Electronic Medical Records Healthcare Practice Management

Three Biggest Mistakes to Avoid with the ICD-10 Transition

by Nitin Chhoda PT, DPT | Jul 13, 2015 | Healthcare Practice Management, Medical Billing, Physical Therapy Billing, Physical Therapy Management

Dramatic Decrease in Productivity

When Canada implemented ICD-10 codes, it was only a fraction of what the U.S. plans to add on October 1, 2014.

The problem – productivity among physicians and billers/coders never returned to pre-implementation levels.

The American Academy of Professional Coders predicts the same for U.S.

The organization indicated that the sheer number of codes, combined with the new and unfamiliar alpha-numeric code combinations, could reduce productivity by up to 50 percent.

That translates into reduced reimbursements and greater turnaround times on claims.

The first few months of implementation will be a critical time for practices financially as they deal with inevitable errors that mistakenly deny claims and requiring multiple resubmissions, further slowing down the system and cash flow.

Insufficient Billers/Coders

Experienced billers and coders are in short demand and those with in-depth knowledge of ICD-10 codes are even fewer.

Practices may find that those with expertise are taking employment as trainers and consultants, further narrowing the pool of ICD-10 specialists available to work in practices.

The lack of billers/coders familiar with ICD-10 codes will slowly increase as more are trained, but the shortage doesn’t bode well for practice owners trying to maintain their cash flow.

Complacency (The Notion that ‘It Will Get Delayed’)

Many practice owners aren’t moving as quickly as they should and preparing sufficiently for the coding transition, out of a sense of complacency.

Some are hoping another delay in implementation will buy them more time, while others either aren’t sure where to begin or view it as a simple software upgrade.

Some see the coding change as an inconvenience, and not one that’s a high priority.

The Centers for Medicare and Medicaid Services has indicated there will be no more delays and the implementation will occur on Oct. 1, 2014 as planned. The organization has an extensive array of data, resources and timelines to assist practices prepare.

Clinicians that aren’t ready on implementation day will face severe consequences. Any claims with a date of service after October 1, 2014 without ICD-10 codes will automatically be denied.

The ICD-10 transition will affect every practice.

Extensive training for staff, electronic medical record software upgrades and hardware systems will be required.

The procedure will place added stress on staff, disrupt normal office procedures, and affect the financial health of clinics.

Procrastination won’t make the ICD-10 transition go away and it’s far better for practices that prepare for the deadline over time instead of waiting until the last minute and hoping for the best.

Clinicians that don’t prepare their practices will suffer from reduced productivity and the inability to collect on reimbursement claims.

Healthcare Insurance and its Effects in the New Economy

by Nitin Chhoda PT, DPT | Jun 1, 2015 | Healthcare Practice Management, Physical Therapy Documentation, Physical Therapy Management

Nitin Chhoda discusses the current status of healthcare insurance in the country and how practice management, patients, as well as the insurance companies deal with the situation.

Healthcare is a complicated and convoluted process in the U.S. that involves patients, practitioners, insurance providers and a multitude of clearinghouses established specifically for processing, verifying and paying claims.

Each entity has its own set of rules, regulations and protocols governing covered expenses and how reimbursement claims must be submitted. The system has patients confused and healthcare providers fighting for revenues.

The multi-tiered healthcare system in the U.S. is a slow and ponderous process, but one that’s essential for the financial stability of practices and to ease the pain and suffering of patients. Due to the many facets of the industry, it can leave even insured patients with insufficient coverage or none when they need it most, while clinicians are buried in a mountain of paperwork and rejected claims.

Reactive healthcare is the new normal

Until recently, healthcare was a reactive system focused on treating ailments and illnesses as they appeared. The beginning of the 21^st century saw a shift in the thinking of insurance company executives toward preventative measures and ways for clients to avoid becoming ill or developing conditions such as diabetes and heart disease.

