Medical Coding and Billing Vocabulary

Posted on June 11, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Basic HIT Nomenclature and HIPAA

[By Richard J. Mata; MD, MIS, CMP™ [Hon]

For the Health Information Technology [HIT] department of a hospital, clinic or medical practice and its coders, the following medical vocabularies are mandated by the Health Insurance Portability and Accountability Act [HIPAA].

Diseases

For diseases: the 9th or 10th International Classification of Diseases (ICD) Clinical Modification should be used. ICD9-CM is maintained by the Centers for Disease Control National Center for Health Statistics, while ICD-10 is maintained by the World Health Organization.

Procedures

For medical procedures: a combination of ICD-9-CM, Current Procedural Terminology maintained by the American Medical Association, the Current Dental Terminology maintained by the American Dental Association, and Healthcare Common Procedure Coding System (HCPCS) maintained by CMS, which is also used for medical devices.

Pharmaceuticals

For drugs: these should be coded according to their National Drug Code classification.

Assessment

“A recent change to Medicare policy made by the Centers for Medicare & Medicaid Services (CMS) helps ensure claims processing isn’t delayed when the only missing information on the CMS-1490S form is the provider or supplier’s National Provider Identifier (NPI).

CMS Transmittal 1747, Change Request 6434, issued May 22, notifies A/B Medicare Administrative Contractors (MAC) and carriers of editorial changes to Medicare policy in Pub. 100-04, Medicare Claims Processing Manual, chapter 1 regarding the monitoring of claims submission violations and the handling of incomplete or invalid claims.

In either case, as stated in the transmittal, “If the beneficiary furnishes all other information but fails to supply the provider or supplier’s NPI, the contractor shall not return the claim but rather look up the provider or supplier’s NPI using the NPI registry.”

http://www.aapc.com/news/index.php/2009/06/missing-npi-no-reason-to-deny-says-cms/

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Filed under: Glossary Terms, Health Insurance, Information Technology, Practice Management, Research & Development | Tagged: ADA, AMA, CDC, CDT, Centers for Disease Control National Center for Health Statistics, CMS, CPT, current dental terminology, current procedural terminology, david marcinko, HCPCS, Healthcare Common Procedure Coding System, HIPAA, hope hetico, ICD-10, ICD-9, international classification of diseases, IT, MAC, medicare, National Drug Code, National Provider Identifier, NPI, Richard Mata, WHO | 2 Comments »

Appraising a Medical Practice

Posted on June 10, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

The “Art of the Deal” for Buyers and Sellers

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chief

Are you considering selling your practice — or merging it with another? Thinking of buying? If you are, you’re hardly alone. Despite the decline of the big physician practice management companies [PPMCs] of the 1990s, the merger-and-acquisition market remains robust for small, private practices, as they respond to the continuing financial squeeze being placed on them, in 2009.

Read: http://www.humana.com/providers/NewsLetters/HumanaWeb1stQ07/articles/CoverStoryOne.html

Assessment

Humana’s YourPractice is a quarterly publication for office staff, physicians and other health care providers within the Humana network, and is produced by Corporate Communications in conjunction with “Physicians Practice”.

Note: David Marcinko is also a writer for Physicians Practice

Conclusion

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Health Care Uses for Twitter [Suggestions for Micro-Sharing]

Posted on June 9, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Health Care Should be the Leader in MicroSharing – Why isn’t It?

[By Staff Reporters]

According to by Phil Baumann, RN BSN; @ www.PhilBaumann.com

“Twitter may either be the greatest time wasting prank ever played on the internet community – or- it may be the best thing since sliced bread. It’s easy to make the first case if you read the public time-line for a few minutes. It’s a bit harder to make the second, but I’ll do my best to make it. Specifically, I’d like to take a stab at offering 140 health care uses for Twitter. Twitter’s simplicity of design, speed of delivery and ability to connect two or more people around the world provides a powerful means of communication, idea sharing and collaboration. There’s potency in the ability to burst out 140 characters, including a shortened URI. Could this power have any use in healthcare? After all, for example, doctors and nurses.”

Assessment

Read the 23 page white-paper here:

Link: http://blogs.usask.ca/medical_education/archive/2009/02/140_healthcare.html

Conclusion

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Filed under: "Doctors Only", Career Development, Information Technology, Marketing & Advertising, Media Mentions and PR, Practice Management, Research & Development | Tagged: betwittered, healthcare communications, micro-sharing, microsharing, phil baumann, tweet, tweets, twitter, twittering, URI, www.PhilBaumann.com, www.twitter.com | 19 Comments »

My Favorite Health 2.0 Experience from the Exam Room

Posted on June 4, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

HIT From the Trenches

By Hayward Zwerling; MD

I was in the exam room talking to a patient, who I am treating for hyperthyroidism. The patient complained of profound fatigue, of several months duration. It was unclear if the problem was being addressed by the PCP. While talking to the patient, I reviewed all his labs which were in ComChart EMR. There was nothing obviously wrong.

A True Story – July 07, 2006

From within the exam room, and while still talking to the patient, I connected to my hospital’s computer and download all his labs which were less than 1 year old. I then had ComChart file the labs into his ComChart chart. I then had ComChart EMR create a chart of all his CBCs by clicking the “Chart … CBC” button in the labs. It was obvious that his hematocrit had dropped precipitously sometime between January and March.

The PC computer I was using had Skype installed (a free program which allows you to make free telephone calls from your computer.) I also have a headset attached to this computer, which I use with Dragon NaturalSpeech Medical. While still in the exam room, and from within ComChart EMR, I clicked the “PCP” button in the patient’s Progress Note and a dialog box popped up and asked “Do you want to go to the Dr. XXX’s Addresses file?” I selected “yes.” I then clicked on the label “private,” which is in front of the physician’s “private” phone number. ComChart opened Skype and connected the call. I spoke with the PCP and I arranged for the patient to see the PCP the following day.

I then click the “orders” button and selected my “anemia work-up” panel. This created a lab order slip which included all the necessary blood tests. I choose the option “Send copy of results to … PCP” and then clicked the button “Fax order slip” to lab.

Contemporaneous Progress Notes

Finally, in front of the patient, I dictated a Progress Note, using Dragon NaturalSpeech 8 Medical. The resultant Progress Note included the chart of the patient’s CBCs. I then selected the PCP as the recipient, and clicked the button “Create queued fax.” In my office, I have one computer which continually sends out the “queued faxes” as soon as they are created. Thus, the PCP had received a copy of the Progress Note and the lab had received the lab order slip even before the patient left my exam room. The entire process occurred within a few minutes.

Assessment

Needless to say, that patient was impressed that my office was able to use technology in order to efficiently advance their healthcare. And, the fact that it all happened in front of the patient, seem to reassure the patient and de-mistify the healthcare delivery process.

Conclusion

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Filed under: Information Technology, Practice Management | Tagged: CBC, ComChart, ComChart eMR, CPC, Dragon Naturally Speaking, EHRs, EMRs, hayward zwerling MD, health 2.0, PC, Skype, SMAC | 2 Comments »

Credit Card Acceptance in Medical Practice

Posted on June 4, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

One-third of Physician Practices Not Accepting CCs

By Staff Reporters

The Physician Office Credit-Card Acceptance Survey, by SK&A Information Services, an Irvine, Califironia based provider of healthcare information solutions and research, suggests physician practices are limiting credit card [cc] payments because patients are being adversely affected by high interest rates, maxed out credit limits and a more challenging ability to qualify for unsecured credit.

Assessment

Read this report in HealthcareFinance News, on May 29 2009, by Richard Pizzi,

http://www.healthcarefinancenews.com/news/one-third-physician-practices-do-not-accept-credit-card-payments

Conclusion

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Filed under: "Doctors Only", Accounting, Practice Management, Risk Management, Surveys and Voting | Tagged: credit cards, healthcare information solutions, Physician Office Credit-Card Acceptance Survey, SK&A Information Services, unsecured debt | Leave a comment »

The Power of “ME Inc” for Physicians

Posted on June 3, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Embracing a New Competitive Practice Culture

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

There are more than 900,000 physicians in the United States. Yet, the brutal supply/demand/demographic calculus of the matter is that there are just too many aging patients chasing too few doctors. Compensation and reimbursement is plummeting as Uncle Sam becomes the payer-of-choice for more than 52% of us. And, the government as payer will likely increase with the Obama Administration. So, going forward, it is not difficult to imagine the following four rules for a new-wave competitive medical care culture for all physicians.

[A] Rule No. 1

Forget about large office suites, surgery centers, fancy equipment and the bricks and mortar that comprised traditional medical practices. One doctor with a great idea, good bedside manner or competitive advantage, can outfox a slew of CPAs, while still serving the public and making money. It’s a unit-of-one healthcare economy where “ME Inc.”, is the standard and physicians must maneuver for advantages that boost their standing and credibility among patients and payers. Examples include patient satisfaction surveys, the rise of evidence-based medicine; outcomes research analysis, concierge medicine, direct reimbursement payment plans, and economic credentialing; etc.

[B] Rule No. 2

Challenge conventional wisdom, think outside the traditional payer box, recapture your dreams and ambitions, disregard conventional gurus and work harder – and smarter – than you have ever worked before. Remember the old saying, “if everyone is thinking alike, then nobody is thinking”. Do insurance panel members think rationally or react irrationally?

However, you should realize the power of networking, vertical integration and the establishment of virtual medical practices, which come together to treat a patient, and then disband when a successful outcome achieved. Job security in this structure is achieved with successful outcomes, and perhaps not necessarily a degree in the near future. Medical futurists even presume the establishment of virtual medical schools and hospitals, where students and doctors learn and practice their art on cyber-entities that look and feel like real patients, but are generated electronically through the wonders of virtual reality units.

www.HealthcareFinancials.com

[C] Rule No 3

Differentiate yourself among your medical peers. Do or learn something new and unknown by your competitors. Market your accomplishments and let the world know. Be a non-conformist. The conformity of health insurance plans are an operational standard and a straitjacket on creativity. Doctors should create and innovate, not blindly follow entrenched medical society leaders into oblivion. Seek, and practice, health 2.0 collaboration with all stakeholders.

[D] Rule No 4

Realize that the present situation is not necessarily the future. Attempt to see the future and discern your place in it. Master the art of the quick change and fast but informed decision making. Do what you love, disregard what you don’t, and let the fates have their way with you. Then, decide for yourself if health plans adhere to any of the above rules?

Assessment

Regardless of the future de facto business model of the learned profession of medicine, current practice models are no longer the structure of choice. Rather, a more laissez-faire and highly competitive business model should be pursued. Physicians have been slow to accept this philosophy. Remember, as a physician, if you merely want a static job with promised security, pledged retirement benefits, limited goals and structured regulations; join a health plan panel and become their laborer.

However, if you desire more, such as the possibility of a dynamic career, the unlimited security of your brainpower, non-defined retirement contributions, infinite potential with rules you can create along the way; incorporate the power of ME, Inc., in everything you do. Remain a competitive professional and be a physician ... Get fly!

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Filed under: Career Development, Ethics, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, Inc., Managed Care, Practice Management | Tagged: Comparative Medical Effectiveness, competition, concierge medicine, CPAs, david marcinko, direct reimbursement, healthcare competition, outcomes research, physician economic credentialing | 3 Comments »

Interview with Jack Levy of Securebill, Inc

Posted on June 1, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

President – Securebill, Inc

What: An Interview and Special Report Exclusively Prepared for the ME-P
Who: Mr. Jack Levy, CISSP [President – Securebill, Inc]
Topic: Physician Selection of eHRs
Reporter: Amaury Cifuentes; CFP®
Where: Internet Ether

Although skeptics of eHRs abound, President Barack H. Obama’s signing of the American Recovery and Reinvestment Act [ARRA] of 2009 has created a massive push for their implementation. The Act provides $19.2 billion, including $17.2 billion for financial incentives to be administered by Medicare and Medicaid. This assistance of up to $40 to $65 thousand per eligible physician, and up to $11 million per hospital, begins in 2011.

Link: https://medicalexecutivepost.com/wp-content/uploads/2009/05/jack-levy-interview.pdf

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Filed under: Breaking News, Career Development, Information Technology, Interviews, Practice Management | Tagged: Amaury Cifuentes, American Recovery and Reinvestment Act, ARRA, CISSP, EHRs, electronic medical records, EMRs, HITECH, Jack Levy, Medicaid, medicare, obama, Securebill | 1 Comment »

Feds Propose Educational Website on ePHRs

Posted on May 31, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Site Aimed at Consumers

[By Staff Reporters]

As reported by Mary Mosquera on May 22 2009, the Office of the National Coordinator for Health Information Technology (ONCHIT) just proposed developing a Web site for consumers. The site is to contain facts about electronic-personal health record systems and their privacy policies. It aims to help consumers and patients make informed decisions.

http://govhealthit.com/articles/2009/05/22/feds-propose-phr-website.aspx?s=GHIT_260509

Assessment

The Department of Health and Human Services [DHHS] Agency information collection request, for a 30-days public comment period, is also located here.

http://edocket.access.gpo.gov/2009/E9-12023.htm

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Filed under: Breaking News, Career Development, Information Technology, Military Medicine, Practice Management | Tagged: CCHIT, DHHS, EHRs, electronic health records, electronic medical records, EMRs, ePHRs, ePRs, medical records, Office of the National Coordinator for Health Information Technology, ONHIT | 5 Comments »

About Timely Medical Alternatives; Inc

Posted on May 30, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Canadian Health System Alternatives

By Staff Reporters

In 2003, Timely Medical Alternatives Inc. was formed to help Canadians, on long medical waiting lists, to take personal responsibility for their own medical care and “Leave the queue” [the national healthcare system waiting-list].

Urgent Need

According to their website, the need for private medical services is thriving in Canada. The mission of Timely Medical Alternatives [TMA] is to accommodate Canadian’s needs for private medical services by providing them with options, referrals to hospitals, clinics and diagnostic imaging facilities.

Link: http://www.timelymedical.ca

Assessment

Timely Medical Alternatives, a PPO, says it is able to expedite most types of private medical services from diagnostics to virtually all types of surgery, including procedures not available within the Canadian healthcare system. Wait times for clients are measured in days rather than in months or years.

