Medical doctors learn from doctors, work with doctors, and deal with the mechanization of being a doctor.

In private practice, you need to walk across the bridge between a medical world to the world where your patients spend their time. You need to be a human being—at least part of the time—to win the respect and affection of your patients.

There is a revolution in how doctors relate to their patients. Be sure you understand how to deal with the following relatively new developments in this ageless relationship between patient and doctor:

1. Patients like to be thought of as clients and you as their consultant, helping them find their way to better health.
2. A patient (or client) of yours may know as much about their illness as you do.
3. Patients are not afraid of computer-assisted diagnosis and care.
4. Patients expect more from you than prescriptions and orders.

Some examples of how these new developments can be turned into practice-building traits in your  private practice…

• Offer a handshake and a smile. You’re on equal footing with your patient. Show it.
• When a patient offers information you doubt, say “That’s interesting!” and ask for the source so you can study it yourself.
• Show your concern for each patient by asking (and caring about) how they are doing. Remember each name. Look at your client with a smile in your eyes.
• Give the patient work to do. Keep a log for a couple of weeks. Switch to another type of diet. Walk a certain number of miles or paces. Carry out exercises you feel would help.
• Ask your patients questions about how they feel they are doing. At the end of your time together, ask if there are any questions and then wait for a response.
• Every patient should leave with a diagnosis. Let them know what you don’t know, what you expect, and, most of all, what you do know about the patient’s condition.

Submitted by Griffith Publishing

My mouth waters as I think about a spectacular meal I savored in the south of France. Besides the perfectly prepared and presented food, I remember one other highlight. The menu from which I ordered did not list prices. 

The waiter handed the man with whom I shared the meal a different menu with the prices—despite the fact that I was picking up the tab.

It was as if the restaurant was saying to me, “Let’s pretend that money does not exist. Go ahead and order anything you want. Don't worry your pretty little head about money.”

Playing “Let’s Pretend”

In many ways, my experience practicing medicine was like eating at that restaurant. My patients and I made treatment decisions as if the bills were being paid with Monopoly money. Small wonder healthcare costs soared.

Many physicians bring the "let's pretend money doesn't exist" mindset into their lives.

We use service and impact to measure our professional success. Many physicians believe that if they focus on money, they tarnish the integrity of their contributions. 

And the outcome? Year after year, half of physicians report they are behind in retirement planning. 

Embracing “Let’s Build TrueWealth”

​Physicians want to create careers and lives that work for them.

In my upcoming book How Doctors Build TrueWealth..and It's Not Just about the Money, I make a bold statement.

If you want to transform your life, transform your relationship with money.

​I believe entrepreneurship is about re-coupling the professional value you deliver with the fees you charge.

I believe that a life of TrueWealth re-couples hopes and dreams with the reality that there is no free lunch--or dinner. You need money to dine at exquisite restaurants or fund legacy projects or make work optional. 

To build TrueWealth, physicians need to re-negotiate the terms of their relationship with money. After all, we are all in a lifetime relationship with money--whether we like it or not. There is no divorce!

The transformation begin by thinking about money as the treasured family member rather than the unwanted step-child. 

It means spending time with money and treating it with more respect.   

It means making conscious choices about how money is earned and spent and invested.

It means collecting your professional fees.  

If you want to transform your life, transform your relationship with money.

Vicki Rackner MD, FACS
Principal, Thriving Doctors

I’ve listened to the money stories of hundreds of doctors, and some conversations stand out.  

​One doctor Beth said, “My relationship with money just isn’t working for me. My money brings me little joy, but lots of conflicts, anguish and uncertainty.  If money were a person, I’d divorce him.  But we’re stuck together. For life.”

Many doctors echo a recurrent theme: money is not working for them.   They are experiencing MONEY DRAMA.

Here are three ways MONEY DRAMA gets played out:

• Inner Conflicts.  Money is often associated with anxiety, embarrassment, guilt and shame. 
• Conflicts with Others  Money often becomes the source of conflict within marriages and families. 
• Mysterious Forces that Drive Unwanted Money-related Behaviors This might include over-spending, jumping into Dumb Doctors Deals (DDD’s)  or never truly enjoying the things their money can buy because it’s so painful to part with money.

Many doctors believe that their money drama would go away if they just had more money. 

While it's true that MONEY DRAMA can get in the way of building wealth, more money usually leads to more drama.

Here are two questions you can ask to help you take the first step of ending money drama:
​
What are three ways your money-management style is working for you? You might say, “I do a good job of saving.” Or, “I’m generous with others.” Or, “I now know my monthly expenses.”  
What are three ways that your money-management style is NOT working for you?  You might say, “I have ongoing fights about money.” Or, “I don't collect what I'm owed.” Or, “I get so anxious about money that I just ignore it.” 