It’s a high goal that can mitigate a wide range of expensive healthcare problems, but doesn’t factor in variables such as genetic predispositions, or work and environmental elements. It’s a system that penalizes the elderly, infirm and those experiencing ongoing health issues or who require extensive treatment.

Insurance creates conundrums for the insured

When the Affordable Health Care Act is fully implemented, millions of previously uninsured individuals will have access to a core group of services through insurance policies obtained through their employment or a healthcare practice management insurance exchange.

Unfortunately, as insurance companies increase deductibles, co-pays and other costs, patients are delaying or failing to seek treatment and practitioners are experiencing distinct drops in revenues.

Today’s healthcare insurance may not cover specific services patients need or may require thousands in out-of-pocket costs clients can’t afford.

Healthcare insurance providers are forcing patients to shoulder more of the cost burden and setting limitations on costs and treatments. The result is that many clients that have insurance are no better off than those without.

Creating revenue strategies is a multi-pronged process

To ensure sufficient cash flow, clinicians must develop and implement strategic plans to contract with the best paying providers and examine client insurance coverage closely before beginning treatment. In some instances, clinicians may need to refer patients to other facilities or resources to obtain whatever treatment is available.

The technology embodied in an electronic medical record (EMR) system is a clinician’s best friend for verifying insurance, providing enhanced documentation and submitting reimbursement claims.

EMRs empower practitioners, providing them with the tools to manage client treatment needs against their insurance coverage.

EMRs can identify claims that may pose potential problems, while offering electronic reimbursement submissions to facilitate payment turnaround times.

The structure of the healthcare system in the U.S. is difficult to navigate for patients and practitioners and the new direction being taken by insurance companies is actually narrowing options for the insured and creating financial hardships for practice owners. To remain solvent, clinicians will be required to make hard decisions about the patients they treat, the insurance they accept and the providers with which they contract.

Healthcare Practice Management: The 4-Prong Approach

by Nitin Chhoda PT, DPT | Jun 1, 2015 | Healthcare Practice Management, Physical Therapy Documentation, Physical Therapy Management

To manage a practice, it’s important to adopt a multi-faceted approach that consists of four ‘pillars’. This allows for a more efficient, streamlined and successful practice, according to Nitin Chhoda.

Managing a healthcare practice management is a lot like running other small businesses, except for a few glaring differences.

In general, a small business can predict how often and how well they will be compensated for products or services.

This is because the client or customer who received the products or services is the same as the payer. In healthcare practice management, the payer is often a third party, in the form of a health insurance company or a governmental program.

To ensure that a medical practice is financially secure, healthcare practice management must take a 4-pronged approached; everything within the practice needs to be integrated with the rest of the practice. Most importantly, scheduling, documentation, billing, and marketing must all be integrated to get the most efficiency and productivity from the staff.

Start with Scheduling

Making your scheduling of healthcare practice management efficient is fairly obvious; for every open appointment slot of each day, there should be a patient coming in to the clinic. The problems arise when there are either not enough patients or patients cancel appointments and the slots are never filled.

Historically, medical practices haven’t had much of a choice when it came to making the scheduling process more efficient or precise. But with technological advances, scheduling has evolved so that filling slots is easier and tracking patient visits becomes automated.

Scheduling and Marketing

To get the most from your schedule, it turns out that the healthcare practice management will have to do some marketing. Usually this means projecting a certain image to the general public and attempting to entice patients to come to your practice rather than alternatives.

Marketing is also important as patients move through the system, and encouraging referrals from current patients should be part of the healthcare practice management plan. Without good marketing, it will be hard to keep your schedule full.

Scheduling and Documentation

Of course, usually it is the receptionist who handles both scheduling and the pulling and re-filing of medical records. The responsible healthcare practice management staff member must take the time to look over the schedule and pull the correct records each day.

They must also know when to schedule the next visit based on the clinician’s notes from the current visit. This entire process can be automated and streamlined with current technology.

Documentation and Billing

And the bottom line for any healthcare practice management will be collection of payments from the payer, whether that is the patient or their health insurance company.