Link: www.HealthDictionarySeries.com

Sicko Alternative

The movie documentary Sicko was directed by Michael Moore in 2007. It compared the highly profitable American health care industry to other nations, and HMO horror stories

Link: www.michaelmoore.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Please compare and contrast TMA to “Sicko”, our current domestic health system, and the Obama administration’s vision of national healthcare for the US; and opine .Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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About the ASTER Pilot Project

Posted on May 29, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Improving the Reporting of Adverse Events

By Staff Reporters

According to its website, ‘ASTER’ stands for “ADE Spontaneous Triggered Event Reporting”. The ASTER study was conceived as a proof-of-concept project for a new model of gathering and reporting spontaneous adverse drug events (ADEs).

A Collaborative Project

ASTER is a collaboration of the following organizations and individuals:

Brigham and Women’s Hospital (Dr. David Bates is sponsor, Dr. Jeffrey Linder is Lead Investigator)
Partners Healthcare – use of the Longitudinal Medical Record
CDISC (an international standards group)
CRIX International (a public/private not-for-profit organization)
Pfizer Incorporated

Assessment

ASTER will implement automated ADE collection in an ambulatory clinic electronic health record (eHR). It employs a flexible standard for data collection known as “Retrieve Form for Data” (RFD) from CDISC and Integrating the Healthcare Enterprise (IHE), and will use CRIX International to host the application. The application allows direct downloading of data from the EHR and will forward the report to the FDA in the proper formats for electronic reporting of individual case safety reports (ICSRs).

http://www.asterstudy.com

www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/05MAY2009/0905HHN_Inbox_Medication&domain=HHNMAG

Conclusion

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Filed under: Breaking News, Career Development, Drugs and Pharma, Information Technology, Practice Management | Tagged: ADE Spontaneous Triggered Event Reporting, ADEs, adverse drug events, adverse drug reactions, ASTER, CDISC, CRIX, Dr. David Bates, Dr. Jeffrey Linder, EHRs, EMRs, FDA, ICSRs, IHE, longitudinal medical records, Partners Healthcare, Pfizer | 2 Comments »

Hospital Loses Twenty-Five Million Dollar Investment

Posted on May 28, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Investment Losses Cited

By Staff Reporters

www.HealthcareFinancials.com

According to Brian Bandell, of the South Florida Business Journal on May 20 2009, Baptist Health South Florida [BHSF] could not climb out of the red in the fiscal second quarter that ended March 31, 2009. Its investment losses wiped out operating income, according to a report the nonprofit issued to its bondholders.

Investment Losses Nix Operating Income

The Miami-based health care provider lost $24.8 million on operating revenue of $530.2 million in its second quarter. That’s improved from a loss of $26.8 million on operating revenues of $470.2 million in the same quarter of 2008.

Link: http://www.bizjournals.com/southflorida/stories/2009/05/18/daily47.html

Assessment

Perhaps the BHSF CFO and CEO should read Tab 8, Chapter 3 on: Hospital Endowment Fund Management, by J. Wayne Firebaugh, Jr; CPA, CFP® CMP™ in Healthcare Organizations [Financial Management Strategies]?

T.O.C. Link: toc_ho[1]

Conclusion

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Filed under: iMBA, Inc., Investing, Practice Management | Tagged: Baptist Health South Florida, david marcinko, endowment fund, hosptial endownment funds, Wayne Firebaugh, www.healthcarefinancials.com, www.healthdictionaryseries.com | Leave a comment »

About Fiduciary Benchmarks, Inc

Posted on May 27, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Independent Custom Benchmark Groups

By Staff Reporters

Department of Labor [DOL] regulations under ERISA, and specifically pending section 408(b)(2), requires that retirement plan sponsors obtain fee disclosures for their plans and that all fees be “reasonable” for services provided.

Fiduciary Benchmarks, Inc. [FBi] was launched to support plan sponsors, advisors, consultants, record-keepers and other plan service providers in addressing this obligation. Fiduciary Benchmarks helps document a thorough and objective process and well-informed decisions. This is an increasingly important topic for hospitals, healthcare systems, CXOs, CFOs, sponsoring medical entities and many modern physician-executives.

Background

Fiduciary Benchmarks, Inc was founded in October 2007 with the express purpose of providing pension and retirement plan benchmarking services. The genesis of the firm was recognition by FBi principals that the marketplace did not have an efficient and affordable way to help plan sponsors meet their fiduciary obligation to determine if plan fees are reasonable.

Progressing Past Current Approaches

Existing marketplace approaches to assessing fee reasonableness (including the use of simple averages books, issuing RFIs, participating in a mock RFPs or actually taking a plan to market) were falling short in terms of validity and/or the time, effort and disruption involved. These gaps continue today.

FBi Modern Approaches

FBi spent more than a year sharing their methodology and reports with the marketplace. They solicited and considered feedback from record-keepers and TPAs, advisors, consultants, independent auditors and ERISA attorneys. As a result, products are claimed to be well vetted and improved.

Link: http://www.fiduciarybenchmarks.com

Fiduciary Report [The Duty to Use Outside Sources]

“Fiduciaries are not expected to be experts. They may reasonably rely on the assistance of others in performing required investigation of and data gathering process. One of the key issues in determining whether reliance on the expert is reasonable is whether the expert is independent and unbiased.”

-Fred Reish

Assessment

In order to remain independent and conflict free, FBi does not perform any traditional investment consulting, plan monitoring and/or record-keeper search work. FBi offers benchmarking services, where desired, by plan sponsors, directly. Fiduciary Benchmarks, Inc. is a completely independent company.

Conclusion

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Economic Facts your Dentist Doesn’t Want You to Know

Posted on May 25, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Some Office Visit Schedules Linked to Insurance Payment

By D. Kellus Pruitt; DDS

http://thebulletin.us/articles/2009/05/21/herb_denenberg/doc4a15404e56e5f308210565.txt

Here is the link to an article written by Herb Denenberg titled: “Some Facts Your Dentist Doesn’t Want You to Know”. In it, he shared with his readers some information about dentistry that is hard to find. I submitted the following comment.

Dear Herb Denenberg,

Yours was a great article, and as a dentist with 27 years in a comfortable practice and 32 years in an expensive marriage, I find your cost-saving points oh so painfully accurate. Nevertheless, I must honestly agree that not only can some patients safely go a year or more between check-ups (ouch!), but many don’t need bitewing x-rays every year either (Good thing neither my patients nor my wife read the stuff I write).

Of BiteWing X-Rays

Readers who are hopefully from places other than the east side of Fort Worth can easily understand that the more treatment and x-rays I recommend, the more money I make. I must honestly add that my devoted and trusting dental patients, like most Fort Worth dentists’ patients, are reliably willing to accept my recommendations for these kinds of procedures without questioning the need. Let me put it this way: Annual bitewings are an easy $56 sale, mostly because fee-for-service insurance pays for them at 100% anyway. (If an angry dentist should ask who told you that, it wasn’t me). That is why it should not be taken lightly my approval of the advice about dentistry published in the book “1,001 Things They Won’t Tell You.” And; they won’t, sometimes.

Ethics and EBD

True to ethics I learned at the University of Texas dental school, in San Antonio (UTHSC), in the last six months, my hygienists and I have been determining which patients are safe to go a year and a half without routine bitewing x-rays. They are commonly taken every year simply because it has always been that way, and that interval was adopted as the minimum time most insurers allow. As readers can see, not a hint of Evidence-Based Dentistry [EBD] was involved in that determination. It was just a 1950’s guess.

Extended Prophylactic Schedules

This week we found four candidates in our practice for extended schedules. Our honesty will save these patients (their insurance companies) money by eliminating unnecessary care. And I really, really hate saving insurance companies money, on principle alone.

In My Defense

In my defense of continuing to maintain a large number of my patients on 6 month prophys and 12 month x-rays – and with the hope of restraining local dentists from throwing rocks through my windows – let me say up front that most people still need the old-school schedule in order to prevent disease. And, a few of the more fragile cases need x-rays and cleanings even more often than insurance allows.

Assessment

My patients and I are fortunate that I can freely charge the prices I deem necessary in order to put my patients’ interests above my wife’s. Let’s face it. Ethics are invisible to dental patients and they are not free. Ethics are a precious courtesy that dentists who accept managed care insurance find themselves forced to eliminate because contracts prevent them from raising fees as the market demands. Managed care dentistry is dentistry by the lowest bidder with no quality control. I only wish that someone would have pointed out that chunk of information in the book. Now, I’d better have my wife go ahead and start my car in the morning when she grabs the paper.

Conclusion

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Filed under: "Doctors Only", Career Development, Ethics, Health Economics, Health Insurance, Managed Care, Practice Management | Tagged: ADA, bite wing X-rays, cavities, Darrell Pruitt, DDS, dental visits, DMD, EBD, evidence based dentistry, Herb Denenberg, UTHSC | 7 Comments »

Understanding Periodic or New Employee Practice Compliance Audits

Posted on May 22, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Perform and Improve as Needed

By Patricia Trites MPA, CHBC; with Staff Reporters

www.HealthcareFinancials.com

There are several types of compliance audits that a medical practice, clinic or healthcare organization might need to perform. The starting point, discussed elsewhere on this ME-P, is to obtain a baseline audit. The next step is periodic audits or reviews that are performed after information is obtained from the baseline audit.

Periodic Audits

Periodic audits are performed on an on-going basis. Depending on the volume of billing, these may occur weekly for a large multi-specialty ambulatory clinic to quarterly for a small medical practice. These periodic audits can be random or scheduled. Sometimes in the process of seeing how things run, a surprise review can be informative to staff and practitioners.

New Employee Audits

New employees require regular training and reviews until there is confidence in their capabilities. Background checks are often helpful to find out whether there are any potential conflicts. In hospitals, health plan offices, surgery centers, and other regulated facilities, background checks are a normal part of the credentialing process. This process typically includes Medicare violations, which would show up on the National Practitioner Data Bank report. However, independent medical practices do not have access to this type of information and may have to rely on other organizations to obtain the information. The OIG and the General Services Administration both maintain a database of excluded persons and entities that can be accessed through the Internet. As part of the organization’s initial and periodic audits, queries of these two databases should be performed for all employees and independent contractors (like locum tenens physicians). Failure to do so can put the practice at risk of large civil money penalties ($10,000 for each occurrence) and liability for refunds of all claims the excluded individual had part in providing or billing.

Assessment

Additional audits can be performed whenever new employees are added, or if there are complaints or issues that arise in the course of business; prn.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated? What interesting, informative or strange tidbits have you uncovered in your auditing processes?

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Medical Inventory Supplies and Management

Posted on May 21, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Traditional D.M.E. and Turn-Over Rates

[By Staff Reporters]

Healthcare inventory represents tangible medical items used in the delivery of healthcare services, or for patient use and resale, or durable medical equipment [DME]. A certain quantity of safety stock should always be available. Inventory ranges from normal administrative office supplies to highly specialized chemicals and reagents used in the clinical laboratory.

Capital Supplies

Inventory should be distinguished from capital supplies, such as major equipment, instruments, and other items that are not used up faster than inventory or related inventory wastes.

Understanding Inventory Turnover

Historically, asset utilization ratios provided information on how effectively the enterprise used its inventory assets to produce revenues, or deplete its cash. For example, the inventory turnover ratio (ITR) determines the total volume of inventory turnover (change) during a pre-determined accounting period (month or quarter). It is defined as cost of inventory purchased for the period, divided by average inventory (AI) at cost.

Supply Chain Management

Dunn and Bradstreet, the supply chain management and consulting company; does not provide exact comparatives for private healthcare ITR. Nonetheless, ITR is useful as an internal performance indicator of inventory turnover speed and cash flow enhancement. Currently however, for public hospitals, 60 – 75 days is estimated to be the average time for inventory turnover.

Assessment

The main problem with traditional ITR, similar analyses such as AI, and the usual inventory costing methods (e.g., last-in first-out, first-in first-out, specific identification, average costs), and even just-in-time inventory costing, is that they do not embrace supply chain inventory management models. This occurs because sources of profit or loss are not recognized in the traditional inventory cost accounting equation:

Cost of goods sold = beginning inventory + net purchases – ending inventory.

Conclusion

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Filed under: Accounting, iMBA, Inc., Practice Management, Recommended Books | Tagged: average inventory, cost accounting, DME, durable medical equipment, first-in, first-out, inventory costing, inventory costing methods, inventory turnover ratio, ITR, specific identification, supply chain management | 3 Comments »

Doctor’s and Tax Deductions

Posted on May 20, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Physicians Can Take More Tax Deductions

By Staff Reporters

Now that tax season is over, it’s time for physician practices to start saving receipts and filing tax records again.

The Report

According to the May 04, 2009 report of Chelsey Ledue, Associate Editor of Healthcare Finance News; there are more than 400 possible deductions that medical practices can take, although most physicians only know of a few common ones.

Link: www.CertifiedMedicalPlanner.org

Assessment

In reality, “most docs are taking somewhere in the neighborhood of 40 deductions”, according to one industry expert.

Link: http://www.healthcarefinancenews.com/news/physicians-can-take-more-tax-deductions

Conclusion

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American Recovery and Reinvestment Act Primer for Physicians

Posted on May 20, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Free ARRA Webinar Series

By Staff Reporters

Are you ready to maximize American Recovery and Reinvestment Act (ARRA) opportunities in your medical practice?

The Webinar Series

This webinar series is designed to support physician practices as they prepare for a new health care environment. As new information becomes available, experts and health care leaders representing diverse sectors will review key components of ARRA and offer insights on the impact to the physician community.

Topic: Stimulus 101: Basics of the Health Information Technology Provisions

When: Thursday, May 21, 12:00 PM CST

Presenters:

Glen Tullman, Chief Executive Officer – Allscripts
Margaret Garikes, Director of Federal Affairs – AMA

Assessment

Plus, hear from practices using eHR systems and how they made the transition.

Registration: https://cc.readytalk.com/cc/schedule/display.do?udc=1ip8sqjax7frw

Conclusion

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Health Information Technology Security and Encryption

Posted on May 18, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding the Risks of eMRs and Internet Connectivity

[By Carol S. Miller; RN, MBA]

E-mails, PDA data, and Internet connectivity, unless encrypted, can be read by anyone. Therefore, if these items are not encrypted, physicians should be careful of what they say and how they say it, especially when discussing any patient information with other providers, vendors, or managed care organizations. In addition, just because you deleted e-mail from the system does not mean that you have deleted it from the server or from the computers that maintain copies of your server’s data. HIPAA regulations set forth the criteria in electronically transferring patient related data via the Internet.