Beth is right: doctors cannot divorce themselves from money.  However, they CAN end the money drama and make peace with money.

​Vicki Rackner MD is an author, speaker and consultant who offers a bridge between the world of medicine and the world of business. She helps businesses acquire physician clients, and she helps physicians run more successful practices. Contact her at (425) 451-3777.

Let’s face it, receiving reimbursements is a critical component in keeping your medical practice up and running. You need these funds to pay staff, purchase supplies, and treat patients. For these reasons and more, it can be frustrating when a claim is rejected or denied. Unfortunately, 30% of claims are not paid the first time—they are either denied, lost, or ignored. Of those, 65% of denied claims, on average, are left unresolved by practices. It’s no wonder why private practices are struggling to keep their doors open.

To assist these practices to stop the internal bleeding, it is essential to understand how much these rejections and denials are affecting your practice.

What’s the difference between Rejection and Denial?
A claim rejection occurs prior to claim processing and is typically related to input errors or invalid data. A denied claim is processed by the payer and determined to be unpayable. In both instances, the payer will return a notification for the reason of rejection or denial.

What are most common reasons for rejections and denials?
Let’s start by running down a list of several well-known reasons claims get rejected.

• Incorrect Patient Demographics - This can include using a nickname instead of the name on file with the insurance company, an incorrect date of birth, the wrong insurance ID, missing information, or submitting to the wrong insurance.
• Missing or Incorrect Information- We are all human and we all make mistakes. That is why it is important to double and triple check information on the claims. At times, a claim may be denied because it is missing information, such as a service code. However, it is also common for claims to be denied because the information was entered incorrectly. Such as a birth year of 1984 being entered as 1948 as an example.
• Incorrect Coding – Using the wrong CPT code, an ICD-10 code that does not match the CPT code, or the wrong modifier are all cause for a rejection.
• Incorrect Place of Service – Was the service performed in the office, at the hospital, inpatient or outpatient, emergency room or nursing home? Each place has a different two-digit code that must match the CPT code. 
• Out of Date Information – Using patient information that is out of date or an old CPT or diagnosis code. 
• Duplicate Claim – Submitting the same claim again whether by accident or on purpose. 
• Eligibility - Patient is not eligible or has no insurance coverage.
• Prior Authorization Was Required- At times, a claim may be denied because prior authorization from the insurance company was required. In certain cases, procedures like MRIs and CT Scans are included on the pre-authorization list.
• Outdated Insurance Information- Claims can be denied due to outdated insurance information, such as sending the claim to the wrong insurance company.
• Claim Was Filed Too Late- Let’s face it, you are busy. It is not uncommon for items to slip through the cracks. However, when it comes to submitting claims, it is important to get them submitted in a timely manner. Most insurance companies have a window of time where they will accept claims. If you wait too long and miss the window, your claim is likely to be denied.
• Services Not Covered-When it comes to medical insurance, there can be exclusions. Many times patients are unsure of what their plan covers and will rely on your office to get these questions answered.

How to track your denials
The first step in reducing your practices rejections and denials is to understand where your practice denials are coming from. Creating a simple spreadsheet to categorize the denial/rejection reason over a period of time. For example, begin with a month to help you start with a more broad understanding.

The next step is to identify the top reason to determine the culprit of why this is occurring. Instead of looking at merely number of claims, it is important to add up the total charge amounts as well. You might have 100 claims denied for one reason with a total charge amount of $15,000 compared to a different denial reason comprising of 50 claims worth $50,000.

Once the main reasons are identified, create a proactive solution to mitigate future occurrences.

 6 Tips to Help Reduce Claim Rejections
Once you have identified the top reasons, now review that with some tips below.

1.   The process starts BEFORE the patient is even seen!
Ninety of preventable denials are the result of practices not focusing enough attention on the front-end revenue cycle process. This means the front desk plays an important role when each patient appointment is scheduled. That is a critical step to capture and or update insurance info when patients schedule their appointments.
2.   Has anything changed?
This is a common intake question upon check-in. “Has anything changed?” If the patient writes NO, that gives a clear indication that the front desk doesn’t need to re-verify their insurance coverage. It is important that patient’s insurance coverage should be re-verified with EVERY appointment.
3.   The amount of information collected
Often when the task of verifying insurance is needed to be complete, merely active or non-active is confirmed. All pertinent information should be verified, such as amount of deductible being met, what coverages are included, etc. Are pre-authorizations required? Verify the proper EDI payer ID when verifying coverage. Verify the services covered or any medical necessity LCD, NCD requirements. Are referrals needed?
4.   File Claims Within 24 Hours
Avoid timely filing issues and file claims immediately. You may have to put a claim on hold to obtain correct billing information or ask the doctor about a code, but don’t forget about it. It’s also important that you work the claim rejections right away, as time is of the essence in both cases. 
5.   Have access to updated codes
Medical codes change very frequently, it is important to make sure you have access to all of the updated codes including ICD-10, HCPS, CPTS, Modifiers, POS, etc.
6.   Insurance Participation
A Provider that is not participating with insurance may also cause your claim to be rejected. All your rendering providers need to be listed under the billing providers contracts to be processed in network. This could be verified prior to claim being filed. 