Medical billers and coders need access to those medical files, too, and they need to know what the clinician has been doing to help the patient get better.

Integration

By realizing that there are important connections between the four major parts of a practice, healthcare practice management can look for the ways that communication and transfer of information has become inefficient within the practice. Efficiency can only be improved when management is seeing the connections and assessing the performance of each aspect of the practice as it relates to the rest.

The Revised CMS-1500 Claim Form

by Nitin Chhoda PT, DPT | Mar 29, 2014 | Healthcare Practice Management, ICD 10, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

The transition to ICD-10 codes comes with a revised CMS form to facilitate reporting. The National Uniform Claim Committee (NUCC) approved the use of the revised CMS- 1500 Claim Form in February 2012. The new CMS-1500 form will be printed with 02/12 in the lower right hand corner to indicate it’s the replacement for the 08/05 version.

The CMS-1500 must be used when billing Medicare and other federal payers for services. Clinicians must indicate when submitting claims on CMS-1500 if they’re using ICD-9 codes or if they’ve already made the transition to ICD-10. It’s essential that clinicians maintain communication with their payers and clearinghouses and conduct testing to ensure submissions are being transmitted and received correctly.

Medicare began accepting the revised version of claim form CMS-1500 on Jan. 6, 2014 and all submissions after March 31, 2014 must be done with the revised CMS-1500.

For those who have received a waiver for electronic transmission, Medicare will continue to accept paper claims, but only on the revised form. Medicare will deny any claim submitted on the old CMS form on and after April 1, 2014.

The new CMS-1500 was required to correctly report and document the thousands of new ICD-10 codes and the alpha-numeric system that will be used. Use of the new form is mandatory when billing any federal payer. Many of the line-by-line item changes were relatively small, such as changes in wording. For example, TRICARE CHAMPUS has been shortened to TRICARE and the Social Security number is now referred to as an ID number.

Other line items with which clinicians were familiar were eliminated entirely, since the information will now be reported elsewhere on the form or not at all. A number of lines now read “Reserved For NUCC Use” and data that includes employer’s name, school and balance due that wasn’t reported on 837P weren’t deemed necessary and aren’t required on CMS-1500.

An enhancement on the form allows clinicians to list up to 12 diagnosis codes per patient. CMS-1500 has a number of open fields, but they can’t be utilized to report additional data. Practitioners now have qualifiers to identify them as a referring, ordering or supervising provider and diagnosis codes that were labeled 1-4 now have an A-L designation.

The ICD-10 codes are more specific and the CMS-1500 reflects that. The new form has a QR Code that can be scanned with a smartphone. The QR Code takes users to the NUCC website. The revised CMS-1500 also underwent changes that would provide practitioners with the ability to add extra qualifiers when needed.

Any reimbursement claims filed prior to implementation of the revised CMS-1500 that must be resubmitted for any reason should be transmitted utilizing the revised form. This is true even if the previous claim was submitted on the earlier form.

A copy of the form can be downloaded for examination purposes, but it can’t be utilized to submit claims. CMS-1500 uses exact red ink match technology and much of the embedded information will remain invisible when it’s scanned with an Optical Character Recognition (OCR) device. Clinicians should be aware that payers can opt not to process claims that are submitted in black ink and doesn’t use the red ink match technology.

It will take some time for clinicians to familiarize themselves with the revised CMS-1500 form and the new ICD-10 codes, but the form is now an accomplished fact. The new codes and forms are a reality of the healthcare environment and clinicians must use them or risk not receiving reimbursements.

How to Streamline Patient Intake

by Nitin Chhoda PT, DPT | Mar 25, 2014 | Electronic Medical Records, Healthcare Practice Management, Physical Therapy Documentation

Scheduling and patient intake doesn’t have to involve time consuming manual data entry and can be completed automatically with the In Touch EMR™. The software provides practices with automatic functions to save time and streamline the before, during and after workflow. Completely HIPAA compliant,

In Touch EMR™ contains military grade protection to safeguard all patient information. The software is compatible with multiple browsers on PCs and Macs.