Secure and Encrypt Messages and Health Information

If you want secure messages, an encryption program should be used. If the message is intercepted the text will be scrambled to anyone other than your intended recipient. Most physicians feel encryption is too time consuming; however, programs such as Pretty Good Privacy at www.pgp.com provides an easy and nearly seamless integration into e-mail and operating systems, encrypting the sensitive files but still allowing ease of communication. PCP software developed by MIT and endorsed by HIPAA, uses privacy and strong authentication. Only the intended recipient can read the data. If files were intercepted, they would be completely unreadable. Other software programs are available in the marketplace that will work using a private key – similar to a password. Tell the program the name of the file you want to encrypt and the private key, and the program uses a mathematical algorithm to encrypt the file. For reference material on various encryption and security software programs, search the web under “encryption” or go to one of the following sites: www.zixit.com, www.cisco.com, www.aspencrypt.com, or www.verisgn.com.

Assessment

In addition to encryption, the office needs a good anti-virus program that is designed to detect and prevent viruses, such as Norton Anti Virus at www.symantec.com and McAfee VirusScan at www.mcafee.com

Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Book Reviews, Career Development, iMBA, Information Technology, Practice Management, Recommended Books, Sponsors | Tagged: carol s. miller, david marcinko, EHRs, EMRs, health 2.0, health data encryption, health information security, healthcare IT, HIPAA, hope hetico, internet connectivity, PDAs, www.healthdictionaryseries.com, www.medicalbusinessadvisors.com | 6 Comments »

On Medical and Other Patient-Centric Specialty Homes

Posted on May 15, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

New Guidelines Released

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

According to Chris Silva, AMA News on May, 12 2009, new medical home guidelines have just been released.

Physician Input

Four physician organizations have developed new guidelines for medical home projects to ensure consistency and help define how a patient-centered home model should look. The 16 guidelines include recommendations on who should collaborate on the projects, how they should choose practices to participate, what type of support should be provided to practices, how practices should be reimbursed, and what each project should do to analyze and report results.

Link: http://www.ama-assn.org/amednews/2009/05/11/gvse0512.htm

Assessment

Physician groups hope clarity and consistency will lead to broader acceptance of the programs. But, what about mental health homes or dental homes; how about podiatry or optometric homes, etc? What about patient mobility?

Is this concept even viable given our increasingly mobile society? Or, is this philosophy fixed in the last century; especially in light of the Obama Administration’s HIT, and eHR initiatives? Was the fluid health 2.0 culture even considered? What are we missing?

Conclusion

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Filed under: "Doctors Only", Breaking News, Career Development, iMBA, Inc., Information Technology, Op-Editorials, Practice Management, Quality Initiatives, Research & Development, Sponsors | Tagged: Chris Silva, david marcinko, dental homes, EHRs, HIT, medical homes, obama, patient centric medical homes | 15 Comments »

Physician [Fee] Schedule Augmentation

Posted on May 14, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Organizing and Analyzing Financial Data

[By Christy Clodwick; MHA]

After all medical practice management data has been gathered, organize it onto a spreadsheet or chart. This analysis report will help to determine the codes and/or health plans that should be targeted for process improvement.

Focus … Focus … Focus

The focus should be on the highest volume and dollar value codes. Does this mean patients with unusual conditions or low dollar value codes are not treated? Hopefully it will not; but it will push this process forward and the practice will see the greatest benefit from these categories. When you review the report and find that a fee is being paid at a much lower rate, this would be indicative of a necessary negotiation with the payer for an increase for that procedure. Most health plans are committed to preventing disease. Maybe, but they are still actually aimed at treating diseases; not preventing them. If this is true of many payers then they should be willing to provide the incentives for those services to be carried out. You will find that some payers’ fee schedules are very much out of line with a percentage of Medicare payments, therefore the practice administrator should focus on those payers and bring evidence of the inadequacies to their attention.

The Specialists

Specialists are, for the most part, paid at a higher rate than primary care physicians not usually for the same service! And, with GPs as gatekeepers, the specialty doc incomes may have actually decreased in some instances, while the GPs may have increased. There was a time when Medicare had two conversion factors, and this was the result. This inequity could also be used as a tool for better reimbursement rates.

Finalizing the Fee and Revenue Analysis

When the final preparations of the fee analysis have been completed, it is time to react to the results of the findings. There are several options to choose from when it has been determined that a health plans fee schedule is not in tune with the practice’s financial growth. The practice should act on these results as soon as they are discovered, to avoid the loss of any more revenue.

No longer Accepting Health Plans

During the analysis phase, you may determine that a health plan’s payment levels are extremely low. You will have to determine whether the plan is worth negotiating or the practice administrator should consider dropping out of the plan altogether at the end of the contract period. It will have to be carefully determined by the local market. If the practice is in a highly competitive market, this process should not be considered as first choice. However, if the market is very slim, the health care purchaser will be responsible for complaining to the health insurance plan provider that there is simply not enough physician coverage for their employees for the area. This could be a very effective way to force a negotiation with the health care company. If this were the case, the area would have less managed care and more MC/MD.

Not Accepting New Patients from Low Paying Health Plans

One option would be to not accept any more patients from the health plan that is reimbursing the practice with low rates. Although this may initially lower your patient count, over time the practice will benefit from new patients with health plans that have a better reimbursement policy. Include snapshot of what the final analysis or report should look like and the details of what it should include. This can be used in any specialty to assist in putting together the individual practice analysis to achieve the same results. But is it noble or ethical? What about any willing provider laws?

The Future for Health Care Reimbursement

The health care purchasers who pay most of the bills, such as employers and the government, will soon be challenging the annual increase and the overall cost of health care. The cost increases of the hospital and pharmacy sectors of healthcare are far higher than that of the physician. However, the pressure for cost containment is being felt across the board. This will eventually depress future reimbursement for all healthcare providers. In the future it will be hard for practices to keep up with the demands of labor, malpractice and supply cost increase. All medical providers need to plan for this future paradigm. To offset this trend, physicians will need to get the most out of the work that they are doing today as well as look to new revenue generating procedures for their practice that will be cheaper and more convenient to the patient.

Process Improvement

The biggest benefits will come from continually improving the process of the daily operations of the practice, as well as ensuring accurate diagnostic coding. This will enable a practice to keep up with charge capturing through the explanation of benefits (EOB) when the charge has been processed and paid by the health insurance provider. When this process identifies that there is room for negotiation, the provider should proceed for a better reimbursement rate. If the provider is in a dominant market, the payers will be more likely to issue sweeping fee increases and so can you give me an example of this ever happening? By completing a Practice Fee Analysis, any practice should be able to use this tool to demonstrate the inequities and negotiate a better reimbursement rate for the practice.

Assessment

The first step in the negotiation process would be to contact a representative of the health insurance company that is in question. If you can produce compelling evidence to the representative, the negotiation process should be the next meeting. These folks may be fired if they do what you suggest, too frequently. Continually updating the practice fee schedule will help the practice stay on top of the contracts that it practices under. Practices that present a well-documented argument may (almost never) be rewarded with positive payer response. Again, proper planning will make for great future performance in any health care practice.

Conclusion

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Filed under: Accounting, Book Reviews, Career Development, Glossary Terms, Health Economics, Health Insurance, Managed Care, Practice Management, Recommended Books, Sponsors | Tagged: CPT, david marcinko, fee analysis, fee schedules, healthcare plans, hope hetico, Medicaid, medical practice management, medical reimbursement, medicare, revenue analysis, RVU, www.healthcarefinancials.com, www.healthdictionaryseries.com | 2 Comments »

On HIT Cost Savings

Posted on May 14, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Real or Imagined Solutions

According to David M. Cutler, of the Center for American Progress Fund [CAPF] on May 11, 2009, health care will be the major challenge to the federal budget in coming decades. Rising health costs will account for nearly all of the expected increase in government spending relative to gross domestic product [GDP].

Healthcare Costs and GDP

Health care currently accounts for 16 percent of domestic GDP, and that share is forecast to nearly double in the next quarter century. Spending money on health care is not bad, but wasting money is very bad.

Link: http://www.americanprogressaction.org/issues/2009/05/health_modernization.htmlHIT

HIT to the Rescue

But, $600 billion might be saved over the next ten years, and $9 trillion saved over the next 25 years, if HIT initiatives are used; says the CAPF.

Assessment

Estimates suggest that a third or more of medical spending—perhaps $700 billion per year—is not known to be worth the cost. Wasting hundreds of billions of dollars on inefficient health care is a luxury the country cannot afford.

Conclusion

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Filed under: Career Development, Health Economics, iMBA, Inc., Information Technology, Practice Management | Tagged: CAPF, Center American Progress Fund, David Cutler, federal budget, GDP, health costs, health technology, healthcare economics, HIT, medical spending | 3 Comments »

About HealthCareTownHall.com

Posted on May 12, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

The Great eHR Debates

By Staff Writers

Milliman hosts this blog to encourage an informed dialogue about healthcare reform. Healthcare is complicated, and there is no single, silver-bullet answer to the question of “How do we best improve the current system?” But thoughtful discussions will help move reform in the right direction and mend the fractured system.

Assessment

A shout-out of thanks, for this link, goes to Jeremy Engdahl Johnson of Healthcare Town Hall.

Link: http://www.healthcaretownhall.com/

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Negotiating Physician Fee Schedules

Posted on May 11, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Better Data for Improved Fixed Compensation

[By Christy Clodwick; MHA]

[By Dr. David E. Marcinko MBA]

It is known that most health plans operate with fixed fee schedules. While these fee schedules have little or nothing to do with RBRVS, and most are based on a percentage of what Medicare pays, the question is: “are they tied to levels that are more than 3 or 4 years old?” Physicians who have no negotiating tools or a plan in place, and who question the methodology that the payers are using, are (too casual-left) with a ‘take it or leave it’ response from the health insurance provider.

Gathering the Data

A good solid foundation of data is necessary to negotiate better reimbursement rates successfully. The practice administrator or accountant (not 1 in 100 accountants can actually do this) should have this information readily available, especially if the office has an automated billing system.

Steps to Preparing a Fee Analysis

First and foremost, the medical management team in charge of this project will need to determine the most commonly used CPT® codes for the practice. The bulk of primary care or family practice physician fees should be derived from the revenue of the office visit, hospital and preventive medicine codes. This in turn may limit the number of codes for the study. The frequency of each CPT code should be listed over a 12 month period. If applicable, laboratory fees should also be included to see if there are fluctuating reimbursement schemes for these services. The codes on the list should account for at least 75% of the total practice charges.

Determining Top Payers and Reimbursement by Payer

It is known that Medicare and Medicaid use established fee schedules and do not negotiate, therefore the focus should be on the other major payers that make up the bulk of the reimbursement. In this process, make sure that the payers in the report are the practice’s top payers. The practice administrator will also need to determine the reimbursement for each code that is sent to the various payers’ list in the report. The administrator or team leader (the average GP has 3-4 employees, so I don’t think there would be a team leader, here). For this project we can use the Explanation of Benefits EOB that is received from each payer that has been selected for the report. When including this data, make sure the allowed amount, not the paid amount, is referenced. After this information has been gathered, each payer’s reimbursement rate will need to be calculated as a percentage of Medicare’s reimbursement rate. Medicare’s current rates for any geographical area can be found through the “Medicare Physician Fee Schedule Look-up” tool at:

Link: https://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_alp.php?p_sid=1reSKuxj

This site also provides a reference to Relative Value Unit, (RVU) that Medicare assigns to each code.

RVU Conversion Factors

It is important for the practice administrator or manager to understand the RVU conversion factors and how they work, simply because most payers are in the beginning stages of using this method. To calculate a payment for service you multiply a particular CPT Code by the Medicare conversion factor for that code. For an example we will use the code 99214 – office visit. The Relative Value Unit for that Code is 2.2. The Medicare conversion factor for the same code is $37.34. The calculation would result in a rate of $82.15. Geographical adjustments must be taken into account when performing these calculations. The next step in this process would be to review the fees for each code listed in the report. Calculate each fee as a percentage of Medicare’s rates. You will find different statistics for each payer.

Apply the Rules and Process

Follow these basic rules when applying this new process:

First, if the charges are being reimbursed at 100%, the fee may be too low. At this point, raising the fee for that code would be acceptable (Usually not the case). Next, If several fees are in this category, the practice should just set all its fees to a percentage of Medicare reimbursement across the board, such as 125 percent (many managed care plans pay at less than MC, i.e., 80% MC). Finally, a tiered fee schedule would be applicable if the payers seem to pay more for certain procedures or diagnostic studies. That would set evaluation and management codes at 125 percent of Medicare reimbursement while charging 150 of Medicare reimbursement for other procedures and diagnostic tests.

Assessment

The medical practice administrator should make sure that, no matter which fee schedule is best suited for the practice, it is updated annually to prevent loss of any increases that may occur per payer.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Career Development, Glossary Terms, iMBA, Inc., Managed Care, Practice Management, Recommended Books | Tagged: CPT codes, david marcinko, EOB, hope hetico, Medicaid, medical fee schedules, medicare, physician fee schedules, RBRVS, RVU | 2 Comments »

Improving Financial Viability of Medical Practices

Posted on May 10, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Medical Practice Financial Management

By Christy Clodwick; MHA

To combat the climate of barriers and frustrations in medical practice today, physician executives and administrators need to create innovative ways to change and improve medical providers’ outlook in the health care marketplace.

Many Barriers

The barriers—federal anti-trust laws, lack of state or federal regulatory action, marketplace resistance and tremendous cost pressures—are being confronted throughout the healthcare sector and are being felt by medical practices of all sizes, including hospital organizations, medical organizations as well as independent solo practitioners. Although there are tremendous financial pressures in operating a healthcare practice, the demand for healthcare is on the rise. To remain viable in today’s healthcare market place, strategic planning is needed at all levels of every practice’s processes.

Disenchanted Doctors

It is increasingly acknowledged that physicians in today’s health care market are becoming disenchanted with the reimbursement compensation from managed care. This also affects the outlook that they have on the medical profession as a whole. It is important to point out that there are ways to put processes in place to combat or, at the very least, survive all the changes taking place. Strategies can be put in place to offset the high demand for quality care and the discouragement and outrage that physicians are feeling about reimbursement. Physicians did not learn the business side of medicine in medical school, although many physicians today are choosing to diversify their careers by going back to school to get an MBA, or even just further business knowledge, to stay abreast of the changes. Selecting an outside source to assist a practice with the needs of business growth planning can be difficult, if the physician or practice administrator does not know what the needs really are. The best option would be to ask for a recommendation from a colleague who has hired consultants to assist in his or her practice, or to call on the local hospital administrator for assistance in locating an appropriate consultancy firm or management company.

