Boost Your Bottom Line 11/16/2009
News Flash — we are in a recession. Unless you have been living under a rock for the past 18 months, it’s impossible to ignore the fact that we are living in uncertain economic times. The gloomy outlook makes headline news day in and day out. “For Sale” signs line some residential neighborhoods and “For Rent” signs line some, once busy and highly sought after commercial streets.
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Using Templates to Improve Technician Efficiency 11/15/2009
Efficient use of a practice’s staff time = greater profitability. That’s an equation that every doctor and manager knows to be true. But awareness of that fundamental link between superior productivity and increased revenue isn’t enough. The challenge is to fully realize efficiency within your own practice. Nowhere is this more a challenge than in a practice’s technical department. Since patients and problems can gobble up precious time beyond your control, it is all the more crucial to ensure that everything within your ability to fully affect is handled as efficiently as possible.
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Employee Policies 101, or Avoiding an HR Nightmare 10/12/2009
No one intentionally hires a bad seed, but it happens — unfortunately far too often. Take the case of a Wisconsin doctor who managed to get hired three times following a conviction for sexual assaults on patients. His record was available for anyone who cared to look. Unfortunately, none of the three practices that hired him did. The result? A string of sexual assaults on patients. While an extreme example, there is much to learn from this and other cautionary tales.
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Are You up to Code? How to Burnish Your Skills at the Joint Meeting 09/14/2009
One of the most difficult things for a young ophthalmologist starting out in practice is the confusing world of coding. You have years of training in the science of ophthalmology, but little to none on the business side of medicine. The reality is medicine is a business, and with the recession and downturned economy, knowing that business is more important than ever. Proper coding is the key to not only receiving the full reimbursements you are entitled to, but also avoiding costly penalties. Whether you need a crash course or just a quick coding review, the Academy’s Joint Meeting has something for you.
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Job-Seeker’s Guide to the Joint Meeting 08/17/2009
By the end of the 2010 academic year, today’s residents and fellows will be looking to join a practice in what is and will, at least in the short term, continue to be an employer’s market. The good news is, if you’re coming to the Academy’s Joint Meeting in San Francisco this fall, you can take advantage of more than just the clinical education offerings. The meeting has much to offer job seekers as well.
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EHR: Where Are You on the Continuum of Adoption? 07/13/2009
Momentum has been building toward the adoption of electronic health record (EHR) technology. The Academy conducted a survey in 2006, which indicated that about half of the membership had or were planning the implementation of an EHR system within two years. EHR adoption was more common in larger group practices, but was also on the rise in small practices. It was greatest in multi-subspecialty groups, with 71 percent planning EHR implementation in the next two years. The latest Academy/AAOE member survey indicated that 31 percent had converted to an EHR system and 25 percent planned to convert within two years.
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The Technician’s Role in Obtaining the Advance Beneficiary Notice 07/13/2009
Who has the responsibility to inform patients about the possibility that the test or surgical procedure they are to undergo may or may not be covered by Medicare? Quite often, it is the ophthalmic assistant or technician. The new and improved Advance Beneficiary Notice (ABN) — renamed the Advance Beneficiary Notice of Noncoverage — became effective March 1. This Medicare form replaces the former ABN-G and the Notice of Exclusion of Medicare Benefits.
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Selecting a Medical Billing Vendor 06/15/2009
With declining reimbursement rates and rising operating expenses, it’s no surprise the business of health care has become more complex. As a result, the practice administrator has less time to manage the myriad of practice needs. These include ongoing challenges with patient benefit plans, issues related to computer system technologies, the privacy of data stored on those systems and the multifaceted laws surrounding all aspects of human resource management. All of this leaves even less time to manage the critical billing and collections process.
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Testing Before Cataract Surgery: When to Use OCT 05/11/2009
The American Academy of Ophthalmic Executives (AAOE) receives many coding questions concerning cataract surgery. One in particular caught our eye. It involved the use of an optical coherence tomography (OCT) on diabetic and age-related macular degeneration (AMD) patients prior to cataract surgery, to investigate and discriminate the cause of vision loss.
