Doctors - All Eyes Are On You For MU2

The Federal government is making a big investment in time and money to get physicians onboard with computerized medical records. It’s not just that computerization will make your practice smarter and more efficient. The government sees computerization as a way to make sure the healthcare community is getting the information it needs to make quality medical decisions and achieve low cost, high quality results:

These are laudable goals, but there’s a catch. It takes extra time, effort and money for both the physician and their practices to make computerization really work. For medical information to be shared and available everywhere, complete and accurate information needs to be entered into the system – and in the correct manner. The physician is naturally central to this process and so all eyes are on the physician to make sure this happens.

Meaningful Use Stage 2 has some new requirements for the physician and some new techniques for monitoring physician adoption of electronic health records. You need to understand these changes so that you and your practice can adapt successfully.

1) Your new 2014 certified system will report Meaningful Use measures for you. Instead of your practice attesting manually as was done during Stage 1, most of the information submitted to the government for attestation will be generated automatically by your computer system. The system will record whenever you do and do not comply with Meaningful Use objectives and will report the measures for you.

2) You are required to share computerized patient charts with other clinical entities whenever a patient transitions away from your care to theirs. As you move responsibility for a patient to another care entity, you will be sending along a computer file, called the ‘CDA’, which will be comprised of the information you painstakingly entered into your computer system. This information includes problem lists, medications, medication allergies, orders, results, etc. You will want that information to be complete and accurate, and the onus will be on you to make sure that happens.

3) You are required to share the chart with the patient. After each visit, your practice will give the patient a summary of the visit, which will be generated from information entered into the computer system.  Also, your practice is going to make your full internal chart available to the patient online. Patients will be able to share their charts with other care entities themselves. You will want to make sure your computerized charts are accurate and complete.

4) You will be sending the government quality reporting covering nine Clinical Quality Measures (CQMs). These reports come from your computerized system and will only be accurate if the information in your system is complete and accurate.

5) Your system will be alerting you with five or more clinical decision supporting interventions. As you open up the patient’s chart, the system will evaluate the patient’s medical record and provide alerts as needed for 5 different intervention rules. To avoid false alarms for yourself and your staff, the patient’s medical record will need to be complete and accurate. And you cannot turn these alerts off. Your computer system will share with the your automated attestation.

So all eyes will be on you, the physician for MU Stage 2. There are checks and balances in place to make sure the computerization is happening. To be sure, meeting Meaningful Use requirements in Stage 2 will be more difficult but with some education and focus you can ensure you are on track and successful.

Monitor Days In AR For Optimal Financial Performance

There are several important metrics practices should benchmark and monitor regularly, but if you can benchmark only one metric, it should be your days in AR (Accounts Receivable). Your days in AR is the best indicator of how your billing and collections department is performing. AR is defined as the total dollar amount that is owed to you from patients and payers.

Even if you know what your total accounts receivable is, unless you benchmark your days in AR, you really have no idea whether your AR is good or bad. Before going through the benchmark process with a practice, we often hear from the practice manager or one of the physicians that “we think our AR is fine” or “we are probably collecting everything we can.” In reality, most practices have no idea how much money they are leaving on the table. Once practices go through the benchmarking process, they come to understand how they are performing and can take action to improve their billing and collections processes.

Days in AR is the one indicator that measures how long, on average, it is taking you to get paid for your services by insurance payers and patients. For instance, if your days in AR is 40, then it takes 40 days (on average) for you to be paid. AR essentially represents all of your outstanding money in terms of number of days’ worth of charges. If you charge out an average of $5,000 every day, and have $200,000 in outstanding AR, then your days in AR is 40 ($200,000/$5000). Here is how that is calculated:

Divide your annual gross charges by 365. The answer to this will be your average daily charges. Now divide your total AR by your average daily charges. Voila:  The answer is your days in AR.

The ideal days in AR will vary some based on practice specialty. However, in general, most office-based services should be paid within 30 days and hospital/surgical services should be paid within 40 days. On average, if your days in AR are over 45-50 days, there is a problem that needs to be addressed.

Additionally, it is important to look at days in AR by payer because this analysis will reveal specific collections issues. For example, your Days in AR could be great for Medicare, but not for Blue Cross.

There are many causal factors that contribute to a high days in AR number, but most are related to three areas: Inability to regularly follow-up on unpaid claims, claim denials, and weak or non-existent patient payment policies (or a lack of enforcement of good policies).

To improve your days in AR – or if it looks good to ensure that it remains healthy, ask yourself the following questions:

Do I have dedicated and expert staff that are able to follow up on unpaid claims each day?  Very often, practice staff has multiple competing priorities and responsibilities, making it difficult for them to spend the time on following up on AR.

How many denials does my practice receive every month and what percent of claims do these denials represent?

Of my denied claims, how many are appealed and eventually paid?

What policies are in place to ensure that denied claims are resubmitted accurately and in a timely manner? Studies estimate that 30% of claims are denied and of those, 40%-50% are never resubmitted. This means that 12%-15% of all claims are never paid.

