Vol. XIII Issue IV Fall 2015 Florida MGMA News...A Quarterly Publication of Florida Medical Group...
Transcript of Vol. XIII Issue IV Fall 2015 Florida MGMA News...A Quarterly Publication of Florida Medical Group...
A Quarterly Publication of Florida Medical Group Management Association
Florida MGMA NewsFlorida MGMA News
Vol. XIII Issue IV
Fall 2015
MARK YOUR CALENDARS! Florida MGMA Annual ConferenceJune 22-24, 2016 - Hyatt Regency Grand Cypress, Orlando
The Florida MGMA 2016 Conference will be held June
2224 at the Hyatt Regency Grand Cypress. This is later
than our usual May dates, so mark your calendars and
bring your family! The Hyatt Regency Grand Cypress is
an excellent location for a quick summer vacation right in
your backyard! Your hotel stay includes a 850,000 gallon
lagoonstyle pool that has 12 waterfalls, a water slide, a
rope bridge, and a swimthrough rock grotto with a hidden
jacuzzi. Also included is use of the fitness center as well
as various bikes and boats and even a rock climbing
wall...all at no additional cost! We have secured group
rates on the hotel which will be sent out to all members in
January.
Located just one mile from Walt Disney World® Resort
and five miles from Sea World®, Hyatt Regency Grand
Cypress is the perfect option for experiencing everything
Orlando offers. No matter what you’re in the mood for,
Hyatt Regency Grand Cypress has it, from world class
championship golf and tennis to leisurely afternoons sail
ing on our private lake. As a Disney Good Neighbor Hotel,
the resort offers easy access to the most popular theme
parks in Orlando, as well as attractions, cultural activities,
spectator sports and worldclass shopping. You'll find an
endless variety of things to do during your resort retreat.
Our conference agenda will be mailed to all members in
January, but make your plans now to join us! Please con
tact our office at [email protected] if you have any
questions.
2014 2015
BOARD OF DIRECTORS
President
Marynell Lubinski, FACMPE
Miami Jewish Health Systems
President Elect, Conference Chair
Sherry Mills
North Florida Surgeons
Treasurer
Ilene GilbertDroge, FACMPE
SMH Physician Services, Inc.
Past President
Michael A. Franks, MPA, CMPE
Premier Dermatology
Florida Collaborative Chair
Kevin Lockett
Mayo Clinic
ACMPE Representative North
Tom Menichino, FACMPE
The Villages Health
ACMPE Representative South
LoriAnn Martell, LPN, CMPE
Advanced Medical Center, Inc.
Vice President North East
Thomas Balestrieri
NoPark Avenue Dermatology
Vice President North West
Chip Geitz, CPA, CMPE
Medical Center Clinic
Vice President Central
Gerry Bessette
Medical Associates of Brevard
Vice President Central West
Tracey Mitchell
USF Physicians Group
Vice President South East
Mario Salceda
Memorial Healthcare System
Past President at Large
Henry Del Riego
FIU HealthCare Network FIU Health
Member At Large
Kevin Pizzuti, CMPE
Executive Director
Lisa Beard
(561) 4526702 ~ [email protected]
Dear Colleagues,
Dear FLMGMA Members:
I was very honored, and excited, to
be elected to the office of President for
FLMGMA in October 2015, for the
upcoming year (2016).
As I write this message to all my col
leagues on this Thanksgiving holiday,
my mind is filled with all the chal
lenges we faced as Administrators in
our practices this past year: higher
operating costs, Meaningful Use, the
deployment of ICD10 (for which our
Florida Collaborative Committee is an
excellent resource), the Physician
Quality Reporting System (PQRS),
the ValueBased Payment Modifier,
and many others. We will continue to
face, and deal with, the same chal
lenges in 2016, and will continue to be
required to do “morewithless,” as we
all have become accustomed to, over
the passing years. I know that those
factors kept me on my toes, constant
ly adjusting, and I suspect many of
you experienced the same.
One of my favorite quotes comes from
Jack Welch (past CEO of General
Electric): “Before you are a leader,
success is all about growing yourself,
when you become a leader, success
is all about growing others.” I try to
implement that wisdom every day in
my position at North Florida Surgeons
in Jacksonville, FL.
With that, I would like to remind you to
renew your membership with FLMG
MA for the upcoming year, and to
invite a colleague you know that would
benefit from our organization. FLMG
MA offers Webinars throughout the
year (which qualify you for American
College of Medical Practice
Executives credits), with nationally
known speakers, addressing current
topics, to assist you in running your
practices at a stateoftheart level.
These Webinars are free to FLMGMA
members. The networking opportuni
ties throughout the state of Florida are
also a benefit that you cannot receive
from any other organization in our
field.
The Annual Conference will be held
from June 2224, 2016, at The Hyatt
Regency Grand Cypress in Orlando,
FL, and is guaranteed to be beneficial
to all who attend. (MARK YOUR CAL
ENDARS)!!!
