America’s Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association (BCBSA) announced December 13 they have developed a model personal health record—a private, secure web-based tool maintained by an insurer that contains a consumer’s claims and administrative information.
Continue Reading December 19th, 2006
Too often practices think they need to work harder in order to make more money. This may be difficult if providers and staff are already working to capacity and expenses have been trimmed to the bare bone. The solution is to increase what you are getting paid for the work that you are already doing.
Continue Reading September 25th, 2006
I host a monthly medical-legal discussion group in which physician practices gather to discuss issues that are important to their organization. Almost unanimously, the request for next month’s topic was how to better manage accounts receivable. This makes sense with reimbursement declining and practices operating on much tighter margins. Other businesses are not satisfied with collecting only a fraction of their accounts receivable. Why should the medical industry be satisfied when that money is owed for services already performed?
Continue Reading September 20th, 2006
The Office of Inspector General (OIG) of the Department of Health and Human Services issued Final Compliance Program Guidance for Pharmaceutical Manufacturers in April of this year, yet there continues to be rampant rumors of pharmaceutical companies offering long weekends for physicians and their wives in exotic places and, in one example, a five figure check in return for “attendance at a lecture” on a particular drug. Physicians work very hard, and such offers are obviously appealing for many reasons. The question that needs to be asked before accepting such a gift is whether it is appropriate according to the OIG, the Food and Drug Administration Office of Criminal Investigations, the Federal Bureau of Investigation, and the Department of Justice.
Continue Reading September 20th, 2006
Are you confident your practice’s medical records would survive scrutiny by an FBI or OIG auditor? Would your documentation provide a good defense in the event of a malpractice case? Does your practice have privacy protections in place that will prevent any HIPAA violations? If the answer is “no” to any of these questions, continue reading to find out how to improve your medical record documentation and processes.
September 20th, 2006
One of the questions I am most frequently asked is, “We have an employee who is not doing his/her job, but we are afraid to terminate him/her for fear of a lawsuit. What do we do?” The irony of this question is that North Carolina is an employment at will state which means that an employer may fire someone with or without a reason at any time, and an employee may quit at any time with or without a reason. So, why are so many medical practices concerned? They are worried a disgruntled former employee will file a wrongful discharge lawsuit.
How to Fire an Employee and Avoid a Wrongful Discharge Lawsuit (PDF)
September 20th, 2006
Fraud and abuse is both a national issue and a local one. Healthcare organizations should be sure that they are in compliance with federal and state regulations, particularly in light of the increased scrutiny by the HHS Office of Inspector General (OIG), the NC Department of Health and Human Services (NCDHHS), and Cigna Medicare (Cigna).
September 20th, 2006
Collecting money from patients who are past due in payment for medical services is a perplexing issue for most physicians. It is not only frustrating to have to allocate more practice resources to obtain what is rightfully owed for services already performed, but also many physicians are not sure what is permissible under the law. The industry average for small physician practices is around 4% of revenue is spent on collections. For larger entities or hospitals, the average can be as high as 12-15%. However, if collections are managed effectively, it can significantly increase revenue. The key is to understand the applicable laws and develop policies accordingly.
Collections: The Legal Issues (PDF)
September 20th, 2006