 Use of Technology: Good Billing/PM Software & Clearinghouse
Not all billing software is created equal. Look for these services and features that help automate and reduce errors in the claims process:

• Electronic patient intake to reduce manual data entry and errors
• Integrated clearinghouse to automatically verify eligibility to reduce workload
• Claim scrubbing to eliminate errors before the clearinghouse
• Easy and quick eligibility checks within the software
• PM that has automatic clearinghouse updates with new payer guidelines
• EHR with automatic coding update
• Billing analytics to manage and improve insurance reimbursements
• Built-in EHR for streamlined integration between patient care and billing data

Cynthia Andersen is a Certified Medical Revenue Manager, a Certified Physician Practice Manager, a Professional Healthcare Public Speaker and a Licensed Professional Business Coach. You can connect with her at https://www.linkedin.com/in/cynandersen 

Making a dіffеrеnсе іn раtіеnts' lіvеѕ іѕ a grаtіfуіng раrt оf mеdісаl wоrk. Hоwеvеr, аn іnvеѕtіgаtіоn bу Dr. Grеgоrу Lеwіѕ ѕuggеѕtѕ dосtоrѕ mау bе аblе tо mаkе a grеаtеr іmрrоvеmеnt іn реорlе’ѕ lіvеѕ thrоugh thеіr аbіlіtу tо wоrk lеѕѕеr hоurѕ wіth mаxіmum оutрut thаn thrоugh thеіr рrасtісе.
​
Wоrkіng lеѕѕ аnd еаrnіng mоrе аѕ a dосtоr іѕ a fеаѕіblе аnd vеrу іmроrtаnt аѕресt оf уоur саrееr аѕ a mеdісаl dосtоr. Yоu dо nоt nесеѕѕаrіlу nееd tо wоrk as an employee for a large organization tо асhіеvе thіѕ. Hаvіng уоur own private сlіnіс will bring you muсh mоrе satisfaction. Who started their own practice thinking they would love to work long hours, struggle financially and eventually get burnt out? Nо оnе!

I know it sounds crazy, but it is in fact possible to thrive in private practice.

StatisticsLet’s first start with the current statistics effecting private practices in today’s climate. These statistics are directly related to elements within practice workflow and operations that are in desperate need of attention.

Practice owners are starting to realize their patients now have a voice to express any concerns they have with clinicians. Their voices are being broadcast online through social media platforms and online review sites.

In a recent study 19 out of 20 negative reviews for medical practices were caused by inadequate communication and disorganized practice operations.Another study found 90% of preventable claim denials are a result of medical practices not focusing enough attention on front end processes. This includes retrieving the proper patient registration information including insurance information, verifying insurance and the accuracy of this information. 

The number one cause of claim denials is inefficiently determining practice eligibility. This leads to money going down the drain.

And 65% of denied claims are left unresolved by practices. Which could represent thousands of dollars daily, weekly, monthly. If you are feeling a cash flow crunch, this is a common area of concern.

There are other issues happening due to inefficiencies in practices that are causing patients to be upset and frustrated. Specifically, having to do with patient wait times. Right now, the national average time a patient waits is over 45 minutes past their scheduled appointment time. And 97% of patients are frustrated by this.

This could result in lost patients. The Centers for Medicare and Medicaid Services (CMS) estimates a practice can earn $750 a year on one Medicare patient annually. To quantify the cost of losing a patient, if 2 patients are lost weekly, that equates to $78,000 of lost revenue potentially.

A large majority of physicians, 77% to be exact, are saying they need more time for direct patient care because a lot the administrative tasks are taking too much of their time.Let's face it, we can't eliminate all administrative tasks, however we can certainly reduce the amount of time spent on them by effectively implementing the proper workflow processes.

MGMA also estimates practices are suffering between a 5% -7% no show rate. This may sound low, until you equate that to dollars. Let's just estimate a small practice has two patients that no called, no showed and didn't reschedule. Let's further assume that each of those patients would have revenued your practice $125. If you do the math annually, that equates to a $60,000 loss of potential revenue into your practice. That's staggering. There is more money down the drain.

