PROFITABLE USE

Revisiting the new 275 Mandate, I wanted to highlight how sending the electronic attachments will benefit your practice.

• It will eliminate paper.
• You will be able to track everything electronically
• Finally you can have all your documents in one place and not stuck in a pile somewhere or even lost.
• Think of the savings on postage

Even better some of the clearinghouses have the tracking ability of the times and dates your claims get to the insurance company payers and can even track down to the person that receives it.  One of my favorites is the Practice Insight clearinghouse at www.practiceinsight.com which is very robust and tracks everything down the nitty-gritty details.  I highly recommend you checking them out.

This is also going to help you get paid in 11-14 days instead of a month or more by utilizing the electronic attachment.  Faster reimbursement results in improvement of cash flow and the bottom line.  Make sure to ask your current EMR Vendor and/or Clearinghouse company about the 275 mandate.

One of the most exciting things to happen for provider offices will be the “275 Mandate” which is ready to be signed by the secretary of Health and Human Services. The 275 mandate means that payers will be required to accept six medical attachments: lab, ambulance, emergency department, rehab, clinical, and medical reports. So instead of having to send everything in the mail, payers will have to accept electronic attachments.

This will help simplify the way your office sends out its reports to payers because it will now be in an electronic attachment format. The electronic attachments will be attached in the PWK segment in the 837 file. So you can send your claim and it is as simple as attaching it. What an incredible way to save time, money and increase the bottom line for your practice. I will talk about how this will benefit your practice in my next blog of Part 2 of “How the 275 Mandate Will Help Your Bottom Line.”

Timing is one of the most difficult parts of the business plan. You may ask yourself, how do I find the best time to incorporate an EMR? A busy schedule, overbooked on patients and still wanting to go home at night to your family are all incentives to decide not to begin your EMR quest just yet. However, here are a few ideas and tips to help you decide when you think the timing might be right, because it is, after all, going to be your judgment that will be the best guess as to when is the right time.

1. The timing will most likely be right when you have done all your research and have found the EMR to best fit your practice needs. Remember, no EMR is going to meet 100 percent of the practice’s needs. However, you do want an EMR that can be flexible with some form of customization for your practice.
2. Think back in the past when your practice has been relatively slow, has that been a pattern throughout the years? Those are the times that you may want to consider in beginning the implementation as it will be less likely to inhibit the normal day-to-day functions of your practice.
3. Spearhead the deployment process by convening a multi-disciplinary implementation team that meet weekly to determine goals and assignments. Having a team constantly working on the implementation will ensure that nothing gets “lost” or put on the “backburner.”
4. Remember that a well-implemented EMR improves patient care, enhances the bottom line and provides an opportunity to reinvent workflow. So don’t get discouraged if you see a few bumps in the road, they are bound to occur on any road trip.

Just remember, your business plan, your optimism toward your business plan and your well publicized (throughout your practice) goals will be the vision of your employees. They will provide a sound model for improving workflow, integrating IT and improving patient care.

The first thing in your EMR business plan is to answer why you are thinking about buying an EMR. Here are some typical reasons why most offices want to adopt the technology:

• A piece of paper can get lost; the computer never gets lost. How much time is spent looking for a lab report or a specific chart that was misplaced? With an EMR it is difficult to “misplace” a chart.
• Saved time from not having to pull charts. While some may have their process “down pat,” an EMR can still be more efficient than the fastest medical filer.
• Increase patient capacity to increase revenue. One benefit of an EMR is that you can keep the quality of the visit intact while speeding up the process a little bit more. The increased efficiency allows you to slot in a few more patients than you would have been able to otherwise.
• Automated messaging – no more lost messages. Having electronic notes allows for a cleaner and “easier to read” system where you don’t have to file through several pages of notes, amendments, or undecipherable handwriting.
• Medical records at your fingertips anywhere, anytime. Accessibility is key in being help to help a patient get better. Health Information Exchange is going to play a key role in the care of a patient when we can easily share information among HIPAA approved entities.
• Answer pharmacy questions on the fly/Prescriptions more eligible. An electronic prescription program should be a mandatory part of any EMR. The benefits are obvious: prevention of prescription errors resulting from illegible handwriting, real-time communication between providers and pharmacies and expedites refills.
• Employee satisfaction. Co-pays become easier to track, reimbursement and coding processes become easier and the increased efficiency leads to employee satisfaction with their job.