The Planning Process and Process Improvements

The planning process of any business operation should always include management systems that clarify the business strategy and the metrics that most reflect success with that strategy. They should provide the framework to prioritize resources for projects that will improve the metrics, and leverage leaders who will manage the efforts for rapid, sustainable, and improved business results. This plan should also include improvement of processes that are already in place. In essence, this should be a corporate wide approach to process improvements and management of the processes to control the outcome of the progress of these changes.

Driving Success for Plan Development and Implementation

During the plan development stage, all aspects of operations have to be included in the plan in order to ensure a successful outcome. The plan for a healthcare practice should include time management, cost containment, third party reimbursement (to include annual contract(s) review as many practices have 100-200 contracts), insurance coding and compliance, accounting, business management, capitation economics, marketing and business development, medical advertising, and especially important is the health information management system. Plan development, in short, should focus on:

Understanding and managing patient demands and requirements (this is clinical material).
Aligning key business processes to achieve those requirements.
Using rigorous data analysis to minimize variations in those processes, i.e. fee analysis, revenue analysis, and time management.
Driving rapid and sustainable improvement of business processes.

Future Health Economic Policy

With all the changes that have occurred in healthcare, it is safe to assume it will be a struggle to come up with a perfect plan that will sustain all future changes in such a volatile healthcare market. Practice reimbursement would be a good place to start since this is the lifeblood of any healthcare provider. Income from fees has not nominally increased for more than a decade. The introduction of the Resource Based Relative Value Scale (RBRVS), as well as the adoption of a national fee schedule by Medicare, has virtually eliminated a practice’s ability to generate more income from insurance plans by increasing what the practice charges for its services.

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Conclusion

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Physician Use of the Internet

Posted on May 10, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

The Slow Evolution of a Healthcare Tool

[By Carol S. Miller; RN, MBA]

The Internet is a constantly evolving service that continues to grow at an exponential rate, especially in physician practices. Primarily, the Internet is used as a means to electronically and expeditiously transfer data via e-mail as well as obtain information from a variety of sites. Initially, in the physician’s office, the primary use was e-mail communications with peers, hospitals and others. Next providers linked to hospitals and managed care organizations to obtain more direct connectivity for clinical information and benefit coverage. Today physicians are finding other beneficial avenues to expand their utilization of the Internet. Several examples include:

Direct e-mail inquiries from the patient to the physician.
Patient educational newsletters and links to other healthcare educational web sites.
Continuing medical education (CME).
Chat room consultations, conferences or presentations with other providers.
Nurse to patient e-mail connectivity.
Immediate data on lab results with alerts for abnormal high or low values.
CPOEs (Computerized Purchase Order Entry Systems).
Radiology images.
EMR (Electronic Medical Records).
Monitoring of patients blood sugars or EKGs via the Internet.
Appointment scheduling on-line by patients.
Patient appointment reminders via the Internet.
Secure physician portals such as Medicity, located at www.medicity.com, which allows access to pertinent and prioritized data from a wide range of sources and vendors to include, labs, imaging centers, hospitals, payers and others.
HIPAA compliant Application Service Providers (ASP) for dictation, recording, routing and speech recognition and transcription services, such as Speech Machines at http://www.speechmachines.com.

Access Management

Besides the value to the patient and the physician, the physician can utilize his or her Internet connection with software firms such as NextGen to automate the registration, scheduling, eligibility verification, billing and “clean” claims processing via innovative Web-base solutions in real-time scenarios. All the physician’s office needs is a PC, a standard Internet browser, and a connection to the Internet to take advantage of this service.

Assessment

These resources and more, via the Internet super highway, enable physicians to have quicker and easier access to clinical information and improve productivity. Furthermore, these tools will quickly assist providers with accurate and timely medical decision making, thus improving patient care and outcomes.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

http://www.BusinessofMedicalPractice.com

***

Filed under: Book Reviews, Career Development, iMBA, Inc., Information Technology, Practice Management, Recommended Books, Sponsors | Tagged: ASP, carol s. miller, CPOEs, david marcinko, EHRs, EMRs, health 2.0, hope hetico, internet physicians, medical internet, physician computing, physician connectivity, superhighway, www.healthcarefinancials.com, www.HelthDictionarySeries.com. www.MedicalBusinessAdvisors.com | 2 Comments »

Non-Traditional Property and Liability Insurance Coverage for Doctors

Posted on May 9, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Review of Other Insurance Forms for Medical Providers

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chief

Obviously, not all forms of P and L insurance coverage can be described in detail on this post. However, the healthcare professional or medical practitioner should consider these other forms of commercial property and liability coverage.

Directors and Officers Liability Insurance

The officers and directors of large practices, or healthcare facilities can be held personally accountable, and thus liable, for breaches of their duties by a number of parties.

Commercial Automobile / Vehicle Insurance

As the name suggests, this coverage provides protection for any commercial vehicles owned and operated by the healthcare corporation. If the practice or facility owns automobiles or other vehicles that are used in the “usual and customary” business activities, this coverage is required. The policy-owner should be aware of the nine classifications of automobiles insured to ensure that coverage is appropriate.

Commercial Umbrella Liability Insurance

This coverage is very similar to the umbrella coverage that falls under the personal coverage area. Again, risks above the limits established by the underlying commercial liability coverage trigger the umbrella policy. The word of caution for this coverage is “Read the Provisions Carefully” as there is little standardization among insurance companies. Make sure the umbrella policy covers what you want it to cover, with the right limits of benefits and “trigger” points, with proper exclusions, and proper endorsements (if being used specifically for a medical practice.)

Employee Benefits Liability Insurance

Virtually each medical practice or healthcare facility has employee non-cash benefits in addition to their payroll. These benefits usually include group insurance and some form of retirement plan (a 401(k), for example). Nevertheless, each of these benefit packages expose the employer to liabilities under state and federal statutes. Employee Benefits Liability Insurance covers an employer, or if so stipulated by some policies, the employees who act on behalf of the employer, against liability claims involving alleged errors or omissions, or improper advice or administration of the employee fringe benefit plans. For example, an employer may be liable for not enrolling an employee on a timely manner resulting in no medical coverage. Frequent litigation also arises out of violations of the Employee Retirement Income Security Act (ERISA) of 1974. Since 1974, the provisions and reach of this Act has become massive and errors can occur.

Disclaimer: The author is a former licensed insurance agent and certified financial planner and advisor.

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ADSL – DSL Primer for Physicians

Posted on May 8, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Asynchronous Data Subscriber Line versus Digital Subscriber Loop

By Carol S. Miller; RN, MBA

Asynchronous Data Subscriber Lines

ADSL is a very fast digital line provided by the telephone company. If available in your area, the ADSL provides fast connections, but generally not as fast as cable. There are various choices, beginning around 256 kbps (about five to six times the speed of a fast modem) going up to 7 Mbps. Prices begin around $60 per month (including Internet service). There is also a set-up charge and a card needs to be inserted in your computer.

Digital Subscriber Lines

DSL is a high-speed direct line that can be 20-100 times faster in communication over the modem, depending on the type selected. Prices for the DSL begin at approximately $30-$40 per month and that includes Internet access. In addition, there is a set-up charge and a network card will need to be installed into the computer. Office workstations can usually share DSL circuits over their existing local area network (LAN).

Internet Connection

To connect with the Internet, as a rule of thumb, the faster the better; therefore, the office should have at least 56 kbps. DSL normally runs over the same line as a basic telephone voice circuit and provides Internet access from speeds of 384 kbps all the way up to 1.54 mbps (megabits per second). The advantage of this configuration is you not only have high-speed access to the Internet, your telephone is still free to make and receive calls at the same time.

Integrated Services Digital Network

A digital telephone line that allows voice and data to be transmitted on the same line in a digital format – instead of analog – and at a relatively high speed, usually around 64 to 128 kbps. When reviewing this service, make sure the ISP has an ISDN connection. If not, you will be charge more by both the telephone company and the ISP. Prices for the ISDN average around $300 plus, with an extra fee to install the telephone line and a monthly service charge of $25 to $100 plus to maintain.

Wireless Network (WiFi – 802.11b)

The biggest change to happen to computers in the last ten years has undoubtedly been the Internet. Close on its heels in importance may just be the adoption of the wireless network access. Wireless Fidelity, or Wi-Fi, is now cost effective and available at the computer store. It is no longer necessary to re-wire buildings with Category 5 wire to provide LAN connectivity and resource sharing to multiple computers. Wi-Fi, or IEE standard 802.11b, enables small offices to connect up to four computers to a single network for less than the cost of a single computer. This means the days of multiple analog lines to offer Internet access to every computer, or a printer on every desktop, are going away. Now a single cable modem or DSL line and a centralized printer can service four users. This can save a small business hundreds of dollars a year.

www.HealthDictionarySeries.com

Limited Connectivity

For limited connectivity, computer stores are stocked with wireless vendor products that are cost effective, easy to install, and very robust that will push even the most cautious computer user to take the leap to wireless computing. Not only does it make the initial cost to install a network cheaper than it has ever been before, it eliminates the cost to remodel or move computers within a building since instead of requiring data wiring at each proposed desktop all you need now is an electrical outlet to power the PC itself.

Satellite

This is a more modern device. In the past, satellite connections were at 400K bps or fourteen times faster than the average modem. As an example, a 2MB file would be downloaded in 30-40 seconds. Benefits of the satellite connection are: The connection is always on; it is reliable; there is a secure connection; office can have multiple e-mail addresses; the web space is free; and there is tech support coverage nationwide. Costs include around $300 for the equipment, $150 plus to install the equipment, and around $30 to $50 per month for service. Web site reference is satcast.com (DirecWay Satellite Dish).

Conclusion

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Filed under: Book Reviews, Glossary Terms, Health Law & Policy, iMBA, Inc., Information Technology, Practice Management, Recommended Books, Sponsors | Tagged: ADSL, asynchronous data subscriber line, cable modem, carol s. miller, david marcinko, digital subscriber line, digital subscriber loop, DSL, EHRs, EMRs, hope hetico, IEE, internet connection, ISDN, LAN, moodem, WAN, WiFi, WiMax, wireless network, www.healthcarefinancials.com, www.healthdictionaryseries.com | Leave a comment »

Understanding Automobile Insurance

Posted on May 7, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

A Review for Physicians

By Gary A Cook; MSFS, CLU, ChFC, RHU, CFP® CMP™ (Hon)

Like the Home Owners policy, automobile insurance comes in a package (commonly called a Personal Auto Policy, or PAP) containing declarations, forms and endorsements.

These are: Liability Coverage, Medical Payments coverage, Uninsured Motorist coverage, and Coverage for Damage to your auto.

Important Elements

The important elements of automobile coverage are:

The vehicle or vehicles is covered, whether owned or leased
The insured – the covered driver
What is covered?
What are the limits of coverage – for both property and liability?

Exclusions

What are the exclusions – for example, the business use of a vehicle may not be covered under the personal policy? Other coverage for example includes a friend driving your car, or, coverage driving a rental vehicle. The medical payments coverage outlines the limits of liability for medical services needed as the result of an accident.

PULP

The final area of common personal coverages is the Personal Umbrella Liability Policy. To say that our society has become very litigious may be a gross understatement. The umbrella liability policy transfers the risk of losing substantial assets or future personal income to pay legal obligations resulting from an adverse judgment. The umbrella policy originated to provide risk protection against catastrophic legal claims or judgments. Typically, coverage limits begin at $1 million with upper limits of $10 million, and some unique situations, more. The term “umbrella” arises from the contract language that reflects that the individual carries the appropriate underlying basic coverages (homeowners or automobile) and that this coverage is triggered after the limits of the base contracts are exhausted.

Provided Coverage

An important element of this policy is that coverage provides for protection for the named insured, spouse, and family members living in the household. This coverage should be very important to those households with teenage drivers. Organizations may also obtain the protection of an umbrella policy, with certain limitations and exclusions. Unfortunately, “failure to render proper professional services” is very frequently a common exclusion, though some insurance companies will cover this loss exposure with an increased premium.

Other Policies

Other common policies available include: Watercraft and Airplane coverage, Title Insurance, Flood Insurance (offered by very few private insurance companies), Renters Insurance (which covers the contents), and Condominium protection (like homeowners, but has language for common wall risks).

Personal Legal Expense Protection

Finally, there is the issue of the taxation of premiums and claim payments. Premiums for personal property and casualty coverage are not deductible. Therefore, only under unusual circumstances will any benefits received from the coverage be considered taxable income.

Assessment

However, the benefit payments may be considered capital gain if they happen to exceed the insured’s basis in the property. Uninsured losses are generally deductible under the current Internal Revenue Code.

As usual, specific questions concerning the taxation of premiums or benefits should be directed to your professional advisors.

Conclusion

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Filed under: Book Reviews, Career Development, Financial Planning, iMBA, Inc., Insurance Matters, Practice Management, Professional Liability, Recommended Books | Tagged: airplane insurance, auto insurance, condo insurance, david marcinko, flood insurance renter's insurance, gary cook, home owner's insurance, hope hetico, IRC, PAP, personal auto policy, personal umbrella liability policy, PULP, title insurance, uninsured motorist, vehicle insurance, watercraft insurance | 5 Comments »

Application Service Provider Primer for Physicians

Posted on May 7, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding ASPs

By Carol S. Miller; RN, MBA

An Application Service Provider (ASP) enables healthcare organizations to run complex software programs or applications on remote servers that can be accessed from numerous sites and by numerous devices. By installing and maintaining central, instead of on-site services, ASPs reduce the complexity, time, resources, hardware requirements, technical support, cost of installing and distributing upgraded software (done by ASP at its host site), and cost involved in application management. In addition, ASPs provide the physician a means of low cost entry to new applications in a very short timeframe. Upgrades are quickly deployed and healthcare organizations or medical offices can experience affordable and secure business critical applications. Most ASP services are billed on a per use basis or monthly annual fee. An example of an ASP is NextGen, an Internet based enterprise and a real-time practice management system that includes an electronic medical record, appointment scheduling, connectivity with hand-held solutions and patient indexes.

