients who never took advantage of the welcome to Medicare visit (G0438). After a year they can come back and have a subsequent well visit (G0439). These visits are not necessarily about the exam (although an exam can be a part of it). They are about the overall health assessment of the patient. When done well and documented well, these visits can give the provider a better road map for the care of this patient. The annual well visit (AWV) can be performed by a physician, PA, NP, CNS, or other provider under the direct supervision of a physician.

If you perform electronic eligibility, you can find out if the patient has already had their AWV. There is no copay or deductible for these visits. V70.0 is the diagnosis to use, demonstrating that it is a well visit. If during the course of the AWV a problem is discovered and addressed, an E&M can be appended but documentation must show the two types of visits and clearly demonstrate that there was a need for an E&M service with medical decision making.

It is the elements of the AWV that are often not understood by the provider. In truth, most of the visit, if not all of it can be performed without the patient undressing. The purpose is to assess their health and risks in order to make a plan of treatment or care. The following must be in the documentation to meet CMS requirements per the Medicare Manual of 42 CFR 410.16. These are not suggestions but requirements.

  • Collect self-reported information about the patient
  • Tailor to and take into account the communication of patient
  • Take no more than 20 minutes to complete

It should address the following:

  • Demographic data like age, gender, race, and ethnicity
  • Self-Assessment of health status, frailty, and physical functioning
  • Psychosocial risks like depression, stress, anger, isolation, pain, fatigue, etc.
  • Behavioral risks like tobacco, physical activity, nutrition, alcohol, sexual health, safety in home or in the car
  • Activities of daily living (ADL) such as can they dress themselves, can they eat, grooming and ambulation
  • Instrumental activities of daily living to ascertain if the patient can shop, prepare food, use the phone, clean home, wash clothes, take medication, and handle their finances

With the well visit orders for colonoscopies, EKGs, or labs can also be done. Other services may include bone mass measurements, diabetes screening, glaucoma screening, and ultrasound screening for abdominal aortic aneurysms. Counseling for tobacco cessation (G0436-G0437) is another tool that has been given to the provider along with weight loss prevention.

Until 2012, many of these preventive services were denied to seniors by Medicare. Not only are there preventative services now but also counseling that can help seniors achieve better health. Physicians should not miss out on the financial opportunities that these services provide. As with all things Medicare however, there are rules that must be abided by. It would make sense from a practical point of view, to create a well visit template that would walk you through the visit to make certain you have met all the requirements for Medicare.

If you use Kareo EHR, a well visit template is available already. If you don’t use an EHR or you are looking for a new EHR that provides tools designed for practices like yours, register for the next Kareo EHR demo.

About the Author

KathyKathleen Young is the CEO and co-founder of Resolutions Billing & Consulting, Inc., which was founded in 2003. Kathleen is also the owner of Healthcare Chart Audits, which offers auditing to physicians and attorneys. Kathleen has been in healthcare since 1989 and has worked for physicians, large corporations and three billing companies. Kathleen is a CPC and a CPMA with the American Academy of Professional Coders and speaks to many groups on coding, billing, and auditing.

 

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3 Billing Service Questions about Social Media Answered

Lea Chatham July 16th, 2014

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3 Ways to Grow Your Billing ServiceAt the recent free webinar, 3 Ways to Grow Your Medical Billing Service, Tim Tyrell-Smith and Jim Sholeff talked about how billing services can position themselves to meet the increasing demand for outsourcing from physician practices. They touched on some key trends on the marketplace and reviewed sales strategies to close more deals along with some best practices for managing your online presence and marketing your business. Here, Tim answers three questions that came up about social media and online reputation building.

Q: How important is social media in your billing service marketing? What role does it play in recruiting new providers? Tweet this Kareo story
A: These days the majority of people are on social media and online in general. This includes physicians and practice staff. We are now comfortable looking for services online, and we trust the information we find there. If you aren’t online with a strong website and social presence, then those who are looking may go elsewhere. It also allows you to build social credibility. Since we do business with people we know, like and trust, social media can play a role in supporting your reputation. Social media may not be the most valuable marketing tool you have and it may not bring in the most business, but it should be an important piece of your overall strategy.

Q: Are physicians really using Twitter? If so, can you give some best practices for using Twitter?
A: There are a good number of physicians on Twitter, but as you might expect, the bulk of doctors would rather be caring for patients! To find those who are active, you can use search terms like “Dr.” or “MD” and you should get a good list. For all these channels (i.e., Twitter, Facebook, etc.), make sure you are personal and professional, that you engage your followers by posting regularly and responding to mentions and any tweets that you find interesting, and that you post useful information that has a meaningful call to action. If you are actively taking these steps and regularly following physicians and other practice staff, before you know it, you’ll have a new community of potential customers.

