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5 Quick Tips for Medical Practice Financial Success

 By John Verhovshek

Here are five quick tips to maintain a strong bottom line in a medical practice:

1. Keep tabs on productivity: Monitoring provider productivity helps to manage providers’ compensation expectations, as well as the business’ bottom line. Regular reports, tying productivity to revenue, should be reviewed with providers. Maximizing revenue (charges) is number one for financial strength.
2. Capture all charges: Make sure every service performed is identified and captured on the billing sheet or in the electronic health record (EHR). Providers, nurses, technicians, and any other staff involved in providing services must properly document everything they do. Because medical claims are paid based on procedure and diagnosis codes, documentation and coding must be accurate to ensure no revenue is left on the table. This information also must be captured and reported in a timely fashion.
3. Send clean claims, the first time: Correct insurance information, demographics, and code entry are imperative the first time a claim is filed. Incorrect information results in denials and delayed payments, which directly affects revenue streams and increases costs.
4. Institute effective collections policies: Co-pays, deductibles, co-insurance, or past due balances are much, much easier to collect while the patient is in the clinic, versus weeks or months after the visit. Your billing department must have clear, written collection policies, including how to work denials, following up on aging claims, how and when to collect from patients, and when to send claims to collections and write off bad debt. Set metrics that are measured and reviewed with the staff on a regular basis to maintain effectiveness.
5. Review payer contracted rates periodically to make sure you are negotiating the best rates to maximize revenue opportunities. After ensuring a strong revenue flow, review costs such as liability insurance, cost of supplies, phone contracts, and other operational expenses to make sure you are receiving the best prices available.

CDI Specialists Must Creatively Train Physicians for ICD-10

Author Jennifer Bresnick 

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Clinical documentation improvement (CDI) goes far beyond the detail and specificity requirements of ICD-10, but HIM professionals who are scrambling to get their organizations in shape for the big switch on October 1, 2015 have just twelve months to instill adequate documentation habits in their physicians. While training seminars, online modules, and reference books are the tools of the trade for coders who want to be well-versed in the new terminology in order to keep their jobs, training a physician requires a different approach. At the 2014 AHIMA Convention on Tuesday, Vickie Monteith, RN, MBA, and Cheryl Golden, CPA, MHA, CHC, PCP-A, CHRC, both of Deloitte & Touche LLP, explained the importance of CDI to the ICD-10 transition and how to achieve an effective and thorough training program for clinicians.

A successful CDI program has to appeal to the more selfish side of human nature, Monteith and Golden said. Whether it’s convincing an executive board that hiring a CDI specialist will save money in the long run or appealing to a physicians’ competitive urges, framing clinical documentation improvement as a tool for achieving a desirable goal instead of piling it on top of more and more cumbersome mandates with little benefit, can make the difference.

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“I can’t tell you how many providers want to hire a CDI specialist, and the CFO says, ‘show me the money,’” Golden said. “We want to show providers what the opportunity is. If you can move your case index mix a couple of points, that’s really significant for an organization. Having metrics that you can share will show that accurate documentation really does make a difference for reimbursement.”

“If you’re not doing any sort of CDI scorecard on your physicians, you should be,” Monteith added. “Make sure you give them the data and tell them where their peers are at least once a month. That’s how you’re going to win them over. They’re competitive. They want data. You’re not necessarily going to win them over from the payment standpoint, but it can be beneficial to use benchmarking so they understand where they are compared to the rest of their peers. Make sure you have that for them.”

Monteith suggests using real charts as examples when educating physicians so that they have a point of reference they clearly understand. Dividing education into smaller chunks can also ensure that nothing slips past a flagging attention span. If you can get a physician for 15, 30 minutes, you’re actually doing really well,” she said. “Prioritize what you’re working with.”

A comprehensive CDI program should include education for residents, as well. Monteith noted that some of her clients had designed tests for trainee physicians as they move through their different rotations, requiring a high passing grade in order for them to continue through their modules. “If we can build that into our resident programs, then the residents that become our attendings will be better equipped to pass on good habits themselves and produce quality documentation.”

While the one-year delay may have derailed certain ICD-10 projects, and many organizations have pushed back education in order to ensure that the knowledge is fresh in the minds of their clinical and coding staff members by the time 2015 rolls around, the time to ramp up those efforts once again is already upon us, the presenters reminded the audience.

“We’re sitting in a compressed time frame here,” Monteith warned. “We’re at October 1. If you haven’t started training, if you haven’t built your education for your residents or trained your physicians, you have a pretty small time line. Can you do it? Yes.”

But if you have documentation that’s not cutting it in ICD-9, and you’re translating that into ICD-10 and you’re sending that out to the payers, guess what? You’re getting data that might not be relevant when you get in ICD-10 properly. Instead, if you get people trained and have good documentation that works, you can code and send those out for testing. You’re going to get back a much more realistic picture. If you have started training, good for you. If you haven’t, you really need to be working to figure out when you’re going to start testing and how you’re going to work those claims.”