LoriAnn Martell, LPN, CMPE –
Practice Administrator (the Chairman
of the conference), is already busily
planning with Executive Director, Lisa
A Message from the President
Marynell Lubinski, FACMPE
Florida MGMA President
2
3
Florida MGMA Free Member Webinars
Telemedicine Tim Sagers, MD
Medical Director MercyCare Business Health Solutions
November 10, 2015 / 1:00 2:00pm EST
TO REGISTER: Login to the Florida MGMA Website www.flmgma.com with your User Name and
Password and go to the Education Tab Webinars Page and follow the link
ABOUT THIS WEBINAR:
During this webinar the presenter will cover: 1. The recent evolution in employer and healthcare consumer expectations and
utilization
2. Explain the current spectrum of telemedicine usage in the U.S.
3. Technology required to deliver employer based telemedicine
4. Demonstrate current telemedicine capabilities
Getting Ready for 2016: The Reimbursement Landscape for Medical Practices Elizabeth Woodcock, MBA, FACMPE
December 8, 2015 / 1:00 2:15pm EST
ABOUT THIS WEBINAR:
Discover how shifts in the health care landscape will impact your practice in 2016 and
beyond. In this dynamic presentation, national speaker, trainer and author Elizabeth
Woodcock gives you the lowdown on emerging trends that can pose both opportunities
and threats to your practice in the coming year. You’ll have a front row seat as Elizabeth
shares today’s hot button topics, such as the:
· Final Medicare reimbursement for 2016 – what specialties will feel pain,
which ones gain
· Summary of the CPT® changes for 2016
· Coding and billing for the newly covered advanced care planning
· Payment cuts for the government’s “voluntary” incentive programs, including
the valuebased payment modifier
· Effectively managing the newest payer in the market, namely, your patient
Are you ready for 2016? You’ll walk away from this webinar armed with information and knowledge to understand
how your practice can weather the storms and take advantage of the opportunities in the coming year.
Visit our Webinars page to view past Florida MGMA Member Webinars OnDemand. Be sure you are logged
in to view this page.
Past Archived Webinars:
Leaning In: Skills for Emotional Resiliency Ellen Haroutunian
Automating the Life Cycle of a Practice Dollar? Ken Bradley
Managed Care Analysis and Negotiations Jackie Boswell
Managing Up Marc D. Halley, MBA
4
For two payers and a clearinghouse, the early returns on ICD10 are positive
In a panel led by the Medical Group Management
Association's (MGMA's) Health Information
Technology Policy Director, Robert Tennant, repre
sentatives from payers, such as Humana and
UnitedHealthcare, as well as representative from
Emdeon, a clearinghouse, said they have seen very
low rejection rates and no major issues in the early
days of ICD10. They were all, however, very cau
tious and not willing to get overly excited.
"Everyone is pleased with the results … but no one
is dancing in the end zone quite yet," said Ross
Lippincott, vice president of provider regulatory pro
grams at UnitedHealthcare. "We have quite a ways
to go. We're keeping our foot on the gas in monitor
ing, outreach support, [and] collaboration, and the
whole industry shouldn't be taking a premature sigh
of relief."
As of Oct. 9, Lippincott said United Healthcare had
processed 2.3 million ICD10 claims. He noted that
provider call center volumes were within the normal
range, preauthorizations were processing as
expected, and there was only a slight uptick in rejec
tion rates, at less than 0.2 percent.
Both Lippincott and Sid Herbert, director of the ICD
10 implementation team at Humana, touted their
organizations' efforts to prepare providers for ICD
10. Like UnitedHealthcare, Humana has also seen
low rejection rates and a normal call volume thus
far. More than 50 percent of claims, by Oct. 7, were
coded in ICD10.
"It was somewhat similar to Y2K; we worked like
demons, and everything proceeded the way it
should have," Herbert said. "That's not to say it will
continue that way, but I think we have enough data
that says we won't have major catastrophic issues."
'At the Beginning of This Journey'
It wasn't just payer representatives who had a posi
tive message on the transition. Mike Denison, sen
ior director for regulatory programs at Emdeon,
which has a large allpayer network for its clearing
house services, said even though a lot of providers
didn't conduct any readiness testing with the com
pany before the transition date, most are using ICD
10 codes when they should be. Moreover, he said
they haven't seen a significant increase in claim
rejections, as it's trending in line with prior daily
averages.
Denison said he was "cautiously optimistic," going
forward. The efforts to keep providers prepared, the
three said, will continue past the Oct. 1 deadline. All
three companies offer an ICD10 command center.
Overall, the MGMA's Tennant said he is hearing that
claims are moving through the system. He said if
there were massive issues, the organization
would've found out. Still, in the spirit of waiting to
celebrate, he said there were short and longterm
questions on ICD10 that needed to be answered.
Specifically, he had questions around the four state
Medicaid agencies (California, Louisiana, Maryland,
and Montana) which aren't accepting ICD10 codes,
and whether granular coding would actually lead to
better data and improved quality of care.
Tennant, seemingly halfkiddingly, said that when
the same roundtable convened in a month, they'd
be talking about the increase in denials. However,
considering CMS' previous projections of post Oct.
1denials, he may very well be right.