What policies are in place to maximize payments from patients at the time of service - not only co-payments but payments from patients that have not met their deductible, and co-insurance for patient’s responsibility of procedures? Most practices don’t adhere to best practices when it comes to collecting from patients. Best practices include clearly explaining your payment policies to your patients prior to providing services. You should be able to estimate what the patient will owe, set their expectations, and accept a variety of payment methods, including checks and credit cards. You can also use a credit card to bill for monthly installments of payment plans if the patient signs an authorization.

Benchmarking key areas of your practice is the first step to achieving your practice’s goals and is essential to operating a smart, lean, and focused practice. But if you are finding it difficult to attack several areas at once, start by calculating and monitoring your days in AR. With the right expertise, and enough time and focused attention, your days in AR can be reduced, resulting in optimized revenue and cash flow.

The Importance of Benchmarking

The practice of medicine has never been more difficult than it is today. Providing care to the average patient, billing an insurance company for services rendered, and then actually receiving payment for office visits and procedures has become increasingly complex and expensive. With Meaningful Use Stage-2, ICD-10 and payer reform on the way, it’s only going to get more challenging.

Fortunately, there’s a path forward for doctors who want to remain independent and thrive through all the change that’s happening in healthcare. By making data-driven business decisions based on information rather than intuition, through shedding fixed cost spending, and by partnering with business process experts so that medical staff focus exclusively on patient care, your practice can succeed. At gloStream, we call practices that have adopted this mindset pacesetting medical practices. They are smart, lean and focused and so agile that they don’t just handle change, they thrive right through it.

Critically important to becoming a pacesetting medical practice is adopting a continuous improvement mindset and integrating regular benchmarking. Benchmarking is the process of comparing your practice’s key performance indicators and business processes to industry norms. Common areas that are measured during a benchmark include: staff productivity, payment processing, claims processing, accounts receivable and operational costs.

Understanding where you stand and how you compare to your peers is an empowering exercise. It will provide you with critical information so you can make informed business decisions based on data rather than intuition. For example, a benchmark might reveal that the majority of your accounts receivable are over 180 days which is well outside of industry norms. That would prompt greater attention to A/R follow-up and management. Or, you might discover that your same day close rate is only 70 percent signaling that there’s a slowdown in how quickly claims are being distributed to payers and how quickly you are getting paid. 

Action on either one of these two measures can drastically increase profitability at the practice which is critical to every business owner.  Benchmarking might also reveal that your practice is meeting, or even exceeding, industry averages. That, too, is important information because unless you are measuring your effectiveness, you simply don’t know whether you are over or under performing as a practice.

Ask any lean, smart and focused medical practice how they became an agile business and they’ll tell you that it all started with benchmarking, and that they continue to benchmark on a regular basis.

New HIPAA Privacy and Security Rule Comes Into Effect

Many practices are just learning about the new HIPAA privacy and security rule that came into effect on March 26th. The rule, more commonly known as the HIPAA Omnibus Rule, brings about a drastic change in the way practices are supposed to handle breach notifications. The new rule is the government’s response to the rash of data breaches that have occurred recently.

Under the old rule, when a data breach occurred, healthcare providers were presumed innocent of harming patients until the patients proved otherwise. Under the new rule, when a data breach occurs, the opposite is true: healthcare providers are presumed guilty of harming patients, and will have to prove their innocence. Additionally, the new rule includes business associates such as vendors.

There are a variety of resources and programs available to help you understand the new rule and also conduct a risk audit. Most experts agree that the first step is to identify all parties with access to health records and ensure that records are secure. In many cases parties who don’t need access are allowed to view records, and limited access by these individuals is a good step toward ensuring data security. Additionally, practices are advised to update their security  policies and make sure that all of they employees understand the new rules so they can help prevent data breaches. Finally, make sure you are using an electronic health record product that’s safe and secure.

Although the rule was effective March 26th, providers and their business associates have 180 days to comply before the Office for Civil Rights begins enforcement on September 23. Until then, however, providers will still be held accountable under the old rules.

If you have any questions about the new HIPAA rule, let us know.

The Future Is Bright for Mobile Healthcare Apps

Congressional hearings on mobile healthcare application regulation suggest the future is bright for this technology, says mHIMSS executives Tom Martin and David Collins.

The hearings, held March 19-21, considered the importance of allowing innovation to flourish vs. the importance of regulation for patient safety.

Discussed in the hearings were the dangers of strict FDA oversight and the potential threat of Obamacare taxes on apps—concerns that were dismissed by most witnesses. According to Martin and Collins, while a few developers are waiting on the FDA’s final medical app guidance before submitting apps to the market, many developers are bringing innovative products to market, and venture funding for healthcare startups is at an all time high.

Moreover, although a very small segment of the app marketplace could be subject to the excise tax on medical devices, most app categories would not, say Martin and Collins. This likely gives app developers the confidence to bring new apps to the market, and that could lead to an explosion of mobile healthcare technology that complements today’s electronic medical record and practice management solutions.