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.

Physical Therapy Documentation: The Importance of Personalization in Your Physical Therapy EMR system

Physical Therapy Documentation: The Importance of Personalization in Your Physical Therapy EMR system

Personalization is critical when choosing the right physical therapy documentation or EMR for your practice.

Nitin  Chhoda discusses the importance of personalization and customization in the physical therapy documentation process, and how it should affect your selection of a physical therapy EMR.

physical therapy documentation personalizationThe best limbo dancers are extremely flexible and that same quality is essential in a physical therapy documentation system.

The majority of EMRs were developed and written with a specific user in mind, from hospitals and physicians to surgeons.

EMRs reflect the reasoning of the creator rather than the end user. It’s essential to select an EMR developed by or for a physical therapy practice to ensure the EMR doesn’t begin dictating how the clinic conducts business.

Selecting the Best Physical Therapy Documentation System

When selecting a physical therapy documentation system, the two key factors are flexibility and control. The system must offer the flexibility to meet the individual needs of the practice for the present and the future.

Therapists must be able to control every aspect of the physical therapy documentation process without interference from the EMR. Documentation software provides the means to achieve a more efficient and profitable practice.

It should never intrude on or force therapists to compromise on the way they operate their business.

Have an Effective EMR

Many EMRs look and sound good in theory, but ignore the practical concerns of the clinical environment. Physical therapy practices vary widely in the services offered, professional experience and work environment and an EMR must be able to adapt to the diverse needs of the individual practice.

A good physical therapy documentation system offers additional options as needed to grow with the practice.

An effective EMR integrates easily with existing office systems to expedite physical therapy documentation of patient records, enhance marketing endeavors, and provide patient portals for additional functionality. EMRs automate many of the time consuming tasks typically handled by staff members, freeing them to engage in pursuits that promote the clinic, acquire new patients, and increase the level of the practice’s customer care.

Customized Pattern

The ability to create customized templates, without restriction, that accurately reflects the services and treatment options of the individual practice is essential. Therapists should be able to create their own templates, without hiring a tech specialist to navigate the system.

Not all patients respond the same way to treatment, requiring therapists to be creative to achieve the best results for the client. Any EMR should include the ability to combine any number of physical therapy documentation services and bill accordingly.

Reimbursements

physical therapy documentation processPhysical therapy documentation, billing and coding options specifically designed for use by therapists help navigate the increasingly complex requirements for reimbursements.

The ability to submit claims electronically should be a function of physical therapy documentation software.

Reimbursements are received quicker and additional information and clarification can be accomplished almost immediately. EMRs also allow therapists to work with an extensive number of payers for the best reimbursements.

As more complex and innovative treatments are developed, physical therapy documentation must be able to change and evolve to meet the needs of practices.

Flexibility in all facets of EMR software is needed, from time stamps to avoid legal issues to the ability to create custom forms that reflect the special requirements associated with physical therapy clinics. Both web-based and server-based EMRs are available, but the key to successful implementation is always the ultimate flexibility of the selected software and its ability to facilitate clinic expansion and profitability.

Physical Therapy Marketing: Limiting Exposure to Bad Payers

Physical Therapy Marketing: Limiting Exposure to Bad Payers

Searching for the best insurance companies maybe hard to find, but it doesn’t mean that they do not exist. Nitin Chhoda exposes simple techniques on how to identify and contract with the best payers so that your practice will have continuous income.

Knowing the bad payers when it comes to your physical therapy practice is not as hard as you might think. Nitin Chhoda reveals ways you can recognize bad payers in order to avoid them, and spend more of your time caring for patients.

physical therapy marketing limitsEvery physical therapy marketing in a practice goes through the process of determining which are the best paying insurance companies. You may find that one of the best ways to learn about bad payers is by asking around.

Of course, you may not feel like going into the competitor’s office as part of the physical therapy marketing plan, but there are ways to get information that don’t involve any risk.

Call Around to Other Healthcare Service Providers

The best information will come from other physical therapy marketing services and practices. Some insurance companies may have better policies for certain types of medical care than others.

However, if you are unsure about contacting other physical therapy managers and owners, you can also talk to those healthcare providers that you already have a relationship with.

Are there other physical therapy marketing and management offices where you refer your patients to when they need a different kind of care? Do surgeons or specialists send their patients to you when they need physical therapy?

Get in touch with the people you know and ask them a few questions about their best payers and their worst. Most professionals will be happy to share the information.

Same State, Different City

Another way to get good information is to get in touch with other physical therapy marketing services of other practices that are in the same state as you, but in a different city or town. This may feel a bit awkward at first, but the benefits of learning about bad payers are well worth a little confusion.

Remember to talk to the other managers as your peers. Remind them that you’re all in the same boat and you think this kind of information should be shared so that you can all avoid insurance companies that are bad at paying their bills.

In fact, you may find that someone has started to compile a list already. There tend to be way more resources out there than you expect – it’s just a question of finding them.

It may be that a local physical therapy marketing business group has already identified some of the worst and best payers and they might be willing to share the list with you. You never know if you don’t try.

physical therapy marketing payersStart a List of Your Own

Of course as you go, you will learn which companies you prefer and which seem to always reject your claims.

Keep track of those companies, mostly for your own physical therapy marketing practice and so you can adjust who you contract with, but also because perhaps one day someone will call your office asking for advice.

Physical therapy marketing in a practice can benefit from working together, and in some cases a good deed will pay dividends. If a practice becomes overwhelmed with new patients, perhaps they will send some your way if you’ve done them a favor in the past.

Running a healthy and thriving physical therapy practice is a lot of work. There are some very important decisions to make, and they will keep coming. The more you can work with others and build relationships with those payers that are good, the better off your physical therapy marketing practice will be.

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.