Nitin Chhoda emphasizes that a physical therapy practice should be aware of all the regulations and laws that are connected within the practice. Not everyone can be an expert, but assigning a dedicated staff member to focus on regulations, laws and the changes that are made will be helpful to your practice.
For a large hospital or clinic to keep a lawyer on staff is not uncommon, and in many ways it makes sense to always have a legal specialist available to answer questions about the rights of the hospital and their patients.
However, for a small practice it is much harder to justify having legal representation on staff. There are many horror stories of legal problems causing bankruptcy for a medical practice.
Health care practice management should include some basics about the dangers of making legal decisions for which the outcome is unclear. However, because of the focus on patient lawsuits, health care practice management teams often forget to think about regulatory legal blunders.
Understanding HIPAA regulations is one of the most important jobs of health care practice management. While mistakes in following HIPAA regulations can be damaging, they are also some of the easiest mistakes to avoid, if the health care practice management team is aware of common mistakes that are made.
The most common problems that health care practice management run into focus around liability for fraud, mishandling overpayments, violations of privacy, and not responding to Medicare inquiries. Third-party payer audits and certificate-of-need process should also be comfortable topics for health care practice management consulting professionals.
HIPAA violations can be avoided if at least one member of the health care practice management within your practice understands HIPAA thoroughly. It may seem like a very big and ominous law, so expecting everyone to know everything will be challenging.
But at least one person should be or become a HIPAA specialist so the practice has someone to ask before procedures and standards are set that will violate HIPAA regulations.
Legal blunders relating to contracts are also very common. Naturally, health care practice management professionals are on high alert about any contracts, especially with staff, physicians, and clinicians.
You can also run into trouble with non-compete clauses if you work with physicians who are providing services for more than one practice, especially in-office ancillary services.
To avoid legal problems, it is best to negotiate all contracts in full, taking the time to review all aspects that may introduce conflicts within the practice.
At the first sign of a problem, make sure that communication is open and honest so that changes can be made before a problem becomes a legal issue.
The HITECH Act will also pose a lot of risk for health care practice management, as the punishments for not following HIPAA regulations are more severe as a result of the HITECH Act.
Additionally, funding through the HITECH Act is expected to increased oversight so that infractions are more likely to be discovered.
Regulatory oversight can be the least of your worries if you have focused on improving your knowledge of the regulations.
Managing a health care practice can include complex facets, and being aware of risks to the practice should be a high priority. The best way to avoid a risk is to understand what constitutes risky behavior.
The first priority of physical therapy management is to give 100% patient care while obeying the law. Nitin Chhoda explains why avoiding legal suits is important, as this will affect the standing of your physical therapy business.
Even if the case is eventually decided in favor of the practice and it is determined that you did nothing wrong, the legal cost of defending the practice can be devastating.
On top of financial fears due to legal expenses, there is a very good chance that your other patients will hear about the lawsuit and some patients may leave your practice for less tarnished options. Potential new clients may learn about the lawsuit as their introduction to your practice.
Needless to say, avoiding legal action from patients is a very big priority for health care practice management.
Steps to Avoid a Lawsuit
With so many opportunities for patients to accuse a health care practice management systems of negligence or malpractice, it may seem impossible to avoid a lawsuit if it’s coming at you. But there are some steps you can take to ensure that patients are heard before they start thinking about legal action.
Most importantly, clinicians and all staff of the health care practice management should be educated about the risks of legal action.
Criminal and civil lawsuit examples should be discussed among the staff so that everyone understands their role in avoiding a lawsuit. This should include not just patient-staff relations but also the employee-employer responsibilities.
When a situation does arise where a patient or employee feels they are being taken advantage of or mistreated, the action that health care practice management takes may determine how far things escalate. Never underestimate a claim, even if it is totally unfounded.
Be sure to spend time listening to the complaints, as it may be enough for the patient to be heard and acknowledged. However, rather than giving in and being apologetic, be sure to stand firmly on your policies and avoid saying things that could incriminate your health care practice management.
The first step in any litigation will include mediation. In some ways, you should consider mediation as your first option when a serious complaint of your health care practice management is filed.
There should be an easy-to-use complaint filing system and ways for patients to give feedback, so that they feel confident they are being heard. If a patient is frustrated while simply trying to file a complaint, their estimation of your practice will only diminish further.
Introducing a third party mediator or legal consultant for the health care practice management can be the right step for many situations. Especially if you have legal advice that suggests you are not in the wrong, bringing a third opinion into the conversation may help you to avoid an actual lawsuit.
And just like in any legal situation, it will probably be less expensive to work things out before things escalate, even if you win your case in the end.
Bigger Picture Thinking
Avoiding legal mistakes will be a challenge for any health care practice management team, but most especially for small practices that do not have significant resources.
Remember to focus on the big picture and consider how each step and each action your practice takes will reflect on the community’s perception of the practice.
But don’t be afraid to stand up for what you know is correct and to hear out complaints in an effort to reduce the potential for damage.