Reverse ASPs in Healthcare

Healthblocks (www.healthblocks.com) coined the term “reverse ASP” to signify that as an ASP, it provides unique solutions through the Healthblocks eSite, tailored to the situations and circumstances that face healthcare organizations and care givers on a daily basis. More formally, a reverse ASP deploys through portals, hosts and manages access to medical applications that offices, in a single, seamless manner, can view a patient’s clinical information. The applications are delivered over networks on a subscription basis and the reverse ASP remotely manages the packaged application over a network. The following benefits are achieved in this model:

Hardware/software located on recipient’s facility can connect disparate facilities
User names/passwords are located on-site with extensive integration with legacy systems
Existing clinical data remains on-site without danger of lost data
Connectivity to ASP solutions is not dependent upon an ISP

Assessment

A reverse ASP model provides physicians, nurses, allied healthcare providers and related personnel with rapid access to confidential clinical patient information. It can also benefit and help extend the reach and usefulness of third-party e-health solutions in a cost-effective manner.

www.HealthDictionarySeries.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated? Who can update the above for modernity?

Link: https://healthcarefinancials.wordpress.com/2009/03/13/rip-retail-financial-services-industry/

Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Health Administration Terms: www.HealthDictionarySeries.com

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Physician Property, Casualty and Liability Protection

Posted on May 6, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Essentials of Risk Management

By Gary A Cook; MSFS, CLU, ChFC, RHU, CFP® CMP™ (Hon)

Medical professionals may not be familiar with the unique differences between the terms – property, casualty and liability. Property insurance is coverage for the loss of, or damage to, real and personal property caused by fire, theft, explosion, riot, vandalism and a host of other risks. Casualty and liability are generally interchangeable terms for the coverage of legal liability due to injury to others or damage to their property.

Personal Liability Coverage

One of the most common of all personal liability coverages is the Homeowner’s policy. This is not one policy, but several policy declarations (what is insured – the location), forms, endorsements, and “floaters,” which protect the structure of the home against loss, as well as the personal property (contents) to various degrees. Risks for homeowners need not be consistent across the country and the rates generally reflect the differences. For example, homes in the Midwest need protection from tornados, while homes along the East, West and Southern coasts need coverage for hurricanes and flood risks.

Policy Form

The Home Owners Policy Form contains five categories of coverage for property:

The dwelling
Other structures
Personal property
Loss of use
Additional coverages, such as debris removal, trees, shrubs, and plants, or now, electronic theft (credit card, checking account theft).

The Contract

The contract contains three areas of Liability Coverage:

Personal liability
Medical payments to others
Miscellaneous liability benefits.

The Endorsements

Endorsements are an important aspect of the Homeowners coverage because they permit the customization of the coverage to the unique requirements of the individual. Two examples:

We noted that the West coast does not have tornados, however, they do have earthquakes and therefore, an endorsement can be added which will transfer the risk for earthquakes – or even volcanic eruptions. If the individual doctor has a home business, the business property can be protected against such perils as loss of business records due to fire or water damage. There is, however, no coverage for liability for providing poor professional services.

The Floaters

Finally, the Homeowners policy may contain “floaters” (named because the articles covered are moveable, thus “float around.”). The use of floaters can be very beneficial for coverage of unique or expensive electronic equipment and most commonly, jewelry. The other common personal coverage is Automobile Insurance. Forty-two states have compulsory insurance laws that require insurance on automobiles before it is registered. Various states have unique laws pertaining to:

Financial Responsibility, or proof of responsibility, by carrying insurance, a cash deposit, bond or security for future liability effective after an accident, which is the major criticism of these laws.
Unsatisfied Judgment Funds that compensate individuals who are unable to collect from a judgment resulting from an automobile accident.
Uninsured Motorist Coverage is required in most states as mandated by state insurance regulators. In essence, the insured’s own insurance company acts as the insurance company for the uninsured motorist.
No-fault Automobile Insurance stems from the problems associated with today’s tort law. These policy forms, however, vary dramatically by state and a full discussion is not possible here. Information and advice from a professional insurance agent is always recommended.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Long-Term Care Insurance

Posted on May 5, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

A Review for Doctors and Advisors

By Gary A. Cook; MSFS, CLU, ChFC, LUTC, RHU, CFP®, CMP™ (Hon)

Long-term care (LTC) insurance is considered one of the newest forms of personal coverage insurance. LTC insurance is designed to transfer the financial risk associated with the inability to care for oneself because of a prolonged illness, disability, or the effects of old age. In particular, it is designed to insure against the financial cost of an extended stay in a nursing home, assisted living facility, Adult Day Care Center, hospice or home health care. It has been estimated that two out of every five Americans now over the age of 65 will spend time in a nursing home. As life expectancy increases, so does the potential need for LTC. One unfortunate consequence of being the “new kid on the block” is the lack of actuarial data specifically collected for this style of policy. This results in policy premiums being underpriced to sustain the claims currently being experienced. During the first half of 2003, at least three insurance companies stopped writing these policies because of their losses. Those insurers remaining in this market are expected to increase premiums quickly. Unless these policies can be profitable for the company, their future will be an uncertain one.

Medicare

Any discussion of LTC must begin with an understanding of what Medicare is designed to cover. Currently, the only nursing home care that Medicare covers is skilled nursing care and it must be provided in a Medicare-certified skilled nursing facility. Custodial care is not covered. Most LTC policies have been designed with these types of coverage, or the lack thereof, in mind. To qualify for Medicare Skilled Nursing Care, an individual must meet the following conditions:

Be hospitalized for at least three days within the 30 days preceding the nursing home admission;
Be admitted for the same medical condition which required the hospitalization; and
The skilled nursing home care must be deemed rehabilitative.

Once these requirements are met, Medicare will pay 100 percent of the costs for the first 20 days. Medicare covers days 21 to 100 along with a daily co-payment, which is indexed annually. After the initial 100 days, there is no additional Medicare coverage. Medicare Home Health Services cover part-time or intermittent skilled nursing care, physical therapy, medical supplies and some rehabilitative equipment. These are generally paid for in full and do not require a hospital stay prior to home health service coverage.

Critical LTC Policy Features

According to the U.S. Department of Health and Human Services and the Health Insurance Association of America, there are seven features that should always be included in a good long LTC policy:

Guaranteed renewable (as long as premiums are paid, the policy cannot be canceled).
Covers all levels of nursing care (skilled, intermediate and custodial care).
Premiums remain level (individual premiums cannot be raised due to health or age, but can be raised only if all other LTC policies as a group are increased).
Benefits never reduced.
Offers inflation protection.
Full coverage for Alzheimer’s Disease (earlier contracts tried to eliminate this coverage).
Waiver of premium (during a claim period, further premium payments will not be required).

In addition, there are another seven features considered to be worthwhile and are included in the better LTC policies:

Home health care benefits
Adult day care and hospice care
Assisted living facility care
No prior hospital stay required
Optional elimination periods
Premium discounts when both spouses are covered
Medicare approval not a prerequisite for coverage.

ADLs

Most LTC policies provide benefits for covered insured’s with a cognitive impairment or the inability to perform a specified number of Activities of Daily Living (ADLs). These ADLs generally include those listed below and the inability to perform two of six is generally sufficient to file a claim:

1. Bathing: Washing oneself in either a tub or shower, or by sponge bath, and includes the task the getting into and out of the tub or shower without hands-on assistance of another person.

2. Dressing: Putting on or taking off all necessary and appropriate items of clothing and/or any necessary braces or artificial limbs without hands-on assistance of another person.

3. Toileting: Getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene without hands-on assistance of another person.

4. Transferring: Moving in and out of a bed, chair or wheelchair without hands-on assistance of another person.

5. Eating: The ability to get nourishment into the body without hands-on assistance of another person once it has been prepared and made available.

6. Continence: The ability to voluntarily maintain control of bowel and/or bladder function, or in the event of incontinence, the ability to maintain a reasonable level of personal hygiene without hands-on assistance of another person.

Other Issues

Another issue concerning ADLs is whether the covered insured requires “hands-on” assistance or merely needs someone to “stand-by” in the event of difficulty. Obviously, LTC policies that read the latter are considered more liberal.

Long-Term Care Taxation

Some LTC policies have been designed to meet the required provisions of the Kassenbaum-Kennedy health reform bill, passed in 1996, and subsequently are “Tax Qualified Policies”. Insured’s who own policies meeting the requirements are permitted to tax deduct some of the policy’s premium, based on age, income and the amount of total itemized medical expenses. The major benefit of the tax-qualified LTC policy is that the benefit, when received, is not considered taxable income. There are several initiatives in Congress, however, which would expand and simplify these deductibility rules.

Assessment

Regardless, the medical professional or financial advisor [FA] should investigate the opportunity afforded them through their current form of business, or client use, for any purchase of a LTC policy. And, small businesses may be permitted to deduct LTC premiums on a discriminatory basis.

Conclusion

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ISP Primer for Physicians

Posted on May 5, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Basic Access and Connectivity

By Carol S. Miller; RN, MBA

To connect with an Internet service, the medical office will need a computer, modem, telephone line and software. The modem, either external via a connection or internal via a built-in or slot card, takes the digital signals from your computer and converts them to analog signals that your phone line uses. As a rule of thumb, the faster the better; therefore, the office should have at least a 56 bps or use a DSL line.

Accessing the Internet

To access the Internet, the office must obtain an Internet Service Provider (ISP) such as America Online (AOL), Earthlink, ATT Worldnet, Microsoft Network Premiere (MSN), Hot Link, or others. The cost varies on the plan selected but usually averages in the range of $10 to $25 per month. In selecting an ISP, several guidelines need to be considered:

The major online services often make it very easy to connect to the Internet, but may be more expensive;
Many low-priced ISPs may have customer service that matches their prices;
In selecting the ISP, make sure the provider has a toll-free or local support telephone line;
For a nationwide directory list of ISP providers, go to the Internet site of www.isp.com.

Besides the POTS (plain old telephone service), the physician may wish to have a faster connection to the Internet. Several options are available.

Cable Modems

Cable connection is very fast, providing a lot of bandwidth (the amount of information that can be sent through a particular communication channel). As an example, in the time it takes to transfer a half page across a 56K connection, the cable connection can transfer over 25 pages. As is suggested by the name, the local cable TV provider or community antennae TV (CATV) deliver this service.

www.HealthDictionarySeries.com

Conclusion

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Link: https://healthcarefinancials.wordpress.com/2009/03/13/rip-retail-financial-services-industry/

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Essential Insights on Successful Physician Budgeting

Posted on May 4, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Avoiding Common Cash Flow Budget Mistakes

[By Dr. David Edward Marcinko; MBA, CMP™]

[By Hope Rachel Hetico; RN, MHA, CMP™]

[Publisher-in-Chief and Managing Editor]

Although some doctors might view a budget as unnecessarily restrictive, sticking to a spending plan can be a useful tool in enhancing the wealth of a practice. We emphasize the keys to smart budgeting and how to track spending and savings in these tough economic times.

Money and Happiness

There is an aphorism that suggests, “Money cannot buy happiness.” Well, this may be true enough but there is also a corollary that states, “Having a little sure reduces the unhappiness.” Unfortunately, today there is more than a little financial unhappiness in all medical specialties; not just the specialty of podiatry – where this article first appeared as a free-lance writing project. The challenges range from the commoditization of medicine, aging demographics, Medicare reimbursement cutbacks and increased competition to floundering equity markets, the home mortgage crisis, the squeeze on credit and declines in the value of a practice. Few doctors seem immune to this “perfect storm” of economic woes.

Most Doctors Financially Hurting Today

Far too many physicians, dentists and other medical providers are hurting and it is not limited to these above-average earning professionals. However, one can strive to reduce the pain by following some basic budgeting principles. By adhering to these principles, most physicians can eliminate the “too many days at the end of the month” syndrome and instead develop a foundation for building real wealth and security, even in difficult economic climates like we face today.

Three Budget Types

There are at least three major budget types. [1] A flexible budget is an expenditure cap that adjusts for changes in the volume of expense items. [2] A fixed budget does not. [3] Advancing to the next level of rigor, a zero-based budget starts with essential expenses and adds items until the money is gone. Regardless of type, budgets can be extremely effective if one uses them at home or the office in order to spot money troubles before they develop.

Assessment

For the purpose of wealth building, medical professionals may think of a budget as a quantitative expression of an action plan. It is an integral part of the overall cost-control process for the individual, his or her family unit or one’s medical practice.

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

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Advisor’s Checklist for Physicians Seeking Insurance

Posted on May 3, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Background, Education, and Certifications

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chief

The following are sample questions and information gathered for Professional Liability Coverage

The Checklist

**Medical specialty information by percentage of practice.

**Information on medical education, including information on medical school, internship information, residency information, and fellowship information, if any.

**Information on medical experience, including information on military discharge (DD214), public health service, moonlighting, ‘locum tenens’, and private practice information. Have dates and locations available. Other information includes:

Information on completed continuing education hours in the past two years.
Publications, speeches, instruction, etc.
Information on medical licenses, including state, license number, expiration dates, and current status.
Information on board certifications.
The above information may be contained in a Curriculum Vita, if you have one.
On an “as applicable” basis:
Complete details including dates and outcomes of any board certification revocations or suspensions, license revocations or suspensions, alcohol or drug addictions and treatments, criminal or sexual misconduct charges, or Medicare or Medicaid charges.
Previous Insurance Information
Insurance history, including the name, policy number, whether the coverage form was occurrence or claims made, policy period, limits of liability, deductible amount, and prior acts date, for your current carrier, and your first, second, third, and fourth prior carrier, if applicable.
Information on any insurance company cancellations or non-renewals.
If your current policy is a claims-made policy, whether you are obtaining tail coverage from your current insurance company.
Copies of prior policies, if available.

Current Medical Practice Information

Information on supervision and employment of residents, physician assistants, nurse practitioners, CRNAs, nurse midwives and other physicians;
Information on networks or managed care organizations associated with (IPA, PHO, MSO, etc.), including group name, type of organization, and relationship;
Information on other contractual relationships other than PPOs, HMOs, IPA, etc;
Full information on all hospital privileges, including hospital name, location, and type of privilege.
Information on any suspension, denial, revocation, restriction, or other sanctioning of hospital privileges.

Classification and Specialty Identification

Full information on procedures performed, including details of surgeries, average number of patients seen weekly, specialty practice areas, etc.