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Who Fits the Bill? 12 Questions to Ask When Filling a Billing Vacancy 04/13/2009
Ophthalmologists rely on the knowledge and skills of their billing staff to help keep the office compliant and assist in appropriately maximizing reimbursement. When recruiting billing staff, some practices look for applicants with little or no billing experience — if they are then trained in-house, they won’t bring any noncompliant ideas to the practice. However, if you would prefer someone who can hit the ground running, here are 12 questions to test an applicant’s coding savvy.
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Collecting Unpaid Charges: What a Practice Can and Can’t Do 03/16/2009
The ophthalmology practice, like any business, invariably encounters a percentage of charges that go unpaid. When an insurance company or other payor is involved, the collection process for those unpaid obligations is viewed under the law in the context of one business pursuing another in satisfaction of a contractual obligation.
However, when the unpaid debt is the obligation of a patient, both federal and state laws impose extensive requirements on the business seeking payment. These laws are designed to protect the consumer from overreaching collection practices. In addition, state and local medical societies may have procedural and ethical requirements that must be observed when it comes to collection of payment for medical care and treatment.
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Network Your Way to a Job 03/16/2009
networking verb 1 : Creating a web of contacts to support and help others. 2 : Oftentimes thought of as schmoozing and pandering to get what you want, but in reality, the art of building alliances.
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Three Ways to Foster an Inviting Office Culture 02/10/2009
Every organization has a culture unique to that organization and a doctor’s office is no exception. The culture determines how patients, staff and doctors feel when they walk in the office. The ophthalmologist plays the key role in determining the culture of his/her office. If we want our office culture to be one of excellence, competence and friendliness, we must work to set that tone. Various aspects contribute to the culture we might find in our own office.
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Getting Medicare-Secondary-Payer Claims Right the First Time 02/10/2009
When is Medicare not responsible for primary payment for beneficiaries’ medical claim? CMS has detailed this issue in a fact sheet for physicians and administrators. Medicare secondary payer (MSP) is the term used by Medicare when Medicare is not responsible for paying a claim as primary.
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Be Prepared for an Audit 01/12/2009
When ophthalmologists are audited and they want the best-case/worst-case scenario, they tend to call me. It is interesting to note that when a physician calls, he/she begins with, "Guess what my staff has done wrong." And when a staff person calls, the conversation tends to begin with, "Guess what the doctor has been doing incorrectly." While it is true that the physician is ultimately responsible for documentation and subsequent code and diagnosis code selection, staff must be of immediate and ongoing assistance. Here are three ways your office can be prepared for an audit.
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Record Retention and Destruction 01/12/2009
While ideally records should be kept forever, this is not always practical. To ensure that present and future patient needs are adequately met, and that allegations of malpractice can be successfully defended, retain records according to the following guidelines. Once the retention guidelines have been met, the records may be destroyed.
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Avoiding Illegal Service Referrals: The Stark Statute Explained 11/24/2008
At its core, the Stark statute is this basic: If you, as a physician, or a member of your immediate family has a financial relationship with an entity, then you may not refer a Medicare or Medicaid patient to that entity and that entity may not submit a bill for any item or service defined as a designated health service (DHS), unless you qualify under one of the Stark exceptions. Unlike other regulations physicians usually deal with, the Stark law is a "strict liability" law, meaning that if you bill or the entity you referred to bills for a DHS and you are not protected by an exception, you are in violation of Stark (i.e. no intent is required).
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Signs and Symptoms of the Best Practices 11/24/2008
Since I work in ophthalmology, I tend to either accompany family to the ophthalmologist office or certainly hear details following the exam, surgery, etc. Over the past few months, several family members have had strabismus surgery, retinal detachment surgery, cataract extraction with IOL, bilateral blepharoplasty, retinal tear repair, basal cell carcinoma removal and glaucoma surgery, as well as numerous special testing services and exams. During those visits, I’ve found that, in addition to coding correctly, many of the offices I’ve visited have displayed what I consider to be signs and symptoms of the best practices. Here are a few of the highlights.
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Costly Coding Errors 10/15/2008
The six examples presented are real. Each case presents the:
* Scenario
* Error
* Outcome
* Financial Impact
* Cure
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Staying Ahead in the Digital Age of Medicine 09/15/2008
PDAs. Online forums. Google and the Academy’s new Ophthalmic New & Education (O.N.E.™) Network. As a young ophthalmologist, you’re probably already using many of these technologies and services for problem solving, communication and research. But with Medicare’s introduction next year of bonuses for physicians who e-prescribe, electronic workflows won’t be an optional part of practicing medicine much longer. Successful participation in this changing system requires both fully interoperable systems and devices in your practice and an understanding of Medicare’s new bonuses.