After seeing the benefits of an EMR the next step would be to compare it specifically to your own practice:

1. Study your current practice workflow from the front to back. Determine which workflows will work in an electronic environment and which will need to change and write them down. In almost every situation, nothing will come from a plan that isn’t written down.
2. How will adopting an EMR help the practice to be more effective and efficient? A list of specific pros and cons applicable to your practice will always put something like this into perspective. You can then see if the benefits outweigh the costs and inefficiencies that may occur.
3. Finally, list everything you hope the system will do for you. What can’t you live without? Patient call logs, consult letters, E/M coding, prescription management, order entry for labs and imaging or integrated patient management? The list continues but the more specific you are with what you want, the more satisfaction and profitable use you will get out of your EMR.

When physicians asked me a few years ago if they should buy an EMR for their practice, I would without hesitation say “absolutely!” “They will make your practice more effective and efficient in the long run.” But that was when the industry was not so heavily regulated and difficult to understand.

Today, with certification regulation, meaningful use, and legislation aimed at ending incentives to adopt an EMR, I tell physicians now to back away from the diving board and survey the pool before they decide to dive in.

Here are some good practical tips to follow:

1. Do not be seduced by “Meaningful Use Payouts” – this is taxable income for you! $$$
2. Educate yourself as much as possible.
3. Consider the benefits and challenges – “short term pain for long term gain.”
4. Develop a plan and produce goals you would like to achieve as a practice and then decide if an EMR fits in that long-term plan.
5. Create a new business plan incorporating the EMR in the practice for focus, navigation and simplification. Like using a GPS on the highway, it assists in getting you where you need to go as quickly and as smoothly as possible.
6. Consider using or get advice from an experienced EMR Consultant – they know all the pros and cons of the industry and are dying to share it.
7. Do not start a dialog with EMR Vendors until you done all of the above.

So bottom line here is that an EMR is a great tool to help drive your practice, but with any tool you have to read the manual and educate yourself or the final result could be disastrous.

The patient is most motivated to pay before they see the physician, so this is the best time to collect co-pays. Don’t let them just walk away!

Collecting co-pays should be routine for the front office staff.  Train your office to be courteous, professional and kind but be consistent and firm. All medical office personnel need to know that co-pays are a significant amount of total revenue of the practice. Make sure to reward employees with bonuses for collecting because it is a huge cost savings for the practice.

When patients schedule appointments the front desk staff needs to be sure to tell the patients about the policy. Remind them it’s important that they need to bring their insurance cards and their co-pay to the visit. Explain this is a standard business practice/ office policy for the practice.

There are several ways to communicate to the patients in a tasteful way. Your practice can eliminate the hassle of billing and mailing costs which will reduce office costs!

• Have the billing team prepare daily reports for front office staff to refer to as patients are being checked in. The front desk can let the patient know upon arrival what their co-pay estimate is and verify what method of payment they will be using.

• Another way is posting signage at the front desk in the office that states “Your insurance company requires that we collect your co-payment at time of service.”

• If you have a website, add it to your office policies online.

• When patients check in, have them read and sign a form outlining your policy.

When patients call in to make an appointment remind them of your policy and indicate what they’ll owe and your methods of payment.

If you don’t currently accept credit card payments – you should.  Not only does this help eliminate excuses patients have for non-payment, but can help reduce the high costs of billing and collections.

One of the medical office credit card processing companies I have found to work well is Easy Pay Solutions (www.easypayasolutions.com). It is a software based solution installed on the office computers which includes a USB card swipe. It interfaces with many of the EMRs and has a huge advantage over typical credit card terminals:

• It stores credit card signatures on file with consent from your patient
• Automatically debits their credit card account when the EOB arrives
• Funds are in your bank typically in two days.
• The patient is notified by email that the debit occurred thus reducing the patient receivables.
• The fees are the lowest in the industry.