"We're only at the beginning of this journey. We're
now at the point where can move information back
and forth between providers and payers based on
realworld conditions. We're beginning a learning
process that will benefit us all over a short period of
time. This is beginning of the journey. I'm hopeful
the issues will be small, but be assured, that it's in
the payers' best interest to actually pay a claim
quickly, accurately, and effectively. Anything beyond
that causes rework and dissatisfied the provider, so
there is no real positive result," said Herbert.
http://www.physicianspractice.com/icd10/cautious
optimismearlydaysicd10#sthash.ZKKAlKRz.dpuf
5
We relentlessly defend, protect, and reward the practice of good medicine.
Our revolutionary approach is seamless and cost-effective. As the
nation’s largest physician-owned medical malpractice insurer and
an innovator in creating solutions for organizations like yours, we
have the resources and experience to meet your needs. We’re already
providing medical malpractice insurance to 2,600 sophisticated
medical groups across the country—supporting more than
59,000 physicians.
Learn more about our fl exible risk solutions for groups.
CALL OUR JACKSONVILLE OFFICE AT 888.899.9091 OR VISIT WWW.THEDOCTORS.COM
WE ARE TRANSFORMING THE WAY PHYSICIAN
GROUPS MANAGE MEDICALMALPRACTICE RISK
WE ARE TRANSFORMINGWE ARE TRANSFORMINGTHE WAY PHYSICIANTHE WAY PHYSICIAN
GROUPSGROUPS MANAGE MEDICALMANAGE MEDICALMALPRACTICE RISKMALPRACTICE RISK
TRANSFORMINGTRANSFORMINGTRANSFORMING
6
Florida MGMAWelcomes New
Members
6
Active Members
Esther Kovacs
Urology Center of Winter Park
Winter Park
Miriam Williams
Panama City Urological Center
Panama City Beach
Florida MGMA Job Board
Title Company City
Director Physician Practices Memorial Healthcare System Hollywood
Billing and Collections Manager Internal Medicine Associates of Lee County Ft. Myers
Billing Manager Internal Medicine Associates of Lee County Ft. Myers
Medical Practice Administrator DoctorsManagement, LLC Vero Beach
Director of Operations for Primary Care Sarasota Memorial Health Care System Sarasota
The following positions are currently being advertised in the Florida MGMA Job Board.
For full details, please visit our website at www.flmgma.com.
Members may post their open positions at no cost.
Payers Won't Always Be So Lenient in ICD10
So far the in the new ICD10 world, CMS and private payers have been going on
easy on specificity requirements. For many practices, this has been a huge help.
However, if you are getting comfortable with this flexibility as the new norm then
you may be in for an unpleasant surprise.
The introduction of ICD10 has always been handled with something of a carrot
and stick approach. For years CMS and congress alternated between warnings
and reassurances, urging providers to thoroughly prepare while offering repeated
delays and concessions about easing the requirements during the transition. The
delays led many practices to think ICD10 wasn't coming at all, causing them to put
off training, testing, and making financial preparations until dangerously late, and
scrambling to get ready when it was obvious no more delays were in the cards.
The concessions on specificity might be creating a similar false sense of security.
It's going great! We aren't getting a huge increase in denials! We've nailed this
thing! But if you're counting on payers continuing to accept codes that are only "in
the family of codes" or "just make sense," and trusting your software to know things
that you don't, you are living on borrowed time. More help from Congress is unlike
ly to arrive this time, either. "When CMS announced the flexibility rule," said Robert
Tennant, senior policy advisor for the Medical Group Management Association,
"interest on Capital Hill diverted almost immediately."
Barbie Hays, coding and compliance strategist for the American Academy of
Family Physicians, said that she has received several calls from people asking
how to code something that their EHR couldn't find. "Practices should NOT rely on
their EHR," she said. If you're having this problem, Hays said you have a couple
of options. "I would first recommend getting an actual hard copy of the ICD10CM
code book. There are many vendors that sell this, such as OptumIngenix, Amazon,
and the AAFP (the AAFP does not endorse any particular vendor or brand). The
second option— and this is not recommended, but could work in a pinch— is to
Google the term and read the results." Hays adds that this last maneuver is not
advisable if you are not familiar with coding convention and practices.
Bottom line is this: If things are going well for you because you are relying on your
EHR and the indulgence of your payers, you might be headed for a fall. If you
aren't up to speed with ICD10, get that way as quickly as possible. You've heard
it before but they weren't crying wolf last time and they aren't now.
Avery Hurt
Physicians Practice
New Local Chapter Formed
We have formed a new local chap
ter in the Panama City Beach
Area! For more information,
please contact:
Linda Swadener, FACMPE
Practice Administrator
Surgical Associates of NW Florida
(850) 215[email protected]
7
ACMPE...The Road to Certification
As leaders in the healthcare field, have you ever thought
about where you are, where you have been and what
you will be doing next? I sure have. I have been in
healthcare 25 years, and the changes I have been part
of are amazing. I am a firm believer my career is more
than a job. It is a passion. I don’t believe our jobs as
administrators, managers, physicians, etc. need to be
this hard. I also realize I could not have survived some
of the changes without the great mentors, colleagues
and friends I have made along the way. The rules, reg
ulations and responsibilities administrators and manag
er are faced with can be stressful. MGMA has worked
hard to provide many resources to help reduce our
stress. One of the great resources MGMA has provided
to us is the opportunity to become board certified in the
American College of Medical Practice Executives. Once
you become board certified, you then become eligible to
obtain your Fellowship in the American College of
Medical Practice Executives.
