Insurance Benefits and the Law: How Clinicians Deal with It?

Insurance Benefits and the Law: How Clinicians Deal with It?

Nitin Chhoda discusses how clinicians can handle the insurance benefits of their employees without jeopardizing the business revenue and have a win-win situation for both staff and private practice business.

insurance benefits and policyAs a clinic owner and employer, medical practitioners including that of physical therapy management offices, are subject to the same tenants of the Affordable Health Care Act as the owner of a production plant when it comes to offering their staff insurance benefits options.

Businesses that don’t offer healthcare insurance benefits face stiff fines, but an increasing number of employers in all industries are choosing to pay the penalty as an easy means of managing costs.

The downside to that method is that clinics run the risk of losing the best and brightest staff to practices that offer insurance benefits, no matter how meager.

In an effort to retain staff and comply with the law, many employers are experimenting with a variety of options, from changes in coverage to quirky new insurance benefits plans.

Abbreviated Policies Don’t Make the Grade

These no-frill plans offer very limited benefits and provide reduced rates on the most basic of medical services. With the increasing costs of premiums, deductibles and co-pays, many employees will deem the cost and coverage acceptable, when compared to no coverage at all. Clinicians should be aware that these aren’t considered full insurance benefits plans and don’t meet the government mandated criteria.

Benefits for Employees Doesn’t Have To Include Spouses

While employers are required to provide insurance benefits for full-time employees and dependent children under the age of 26, nothing in the Act ensures coverage for spouses. Clinicians who have traditionally offered healthcare policies that include the employee’s family members are opting to eliminate coverage for spouses.

The assumption is that the spouse is working and will obtain their own insurance benefits and health coverage through their employer.

It’s a solution that allows clinic owners to provide required coverage and save money.

What Does “Affordable” Really Mean?

One of the primary tenants of the Affordable Health Care Act that’s causing confusion for all is the term “affordable”. The Internal Revenue Service proposed rules to take effect in 2014 that indicate an employer-sponsored plan is affordable if it doesn’t exceed 9.5 percent of the individual’s household income.

That definition offers employers some parameters with which to work when configuring insurance benefits packages. It also opens the door for a variety of staff retention problems as talented professionals seek positions that specifically combine higher wages with better benefits.

The word affordable is misleading. The Act mandates coverage, but doesn’t say employers must make it affordable.insurance benefits

Affordable healthcare coverage should be within the grasp of everyone, but providing those insurance benefits can represent a hardship to smaller practices.

Practitioners are forced to run a gauntlet of penalties, less profitability and loss of experienced staff for lack of insurance benefits.

They’re all factors that each medical professional will have to weigh carefully as they will impact clinics and quality of care for years to come. ll have to weigh carefully as they will impact clinics and quality of care for years to come.

The Four Ds of Negligence

The Four Ds of Negligence

Nitin Chhoda shares the four Ds of negligence in a private practice setting so that clinicians can prevent negligence from occurring in the business.

negligenceThe medical profession is a rewarding one, but full of opportunities to inadvertently run afoul of rules and regulations. Most patients are sincere.

They simply want to get better or see an end to their pain, but there exists a pool of unscrupulous clients who are vigilant in their search for a reason to sue a medical provider for a breach in one of the four Ds of negligence.

The four Ds encompass duty, dereliction, direct cause and damage. The majority of healthcare practice management providers won’t experience the harm to their reputation, clientele and clinic that result from a lawsuit, but medical professionals should be aware that they can be held liable vicariously through the actions of their staff.

To avoid the four Ds of negligence, it’s essential that everyone is conversant in the proper procedures. To be guilty of negligence, a disgruntled patient must prove that the practitioner took action, or failed to, that was ultimately detrimental to the client.

Clinicians should be wary of patients that come into the office requesting specific medications, tests and treatments.

1. Where Duty Begins and Ends

The first of the four Ds refers to duty. Clinicians have a duty to their patients to provide the most accurate diagnosis and care, utilizing their extensive education and experience. Healthcare workers have a duty to inform patients of potential problems they observe upon examination in the clinical setting. They’re under no obligation to provide medical information about any condition they notice in connection with strangers and casual acquaintances, which is a part of negligence.

2. Dereliction of Duty

Dereliction is the second of the four Ds of negligence and refers to actions that a healthcare provider may fail to take. If a medical professional observes a skin condition that could be cancer but neglects to inform the client, it’s a breach of duty.