The other option you may want to consider if you have a smaller practice would be to use PayPal’s credit card processing system. It’s simple. Just go to the PayPal.com website and set up a practice account. There are no fees or charges to set it up. Then once your account is active (in minutes) then the office can begin to process credit card payments via internet by keying in all credit card information.  PayPal accepts all major credit/debit cards.  All credit card processing is handled through PayPal and your account will keep all practice information stored right there in the account.  A PayPal transaction fee for accepting that patient’s credit card is 59 cents and PayPal transaction fees are 1.9% to 2.9% plus 30 cents.

Card acceptance will improve your cash flow with more timely payments, reduce overhead and billing related expenses such as tracking overdue bills, collections, and returned check fees.

Getting the patients to fill out patient information forms completely will insure that you get all the information you need to get paid by the insurance company.

Today it is very important to keep accurate medical records whether paper or electronic.  This information includes personal contact information, current medications, past medical history, current medications and insurance information.  Making sure the patient’s information is accurate helps you determine the possible causes of illness and treat the patient more efficiently while ensuring your office is paid for their services.

Anytime the patient calls for their appointment, insist they bring in their identification and insurance card at that time. It is a good practice to ask the patient on every visit to verify their name, date of birth, insurance and address.  Prevention is the key for billing accuracy, liability and malpractice.

Let technology help you simplify the process of capturing patient data.  Here are 2 great ways to get started:

1.  Use a Patient Portal.  Most EMR’s have them built in to their software.  If you don’t use it or are not aware of it, ask your vendor about it.  Most patient portals are customizable for your practice with the ability to turn on/off to meet practice needs.  Using the portals can help cut down on administrative time for tasks such as patient registration, patient demographic management, and patient intake forms.

2.  Another really cool tool is the Topaz Clip Gem (Computime). Topaz makes what I think is reliable and durable electronic signature equipment and has great healthcare applications and pads. This is a great tool for cutting down on paper and capturing electronic signatures of patients.  The Clip Gem can be used like a clipboard, you attach patient forms to be marked or signed.  The pen uses real ink but also creates a simultaneous electronic copy. You then can give the patient a paper copy, while you capture it digitally in the EMR.

As more medical practices face the challenge of transitioning from conventional paper medical records to electronic medical records, medical practices are asking if they need to hire an “in-house” IT person or outsource to an IT company.

For small, and even in some cases large practices, it is not cost effective to hire a dedicated IT person full time.

The most cost effective approach is to find an IT Healthcare Industry expert or company to contract with that you can call when needed for all your IT issues.

Back when I sold EMR’s, I made every medical office have a dedicated IT person and if they did not, I recommended one and would not proceed to even make the sale till this was fully in place.  I even incorporated in contracts that this was the physician’s obligation. I in turn, had my own EMR IT specialist who could work in conjunction with the office IT specialist because what can go wrong will go wrong and all medical offices often need a quick fix in order to stay in productivity.

So when you decide to go to an EMR, get the IT person(s) involved even in the decision-making process. Paying that IT person to be involved could potentially save you from any hardware/software hassles and headaches down the road. Their expertise is priceless. Include them in all training and working closely with the EMR Implementation and training team.

I have seen personally seen this process be successful and I highly recommend it to all practices. Leave the patient care to the medical experts and IT stuff to the IT experts.

One of the biggest challenges for many practices adopting EMRs today is the disruption of workflow and productivity.

Choosing the right EMR that will adapt well to your current practice is vital. That’s why any practice wanting to leap into an EMR needs to evaluate its current method of doing things. Your practice also needs evaluate areas in which you want to be more effective and efficient. So, when you start the EMR evaluation process, if you already have these evaluations completed, making your way through the EMR maze of 400 companies will be less complicated.

Keep in mind that EMRs are in constant evolution; if the one you’re considering can’t do one thing now that you would like it to do, ask if the company will be looking at including that particular feature in the future. EMR company programmers are always working on ways to stay up with the competition and be innovative to gain market share.

EMR companies may customize the application to meet the needs of your practice and others if presented with a regional request or a huge demand for a feature. They will most likely charge for this, but if you help facilitate it and stay involved, they may not. Assist proactively by giving them the regional requirements and documentation to support it. Then work closely with them, answering questions and performing beta tests on the new feature/add-on feature for the company. Just don’t be afraid to ask or bring an idea to them. I’ve done it many times and it has been a very positive experience for all parties involved. The practice(s) gets want it needs and it increases revenue for the EMR company and market share.