Am I eligible?
You are eligible to apply for the board certification once
you have completed a minimum of two years in health
care management, with at least 6 months in a supervi
sory role.
Why do I need to become Board Certified?
Some may ask, why become board certified? While
there are many answers to this question, most who
chose to make this a career goal do it for the experience
of gaining knowledge about subjects they may not have
much exposure to. Board certification gives administra
tors and managers recognition for skills and knowledge
they have and the opportunity to learn new skills.
How do I get started?
There are three steps to certification:
1. Join MGMAACMPE
2. Pass 175 question objective exam and 3 quest ions
essay exam. (Exams are held in various testing sites.)
3. Accumulate 50 hours of CEU’s (Continuing Education
Units). CEUs are obtained by taking the practice exam
for the test, attending local, state and national confer
ences and meetings, educational webinars, online
study groups, and by reading articles in the MGMA con
nection.
The next certification exams will be held November 9
21, 2015. Registration information is located at
www.mgma.com/exams.
Exam sites can be found at: http://www.castleworld
wide.com/cww/oursolutions/testdelivery/testsite
cities/#uslocations
Preparation for the Exam:
A great way to prepare for taking the exam is to practice
to see what areas you may need to study more.
Remember this exam is based on what you do as
administrators and managers every day. Don’t get lost
in forever preparation. This often leads to frustration
and then procrastination. Practicing first will give you
the confidence you need to successfully pass the exam.
The Body of Knowledge web portal
(www.mgma.org/bok) is great resource to use when
preparing for the exam. All 6 domains are on the website
and will also allow you to take a quiz over each domain.
There are also sample essay questions.
Fellowship
Once you have successfully completed your board cer
tification, you will have an opportunity to obtain your fel
lowship. Fellowship is the highest distinction in Medical
Practice Management. In order to obtain fellowship sta
tus with the College of American Medical Executives,
you must submit a professional paper on a relevant
healthcare topic.
Questions? Contact our Florida MGMA ACMPE
Forum Representatives!
LoriAnn Martell, LPN, CMPE 239.216.1252 or
Tom Menichino, FACMPE 352.674.8905 or
Keeping the game fair...
...so you’re not fair game.
800.282.6242 • ProAssurance.com
Healthcare Liability Insurance & Risk Resource Services
ProAssurance Group is rated A+ (Superior) by A.M. Best.
Your Florida medicine
is getting hit from all angles.
You need to stay focused and on point —
confident in your coverage.
Get help protecting your practice,
with resources that make important
decisions easier.
Want to reduce risk? >> ProAssurance.com/Seminars8
The 16 Most Absurd ICD10 Codes
There are 68,000 billing codes under the new ICD10
system, as opposed to a paltry 13,000 under the cur
rent ICD9. The expansive diagnostic codes, intended
to smooth billing processes and assist in population
health and cost reduction across the healthcare deliv
ery system, have providers across the board worried
about integration: A recent survey by the American
Health Information Management Association and the
eHealth Initiatives found that 38% of providers think
revenue will decrease in year following the switch from
ICD9, while only 6% think revenue will increase.
Still, providers are preparing for the switch. After yet
another delay this year, the official changeover date is
set for October 1, 2015 , and 40% of respondents say
they will be prepared to do endtoend testing by the
end of this year.
Despite the controversy surrounding ICD10, there is
one universally agreedupon upside to the hyperspe
cific coding system: Weird and obscure codes that
stand for bizarre medical injuries. There's even an
illustrated book, Struck by an Orca: ICD10 Illustrated.
(Healthcare Dive is super into it.)
Therefore, behold! The 16 most absurd codes in the
entire ICD10 set, with a little advice from Healthcare
Dive on how to handle these cases should they come
into your ER:
16. V97.33XD: Sucked into jet engine, subsequent
encounter.
Sucked into a jet engine, survived, then sucked in
again? First of all, that really, really sucks. Second of
all, this patient is obviously Wolverine, and should be
detained for imaging and posterity.
(Technically, this means "subsequent encounter with a
physician" not "subsequent encounter with a jet
engine," but that's less dramatic.)
15. W51.XXXA: Accidental striking against or
bumped into by another person, sequela.
The "sequela" here implies the kind of human bumper
cars that can only happen at a music festival, the sub
way or possibly an active combat zone. Potentially
fatal for agoraphobics. Recommend handling with
care.
14. V00.01XD: Pedestrian on foot injured in colli
sion with rollerskater, subsequent encounter.
First, are roller skates even still a thing anymore? I
mean, other than how one knows spring has sprung in
Central Park? Second, can you call a person on roller
skates a pedestrian? Thirdly, if the answers to one and
two are "yes," then these things should be outlawed,
because they are obviously dangerous.