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AAOE Program Offers Comprehensive Course Selection for YOs 09/15/2008
At the Joint Meeting in Atlanta, the American Academy of Ophthalmic Executives (AAOE) will be presenting a number of CME-bearing courses to help young ophthalmologists (YOs) navigate the complexities of practice management. Whether you are still in training or have already entered practice, the comprehensive program will give you the information you need to be successful in your career.
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Maximizing Patient Referrals 08/18/2008
Your patients present a golden opportunity to market your practice. Should you overlook or choose not to cultivate this group of credible advocates, you may be passing up a low-cost, high-return method of marketing and growing your practice.
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Common Coding Errors 08/18/2008
To help you navigate the often-confusing world of coding, we’ve compiled several of the most common coding errors and the correct way to code these procedures. Topics include: suture removal, benign and malignant skin lesion removal, complications during the global period, exam before second eye surgery, two providers same day and A-scan coding 76519 and 92136.
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Branding on a Budget 07/16/2008
Companies, large and small, are paying top dollar to create and promote their brand(s). They hire research firms to survey the consumer, consultants to interpret the data and marketing agencies to take the findings and develop brands, visuals, names and tag lines. The costs associated with this formal branding process can be significant. However, it is not an all-or-nothing situation. You possess numerous tools to help develop your own brand. The following three steps have been modified for the ophthalmology practice based on what professional services marketing agencies provide for their clients.
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Fraud or Abuse? You Make the Call on Coding Mistakes 06/18/2008
As reported to the Academy, Medicare is currently auditing the following coding mistakes. Some are the result of focused medical review audits, others from whistle blowing cases. Auditors will determine if these errors are a result of coding mistakes or an intentional act.
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Improving Practice Efficiency for the Baby Boomer Generation 05/21/2008
The “baby boom” generation, nearly 80 million strong, was born between 1946 and 1964. That means that by 2011 the first of those boomers will be 65 years old and eligible for Medicare. Additionally, by 2030, this soon-to-be over-65 population will double what it was in 2000. This equates to approximately 70 million people over the age of 65. What this “graying” of society means for ophthalmology is that we can expect to see a large influx of patients in the very near future … and we are grossly unprepared to handle them efficiently and effectively.
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How Much Do You Know? Questions You May Encounter in Your Ophthalmology Practice 05/21/2008
How up-to-date are you with your knowledge of practical issues as well as the legal and regulatory issues that affect your practice? Take our quiz and see how up to date you are in your knowledge of some of these general questions affecting most ophthalmology practices. The answers follow the quiz.
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No File Left Behind 05/21/2008
What three things do Martha Stewart, Frank Quattrone and Arthur Andersen have in common? All three built successful corporations whose reputation was later marred in obstruction-of-justice cases relating to the mishandling of electronic records. And in all three cases, it was discovered too late that not having a systematic practice process for electronic records management was most certainly, “Not a good thing!”
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Accounting Statements for Ophthalmology Practices 04/23/2008
In this article, I will review some accounting principles and accounting statements that are useful to describe the financial state of your ophthalmology practice. I will also review aspects of more traditional accounting, and the reports that define the performance and financial condition of the “business” of your practice.
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Dealing with Difficult People 04/23/2008
One of the most impressive talks that literally changed my way of thinking and interacting with others was from Lloyd D. Newell, a motivational speaker, on the subject of dealing with grumps, grouches and difficult people. In this article, I would like to share what I have learned about conflict management from a variety of sources in 24 years of ophthalmology.
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Negotiating Your First Contract: What to Say and How to Say It 03/21/2008
You have received an offer. It looks good, but lacks a few features that you were expecting. You’re not sure what to do next. On the one hand, it’s a great group in an attractive location. But some of the terms are less attractive than those in other employers’ offers and there is no mention of partnership. What do you do?
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Top 10 Marketing Tips for Your Practice 03/21/2008
Administrators and managing physicians often view marketing solely as advertising to attract new patients. Marketing is stereotyped as newspaper ads, billboards and direct mail campaigns, with LASIK surgery advertising currently being the most obvious. Marketing is in fact, however, any activity that moves your practice in a desired direction.