ICD-10 education must focus on clinical documentation improvement

Author Jennifer Bresnick 

27

The race towards ICD-10 is quickly becoming a sprint as we hurtle towards the October 1, 2015 implementation date, and the time has come for providers to start thinking about how to prepare the troops.  Both coders and physicians need somewhat training and education when it comes to the complicated new code set, but both paths have clinical documentation in common.  In order for coders to do their jobs properly, physicians must learn how to bring their clinical notes up to par.

Mel Tully, MSN, CCDS, CDIP, Senior Vice President of Clinical Services and Education at Nuance, explains some of the strategies that will help physicians and coders understand and accomplish their goals ahead of the ICD-10 implementation date.

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What seems to be the best method for approaching ICD-10 education for physicians?

We actually started ICD-10 education about 18 months ago, and we started with steady, monthly educational sessions that would provide boots-on-the-ground support to the physicians, meaning that we imbedded the education for our documentation specialists and coders into the current ICD-9 clinical documentation improvement programs that our clients actually practice now.  We feel that physicians should be educated from a clinical perspective, not a coding perspective.  The minute that you start showing them codes, they say, “Oh, I’m not going to remember this.  I don’t want to be a coder.”

So, when we talk to physicians, we say, “Here, please tell us clinically the information that we need to be able to code it in ICD-10.”  This is where it’s very important that the documentation specialists realize what is the clinical threshold for this particular diagnoses, and what specificity is required, and let them actually interact with physicians in a concurrent fashion or, hopefully, real-time with technology, supporting that real-time interaction in the future.  We’ve advocated that this is a practice model.  The more you do it, the better you get.

What are some of the specifics that providers need to focus on right now?

We’ve advised our clients to identify their top 20 DRG codes for medical diagnoses, as well as procedural diagnoses.  Make sure that you’re very efficient, you’re very proficient, that you understand exactly the clarifications and the clinical documentation that’s needed for those particular top diagnoses and procedures in ICD-10.  We have software that actually supports this process, so CDI specialists are able to use a “practice pad” in ICD-10.  And it’s amazing how quickly they get it.  They’re quicker than I am, to be honest with you, because they do it all day, all day long.

It’s something that I call dual CDI.  There’s a lot of talk in the industry about dual coding, and most facilities are probably starting their dual coding right now.  When they start a code in ICD-10, it’s important that the documentation specialists are also doing dual CDI, so they’re actually practicing together.  They’re collaborating.

Will providers have enough time to pack in all the necessary education before October 1?

Well, if they start now, I really think that they could pull it off.  It’ll be a lot more intense than what I envision as being a perfect model or best practice.  First of all, they need to actually make sure their current documentation program is top notch, that they have the right documentation specialists in place, and that they have the clinical acumen and ability to work in ICD-10, because it does require a higher level of clinical knowledge, anatomy and physiology, medical terminology, especially in the procedural documentation in coding.  So, the very first thing I would recommend to them is do you have the right CDI specialists and support in place?  And so, after you determine that, then you’d really need a very strategic, a very step-by-step educational program for ICD-10.

And I don’t think that this education should be homegrown.  I don’t think you can ask your HIM department to actually teach ICD-10 while they’re still trying to learn ICD-10, so it’s an opportunity to choose your consultants very carefully.  Put a lot of thought about what your vendor is going to bring to the table to help you.  It’s not exactly time for drinking from the fire hose, but we’re past the time for the steady stream.

If you have a mediocre program in ICD-9, you’ll have a mediocre program in ICD-10, so it’s time to make those changes, hire appropriately, getting the right people in line. And then, also make sure that you have the tools and the software so that the documentation specialists can actually start practicing and be successful.

The number of diagnoses and procedures is so voluminous that book-based education, in my opinion, is just not an option.  Make sure you have the software, and make sure that you’re getting value from your vendor, and that the vendor has a proven track record of being able to provide education.  Choose those very carefully.

And it may be that you use a combination of vendors.  As I said before, I’m never offended when one of my clients says, “Oh, we’re using so-and-so to help us with this as well.”   I usually say, “Oh, that’s great.”  Do everything that you feel is necessary to get all the education required.

The ICD-10 National Pilot showed that providers might experience significant losses in productivity.  Do you agree with this assessment?

Everybody here talks about how much longer it’s going to take to code in ICD-10, and I don’t disagree with that.  I think it will take a little bit longer.  There’s a learning curve, but what also impacts the final coding is if the coder has to go back to the physician and say, “We need additional documentation.”  So you need to bring those two professions very much together in a collaborative approach to ICD-10.

One way to mitigate that, of course, is physician awareness.  As you get very close to the ICD-10 launch, that’s when I would start providing very specific, specialty education.  You wouldn’t teach your orthopedic surgeons about cardiology and vice versa, so you provide the education that they need for their documentation and do that as closely as possible.  And the other thing is that I really recommend that the documentation specialists actually create and send physicians ICD-10 clarifications right now.  You don’t have to sell them the ICD-10.  You’re just asking for a clinical documentation improvement, and so you slowly start teaching them extra documentation that’s going to be required in ICD-10.