13. Y93.D: Activities involved arts and handcrafts.
Camp is a dangerous thing. Hot glue guns and knitting
needles definitely wouldn't be allowed on a plane, yet
we habitually allow 7yearolds to play with them. This
is a public health crisis that needs to be addressed.
12.Z99.89: Dependence on enabling machines and
devices, not elsewhere classified.
There's a reason they call it the Crackberry. This is an
obsolete joke, but there just isn't an iPhone pun that
can compete with "crackberry."
11. Y92.146: Swimmingpool of prison as the place
of occurrence of the external cause.
There is also a code for "day spa of prison as the place
of occurrence."
10. S10.87XA: Other superficial bite of other spec
ified part of neck, initial encounter.
Alright, people. Let's call a spade a spade. "Other
superficial bite of other specified part of the neck?"
This is a hickey. Admit it. Although why anyone would
be admitted for that remains a mystery.
continued on page 10
9
10
The 16 Most Absurd ICD10 Codes, continued
9. W61.62XD: Struck by duck, subsequent
encounter.
tweet this quote
8. W55.41XA: Bitten by pig, initial encounter .
First, be sure that the patient is restrained from doing
whatever he or she may have done to provoke the pig
in the first place. Security should be placed on alert.
Also, what was this person doing in a farm setting in
the first place? Pigs are not pets.
7. Z63.1: Problems in relationship with inlaws.
Who doesn't?
6. W220.2XD: Walked into lamppost, subsequent
encounter.
No. No. People. You only get to do this once. ONCE.
If a patient is going around whacking into lampposts
regularly, there is a deeper problem here, and he
should be referred to psych immediately.
5. Y93.D: V91.07XD: Burn due to waterskis on fire,
subsequent encounter .
How does this happen? Are water skis even flamma
ble?
4. W55.29XA: Other contact with cow, subsequent
encounter.
"Other contact with cow." OTHER CONTACT WITH
COW? There are codes for "bitten by cow" and "kicked
by cow." What else is there?! What, precisely, is the
contact with the cow that has necessitated a hospital
visit?!
3. W22.02XD: V95.43XS: Spacecraft collision injur
ing occupant, sequela.
The existence of this type of code does not engender
trust in the National Aeronautics and Space
Administration. Shouldn't they have more control over
their spacecraft than that? Or are they just careening
around in the ether, pinging into one another and injur
ing occupants/astronauts?
2. W61.12XA: Struck by macaw, initial encounter.
Macaws are endangered—some are extinct in the
wild—so if a patient has been struck by a macaw,
chances are, it was the patient's fault. Consider calling
the SPCA and/or the police. The macaw needs to be
found and treated immediately.
1. R46.1: Bizarre personal appearance.
LADY GAGA, IS THAT YOU? WE LOVE YOUR MEAT
SUIT.
But seriously, who gets to decide what constitutes
"bizarre personal appearance"? Let the people do
what they want!
Katie Bo Williams
Industry Dive, the parent company of Healthcare Dive,
covers business news for executives in a number of
industries. Many of our publications are free, including
our daily newsletters.
Meaningful Use in 2015 – Finally Set in Stone
11
Last week, the Centers for Medicare and Medicaid
Services (CMS) issued the longawaited Final Rule
on the EHR Incentive Program. The notification was
overdue, as the first day of the final reporting period
for 2015 – October 3 – has passed. Indeed, CMS has
confirmed that the reporting period is any continuous
90 days in 2015. Justifying its delay in the issuance
of the rulemaking, CMS explains that the modifica
tions being delivered accommodate all eligible pro
fessionals who have been diligently working towards
a successful attestation based on the current pro
gram requirements. In addition to releasing the final
criteria for the nownamed Modified Stage Two, this
Final Rule also addresses the future of the program,
in the context of the new Meritbased Incentive
Payment System (MIPS), as well as Stage Three.
Unlike the government, we won’t waste our time
mulling over the program’s future, instead turning our
attention to what actions you need to take now to
avoid the 3% penalty for 2017.
Without further ado, the final 10 Modified Stage Two
criteria and measures for Meaningful Use are sum
marized herein:
1. Protection of patients’ health information through a
security risk analysis.
2. Implementation of 5 clinical decision support inter
ventions, and drug/drug and drug/allergy interaction
checks.
3. Computerized provider order entry for medications
(60%), labs and radiology orders (30% each).
4. Electronic prescriptions for 50 percent of all per
missible prescriptions, including formulary checks.
5. Creation and electronic transmission of summary
of care records for more than 10% of transitions of
care and referrals.
6. Delivery of patientspecific education resources to
more than 10% of all unique patients with office visits
during the reporting period.
7. Performance of medication reconciliation for more
than 50% of the incoming transitions of care.
8. Provision of timely access to health information for
more than 50% of all unique patients seen during the
reporting period to view online, download and trans
mit to a third party; with action confirmed on the basis
of having one patient view, download or transmit dur
ing the reporting period.