Q: You talked about strategies for focusing on local SEO, are there strategies I should use for national approach?
A:  Strategies for local and national search engine optimization (SEO) campaigns are quite similar. The biggest difference is that local SEO relies heavily on location tagging. For example, a national campaign might focus on the keywords “medical billing services” whereas a local SEO version would simply be modified to “Houston medical billing services”. As you might expect, it will be more difficult to “rank” on the best keywords nationally if you are in a competitive industry. This is where a blog or other content on your site can help attract visitors more proactively versus the traffic that will come more passively through Google.

If you missed the presentation, you can check out the slides here, or find out more about the Kareo Billing Partner Program and how it can help you grow your billing service.

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Free Webinar: Patient Collections 101

Lea Chatham July 11th, 2014

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Register now to start improving patient collectionsPatient Collections 101: Let’s Start at the Beginning
Wednesday, July 16, 2014
10:00 AM PT, 1:00 PM ET

When was the last time you took a good look at your patient collections processes? Things have been changing in recent years, and they continue to do so in 2014. Patients are paying as much as 30% of their healthcare costs today out of pocket. While many preventive care services are now covered, there are a lot of people who now have higher deductible plans and higher copays. As a result, having a strong program for effective patient collections is more crucial than ever.

In this webinar, patient collections expert Mary Pat Whaley offers a review of the basics and the best practices for improving patient collections. You’ll learn:

  • How to create and use a payer matrix
  • The value of eligibility and benefits information
  • Why the financial policy is the best patient collection tool you have
  • The role of a credit card on file program in patient collections

Who should attend? Practice managers, billing managers, billing and front desk staff, and healthcare providers who are interested in improving patient collections and reducing A/R.

Register now to learn how to improve patient collections

About the Speaker

Register NowMary Pat Whaley, FACMPE, CPC, is the Co-Founder and President of Manage My Practice. With over 25 years managing physician practices of all sizes and specialties in the private and public sectors, Mary Pat is one of the preeminent physician advocates and practice management consultants in the United States today. In addition to her Board Certification in Medical Practice Management, she is also a Certified Professional Coder and a Fellow in the American College of Medical Practice Executives. She is widely quoted in national practice management magazines including Medical Economics, Physicians Practice, the Journal of Medical Practice Management, Physicians Digest, and Outpatient Surgery Magazine.

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July Kareo Newsletter Highlights Changing Trends in Healthcare

Lea Chatham July 10th, 2014

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The July edition of the Kareo Getting Paid Newsletter highlights changes in patient accounts receivable and trends in physician satisfaction. The newsletter also provides a chance to discover upcoming events, news, and resources from Kareo. Plus, you’ll learn about how to register for our upcoming free educational webinar, Patient Collections 101: Let’s Start at the Beginning, presented by Mary Pat Whaley. Read all this and more now!

Kareo July Getting Paid Newsletter

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3 Ways Bad Patient Collections Practices Hurt Your Bottom Line

Lea Chatham July 9th, 2014

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Register now to learn how to improve patient collectionsWe know that not all patients prioritize paying medical bills.

According to the Medical Group Management Association, in 2010 more than 60% of patient balances were never collected! Tweet this Kareo story

This is not necessarily because patients refuse to pay, but often because practices don’t understand what patients owe or don’t ask patients for payment when they are most willing to pay—at the time of service.

Not communicating to patients about their financial responsibility and not asking for payment at time of service can be detrimental to more than just your revenue. There are other reasons that you want to make sure you have a solid financial policy that you enforce consistently and fairly.

Word Gets Out
If you think patients don’t share which physician practices collect and which ones do not, think again. Word gets around in your community about practices that do not collect at time of service and do not pursue patient collections. Most practices only collect co-pays at time of service and some practices do not even ask patients for their co-pays. If you do not collect co-pays consistently for all patients, you can be sure other patients will demand to defer payment of their co-pays too—one good reason to apply the same collection policies to all patients.

Breaching Payer Contracts
You may have heard that a balance can be written off to bad debt after sending three statements. If you are routinely writing off patient balances, your payer may consider that they are overpaying you since you do not find it necessary to collect the full amount that the patient owes. This can ultimately reduce your reimbursements. When you do not collect from patients, you send the clear message “What insurance pays us is enough and we do not need to collect from patients!” Many patients already believe that physicians make enough from what insurance pays alone—do you want to reinforce that myth?

Unnecessary Expenses
Every time you send a patient a statement it costs you money. Tweet this Kareo story

It costs you money to have an employee open the payment envelope, find the correct patient in the billing system, post the payment, prepare a deposit or remote scan the check, and reconcile the checks with the posted amount. If collecting a $25 co-pay means sending one or more statements, you are reducing how much money you are truly collecting. You are spending a lot to collect a little. The cost savings when collecting at time of service (front-end collections) vs. sending statements after insurance pays (back-end collections) can be as much as 20%.