Unfortunately, 80% of physicians are suffering from burnout caused by workflow issues.The good news is there's a solution. A large percentage, 75% to be exact, of workflow issues can be addressed by simply training and workflow redesign.

The first step is to have a comprehensive practice workflow process and procedure. Every staff member needs to be trained and held accountable for these procedures. These processes will also need to be reviewed and updated regularly.

Importance of ProcessesHaving a well designed process for every step in the practice workflow will eliminate staff complaining that they were never told how to do something. It provides the opportunity to hold your staff accountable and will increase practice efficiency, productivity and profitability, all while keeping the consistency of care.

Practice Workflow consists of:
~ Front Office Processes
~ Customer Service
~ Lobby Design
~ Patient Intake
~ Clinical documentation Process
~ Patient Check out
~ Patient Follow up
​
Every task needs its own step by step process and procedure. Training of these processes need to be conducted with every member of the team that could possibly have to perform that task at one point.

Cynthia Andersen is a Certified Medical Revenue Manager, a Certified Physician Practice Manager, a Professional Healthcare Public Speaker and a Licensed Professional Business Coach. You can connect with her at https://www.linkedin.com/in/cynandersen .

The global pandemic of Covid -19 has inserted itself into our everyday life. Providers are working around the clock to care for those who have been exposed, as well as those exhibiting symptoms. This is enough work to keep everyone occupied day and night, however normal everyday visits for other illness and ailments have not gone away. We understand the need to continue to see these patients, and how instrumental Telehealth will be now and over the coming weeks as the corona pandemic continues. We have compiled from various sources some links that should help answer questions regarding reimbursement for the Telehealth visits your providers might be experiencing currently. We will update this page as more information continues to flow in. 

We understand the rare circumstances in which providers are currently in. Providing care to patients during these challenging times must continue, and we hope this information will help you feel more confident in providing services via Telehealth for those you look after. Please don't hesitate to reach out if you need help.

Medicare Telemedicine Health Care Provider Fact Sheet


Medicare Telehealth Frequently Asked Questions (FAQs)

 
Telehealth Technologies as an Alternative to Patient Office Visits in the Wake of Covid-19


CPT - Reporting of Covid-19 Testing


Summary of Telemedicine Coding - CMS


Summary of Telemed Chart


CDC Dedicated Covid-19 Webpage

Here's the number one question I have been fielding this week: "Are we overreacting to COVID-19?"

My response is this: "Is this the BEST question that positions you to be part of the solution?"

The REAL question on most peoples' minds today is this: "What is the health risk COVID-19 poses to myself, my family and the people around me?"

As of today, March 20th, it appears that simple public health and personal hygiene measures work.  They minimize the risk of becoming infected with COVID-19 and protect the most vulnerable among us like your aging parents or your friend being treated for breast cancer or your neighbor who has gotten a heart transplant.

If you made a list of the top 10 health threats with the greatest probability of taking your life in the next year, COVID-19 would not even be on the list. As the time of the writing, about 3,400 people in Italy lost their lives to infection from COVID-19. Compare that to the 647,000 Americans who lost their life to heart disease last year or the 47,000 US deaths from suicide.

The measures to "flatten the COVID-19 curve" --shutting down restaurants, bars, gyms, hair salons, etc-- are dramatic. They have know and certain untoward economic consequences.  

Are these aggressive public health measures justified?  

Public health official creating policy to care for entire populations ask different questions than doctors caring for individual patients. The best way to screen an individual patient for cancer, for example, may be different than the best way to screen the entire population.   

Further, we as individuals do things like vaccinate our children and refrain from texting while driving to keep the community safe and healthy.  

The limited data suggests that aggressive public health measure work. Life is returning to normal in China. 

Further, the failure to implement aggressive public health measure will have political, health and economic consequences. 

The truth is that our reality is what it is. We ARE working from home. We're not going to be able to exercise at the gym or get haircuts or relax at a bar for a few weeks.  (I was supposed to get a haircut today, and it was cancelled because the salon is closed. When I asked my hairdresser what I should do about my overdue haircut, she said, "Watch a Youtube video about cutting our own hair." Yikes!)

Let's refrain from Monday-morning quarterbacking. Instead, let's focus our thoughts and efforts on activities that allow us to become part of the solution. We can all make a positive impact right now.

Creating solutions begins with asking the best questions.

Thank you for your hard work!  Stay healthy and strong.

Vicki Rackner MD draws on personal experiences-- as a practicing surgeon, clinical faculty at the University of Washington School of Medicine and serial entrepreneur-- to help her doctor clients thrive.  You can reach her at www.thrivingdoctors.com .