Whether you are healthy or not, having the right insurance for you is a must. Nitin Chhoda elaborates the importance of having the right insurance, and how it can help you prepare for future healthcare needs.
The terms healthcare and insurance have gotten a bit muddled in the minds of most Americans. So much of the public debate around healthcare is focused on health insurance.
But the reason that we need a better system of healthcare and insurance is because people aren’t getting the kind of healthcare they need to stay healthy.
It can be difficult to understand the healthcare practice management system if you never need to know how it works. But then one day you do need to understand, and maybe that’s because you’ve ended up in the hospital and are uninsured or underinsured.
The Truth About Healthcare and Insurance
The truth is that patients these days need better healthcare, and healthcare and insurance is the way that healthcare becomes affordable. If you had millions of dollars in the bank, you might not care about health insurance.
If something happened, if you were in a car accident or got sick with a serious disease like cancer, you could pay for your healthcare, even if that meant spending tens or hundreds of thousands of dollars for the best care. However, if you don’t have unlimited funds to spend on unforeseen expenses, healthcare and insurance is there to cover the big costs.
What is Healthcare?
For a moment, let’s forget about healthcare and insurance altogether. Imagine that every time you got sick and needed to go to the doctor, you would just go and the doctor would charge you a fee for the visit, and you could afford to pay that fee.
You have a bad sore throat that won’t go away, you go to the doctor, suspecting strep throat, and the doctor charges $30 for the visit and gives you a prescription for antibiotics. Then you visit the pharmacy and pay $10 for your medication and you’re all better in a week. You don’t feel like you need a healthcare and insurance.
That is healthcare at it’s most simple approach. Of course, the situation gets more complicated if something serious happens.
You have pain in your back all the time and you visit the doctor. You have to go back a number of times for a number of different tests.
Each time it costs $30, plus the costs of the tests. Then your doctor orders an MRI. In the United States, an MRI costs hundreds of dollars. Healthcare and insurance seemed to be important at this time.
Or if someone has back pain that is making their life difficult and full of pain, they do not have a choice about seeking out healthcare and insurance.
The alternative is to live with awful pain all the time, limiting what they do in fear of making it worse, and possibly taking pain medication which will do further damage in the long term, to the liver, kidneys, and other important organs.
Getting Healthcare and Insurance is Part of Life
So rather than risk that this patient will have to pay for all these medical tests and potentially ending up in surgery, which will cost $50,000 to $100,000, the alternative is to buy healthcare and insurance.
You may choose a high deductible and pay for all those inexpensive visits, but if something truly bad happens, you are financially protected from medical bankruptcy.
Although patients know the importance of healthcare and insurance, most do not understand their coverage and benefits. Nitin Chhoda explains how patients misunderstand insurance, and why it is important to openly communicate with them in order to avoid financial struggle.
The nature of health care insurance of a healthcare practice management in the United States leaves most patients pretty confused about what they need and what they are entitled to.
For example, even patients who have health care insurance may not benefit from their insurance most of the time.
If a deductible is built into the insurance plan, the patient will end up paying for most of their doctor visits every year. The only time they benefit from having insurance is when a serious accident occurs or they are diagnosed with a serious illness.
A Patient’s Perspective
From the patient’s perspective, the health care insurance system is confusing and always more expensive than they expect. A co-pay that is required, perhaps $20 for a visit or 20% of the bill, might come as a surprise to a patient that doesn’t understand their policy.
Even worse is when the patient does not understand the deductible of his/her health care insurance. They may look at their policy, find out that a certain treatment is covered, and not realize that they must pay the entire cost because they haven’t met their deductible limit.
For Clinicians and Medical Practices, Misunderstandings Can Mean Lost Revenue
Let’s consider a patient who does not understand the deductible, but they want to go to a dermatologist to test an unusual mark on their skin. They wonder if it’s skin cancer or just a mole, so they figure out that this kind of test is covered by their health care insurance, as long as they get a referral.
First they go to a general practitioner who is covered by the particular health care insurance company. They pay for that visit, or perhaps just a co-pay, and get their referral.
But then they have an appointment with a dermatologist and tests are done to determine what the skin growth is. This is all pretty expensive and the bill comes to $1000.
At first both the dermatologist’s office and the patient believe that the patient must only pay the co-pay of 20%, which is $200 because of his/her health care insurance.
If the patient has a $3000 deductible that they have not reached, a chain of events ensues, which causes expense, wasted time, and stress for the patient and the medical staff.
First, the medical billing staff will bill the health care insurance company for the amount they typically pay, in this case $800. But the claim will be rejected because the deductible has not been met. Then the medical office has to bill the patient that $800 – an amount the patient is not expecting to pay.
From the patient’s perspective of health care insurance, this is a terrible realization. From the practice’s perspective, this has been a waste of time and now they do not know if they will be paid for services already rendered. It is quite possible that the patient cannot afford to pay that $800. Even the $200 was probably a bit of a bummer at least.
The truth is that the patient made the right choices in making a health care insurance.