Prior Claims History (if any)

For each claim, patient’s name; date of occurrence; insurance carrier; location of occurrence; date claim was reported; date claim was closed (if applicable); copies of subpoenas, pleadings, or judgments; amount reserved on your behalf; and amount paid on your behalf. Provide as complete a description of the allegations as possible.

Important Note

This checklist is provided as a guide to assist the Healthcare Professional in gathering the information that insurance companies typically request. Discuss this checklist with your agent to identify additional information as needed.

Assessment

The author has been an expert medical witness in both state and federal court. He is also a former licensed insurance agent and certified financial planner.

Conclusion

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Reviewing Medical PDAs

Posted on May 3, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Physician Use Growing Slowly

By Carol S. Miller; RN, MBA

Handheld personal digital assistants (PDAs), such as Palm Pilot M130, 500 or 515, Sony Clie, Visor Prism or Pro, Psion, RIM Blackberry, Zaurus, iPhone, Zune and other comparable PDA OS platforms, have revolutionized the communication world this past decade. PDAs and their future counterparts are becoming the catalyst for physicians to use information technology, are becoming the intro for physicians into the world of the electronic medical record software, and becoming the virtual office tool, enabling providers to communicate away from the desktop as well as away from his office practice. The reasons for increased utilization with physicians are portability, pocket-size, provides easy access to information at point of care and regardless of location, improves practice efficiency and workflow, improves drug related decisions and decreases adverse drug events.

PDA Components

The common uses of PDAs by physician practices are:

Personal applications such as scheduling, telephone directories, dictionary, “to-do lists” and others
Drug databases
Clinic suite that ties into the hospital information system
Charge and procedure capture
Communications, from provider to provider, provider to hospital, provider to office, and vice versa

Palm Operating System

Palm OS still represents the standard in handheld computing, assisting individuals to manage and access information at any time, at any location. Handhelds are easy to use. Physicians are using the Palm OS and/or compatible PDAs to access their office schedules, receive downloads of clinical information on their patients, and enter clinical services and charges when performing services at remote locations.

PDA Selection

In selecting not only the PDA but also the software, the physician needs to answer the following questions:

What would you like to use the PDA for – clinical reference data, patient information, non-clinical applications, personal data, etc.?
What information do you need to know about the patient that the PDA can simplify?
What is the connection route between the hospital, managed care, or lab and your practice? In other words, how do you get access to the data?
What are your price considerations?
Do you need a color or black and white screen?
What is the system support and warranty?
How do you plan to connect to the office or hospital?
Do you want to go wireless or obtain information via a telephone connection?
Do you plan to render care outside of your office practice, such as in the home, a clinic, hospital setting, etc? If so, what would you like included on the PDA that would improve communication with the office and save time at point-of-service in documentation?

HIPAA

HIPAA regulations do not specifically address the specific term PDA, but the regulations do include guidelines for protecting patient information and transmission of this data that can impact the use of PDAs. Physicians are utilizing handheld digital assistants whether they contain clinical information; or just resource data, may be or not are password protected, and may or may not be officially supported by hospitals or clinics. Providers as they prepare for future applications and usage of PDAs involving patient information must understand the scope of the new HIPAA regulations as it impacts on patient data collected, stored or transmitted. Any application involving patient identifiable data must be HIPAA compliant. The key issues are how to protect the patient information stored on the device, i.e., if lost or stolen, and second how to protect patient information transmitted during a synchronization or wireless transaction. Probably the most vulnerable aspect is the loss rate with recent studies indicating at least 30%.

Security

Most providers using PDAs for patient data utilize a user ID or password level of security. To maintain security, the provider should be required to re-enter their user ID or password every time they enter the application. Likewise, each PDA should have a “time out” feature, requiring a provider to re-enter his ID or password again. This feature will not prevent individuals with technical skills from accessing this information – the only mechanism is encryption.

Synchronization versus Wireless Applications

1. Synchronization transfers information from the enterprise database to the PDA, i.e., hospital lab or x-ray results, patient demographics, consultative notes, and others. It is important that the hospital or hospital system authorize and approve the physician for using and transmitting this information and in turn, the provider authenticates and validates his agreement with the hospital before data is transmitted. In addition for protection, an audit trail of who synchronized and what data was transmitted should be maintained by the hospital system.

2. Wireless providers have immediate real time access to patient data; however this process of transmission is more vulnerable than synchronization. Wireless solutions can utilize a public or private network. HIPAA require encryption for the transmission of data over the public networks – Encryption is optional for others. Sharing data from a wireless over the Internet represents potential security issues; however, more and more technical firms and providers are using a wireless VPN that allows PDA users to connect securely from remote locations just as laptop users do today.

Other Issues

The other issues are who owns the PDA. If the provider does, he or she should be responsible for the security; however if the hospital does, the hospital should be responsible. More current applications of Palm OS will include built-in modems for easier wireless communication, improved secure transactions, and ability of greater resolution for graphics, and other Web-based services. In addition, current and future applications will include refined voice dictation. As an example, MDEverywhere’s package called Everynote allows the provider to digitally record notes and in turn links with MDEverywhere’s coded patient encounter.

The Blackberry

A very versatile product is the Blackberry. It has web browsing capabilities, embedded wireless modem and can (1) write, send receive and respond to messages right from the unit, (2) access web information, (3) has nationwide coverage with no roaming fees, (4) has voice mail message capabilities, and (5) can be the size of a pager or PDA. The next feature with Blackberry will be its text messages to cell telephones. New units start around $150-$300 with monthly service charges of $20-$50 depending on the plan. The wireless Internet connection can be accomplished through Go.Web.

Assessment

The typical cost for a PDA averages between $300 and $600 – depending on color or black and white – plus the cost of additional software and accessories. For wireless connectivity, the physician will need to connect with a communication partner. Reference sites for PDAs are: www.handheldmed.com (for clinical, reviews, and news), www.pdamd.com (PDA resources), www.freewarepalm.com (free software programs), www.palmpilot.com, www.handspring.com. The active shopper can refer to www.zdnet.com or www.palmblvd.com

Conclusion

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Red Flag Rules in Dentistry

Posted on May 1, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Mayday for Identity Theft Provisions 2009

By Darrell K. Pruitt; DDS

On October 22, 2008, the FTC announced that it would delay the enforcement of the Red Flags Rule for healthcare providers for six months – until May 1, 2009. A handful of attentive dentists, as well as ADA Chief Legal Counsel, Tamara Kempf, released a sigh of relief. Ms. Kempf immediately went to work to persuade the FTC to delay enforcement “indefinitely.”

The FTC Delay

Four days later, Kempf caught the mood of the few who were paying attention in her quote for an article on DentalCompare.com:

“We are very pleased that the Federal Trade Commission has postponed for six months its implementation of the ‘Red Flags Rules.’”

http://www.dentalcompare.com/news.asp?newsid=250078

The DentalCompare article continues:

“If the FTC persists in its position that dentists are covered by the rule as creditors, the ADA will make available a sample compliance plan or program well in advance of the new enforcement date. Dentists will have sufficient time to consult with their personal attorneys and to put an appropriate identity theft prevention program into place, according to the ADA’s Legal Division.”

The ADA Legal Division

Did the ADA’s Legal Division follow through with its promise? If information about the Red Flags Rule is posted on the ADA News Online Website early tomorrow morning, is a 24 day warning considered by the ADA to be “well in advance”? (Emphasis mine) As reassuring as Kempf’s words sounded five months ago, it can be argued that the ADA’s intentions were misrepresented to DentalCompare. I checked the ADA Online Website and found nothing at all about preparation for the Red Flags Rule – at least not yet.

http://www.ada.org/prof/resources/pubs/adanews/index.asp

ADA Archives

When I searched the ADA archives for “Red Flags Rule,” I was provided seven links to the topic, but none included “a sample compliance plan or a program.” Three of the links are irrelevant, three are to articles about the delay of the FTC enforcement, and one is a link to a hopeful letter dated November 24, 2008 and addressed to William E. Kovacic, Chairman of the Federal Trade Commission. In other words, I found nothing that will help dentists become FTC compliant well ahead of time.

HIPAA

If the ADA’s help in preparing members for the 1996 HIPAA Rule is any indication of the help members can expect with Red Flags Rule, it will take the ADA at least 13 years to start on the Red Flags. The leaders of the otherwise conservative ADA seem to have bet a huge chunk of membership trust that Kempf and the Legal Affairs department would succeed in delaying Red Flags enforcement indefinitely, and that the Department of Dental Informatics would not have to admit that contrary to what they led members to believe, computers in dental offices are rapidly becoming too dangerous and too expensive for the profession. For many dentists, pegboards, carbon paper and ledger cards are looking better and better. You can forget about paperless practices. What happened, ADA?

The groveling November 24 letter to the FTC chairman that was signed by Kempf and cc’d to ADA President Dr. Johns S. Findley and President-elect Dr. Ronald L. Tankersley, officially begs for forgiveness and appeals for bureaucratic mercy to allow dentists to be excluded from becoming Red Flags-covered entities.

http://www.ada.org/prof/advocacy/let_081124_redflags.pdf

Since the fines for non-compliance of both HIPAA and the Red Flags Rule are obscene, and since the leaders of the ADA continue to fail to inform members what they should do to prepare for unannounced inspections from either HHS or the FTC, I will once again do the Department of Dental Informatics job for them, and let readers in on the secret.

An Economic Threat

If you wish to continue to accept assignment from insurance companies, and/or otherwise extend credit to your patients, the FTC recently posted a helpful pdf document titled “Fighting Fraud with the Red Flags Rule – A How to Guide for Business.”

http://www.ftc.gov/bcp/edu/pubs/business/idtheft/bus23.pdf

Dentists have become the nation’s unpaid fraud inspectors. And if a dentist’s practice is computerized, the more will be expected, or rather, demanded of the dentist, by law.

Here is a brief description of dentists’ Red Flags obligations lifted from the FTC document:

An Overview

The Red Flags Rule sets out how certain businesses and organizations must develop, implement, and administer their Identity Theft Prevention Programs. Your Program must include four basic elements, which together create a framework to address the threat of identity theft:

First: Your Program must include reasonable policies and procedures to identify the “red flags” of identity theft you may run across in the day-to-day operation of your business. Red flags are suspicious patterns or practices, or specific activities that indicate the possibility of identity theft. For example, if a customer has to provide some form of identification to open an account with your company, an ID that looks like it might be fake would be a “red flag” for your business.

Second: Your Program must be designed to detect the red flags you’ve identified. For example, if you’ve identified fake IDs as a red flag, you must have procedures in place to detect possible fake, forged, or altered identification.

Third: Your Program must spell out appropriate actions you’ll take when you detect red flags.

Fourth: Because identity theft is an ever-changing threat, you must address how you will re-evaluate your Program periodically to reflect new risks from this crime.

Note: More “red-flag” information may be obtained from the 2 volume, 1,200 pages, premium print guide: Healthcare Organizations [Financial Management Strategies].

www.HealthcareFinancials.com

Assessment

Since my business office still uses the pegboard, and no patients’ identifiers are on any computer, my official Red Flags policy is simple:

“Staff; if you notice anything unusual in relation to our patients’ accounts; or if you are handed an unusual-looking drivers license, notify me immediately”.

-The Management

My official notice will be fastened with thumb tacks to my wall of safety posters by May 1, 2008, and I will be in full compliance with not only HIPAA, but the Red Flags Rule as well. If the government continues its reckless, heavy-handed, one-size-fits-all laws, it won’t be long before I’ll be able to further undercut the fees charged by all computerized dental offices, and still make more profit. I say bring out the Department of Agriculture.

Conclusion

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Networks Basics for Medical Professionals

Posted on May 1, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Defining WANs and LANs

By Carol S. Miller; RN, MBA

Depending on whether the practice is housed in one or multiple-office locations and there is a need to connect multiple computers, either a local area network (LAN) or wide are network (WAN) should be part of the package consideration.

The LAN

The LAN is a computer network that covers only a small area (often a single office or building). The advantage of a LAN (besides connecting several computers to a network system) is the ability to configure one printer for multiple stations. The same may be said for sharing administrative, clinical, financial and operational data in real-time manner to support smooth office function.

The WAN

The WAN provides the ability to link data on one network for multiple office site locations.

www.HealthDictionarySeries.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated? Who can update this post for modernity?

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Filed under: Book Reviews, Career Development, Glossary Terms, iMBA, Inc., Information Technology, Practice Management, Recommended Books, Sponsors | Tagged: carol s. miller, david marcinko, hope hetico, LANs, medical computer networks, WANs, www.healthdictionaryseries.com | Leave a comment »

MSFT Amalga Video for Hospitals and Health Systems

Posted on April 30, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

It Was One Year Ago Today … Updated for 2009

By Staff Reporters

Release of a new unified intelligence system allows enterprise health providers to unlock the power of all data from their existing IT systems.

REDMOND, Wash. — April 9, 2008

Microsoft Corp. today announced the availability of Microsoft Amalga, the new unified intelligence system that allows hospital enterprises to unlock the power of all their data sitting in isolated clinical, financial and administrative solutions.

What it is – How it works

Amalga is part of the Microsoft Amalga Family of Health Enterprise Systems, a portfolio of enterprise-class health solutions that provides rich integration, giving clinicians and executive’s quick access to valuable, up-to-the-minute information across their health enterprise. Microsoft also announced the availability of the Amalga family of health enterprise products across Europe at conhIT 2008, a healthcare IT conference being held in Berlin this week (http://www.microsoft.com/emea/presscentre).

Health Vault

The patient compliment to Amalga is MSFT’s Health Vault initiative which helps consumers collect, store, and share critical patient health information, for free.

www.HealthVault.com

Assessment 2009

Video interview, by Matthew Holt, originally appeared on The Health Care Blog [THCB] on April 16th, 2009.

Link: http://www.thehealthcareblog.com/the_health_care_blog/2009/04/interview-microsoft-health-solutions-.html#comments

Conclusion

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On Baseline Medical Practice Compliance Audits

Posted on April 28, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Establishing a Reference Point is Key to Success

Submitted by Pati Trites; MPA, CHBC with Staff Reporters

www.HealthcareFinancials.com

There are several types of compliance audits that a medical practice, clinic or healthcare organization might need to perform. The starting point is to obtain a baseline audit. The next step, discussed elsewhere on this ME-P, is periodic audits or reviews that are performed after information is obtained from the baseline audit.