When you add up the consequences of not collecting at time of service, you begin to realize you are spending too much money, losing too much money, and potentially opening yourself to a challenge of your collection practices by patients and payers. Help your practice by establishing a fair financial policy, committing to collecting at time of service, and putting a plan in place to treat all patients—and your practice—fairly.

To learn more about how to implement an effective patient collections strategy, join me for my upcoming free webinar, Patient Collections 101: Let’s Start at the Very Beginning, on Wednesday, July 16. Register Now!

About the Author

Register NowMary Pat Whaley, FACMPE, CPC, is the Co-Founder and President of Manage My Practice. With over 25 years managing physician practices of all sizes and specialties in the private and public sectors, Mary Pat is one of the preeminent physician advocates and practice management consultants in the United States today. In addition to her Board Certification in Medical Practice Management, she is also a Certified Professional Coder and a Fellow in the American College of Medical Practice Executives. She is widely quoted in national practice management magazines including Medical Economics, Physicians Practice, the Journal of Medical Practice Management, Physicians Digest, and Outpatient Surgery Magazine.

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New Survey Shows Latest EHR Trends

Lea Chatham July 9th, 2014

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2014 Technology SurveyThe Physicians Practice 2014 Technology Survey, sponsored by Kareo, shows EHR implementation continues to be the most pressing technology issue for physician practices. Nearly 17% of practices say that EHR adoption and implementation is the most pressing problem while another 16% say it is lack of interoperability, and 13% say it is the cost to implement and use new technology.

Over 50% of practices surveyed already had a fully implemented EHR, but nearly 20% don’t have an EHR at all and another 10% are in the process of installing an EHR. Of the practices that don’t have an EHR at all, about 25% say they are going to purchase one in the next 12 months. But the other two-thirds have many reason for holding out:

  • 25% say they are too expensive
  • Nearly 16% says they can’t find an EHR to meet their needs
  • 11% have heard too many horror stories
  • And, 13% are struggling to get buy-in from all providers

Whatever the reason may be, practices can’t really afford to put off an EHR much longer. “There are so many reasons to implement an EHR today, and they aren’t all clinical” says Tom Giannulli, MD, CMIO at Kareo. “Reimbursement is changing and moving towards value-based models, which really requires an EHR. The ICD-10 transition will be more challenging without an EHR, and in general, having an EHR can improve billing and reimbursement.”

“Since we started using an electronic superbill in the EHR that can be sent to the practice management system, we’ve seen fewer errors and cleaner claims,” says Theresa Jenkins, Office Manager at Appalachia Medical Clinic. “Using an integrated practice management and EHR solution has improved our billing, and we now have much more consistent cash flow.”

On the clinical side, Dr. Giannulli adds, “There are also many clinical benefits too. Having an EHR can reduce prescriptions errors and the need to reorder lab tests. It can also improve patient compliance by giving physicians the tools to educate patients and give them summaries of their care and treatment plan.”

According to the Tech Survey, just under half of those using EHRs say they have seen a return on investment and about the same number say they have seen work flow improvements. In addition, almost 60% say they are satisfied or very satisfied with the vendor they chose. But for many it has taken several tries at implementing an EHR to get there. Over 30% of the practices with an EHR are on their second, third or even fourth or fifth EHR.

So many tries to get it right doesn’t have to be the case for practices that are looking to install an EHR for the first time. With affordable, cloud-based solutions cost is less of a factor now. In addition, there are clear best practices today for EHR selection and implementation. The Small Practice Guide for EHR Implementation can help your practice make a successful implement the first time.

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Free Webinar: Grow Your Medical Billing Service

Lea Chatham July 3rd, 2014

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Register Now3 Ways to Grow Your Medical Billing Service
Thursday, July 10, 2014
10:00 AM PT, 1:00 PM ET

There has never been a better time to grow your billing service. According to the 2014 Black Book Survey, many practices see outsourcing their revenue cycle management as one of the keys that can help them stay independent. In fact, 42% of small physician practices with employed billing staff hope to move billing out-of-house to an outsourcer in next twelve months.

In this webinar, billing service and marketing experts will help you understand what you need to do to take advantage of this growth in outsourcing. You’ll learn how to:

  • Improve your marketing and online reputation
  • Close more deals
  • Use resources from Kareo to strengthen your business offerings

There are many tools that you can add to your arsenal to grow your business and revenue. Kareo can help.

Who should attend?
Billing service managers and staff who are interested in finding ways to grow the business and meet the increasing demand from physician practices.

Register now to learn how to grow your medical billing service

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4 Steps to Assess a Possible HIPAA Data Breach

Lea Chatham July 1st, 2014

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By Ron Sterling

Tweet the articleThe HIPAA Omnibus Rules dramatically elevated your risk of data breaches. From lowering the breach standard to requiring documentation on why you think that you didn’t commit a breach, your practice needs to diligently work to avoid problems and properly handle a breach.