3. Making a Bad Situation Worse – the Direct Cause

Direct cause is the third element of the four Ds. In this type of negligence, the onus is on the client to prove that the healthcare provider knew about a potential risk, didn’t inform the patient, and the client was injured as a result.

4. Collecting Damages from Clinicians

Rounding out the four Ds of negligence is damages patients can collect in a lawsuit. Damages are the financial compensation clients can collect and includes lost wages, medical expenses and mental duress.

Vicarious and Collateral Liability

Practice owners can be held liable for staff members who make mistakes, don’t follow proper procedures or overstep the boundaries of their responsibilities.

negligence of practice

That includes defamation of character, slander and making libelous statements. It also encompasses invasion of privacy, sharing records without informed consent, violating patient care standards, and malfeasance.

Medical practitioners must work within established laws and parameters when treating patients and ensure staff members are cognizant of what constitutes a breach of the four Ds of negligence.

Staff must be trained in potentially litigious situations for themselves, the practice and the consequences. Education, an understanding of procedures and identifying clients that may come equipped with a lawsuit mentality will help anyone in the medical profession avoid the four Ds.

Healthcare Insurance Simplified – the Patient’s Perspective of Health Coverage in the New Economy

Healthcare Insurance Simplified – the Patient’s Perspective of Health Coverage in the New Economy

Although healthcare insurance can be useful in the case of illness, many people do not understand their insurance coverage and limitations.

Nitin Chhoda shares the different perspective of healthcare insurance; from that patient’s point of view to the healthcare service provider.

healthcare insurancePatients and therapists view healthcare insurance from an entirely different perspective.

For patients, it’s a way to defray costs when they require a wide range of services, from prescriptions and hospitalization to well patient check-ups and ongoing physical therapy treatments.

For therapists and healthcare practice management providers, healthcare insurance is the primary means of reimbursement for services.

Healthcare Insurance

Older clients, parents and those who have experienced the need for an extended hospital stay are well acquainted with the value of maintaining a comprehensive healthcare insurance policy. They may complain about the cost of premiums, copays and deductibles, but they know the benefits far outweigh the monetary sacrifices they may make to keep their coverage up to date.

Younger individuals tend to eschew healthcare coverage or purchase less than they need. For this demographic, accidents and healthcare emergencies are incidents that happen to “other” people.

healthcare insurance simplifiedThe entire healthcare insurance industry is a mystery to most patients. They’re unsure of exactly what they’re paying for, the terms of their coverage and their financial responsibility.

Healthcare insurance is often far more expensive than they anticipate, may not cover a wide variety of treatments and procedures, and involve high deductibles that must be met before coverage is available.

A Patient’s Perspective

Millions of individuals across the nation live in constant fear of becoming ill, injured or incapacitated, even when they have insurance. When they do become ill, it may be difficult to find a healthcare insurance provider that accepts their brand of insurance.

Patients often delay treatment, spreading potentially dangerous diseases. When no other option exists, those same clients resort to emergency room treatment that contributes largely to the increasing cost of healthcare costs.

As it exists, the healthcare industry in the U.S. forces patients to make decisions that can radically influence their lives and future finances.

The Affordable Care Act provided coverage to millions who were uninsured or underinsured, but it also created a deficit of healthcare insurance providers in relation to the number of new patients coming into the system.

Those who don’t understand their coverage represent a major loss of income for therapists. When claims for non-covered expenses are rejected, patients must pay the bill and collecting those funds can be a costly endeavor.

The first steps in healthcare reform have been taken, but more must be accomplished. The future of healthcare insurance in the new economy will require patients to pay more for their healthcare coverage and shoulder more of the financial burden in terms of co-pays and deductibles.

Coverage and Limitations

Coverage caps and limitations could very well become the norm. For therapists, the result of such trends is a loss of income and a potential move toward more self-pay patients, a strategy that could effectively eliminate many from the healthcare system and cost practices in the long-term.

The experience and expertise of a good therapist can’t be understated and they deserve to be compensated for that acumen. Therapists are the chief advocates for their patients’ needs, but are often forced by healthcare insurance companies to accept far less for their services than the actual value or are second-guessed by insurance company officials.