9. Confirmation that secure electronic messaging is
enabled – i.e., yes/no.
10. Reporting – or at least on the path to reporting –
to a public health agency or a registry for two meas
ures.
The 10 criteria for the new Modified Stage Two are
changing slightly in 2016, with a requirement to
report that at least one patient seen during the report
ing period sent an electronic message, increased
back to the 5% of all patients in 2017. In 2017, the
“view, download, transmit” objective also reverts back
to the 5% measure. CMS has declared that the 90
day reporting period is only for 2015, with the full cal
endar year reporting required for 2016.
CMS decided not to issue another set of criteria for
Stage One, instead requiring all participants to move
to this Modified Stage Two in 2015 – however, Stage
One participants are provided extensive exclusions
and alternative objectives and measures. Thus,
despite the fact that all eligible professionals are
required to attest to Modified Stage Two, the specifi
cations for Stage One participants essentially create
a separate reporting requirement – one that is much
less burdensome.
CMS has yet to update the website for the EHR
Incentive Program, but you can read the 752page
Final Rule (which will be on view until its official pub
lication, slated for October 16) – or perhaps just
spend a few minutes reviewing CMS’ announcement
that accompanied the issuance of the new criteria.
CMS won’t open the attestation portal until the begin
ning of 2016, but you’ll have until the end of February
to report (with CMS already indicating that they may
extend that through March). Until then, get in gear for
Modified Stage Two in order to gain any remaining
bonus payments – and avoid the payment adjust
ments being imposed in 2017 based on this year’s
performance.
Elizabeth Woodcock, MBA, FACMPE
www.elizabethwoodcock.com
12
Customer service didn't used to be closely associat
ed with running a medical office but it has become
increasingly important in order to survive in a com
petitive market. Consumers have more choices as to
where they receive care and are increasingly con
scious of what they're getting for their money. On top
of that, insurers are starting to tie financial incentives
to patient satisfaction.
To thrive in the new market, patientcentered care
must be woven into the fabric of the practice, experts
say. The whole staff needs to be involved in creating
a culture of service that extends from the time a
patient schedules an appointment to when they pay
their final bill.
"It has to start from the top because if staff doesn't
see it prioritized by the physician they won't care as
much," says Lauren King, director of customer serv
ice at DoctorsManagement, a medical and health
care consulting firm based in Knoxville, Tenn. "It's not
just about having a onehour workshop but establish
ing an ongoing campaign where someone is leading
the cause and issuing frequent reminders.
"Training is critical so that all staff members know
their roles and how they impact patient satisfaction,
says Owen Dahl, a practice management consultant
based in The Woodlands, Texas. That might include
roleplaying where staff members practice how to deal
with different scenarios, such as an angry patient.
"The more you can do to train and review those sce
narios with staff, the better off you will be," he says.
"It reduces the stress on the part of staff members
and helps them communicate better with the patient.
"It helps to establish protocols and give staff the tools
they need to deal with various types of patient
encounters on their own, says Michael Munger, a
family physician and medical director at St. Luke's
South Primary Care in Overland Park, Kan.
Empowering staff to work at the top of their licensure
not only fosters teamwork but also strengthens their
ties with patients.
"Staff members should be able to deal with certain
issues without having to consult with a doctor," says
Munger. "For example, we empower our medical
assistants to talk to patients about their health
screenings and immunizations or go over health
habits. By doing that, we find that patients start to
identify with the nurse and medical assistant as part
of the overall team and feel a bond with them.
"All staff members should not only know their role in
the patient experience but also that they will be held
accountable, says Julie Boisen, managing director
for Navigant Consulting's Healthcare practice, based
in its Plankinton, S.D. office. You can add specific
questions to customer satisfaction surveys about the
quality of care received from individual staff mem
bers, for example, or perform chart audits.
"If the medical assistant is in charge of measuring
patients' height and weight and taking their blood
pressure when they come in, make sure that actually
occurs by conducting an audit," Boisen says. "Those
procedures are reassuring to patients because it indi
cates that you monitor quality of care.
"With ongoing training and frequent communication
among physicians and staff, customer service will
soon become second nature, says Munger.
"Everyone who touches the patient, not just the clini
cal staff, should be working as a team and talking to
each other," he says. "You want your patients to think
of you and your care team as an extended family."
Janet Colwell
www.physicianpractice.com
Customer Service a Key Element to Your Practice
13
How Social Media Can Benefit Your Practice
A large chunk of the US population is turning to social
media for healthrelated information. If its power is
harnessed wisely, it can be a powerful tool for your
practice. Network through these platforms have
expanded the social life of health, which now goes far
beyond a doctor’s office. Patients who share a partic
ular health condition can talk directly to each other,
share their experiences, educate each other, and
recommend doctors and treatments that have
worked for them.
As such, it can be used as an ideal platform to share
your practice visibility, connect directly with target
patients, and influence their opinion about your prac
tice. Entrepreneurial physicians have understood the
possibilities of social media marketing and have
leveraged it to their benefit. It’s about making a brand
of your practice through social media marketing.