Baseline Audits

Baseline audits are preliminary assessments to develop a reference point. Until a medical practice or healthcare organization establishes a track record with items such as coding accuracy or documentation to support medical necessity, it is difficult to determine any performance issues. In the spirit of Total Quality Management [TQM], the information that is shared should be done in a non-punitive manner to demonstrate that the intent of the process is to create a positive environment geared towards fixing the problems. A baseline audit can help any organization understand where the program is and establish a reference for future activities.

Assessment

Additional audits can also be performed whenever new employees are added, or if there are complaints, or issues that arise in the course of business.

Conclusion

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Understanding the Emergency Medical Treatment and Active Labor Act

Posted on April 26, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

An Important and Contemporary Issue – Once Again

[By Patricia Trites; MPA, CHBC, CMP™ (Hon) with Staff Reporters]

The Emergency Medical Treatment and Active Labor Act (EMTALA) is receiving increasing scrutiny from prosecutors during these times of financials stress and credit tightening. The statute is intended to ensure that all patients who come to the emergency department of a hospital receive care, regardless of their insurance or ability to pay. Both hospitals and physicians need to work together to ensure compliance with the provisions of this law.

Triad of Requirements

EMTALA imposes three fundamental requirements upon hospitals that participate in the Medicare program with regard to patients requesting emergency care.

First, the hospital must conduct an appropriate medical screening examination to determine if an emergency medical condition exists.

Second, if the hospital determines that an emergency medical condition exists, it must either provide the treatment necessary to stabilize the emergency medical condition or comply with the statute’s requirements to affect a proper transfer of a patient whose condition has not been stabilized. A hospital is considered to have met this second requirement if an individual refuses the hospital’s offer of additional examination or treatment, or refuses to consent to a transfer, after having been informed of the risks and benefits of treatment.

Third, EMTALA’s requirement is activated if an individual’s emergency medical condition has not been stabilized.

Hospital Transfers

A hospital may not transfer an individual with an unstable emergency medical condition unless:

(1) the individual or his or her representative makes a written request for transfer to another medical facility after being informed of the risk of transfer and the transferring hospital’s obligation under the statute to provide additional examination or treatment;

(2) a physician has signed a certification summarizing the medical risks and benefits of a transfer and certifying that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the transfer outweigh the increased risks; or

(3) a qualified medical person signs the certification after the physician, in consultation with the qualified medical person, has made the determination that the benefits of transfer outweigh the increased risks, if a physician is not physically present when the transfer decision is made. The physician must later countersign the certification.

On-Call Responsibilities

One area of particular concern is physician on-call responsibilities. Physician practices whose members serve as on-call hospital emergency room physicians are advised to familiarize themselves with the hospital’s policies regarding on-call physicians. This can be done by reviewing the medical staff bylaws or policies and procedures of the hospital that must define the responsibility of on-call physicians to respond to, examine, and treat patients with emergency medical conditions. Physicians should also be aware of the requirement that, when medically indicated, on-call physicians must generally come to the hospital to examine the patient. Patients may be sent to see the on-call physician at a hospital-owned contiguous or on-campus facility to conduct or complete the medical screening examination due to the following reasons:

all persons with the same medical condition are moved to this location;
there is a bona fide medical reason to move the patient;
qualified medical personnel accompany the patient; and
teaching physicians may participate.

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: "Doctors Only", Career Development, Ethics, Glossary Terms, Health Insurance, Health Law & Policy, iMBA, Inc., Managed Care, Practice Management, Recommended Books | Tagged: CMP, david marcinko, emergency care, emergency department, Emergency Medical Treatment and Active Labor Act, emergency room, EMTALA, ER, healthcare, hope hetico, hospital, medicare, Pati Trites, www.healthcarefinancials.com, www.healthdictionaryseries.com | 9 Comments »

Understanding Modern Health Plan Delivery Models

Posted on April 25, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

By Defining Terms and Concepts

Staff Writers

www.HealthcareFinancials.com

Here are four important health care delivery models that should be understood by all financial advisors, their clients, patients and the public:

1. PHYSICIAN ORGANIZATION (PO)

A PO is a group of physicians banding together, usually for the purpose of contracting with managed care entities, or to represent the physician component in a Physician Hospital Organization. The PO is a managed care contracting entity owned by and composed exclusively of physicians. The PO tends to be more tightly controlled in terms of members and adherence to treatment protocols than an Independent Physician Association. POs typically share information systems, claims-processing procedures, financial data, medical records, and other technical support functions.

2. PHYSICIAN PRACTICE MANAGEMENT CORPORATION (PPMC)

A firm that purchases physicians’ practices in exchange for a percentage of the gross receivables. The PPMC leases the office back to the doctor or employs the doctor on a salaried basis. The PPMC then contracts with the areas MCOs.

3. POINT OF SERVICE PLAN (POSP)

A type of managed care plan that allows members to choose whether to seek medical care within the plan’s network or seek medical care out of network at the point of service (i.e., at the time services are rendered). It allows members to pay little or nothing, if they stay within the established HMO delivery system. But, it also permits members to choose and receive services from an outside doctor, any time, if they are willing to pay higher co-payments, deductibles and possibly monthly premiums. It is also called an “open-ended” plan.

4. PREFERRED PROVIDER ORGANIZATION (PPO)

A PPO is a select, approved panel of physicians, hospitals, and other providers who agree to accept a discounted fee schedule for patients and to follow utilization review and pre-authorization protocols for certain treatments. It is a system in which a payer negotiates lower prices with certain doctors and hospitals. Patients who go to a preferred provider get a higher benefit — for example, 90% or 100% coverage of their costs — than patients who go outside the network.

Assessment

Link: www.HealthDictionarySeries.com

Conclusion

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Filed under: "Advisors Only", Book Reviews, Career Development, Glossary Terms, Health Insurance, iMBA, Inc., Managed Care, Practice Management | Tagged: david marcinko, dictionary of health insurance and managed care, financial advisors, health maintenance organization, HMO, hope hetico, managed care organization, MCO, physician organization, physician practice management corporation, PO, point of service health plan, POS, PPMC, PPO, preferred provider organization, www.healthdictionaryseries.com | 2 Comments »

Sherlock Expense Evaluation Report [SEER]

Posted on April 24, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

ADVERTISEMENT

Plan Management Navigator

By Marco Georeno

Ph: 215-628-2289

Please find attached the April 2009 edition of Plan Management Navigator. In it we provide an update on the timing of the Blue Cross Blue Shield universe and the Independent / Provider-Sponsored editions of the Sherlock Expense Evaluation Report (SEER). In addition, we expect to circulate the benchmarking surveys for the Medicaid and Medicare universes on or about June 1st, for completion by July 20^th, 2009.

Benchmarking Studies

If you are interested in participating in our benchmarking studies please contact us as soon as possible. Additional information about SEER is available at www.sherlockco.com/seer.shtml or by contacting Doug Sherlock (sherlock@sherlockco.com).

Best Practices for the Healthcare Enterprise

We also endeavor to provide an enterprise view of best practice. Best practice is typically considered to be the most efficient way of achieving a desired outcome. We believe that the best way of determining the best practice in its most practical application is to start with an overall objective and weigh all particular practices in light of how they contribute to that overall objective.

In that vein, over the next several months, Sherlock Company will be offering web conferences focused on best practices. The first conference will address activities within Customer Services, as well as activities or effects in other functional areas. This web conference will be held on Wednesday May 20th at 2:30 PM, Eastern Time. The costs will be $225. Participation is free of charge to health plans participating in our 2009 benchmarking studies. If you are interested in participating, please email Erin Sawchuk (erinsawchuk@sherlockco.com) or call at 215-628-2289.

Assessment

This edition of Navigator also discusses the latest private health plan Dashboard results for the trailing three months ended January 31, 2009.

Link: navigator

Sincerely,
Sherlock Company

Marco Georeno – Analyst
mgeoreno@sherlockco.com

Fax: 215-542-0690

Conclusion

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Filed under: "Advisors Only", "Doctors Only", Breaking News, Career Development, Health Economics, Managed Care, Monthly Reports, Practice Management, Research & Development, Sponsors | Tagged: Blue Cross, Blue Shield, douglas sherlock, Goereno Marco, health econoics, health maintenance plans, healthcare enterprise, Healthcare Finance, HMO, Managed Care, MCO, Medicaid, medicare, Plan Management Navigator, SEER, Sherlock Company, Sherlock Expense Evaluation Report | Leave a comment »

About Medlytix.com

Posted on April 22, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

On Patient Payment Behavior Scoring

[By Staff Reporters]

Medlytix is a healthcare consulting and technology firm specializing in the field of predictive payment analytics. Utilizing sophisticated data mining and scoring strategies, the company reports enhanced hospital revenue cycles and collections for healthcare providers across the country.

The Business of Healthcare

It is a fact that consumers treat medical bills differently than other financial obligations. So, Medlytix customizes revenue-enhancement strategies to target each provider’s individual market.

Suite of Services

All stakeholders benefit from a more efficient operation – from provider to patient. Medlytix offers expertise and technology to enhance the cash conversion and revenue cycle by eliminating inefficiencies while maximizing collections. A customized strategy that’s based on specific needs is crafted. Three offerings include: 1.Medilyzer, 2. Predyx, and 3. Consulting services to improve the bottom line.

Non-Profits Hospitals

Non-profit hospitals exist to serve their communities with quality healthcare accessible to all. By helping hospitals pinpoint charity-care patients who are truly in need, the focus is on the patient.

Assessment

The mission of Medlytix is to build a healthier bottom line for hospitals. As fiscal strength improves, better hospitals provide better service to patients.

Conclusion

How does this relate to emails? Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Accounting, Health Insurance, Healthcare Finance, Information Technology, Practice Management | Tagged: behavior scoring, data mining, healthcare economics, Healthcare Finance, hospital cash conversion, hospital reenue cycle, medilyzer, Medlytix, non-profit hospitals, predictive begavior, predictive payment analytics, predyx | 1 Comment »

Become a Published Print Author with Us

Posted on April 22, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

The Business of Medical Practice [3^rd Edition]

By Hope Rachel Hetico RN, MHA, CMP™

[Managing Editor]

Dear Colleagues,

As you may know, we are commencing work on the third edition of our best selling book: The Business of Medical Practice

TOC 1st: http://www.amazon.com/Business-Medical-Practice-Maximizing-Doctors/dp/0826113117/ref=sr_1_8?ie=UTF8&s=books&qid=1231111232&sr=1-8

TOC 2nd: http://www.springerpub.com/prod.aspx?prod_id=23759

Invitation to Contribute

Accordingly, we would be honored for you to consider contributing a new or revised chapter, in your area of expertise, for a low-effort but high-yield contribution. Our goal is to help physician colleagues and management executives benefit from nationally known experts, as an essential platform for their success in the healthcare 2.0 business industry. Many topics are still available: [health accounting and costing; law, policy and administration; Medicare fraud and abuse; coding and insurance; HIT, grid and cloud computing; finance and economics, competitive models, collaboration and leadership, etc].

Support Always Available

Editorial support is available, and you would enjoy increasing subject-matter notoriety, exposure and public relations in an erudite and credible fashion. As a reader, or preferably a subscriber to the ME-P, your synergy in this space may be ideal. Time line for submission of a 5,000-7,500 word chapter is ample, and in a prose writing style that is “wide, not deep.”

A Health 2.0 Initiative

And, be sure to address health 2.0 modernity. Update chapters from the second edition are also available.

Definition: https://healthcarefinancials.wordpress.com/2008/09/12/emerging-healthcare-20-initiatives

Assessment

Please contact me for more details, if interested. A best selling-book is rare; while a third-edition volume even more so. Join us in this project. Regardless, we trust you will remain apostles of our core ME-P vision, “uniting medical mission and financial profit margin”, promoting it whenever possible.

Front Matter Link: frontmatter1advancedbusinessmedicine4

Contact Info:

MarcinkoAdvisors@msn.com

770.448.0769

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FINANCE:Financial Planning for Physicians and Advisors
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Will the SEC Protect eMRs [Welcome to my Healthcare Nightmare]

Posted on April 21, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

A Frightening Progressive Policy Institute [PPI] Report – Redeux

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

It is no surprise to ME-P readers, that I am a big fan of Dr. Regina E. Herzlinger, the Nancy R. McPherson professor of business administration and chair at Harvard Business School. I quote her often, in our books, despite her recent MA fiascos chronicled here. I am also a competitive medical analyst, IT devotee and health economist, who was a CFP® designee for more than a decade; before my fiduciary reformation. In her books, Creating New Healthcare Ventures and Market Term in Healthcare, Regi rightly states that many medical professionals are becoming depressed at the current state of affairs in healthcare, and want to give up their careers, entirely. We all know that many doctors, like me, no longer wish their kids to follow our professional footstep [Busia; please don’t roll-over in your grave – I know what I am doing – RIP].

But, is the same emerging trend true for FAs?

Medical Career Changers

For example, Gigi Hirsch, MD, a former ER physician and instructor at Harvard Medical School grew so disenchanted with clinical medicine, that she ditched her career and started her own business, MD IntelliNet, in Brookline, Mass. The company places doctors in non-traditional jobs by pairing them with venture capitalists and other businesses seeking physicians. Of course, this re-engineering and formal re-education has been the experience of my personal career journey, as well.

“Don’t Give up Practice, Yet”

And, Herzlinger implores in her book, Market Driven Healthcare, “don’t give up practice, yet.”

Patients Concerned Too

On the other hand, patients and healthcare consumers are also worrying about the looming so-called governmental free-for-all regarding healthcare delivery, mandated benefits and taxes, federally mandated electronic medical records, and data collection reportage and security; etc. Can you say “Big Brother” or “Command and Controll?”

Assessment

So, now may be the time to review Regi’s op-ed piece and policy report, penned for the PPI back, in 1999. It concerns patient and consumer healthcare protections. And, in this time of an Obama administration push for national healthcare – perhaps a prescient word to the wise might be sufficient.

Link: herzlinger

Conclusion

Your thoughts and comments on this Medical Executive-Post are appreciated? Should there be a healthcare SEC surrogate, much link the financial SEC? Or, would another governmental agency be as incompetent as Wall Street’s SEC and FINRA? Do we want FA wonks directing our healthcare needs? As an SEC controlled broker-dealer, and/or FA drone, should you even pursue same in your financial planning practice? What about the independent’s, CFPs and RIA’s? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to this ME-P. It is fast, free and secure.