It’s neither an efficient or cost effective system, and one that can potentially place patients in harm’s way while contributing to a system that makes it increasingly difficult for therapists to operate a financially sound practice.

Healthcare Insurance and Health Insurance – What Are They?

Healthcare Insurance and Health Insurance – What Are They?

Nitin Chhoda explains the health care insurance, its providers, the Insurance coverages and the Affordable Care Act for patients.

He also discusses the importance of knowing the limitations of patients’ insurance so that patients and service providers know what to expect at the time of treatment.

healthcareHealthcare practice management costs that continue to rise and unforeseen medical emergencies are the two overriding reasons individuals buy healthcare insurance.

Essentially, patients purchase insurance against the risk of becoming ill or encountering a potentially expensive and unforeseen medical need.

Accidents and catastrophic medical emergencies happen in the blink of an eye. Healthcare insurance helps defray patient costs and insures healthcare providers receive payment for their services.

Insurance Provider

Patient healthcare insurance is most often provided through an individual’s employer. Business owners contract with insurance companies to provide an established range of healthcare services that can include hospitalization, vision and dental coverage, along with office visits, prescriptions and lab tests.

Available coverage varies widely, with employers shouldering a major portion of the costs while the individual is responsible for co-pays, deductibles and monthly premiums. Medicaid and Medicare represent another form of healthcare insurance. Medicare is administered through the federal government.

Medicaid is funded through federal and state governments and distributed at the discretion of each state. Medicare is accessible by retirees and the disabled. Medicaid typically covers low-income children and adults with no other available options.

Insurance Coverages

Dwindling funds and budgetary concerns have led to coverage limits in both Medicaid and Medicare, making it essential for therapists to verify a patient’s coverage before treatment.

There’s been a push by healthcare insurance providers and employers for patients to shoulder more of the monetary burden of their healthcare, giving rise to a wide variety of special clauses and exclusions in healthcare policies.

Cancer, long-term healthcare needs and disability claims are costly for insurance providers and many policies now require clients to purchase additional, specific coverage for certain conditions. The result of shifts in healthcare insurance policies and practices has resulted in a lack of sufficient coverage for much of the population.

Underinsured clients and those with no coverage present a major problem for therapists who must balance the desire to practice their profession and render aid to those in need, with operating a practice that remains solvent and profitable. The first line of collections when a patient receives treatment is the healthcare provider.

To ensure reimbursements are received in a timely manner, practitioners submit claims to the patient’s insurance provider.

Any amount not covered through the client’s healthcare plan is the responsibility of the patient. It’s essential for therapists to determine a client’s coverage before the time of treatment to ensure the patient receives necessary services and clinicians obtain the payment to which they’re entitled.

The Affordable Care Act

healthcare and health insuranceThe Affordable Care Act extended medical coverage to millions of individuals who previously had no insurance, but significant limitations and gaps in available services still exist.

Clinicians must ensure they have current insurance information for every client they treat before the patient arrives at the office.

It’s an unfortunate reality, but the direction of current insurance company policies may force therapists to decline patients with limited or no coverage to ensure their practice isn’t at financial risk.

Insurance companies represent the first line of reimbursements for clinics, followed by state and government programs, and self-pay patients. Changing and evolving healthcare insurance will require practice owners to examine the state of their businesses and the patients they treat with an increasingly stringent set of criteria.

Health Care Management at Its Best

Health Care Management at Its Best

Producing reports for health care management in order to monitor efficiency of therapists and staff are now possible.

Nitin Chhoda explains how physical therapy EMR changes the productivity and efficiency of physical therapy practice by reviewing the number of patients who have been treated during a certain period of time. 

best health care managementWith an incredible array of technological tools at the ready, there is no reason why health care practice management can’t undergo a renaissance.

In a small practice, the office manager can also serve as patient relations, interpersonal coach, HR manager, and accountant.

But with electronic medical records, the health care manager may become the financial analyst as well. In fact, analyzing efficiency, strengths, and weaknesses of the practice may be the top priority for the health care management field.

How Reporting Improves Efficiency

Both internally and with patients, an EMR can improve efficiency just by virtue of eliminating the majority of paperwork. Communication is streamlined and things like medical billing and coding can be handled more quickly and with fewer mistakes. But for health care management, EMRs are introducing tools that change the way we think about managing a practice.