Here are five benefits of social media that physi
cians should understand:
Richer customer experiences
Every patient interaction you have on various plat
forms like patientreview websites, blogs, Facebook,
Twitter, and LinkedIn is an excellent opportunity to let
the world know about service at your practice.
Through these interactions, you can get to know the
mindset of patients. You can utilize this medium to
address the issues patients may have faced at your
practice, apologize for any inconvenience you’ve
caused, and assure them that nothing less than the
best healthcare services will be provided.
Every post you make on social media platforms can
be a chance to convert potential patients. If you have
a reasonable following on social media, you can reap
trifold benefits of simultaneously connecting with
new patients, existing ones, and other visitors who
can be future potential patients.
Wider bandwidth for brand exposure
Experts say social media is the most important factor
for brand management these days, to showcase your
brand and build brand credibility. A strong online
presence enhances a physician’s trustworthiness as
well as boosts their website’s traffic and search
engine ranking. It provides additional exposure to
your practice.
Improved services
“How a physician or hospital responds to negative
comments and complaints can carry equal or more
weight than positive consumer engagement,” accord
ing to one report from PricewaterhouseCoopers
(PwC). These issues, when brought to attention on
social media, can be addressed and resolved imme
diately because there is an outlet for a dialogue.
When social media users observe that their issues
and problems are handled right away and solutions
are being worked out, they have a feeling that cus
tomer service is taken seriously. On the other hand, it
gives the physician a chance to be aware about what
is being said about his or her practice. This can be a
great opportunity in some cases, where the physi
cians can handle an angry or upset patient at the very
first instance he or she posts something, before the
situation becomes aggravated.
Discovery of new trends
Change is law of nature. Even your patients keep
evolving with time. So how will you come to know
what patients really want out of a consultation? For
instance, because of obesity, someone with diabetes
might be seeking a diet and healthy lifestyle consul
tation to cure the disease naturally. Here, social
media comes to rescue! You can spark a discussion
among patient communities on platforms like
Facebook, Twitter, and LinkedIn. These discussions
continued on page 14
How Social Media Can BenefitYour Practice, continued
reveal the mindset of patients and revelations can be
manifested in the form of better services at your prac
tice.
A costeffective way to connect with patients
According to Hubspot, 84 percent of marketers found
that as little as six hours of effort per week given to
social media is enough to generate increased traffic.
Targeting a large audience through social media with
this time investment, which is about one hour per
day, isn’t a bad deal. Moreover, the only true cost is
the time involved. After clinic hours, if you can spare
one hour per day for engaging on social media, it will
give you a good return on your time invested.
However, if you aren’t able to devote this time, you
can consider deploying a staff member for these
activities.
The doctorpatient relationship is the nexus of
Western healthcare systems. As the patients are
evolving with social media, it’s imperative for physi
cians to evolve with them, or else they will be left
behind the competition. Social media networks are
new channels to represent your practice as a brand
in the online market. It’s time for physicians to recog
nize the practical benefits of using social media to
influence patient perceptions.Manish Chauhan is
Digital Marketing Manager at myPracticeReputation
which is an easytouse reputation management
solution for physicians to help monitor, protect and
promote their medical practices at all times in the
simplest way possible.
Manish Kumar Chauhan
Manish Chauhan is Digital Marketing Manager at
myPracticeReputation which is an easytouse repu
tation management solution for physicians to help
monitor, protect and promote their medical practices
at all times in the simplest way possible.
14
Look for more HIPAA audits in the future
In two recent reports, each with a specific focus,
the OIG strongly recommended that the Office for
Civil Rights (OCR) step up its HIPAA oversight
and enforcement activities. One report assessed
the OCR’s oversight of covered entities’ compli
ance with the HIPAA privacy rule and the second
analyzed the OCR’s enforcement related to
reported breaches. In conducting its analysis
under both reports, the OIG reviewed closed
cases involving alleged or actual violations of
HIPAA privacy requirements and previously
reported breaches. The analysis also involved
surveys of OCR staff and interviews with OCR
officials. The OIG’s findings and recommenda
tions are summarized below.
The OIG took issue with the fact that, rather than
proactive initiatives, the OCR’s oversight activi
ties are primarily reactive in response to com
plaints, selfreporting (in the context of a breach),
tips or media reports. The OCR stated that it has
not fully implemented its proactive audit program,
as mandated by HITECH Act, which is to assess
covered entities’ compliance with the privacy
standards. Accordingly, the OIG recommended
that the OCR implement a permanent audit pro
gram to supplement the OCR’s investigation
activities.
The OCR concurred with OIG’s recommenda
tions and noted that it will be launching a perma
nent audit program in early 2016 to include both
desk reviews and onsite reviews. These audits
will also include HIPAA business associates.
Notwithstanding the anticipated audit program,
the OCR noted that budgetary constraints have
presented an obstacle to the OCR implementing
additional responsibilities as may have been
required. Accordingly, the OCR stated, the
longevity of the audit program will depend on the
availability of necessary resources.
sumers compare plans and
better understand total out
ofpocket costs. HHS also
plans to add more features
in the future, such as the
ability to search for health
plans that include specific
physicians as innetwork.