If that skin growth was skin cancer, it should be tested and removed. If they leave it alone, they may get seriously ill and have to undergo much more expensive and intensive treatments. But they are discouraged from taking those first steps because it is so costly.
Using modern technology for health care management such as EMR can help many patients foresee their medical expenses. Nitin Chhoda explains how medical EMR can determine the status of the patients’ insurance so that they can prepare and get ahead of their expenses.
In a system of health care practice managementwhere insurance seems to be primarily concerned with the financial bottom line, patients often get caught in a bad place.
Patients are left to shoulder hefty bills because their insurance and benefits don’t cover what they expected them to cover.
Patients are often thrown into medical debt through no fault of their own, losing their jobs, sometimes their homes, and often their ability to get back out there and find work again is hampered or completely destroyed by their health care medical condition.
The Modern Technology
So how can modern technology help to make the patient experience less of a downward spiral? There may be nothing that a private practice health care can do to change the laws, so that insurance companies cannot drop patients for irrelevant technicalities.
However, for health care practice management professionals who want to continue to provide services and help people to get better, there are some ways that technology can improve the way things go for patients.
Preparation Rather Than Reaction
One problem that many patients run into is that they are unprepared for the amount of work it will take to recover, and they are unprepared for the amount of money they have to pay for their health care.
Even for patients with insurance, a serious injury or the diagnosis of a serious medical condition or disease can spell financial ruin due to the high price of medical care in the United States.
As a result, patients are terrified that they will end up at the doctor’s office, hearing bad news. They begin to avoid regular check-ups, even without realizing that they are doing so. In fact, many people actually make their health care worse by avoiding their medical care.
Medical EMRs can make a practice more efficient from within, and for many patients, that becomes a benefit. If health care clinicians can access patient files more quickly, easily, and efficiently, they will spend more time learning about the patient and what they need.
If billers and other staff members have more time to figure out what the patient will owe after the insurance company pays their part, the stress of an unexpected bill will be lifted.
Technology can help patients to prepare for what is going to happen as part of their health care treatment or recovery. This empowers them to make the right moves and take the right steps to getting better.
Additionally, with technological advances, it is possible for everyone within the practice to communicate faster and more clearly. If everyone in the health care practice is aware of the needs of patients, patient care improves.
When the staff is in better communication, they will also communicate more effectively with patients. And the more informed your patients are, the better they will understand their role in the process of healing and recovering.
There are ways for clinicians and staff members to make things easier for patients. Many technological options exist today that will help to empower patients and bring better efficiency to everyone involved in the health care of patients.
Nitin Chhoda shares how modern technology such as EMR, and having a good vision about your staffs’ efficiency help you provide better health care for your patients and good management for your practice.
The jobs of clinicians, doctors, nurses, and even receptionists revolve around the ability of everyone in the practice to take care of the patients that come through the doors.
And yet, the way that most health care practice management are run does not align with that primary goal.
The Technology of Today
Today, healthcare practice management professionals must put their focus elsewhere; someone has to be watching the income and expenses to make sure that the practice will continue to run.
Most recently, medical EMRs have surfaced as one tool that health care practice management professionals have implemented in an effort to streamline the practice and become more efficient.
Staff members are taught to be focused on time management, and medical billing and coding staff have to constantly fight to improve their rates of accepted medical claims so claims submission is not just a job of futility.
EMR of Health Care Management
Medical EMRs of health care practice management certainly help staff members, who are often set in their ways, to adjust workflows and become more efficient and more effective at their jobs.
But how does this affect the way that patients experience healthcare at your practice? Will improvements in technology really benefit patients? Can health care practice management clinicians care for patients more attentively if they’ve got a tablet computer in front of them rather than a file folder full of paperwork?
The truth is that everyone in the health care practice management, including patients being treated, benefits when the practice runs more smoothly.
Transitioning to new technology is never simple or easy, but once staff members settle into new rhythms, they may find that they are faster and that they feel more confident about their jobs as a result.
Everything Should Be At the Right Time
Of course, it takes time and a lot of very attentive and well-planned health care practice management to get to that point, but in the new economy, this kind of investment may be the only way to survive into the future. Anything that slows down the practice will reduce competitiveness, and the medical community is trending towards switching to medical EMRs.
For health care practice management where the implementation of a medical EMR seems like too much work and not worthwhile, it may take a little bit of visioning for everyone to get on board.
But imagine a practice that has an integrated medical EMR already installed and functioning properly.
Vision Is the Key
Imagine that the entire staff is already comfortable with the way the program works. Imagine that patients know how much they will pay for each visit, and they even pay up-front because the billing staff knows what their insurance company will pay.
Imagine that health care practice management clinicians have more time with each patient, even though appointments stay the same length, because it is easier and more intuitive for clinicians to review a patient file using the medical EMR.
Everyone benefits, and that includes patients. A confident, happy, and productive health care practice management staff will improve the patient experience. A medical EMR can improve productivity and bring a bit of extra confidence to the staff.