An EMR with reporting capabilities can tell health care management professionals a lot about how the practice is doing. Outcomes and performance of clinicians and patients can be compared with a few clicks.

In the past, it would have been almost insurmountable to extract data on visits per referral and visits per day for each clinician. With the new practice management technology, those reports can be run quickly and simply.

In fact, there are a whole host of important indicators that are being monitored by the software solutions designed for health care management. Most of these indicators can help office managers to see where the lags in efficiency are hiding.

Inefficiencies degrease profitability, and decreased profitability is bad for everyone. The information gathered can be shared with staff members and solutions can be discussed with health care management.

If used appropriately, technological management tools can help turn a practice that is just getting by into a profitable enterprise. From changing the way that medical billing is handled to using proven techniques to speed up recovery and improve outcomes, health care management tools are going to go a long way towards revolutionizing the business side of medicine.

Educational Experiencehealth care management staff

With an increased emphasis on technology, more and more individuals who want to pursue a career in health care management are going back to school.

The job has no educational requirements, but a bachelor’s degree and even a master’s degree are not uncommon.

There are specific programs now that will education students about the pitfalls and advantages available to adaptable health care management.

As the job market widens, these are the professionals that will be handling health care management jobs. And because the role of health care management professionals is changing so quickly, there is a lot of room for improvement in most health care practices.

The office manager has the job of ensuring that things run smoothly and if there are problems, the office manager needs to work with staff to find solutions. A health care management professional who understands the benefits of current technology will have more tools for finding solutions than ever before.

Physical Therapy Management for Physical Therapy Practices

Physical Therapy Management for Physical Therapy Practices

Manual physical therapy documentation can be time consuming. The trend has been for physical therapists to focus on the admin side instead of providing quality care to patients.

Nitin Chhoda says that it’s about time to use physical therapy software so that practitioners can maximize their time treating patients and increase productivity.

physical therapy managementFor most private practices especially physical therapists who see patients two to three times a week, managing physical therapy billing, dealing with medical billing and coding can be a challenge.

Having a Physical Therapy Software

With physical therapy management software, you can simplify the business side and spend more time doing what you really love, which is working with patients.

You probably are accustomed to using paper records. Perhaps you believe that there is a price barrier to adopting an electronic medical records keeping solution. But the truth is: using physical therapy management software will actually save you money.

Lets ignore the cost of office supplies for a second. Paper records take up lots and lots of space. With that much paperwork, pulling up the information on any given client is a slow and tedious process.

Even if you have a small practice, physical therapy management software can drastically cut back on the time it takes you to locate a patient file and make updates to it.  You can also access the records from anywhere, meaning that you can look up a record when not in the office without bothering whoever you have tasked to maintain your records.

Everything is Digitized

Digital records are also more likely to be accurate and read accurately, since you no longer have to rely on handwritten notes.  Being able to read the records means better care for patients. That is a great physical therapy management plan.

Physical therapy management systems can even include full digital check-in for the patient, logging when they arrive and leave.  This can be done from any computer or iPad, meaning that you can use the physical therapy management system for house calls, too.

Simply by pulling up an online or on-the-computer record, you have quick access to the history and details of any patient you are about to see.  Paperless physical therapy management is elegant and straight-forward.

Solid physical therapy management and scheduling software even simplifies the more complicated aspects of running a physical therapy firm, like managing no-shows and cancellations, and filing paperwork with other offices, insurance companies, and healthcare services.

Proper physical therapy management software makes it easy to delete a cancelled appointment, file Medicare updates for patients, and never get rejected for claims because of technicalities. Physical therapy management systems streamline your business processes and help you to care for more patients, more efficiently. A program that saves you time will save you money.

physical therapy management practiceIntegrated Billing

Perhaps the most compelling aspect of a physical therapy management system is the integration of billing tools.

High quality systems offer a complete physical therapy billing tool that is built into the management tools, so that no matter what you need it is right at your fingertips.

You can include a suite of analysis tools to help you manage payment better. You can figure out how quickly your average patient pays their bills, for example. These tools are critical to helping you run your business as smoothly and as financially responsible as possible.

If you have a physical therapy practice, you need an electronic medical record system. If you start now you can get everything set for the 2014 HITECH Act deadlines. Computers and the Internet have revolutionized how business is done.  Embrace that fact and let it make your practice better.  Have the best physical therapy management plan.