Simple And Fast Patient Intake

The patient process begins when a client calls for an appointment. The Web-based In Touch EMR™ allows front desk personnel to obtain the necessary information and schedule an appointment online. The front desk can then create a client chart automatically with the touch of a button.

In Touch EMR™ iPad App

The In Touch EMR™ is the only EMR technology that has its own iPad application. It eliminates paper charts, scanning documents, and filing cabinets full of records. Once a patient arrives for their appointment, they can complete the rest of their intake information with the iPad.

Clients can use the camera in the iPad to take a photo of themselves, their driver’s license and insurance card. The photos are sent directly to the patient’s chart that was automatically created when they scheduled their appointment. Clients can upload medical reports, referrals and prescriptions, along with emergency contacts, complaints, symptoms and medications with a click of a button.

With the integrated abilities of In Touch EMR™, front desk staff can verify insurance eligibility online with hundreds of payers across the U.S. and more can be added as needed. The information comes directly from the payer, virtually eliminating claim denials. The entire process happens before the clinician becomes involved.

Enter The Clinician

The client’s chart has already been created automatically and contains all the needed data for the clinician. Custom templates can be generated to reflect individual practices and with In Touch EMR™, practitioners have the advantage of state-of-the-art voice recognition for documentation. With a click of a button, clinicians can complete their documentation and it’s automatically sent to the biller.

In Touch EMR™ streamlines the patient process from scheduling to billing and is the only EMR that has its own iPad app. The software automatically performs many of the time consuming tasks for which front desk staff is traditionally responsible, allowing them to focus their attention on other concerns such as marketing. The significant savings in time translates to money in the bank and a more efficient and profitable practice.

How to Solve the Problem of Patient Payments

by Nitin Chhoda PT, DPT | Mar 21, 2014 | Electronic Medical Records, Healthcare Practice Management, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

Patients are usually the last to pay their part of the bill for services they received. To encourage patients to pay their bill, practitioners must make it as easy as possible for them to do so. That means implementing a variety of online payment options. Practices that offer that service are more likely to collect from clients without the need for multiple billings and reminders.

Multiple Payment Methods

In Touch EMR™ allows patients to pay with multiple methods that include cash, check, money orders, and credit and debit cards. Older clients are less trusting of technology and are less likely to utilize payment methods that require them to divulge personal information online, or they may not have access to a computer. For those patients, checks and cash are typically the preferred method of payment.

The In Touch EMR™ is the most sophisticated system in the world, providing a convenient way to pay that’s available to clients 24/7. It’s safe, secure and boosts revenues. The company assists therapists in setting up a merchant account that enables payments to be deposited directly into the clinic’s account, usually in as little as seven days.

Recurring Payments

With the In Touch EMR™, patients also have the ability to make recurring payments. When faced with a large bill, many clients panic and don’t pay anything instead of making smaller but steady payments. In Touch EMR™ solves that problem. Client amounts are broken down into convenient and manageable payments that they can make over time. Clinicians can offer discounts for cash payments and balances paid within a specific amount of time to encourage remittance.

Convenience, security And Eco-Friendly

There’s no need to store sensitive data on-site with In Touch EMR™. The software maintains data in the cloud for added security. The software is HIPAA compliant and adheres to the protocols set forth by the Payment Card Industry Data Standard. The cost of collections is significantly reduced and billers can focus more on claim submissions.

The integrated software is an environmentally friendly method that virtually eliminates paper bills and statements. There may be times when a paper document is required and In Touch EMR™ provides the ability to print one when necessary. When an online payment is made, the data goes to the biller for posting.

Convenience for clients is an essential concept for clinicians that want to increase revenue collection. Online options utilize methods with which most patients are familiar. Practices with online payment options are perceived as more progressive and desirable. An added benefit of offering online payment options is that patients are more likely to recommend the practitioner to others, providing valuable word-of-mouth marketing.