An event that compromises the security or privacy of Protected Health Information (PHI) is considered an impermissible use or disclosure of PHI. Impermissible use or disclosure is a breach unless you can show that there was a low probability that the PHI was compromised. This is not an academic discussion since you are required to properly notify patients and the Department of Health and Human Services (HHS) about breaches, and you are subject to fines for breaches. For example, mailing patient information to the wrong party, and unauthorized access to your electronically stored patient records are breaches unless you can show that there is low probability that PHI was compromised.

There are three exceptions to the breach trigger: unintentional acquisition, access, or use of PHI while employees are performing their jobs, inadvertent disclosure to someone authorized to access PHI, and situations where you have a good faith belief that the recipient will not be able to retain the information. For example, a fleeting view of some PHI on a computer screen may not be considered a relevant incident.

Using a “good faith evaluation” and “reasonable conclusion”, you evaluate the incident based on four factors:

  1. PHI Nature and Extent: The sensitivity of the information and ability to identify the patient as well as presentation options are factors in determining the probability. Deidentifying PHI is not easy or straightforward. In addition to name and phone numbers, a picture of a face or a free form text note about the patient could easily lead to identifying the patient. For example, a list of dated deidentified lab results with a separate list of patient appointments for the day of the lab would not present a low probability of compromise. On the other hand, loss of electronically stored diagnostic data that requires special software from the device manufacturer may present a low probability of compromise. This answer would be different if the lost information was PHI contained in an unsecured PDF file.
  2. Unauthorized Person Received or Used PHI: The status of the recipient of the PHI may offer a reasonable way to avoid a breach. For example, sending the patient report to the wrong doctor may lead to a low probability of compromise since the receiving doctor has been properly trained in HIPAA Privacy and Security.
  3. Actual Acquisition or Viewing of PHI: If your organization quickly uncovered the incident, you may be able to prevent the viewing or even possession of the PHI. For example, contacting the receiving party and recovering the information before the other people open the information may present a low probability of compromise. Similarly, if an envelope with PHI was lost, but upon recovery, you determine that the envelope was never opened, you may have a low probability of disclosure or use.
  4. Mitigation Factors: In the final step of your evaluation, you can determine if there were mitigating issues that lead you to a good faith and reasonable conclusion that the information was not disclosed. For example, a thumb drive containing PHI on a patient lost in a healthcare facility but recovered in a nonpublic area may present a mitigating factor.

If you determine that the probability of compromised PHI is low, you do not have a problem. Otherwise, you have a breach and have to respond according to the breach notification requirements.

If you have encountered a breach, within 60 days of discovery of the breach, you have to:

  • Contact the Patients: You have to mail a letter to the last known address of the affected patients. If you cannot contact more than 10 patients, your website or public media with an 800 number should be publically presented for 90 days.
  • Inform HHS: You have to maintain a log of breaches to send to HHS annually. If a breach involves over 500 patients, you have to directly contact the Office of Civil Rights.

With the lower “bar” for a breach and the documentation standards, your practice needs to maintain appropriate procedures, train employees, and enforce your policies to minimize the risk of impermissible uses and disclosures. In order to monitor evolving issues and avoid future problems:

Review each data breach to determine if changes to policies and procedures need to be made as well as remedial training to avoid future breaches.Tweet this Kareo story

On a periodic basis review the impermissible use and disclosures for trends and issues that may require adjustments to your HIPAA compliance strategy. Indeed, continuing incidents that are not breaches could indicate a serious weakness that could lead to a breach. For example, continuing loss and recovery of EHR backups could indicate the need to change the backup procedures or strategy.

Breaches can cost you money and undermine the confidence of your patients in the confidentiality of their PHI. With the lower breach trigger and the documentation requirement for your analysis to determine if a breach has occurred, you need to work to avoid breaches as well as impermissible uses and disclosures.

About Ron Sterling

Ron Sterling Photo 2012Ron Sterling is a nationally recognized thought leader on the implementation and use of electronic health records (EHR). He authored the HIMSS Book of the Year, Keys to EMR/EHR Success: Selecting and Implementing an Electronic Medical Record. Ron has worked with a wide array of practices on EHR decisions and issues, and has reviewed products from over 150 vendors.

 

 

 

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From Physicians Practice: 6 Ways Physicians Are Using Mobile Devices

Lea Chatham June 25th, 2014

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The 2014 Technology Survey, conducted by Physicians Practice and sponsored by Kareo, asked physicians if they are using mobile devices and how. Turns out that smartphones and tablets are becoming as ubiquitous as stethoscopes. More than 50% of physicians are using applications on an iPhone, Android device, or other smartphone. And, what are they using those applications for? Find out in this new infographic from Physicians Practice.

Physicians Practice Infographic

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