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Caring for Our Elderly Patients 02/22/2008
With the typical ophthalmology practice having 65 percent or more Medicare-age patients, it is important not to draw conclusions about patients based on their age alone or their medical condition. However, elderly patients seen in the ophthalmology office have special age-related health problems and emotional needs, which ophthalmic medical assistants should consider.
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Designing Effective Ophthalmic Medical Space 02/22/2008
Efficiency and improved performance are your main motivations behind any capital investment decision. Whether you are considering new equipment or a new or redesigned office, you need to consider how this improvement will help support the practice’s most valuable resource, the physician(s).
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2008 CPT Update 01/25/2008
A quick overview of the six significant changes in CPT impacting ophthalmology for 2008.
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Coding Q&A 01/25/2008
Following the morning session of the YO Program at the Annual Meeting in New Orleans, several people had some very specific coding questions. Here are the more common questions and their answers, as provided by Sue Vicchrilli, the coding executive for the American Academy of Ophthalmic Executives.
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Common Partnership Mistakes 10/12/2007
As a practice management consultant, I have been involved in many aspects of a partnership buy-in, starting them from scratch, modifying existing buy-ins/partnerships and representing those selling as well as those buying-in. My involvement in all of these phases of a partnership have led me to the conclusion that there are a few basic mistakes often made in a number of areas.
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Ophthalmology Practice Benchmarks 10/12/2007
As the business of ophthalmology becomes more and more difficult due to rising expenses and declining reimbursements, it will become more critical to understand and manage practice finances and patient flow. Benchmarks can help us do that—if used appropriately.
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The Art of Patient Communication 10/12/2007
Patients may not be able to judge the quality of their treatment, but they can and do judge how well they are treated. The role of ophthalmic medical personnel (OMP) is to assist the physician in effectively communicating all aspects of the encounter so that the patient leaves the office confident in the care that is received. While perfecting technical skills, don’t forget that communication matters. Too often it is ignored. It is often poor communication in the face of a bad outcome that initiates legal action by a patient.
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Billing 101: American Academy of Ophthalmology 06/13/2007
Ophthalmologists and administrators rely on the knowledge and skills of their billing staff to help keep the office compliant and to assist in appropriately maximizing reimbursement.
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The Buy-In: Transitioning from Employee to Partner 06/13/2007
Whether you have just completed your residency or fellowship training or have already been in private practice for a few years, it is never too early to begin thinking about becoming a partner-owner in a practice. Partnership in a practice is a logical evolution, which likely was discussed (and possibly memorialized, at least to some degree) by the negotiating parties during the initial recruitment/hiring process. Now is the time to understand the key elements involved in a buy-in.
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What is AAOE? 06/13/2007
The American Academy of Ophthalmology is committed to providing you with the information you need to be successful in practice, both the clinical and business aspects. A free membership in the American Academy of Ophthalmic Executives (AAOE)-the practice management arm of the Academy-is provided to you throughout your residency, fellowship and first year in practice. In subsequent years, the $175 membership in AAOE will more than pay for itself.
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Winning Patients and Keeping Them for Life 06/13/2007
"I'm thinking about doing some television advertising to attract new patients," the ophthalmologist told me as we sat down to eat lunch at the Annual Meeting of the American Academy of Ophthalmology. "I feel that I need to get the word out about my offices. I'm just not getting enough new patients and we are suffering financially." "Tell me about your offices," I said, and I sat back to listen.
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Building Your Practice 04/18/2007
When meeting a patient for the first time, introduce yourself as "Doctor" and address them as "Mr." or "Mrs." Ask permission to call them by their first name. For instance, "Good Morning, Mr. Amsler" or "Do you prefer to be called Marc or Mr. Amsler?" Make a note of it in the chart.
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Jumping Into Your First Year of Practice? 07/13/2006
The first year of practice can be an overwhelming experience for even the most well adjusted physician. It can often mean moving to a new community, operating in a new O.R., working with new staff in a setting remarkably different than the typical university training program and making independent clinical judgments alone, perhaps for the first time. All these new experiences can make for a stressful year. However, a logical approach to entering practice may make the experience more pleasant. Here are some ways to help soften the fall. |