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Filed under: "Advisors Only", "Ask-an-Advisor", "Doctors Only", Alerts Sign-Up, Book Reviews, Breaking News, Career Development, Ethics, Financial Planning, Managed Care, Op-Editorials, Practice Management, Quality Initiatives, Research & Development | Tagged: CFP, CMP, Creating New Healthcare Ventures, david marcinko, fiduciary financial advisors, financial advisors, FINRA, Gigi Hirsch, health economists, MA, Market Term in Healthcare, MD Intellinet, Medicare Advantage, ntional healthcare, obama, progressive policy institute, regina herzlinger harvard business school, SEC, socialized medicine | 5 Comments »

About Certified Medical Planner™

Posted on April 18, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR NOTICE

Top 10 Reasons to Become a

Certified Medical Planner™

1. Expertise: Provide health economics, business and financial advice to physicians.

2. Credibility: Gain health industry recognition and fiduciary clout.

3. Opportunity: Focus on the lucrative and expanding physician advisory niche.

4. Recognition: Join a select group of advisory experts.

5. Distinction: Become quality; rather than product driven.

6. Achievement: 500 hours of financial, health economics and management education.

7. Evidence: Validate deep healthcare industry knowledge.

8. Resource: CMP™ text and hand books, dictionaries, and institutional print journal.

9. Distinction: Set yourself apart with our chartered logo and trade-mark identity.

10. Commitment: Become the “go-to” financial advisor for all medical professionals.

www.CertifiedMedicalPlanner.com

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Filed under: "Advisors Only", Career Development, CMP Program, Ethics, Financial Planning, Health Economics, iMBA, Inc., Managed Care, Marketing & Advertising, Practice Management, Quality Initiatives, Sponsors | Tagged: certified medical planner, CFP, CMP, doctors, fiduciary advisor, financial advisor, financial planner, medical management, nurses, physician advisors, Practice Management, www.certifiedmedicalplanner.com | 2 Comments »

About MyFax.com

Posted on April 17, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

A New Internet Enabled SaaS Business Communication Tool

[By Staff Reporters]

MyFax is the fastest-growing Internet fax service used by individuals, small, medium and large businesses to send and receive faxes using existing email accounts or the web. MyFax offers services in North America and Europe, including the United Kingdom, to industries recognized among the fastest-growing adopters of Internet fax including finance, insurance, real estate, healthcare, transportation and government.

Customer Base

More than 15,000 new customers subscribe to MyFax each month. MyFax is part of a total Software-as-a-Service (SaaS) business communications offered by Protus that also includes my1voice feature-rich virtual PBX service and Campaigner, an email marketing service enabling organizations to have highly personalized one-to-one email dialogues with their customers.

Assessment

Additional information is available at www.campaigner.com , www.my1voice.com or www.myfax.com .

Contacts:

Sue Rutherford, Protus

(613) 733-0000 x 519 or srutherford@protus.com

Tracy Shryer, Tech Image

847-279-0022 x230 or tracy.shryer@techimage.com

Conclusion

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Filed under: Information Technology, Practice Management | Tagged: campaigner.com, Darrell Pruitt, EHRs, EMRs, ePRs, HIPAA, my1voice.com, myfax.com, PBX, protus, SaaS, sue rutherford, tech image, tracy shryer, www.myfax.com | 7 Comments »

Dr. Somnath Basu Replies to the CFP® [Mis] Trust Controversy

Posted on April 16, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Restoring Trust in the CFP® Mark … the Ongoing Saga

By Ann Miller, RN, MHA

[Executive Director]

According to Professor Somnath Basu, PhD; Director – California Institute of Finance at the California Lutheran University,

A painful truth is that many financial practitioners are sales people masquerading as planners or advisors in an industry whose ethical practices have a shameful track record.

Restoring Trust in the CFP® Mark

Basu’s article, published in the Financial Advisor online news magazine on April 6, 2009, struck a chord with our ME-P readers the last few days. More than 75 opinions, calls, emails and faxes were received commenting on it.

Link: http://www.fa-mag.com/online-extras/4037-revisiting-cfp-credentialing.html

A Trickle – Not a Barrage

However, we did not receive the barrage of fire and brim-stone that one would have expected in the past [sans several abusive miscreants], attempting to feebly parse each phrase to an informed audience of insiders. Perhaps it is the dismal economy, the shenanigans of Wall Street, or the ire of blind-sided clients that has stunned many financial advisors and Certified Financial Planners® into sober silence – or shall we dare say it – shame. In fact, one caller ruefully said,

“Most everything that Basu and Marcinko said is true. We all know it, even though we pretend not to with a “nod and a wink” to the blind and trusting public; all while posturing as experts to friends and family. But, that’s not what bothers me the most about this whole situation … What I really hate now is that everyone else knows it too!”

I Jealously “Shake my Fist” at Somnath Basu

Rather than individual shame, the general reaction to Dr. Basu’s article – as well as this follow-up ME-P of Dr. David Edward Marcinko MBA [Publisher-in-Chief] – was an almost surreal and collective acceptance of its’ accuracy. The CFP® mark – while certainly premier in the flagging financial services industry – still leaves far too much to be desired in terms of education, competency, disclosure, ethical standing and real professionalism. And, except for some rather Herculean marketing advancements; the CERTIFIED FINANCIAL PLANNING Board of Standards’ stated goal of attaining professional stature for the marks, has fallen far short – or even regressed the past decade – seemingly abandoned for the sake of growth.

Link:https://healthcarefinancials.wordpress.com/2009/04/09/i-jealously-shake-my-fist-at-somnath-basu/

Stepping Up to Redemption and Independence

Since contemplative reflection is the first step toward redemption, we now ask all financial advisors, IAs, wealth managers, etc., and especially the CFP BoS, to step up their game and place client interests first – in writing – by demanding ERISA-like fiduciary status at all times. The public will demand it; soon enough – we guarantee it.

Link: www.fi360.com

Link: https://healthcarefinancials.wordpress.com/2009/03/01/an-interview-with-bennett-aikin-aif%c2%ae/

Oh; to be Treated as Adults!

Now, wouldn’t it be a relief for example, if the arcane rules, and feigned or failed microscopic/micromanaged oversight of the SEC, FINRA and various BDs – that we all abhor – might be someday rendered obsolete? Wouldn’t it be nice to be treated as an adult; not a juvenile employee in need of constant supervision? Then, the march to autonomy may begin, as FAs/IAs/CFP® become treated as professionals, and not sub servant agents, or …. registered representatives.

Assessment

Therefore, we personally thank Dr. Basu’s for his attached and unedited reply, specifically written and personally addressed to our Publisher and all ME-P readers and subscribers:

Dear Dave:

My response is attached.

Best regards.

Som (Dr. B)

Link: soms-reply1

Conclusion

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ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: "Advisors Only", "Ask-an-Advisor", Alerts Sign-Up, Breaking News, Career Development, Ethics, Financial Planning, Insurance Matters, Interviews, Investing, Marketing & Advertising, Op-Editorials, Practice Management, Research & Development | Tagged: broker-dealers, california lutheran university, Certified Financial Planner Board of Standards, CFA, CFP, CMP, CPA, david marcinko, fiducairy advisor, financial advisor magazine, financial advisors, financial planners, FINRA, investoment advisors, MBA, PhD, registered representatives, SEC, Somnath Basu, Wall Street, wealth managers | 24 Comments »

GAO “Stings” FDA and HHS

Posted on April 14, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Bogus Medical Products and Human Testing

[By Darrell K. Pruitt; DDS]

On March 27, 2009, I found the following Associated Press article about a Government Accounting Office (GAO) sting operation. For dentists who are awaiting the final rules from the FDA on the toxicity of amalgam, expect emotional-capricious and expensive. Forget about science, or even logic. For physicians awaiting HHS-supported usability in eMRs … well, good luck.

The HHS – Institutional Review Board

Recently, the GAO successfully gained approval from an HHS-registered institutional review board (IRB) for a bogus and dangerous medical product to be used in human testing. An independent IRB member called pouring a liter of the mystery product into the stomach of a woman following surgery the “riskiest thing I’ve ever seen on this board.”

Daniel Dueber Responds

So what did Daniel Dueber, CEO of the careless IRB, have to say in defense of his company? Since there is no defense, what could he say? According to the AP article, he chose to attack the GAO instead:

“The review board that fell for the GAO ruse, Coast IRB LLC, of Colorado Springs, charged that the GAO violated federal and state criminal laws by falsely representing itself to be a medical device company and forging a medical license. ‘We got hoodwinked,’ said Daniel Dueber, Coast IRB’s chief executive.”

Bart Stupak Responds

Representative Bart Stupak, a Michigan Democrat and chairman of the House Energy and Commerce Committee’s oversight and investigations panel, replied,

“You didn’t get hoodwinked. You took the bait – hook, line, and sinker.”

That’s not all. For those who hoped for rational and well-considered decisions from the Department of Health and Human Services in the Obama administration, it might disappoint some to learn that the GAO was also successful in registering a fictitious IRB.

Assessment

The president of the fake board is a dog named Trooper. If we end up with a Cabinet Secretary at HHS who is a dog-lover as well as a tax-payer, will he or she protect and feed Trooper?

Link:

http://www.boston.com/business/healthcare/articles/2009/03/27/gao_team_wins_approval_for_fake_medical_product

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Filed under: Alerts Sign-Up, Breaking News, Career Development, Ethics, Information Technology, Managed Care, Practice Management, Research & Development | Tagged: Bart Stupak, Daniel Dueber, Darrel Pruitt, dentists, FDA, GAO, Government Accounting Office, HHS, House Energy and Commerce Committee, Institutional Review Board, IRB | 4 Comments »

On Continuity of Medical Care and HIMSS

Posted on April 13, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Considering Pay-for-Retention [P-4-R]

By Darrell K Pruitt; DDS

Here is the question on lots of minds these days; how can we change the way medical providers are paid so they are both incentivized and adequately compensated to provide consistent, high-quality, patient-centered medical homes?

My Novel Idea

Here is a solid, common sense idea; increase providers’ pay gradually according to how long the doctors retain patients – who are free to choose any doctor they wish. Consistency is the mortar of a medical home [i.e., pay-4-retention].

An Ounce of Prevention

If prevention, which predates eHRs by thousands of years, is more than just a modern buzzword, the nation can still shave much more expense from health care by promoting continual, personalized care for consumers than from digital health records alone – void of prevention incentives. Who in the audience still cannot understand that concept? Think of it this way. How do business leaders in the land of the free retain the best employees? They pay bonuses. Even waiters get tips to encourage interest in providing service consumers will return for. What do US physicians get? Guaranteed cuts in their Medicaid payments over the next decade. Physicians no longer encourage their children to become doctors. Surprised? Scared?

Consumers Should Rule

In place of consumers ruling their healthcare in the US, well-positioned, giant stakeholders have persuaded lawmakers to offer physicians bonus money (that will later be taken away), not for curing patients, but for using digital records “in a meaningful manner.” It’s called “Mark and Michael Leavitts’ Clicking for Cash.” Since the rules are made up along the way, they change like the weather. That is why the larger and more progressive medical facilities pay bonuses to retain their best “Coders” and other informatics specialists who keep up with the current Ingenix-styled games in order to maximize profits. It is my opinion that health care IT’s complexity works well with the economic stimulus plan to improve employment in the nation. Entrepreneurial stakeholders will continue to be movie-star popular right up until the complete collapse of Medicare. Then they’ll be impossible to find www.HealthDictionarySeries.com

HIMSS

Have you ever heard of HIMSS?

“The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry’s membership organization exclusively focused on providing leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare.”

– From the HIMSS Web site.

HIMSS Annual Meeting

A week ago, HIMSS convened its annual convention in Chicago. The keynote speakers for the four day event were actor Dennis Quaid; followed by the Chairman and CEO of Kaiser Foundation Health Plan, George C. Halvorson; then the economist and former Chairman, Board of Governors of the Federal Reserve, Alan Greenspan, and finally; Jerry M. Linenger, MD, MSSM, MPH, PhD, Captain, Medical Corps, USN (Ret.), NASA Astronaut, and Space Analyst, NBC News. As one can tell, healthcare IT has lots of momentum. In fact, Dave Roberts, the HIMSS vice president for government relations confidently told Bob Brewin on NextGov.com

“The e-records initiative is an entitlement program like Social Security.”

http://www.nextgov.com/nextgov/ng_20090406_1509.php

Another Entitlement Program – Entitlement for Whom

In Regina Herzlinger’s 2007 book “Who Killed Health Care?” the Harvard School of Business professor argues that entitled stakeholders, including a few ambitious members of HIMSS, are destroying health care in the name of reform. In the first half of her 260 page book, she spells out entrepreneurial malfeasance in simple well-annotated terms. In the last half, she describes why Consumer-Driven Health Care [CDHC] makes sense to her. Professor Herzlinger does not specifically mention the words “medical home” in her book, yet she emphasizes the importance of continuity of care. To promote continuity, she suggests that managed care insurance policies be extended to three years duration and longer. Although she also does not mention dentistry, it is obvious to me that since chronic illnesses like diabetes are exacerbated by poor oral health, continuity of care in dentistry is of special importance. It occasionally takes years to improve some patients’ oral health care. And sometimes we fail.

Assessment

If these assumptions about continuity of care are accurate, it follows that the physical and economic health of the nation depends on long-term medical insurance contracts with employers and freedom-of-choice in providers. So is prevention worth holding ourselves accountable to consumers for once? Maybe it is just me, but I think unprecedented truth in healthcare will soon emerge regardless of stakeholders’ needs for confusion and obscurity. It is called consumerism. And it goes hand-in-hand with the Hippocratic Oath, the free-market and common sense.

Conclusion

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Filed under: Career Development, Ethics, Health Insurance, Information Technology, Managed Care, Op-Editorials, Practice Management, Quality Initiatives, Recommended Books, Research & Development | Tagged: ADA, Alan Greenspan, Bob Brewin, CDHC, consumer driven healthcare, CPT codes, Darrell Pruitt, David Roberts, DDS, Dennis Quaid, EMRs, eRs, George C. Halvorson, HBS, Herzlinger, HIMSS, Hippocratic Oath, HIT, insurance coers, IT, Jerry M. Linenger, Mark Leavitt, medical home, michael leavitt, P4R, Regina Herzlinger, www.healthcarefinancials.com, www.healthdictionaryseries.com, www.NextGov.com | 3 Comments »

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