The 2016 enrollment period
will remain open through
Jan. 31, 2016. To learn
more about the ACA
exchanges, visit MGMA’s
Insurance Exchange
Essentials for Practices
Executives webpage and
view our ACA Patient Resources.
Five options to check status of Medicare ICD
10 claims
To allow physician practices to identify potential prob
lems with claims submitted using ICD10 codes (or
other issues), the Centers for Medicare & Medicaid
Services (CMS) has outlined five ways for physician
practices to check the status of claims submitted to their
Medicare Administrative Contractors (MACs):
1. Interactive voice response: Provides access to
Medicare claims information through a tollfree tele
phone number.
2. Customer Service Representative: Call if you are
unable to access claims information via interactive
voice response.
3.MAC web portal.
4. Directed data entry.
5.Health care claim status request and response
(276/277): Request the status of claims (via a 276
transaction) and receive a response electronically (via a
277 transaction).
Visit your MAC's website for additional information on
these options.
MGMA: Washington Update
CMS allows exclusion for meaningful use
public health reporting objective
Earlier this month, the Centers for Medicare & Medicaid
Services (CMS) finalized changes to the reporting crite
ria for the EHR Incentive (meaningful use) program.
Starting in 2015, eligible professionals (EPs) are now
required to report certain public health measures, which
were previously optional. If EPs were not intending to
report these public health measures, CMS has
announced that they may now claim an alternate exclu
sion in 2015 because the agency issued the changes so
late in the year.
Out of the three public health measures, EPs can claim
an alternate exclusion for up to two measures, depend
ing on their stage of the meaningful use program. To
learn more about this alternate exclusion and all of the
modified 2015 meaningful use requirements, access
MGMA’s memberexclusive overview.
Medicare Part D prescriber requirements
delayed
The Centers for Medicare & Medicaid Services (CMS)
recently announced a delay in the requirement that to
prescribe under Medicare Part D, physicians or eligible
prescribers must be enrolled in Medicare or, for those
who have opted out of the program, have a valid affi
davit on file with their Medicare Administrative
Contractor (MAC). The new effective date for these
requirements will now be June 1, 2016. However, pre
scribers of Part D drugs not currently enrolled in
Medicare should submit their enrollment applications or
optout affidavits to their MACs as soon as possible to
avoid patients’ Part D prescription drug claims from
being denied by their Part D plans beginning June 1 of
next year. More information on these Part D prescriber
requirements is available at:
h t t p s : / / w w w . c m s . g o v / O u t r e a c h a n d
E d u c a t i o n / M e d i c a r e L e a r n i n g N e t w o r k
MLN/MLNMattersArticles/Downloads/SE1434.pdf
ACA open enrollment period begins Nov. 1
Nov. 1 is the start date for consumers to purchase 2016
health insurance coverage through the federal and state
health insurance exchanges, established by the Patient
Protection and Affordable Care Act (ACA). The
Department of Health and Human Services (HHS)
announced upgrades for the federal marketplace web
site healthcare.gov, such as new tools to help con15
Post Office Box 380124
Birmingham, AL 352380124
Visit us on the web at www.flmgma.com
WE KNOW GOOD MEDICINE WHEN WE SEE IT, AND WE’RE DETERMINED TO DEFEND IT.
MagMutual’s Florida Claims Committees consist of physicians
just like you. They review cases with the same care they’d
wish for their own. We hire the top local attorneys who are
guided by our local expert claims specialists. And we won’t
settle a claim without your consent. What else would you
expect of a physician-owned, physician-led company?
Good medicine deserves the best defense.
To learn how MagMutual defends physicians, call 1-800-741-0611
or visit MagMutual.com.
Insurance products and services are issued and underwritten by MAG Mutual Insurance Company and its affiliates.
medicineGood deserves the
medicinedeserves the
E KW, ATI
MgaM
t lj
EHE WNICIDED MOOW GONE KO DD TENIMRETEE DR’ED WN, A
nos ceettimmos Cmiala Cdirols F’lautuM
hh tiih. Tki
deserves thebest defense.
E EE SN WE.TD INEFEO D
snaicisyhf pt osisn
d ’h
deserves thebest defense.
t lsuj
h fsiw
ediug
e a clttes
epxe
o leaTTo
or visit
arusnIarusnI
mae shh ttis wesaw ceivey reh. Tuoe yki
ottl aacop loe the trie h. Wnwr oiehr toh f
stsilaiceps smialt crepxl eacor luy od be
lt eah. Wtnesnor cuot yuohtim wiale a c
d cel-naicisyh, pdenwo-naicisyhf a pt oc
n how MagMutual defends physicians, call o lear
or visit MagMutual.com.
wrednd und aeusse irs aecivred sns atcudore pcna.setailfifs atd iny anapmoe Ccna
d ’yehe trae cm
e ro ahs wyenro
t ’noe wd wn. As
u od yluoe ws
?ynapmod c
n how MagMutual defends physicians, call 1-800-741-0611
lautuG MAy Mn bettirw