Revenue and Expense – Can’t have one without the other?
Some practices may find that they cannot increase revenue as easily as they can decrease expenses. Both or a combination of the two can make a practice more profitable.nnExpenses:nRent, personnel, supplies, equipment, etc. What if you could lower the cost of one or more, maybe all of these?nnRent:nIf space is not needed don’t rent it! If you can out source a function that takes up space, it may be worth it.nnPersonnel:nThese days no one wants to be laid off or suggest that there be a reduction in staffing, but if it makes sense to do so, you have got to do it. Health care is complicated and new regulations and challenges may require new/different people and processes. Maybe even less people but higher skilled.nnSupplies:nGet tough, get what you pay for, get lean. There is a lot of competition out there to supply your office. With that competition come JIT (Just In Time) delivery. You may be paying for space to store supplies when you could get the supplies cheaper and delivered with a day of need!nnEquipment:nSome things you have to have. But when it comes time to replace them don’t be afraid to be creative. Look carefully at leasing. Like supplies, there is a lot of competition for your business. Computers and anything electronic is coming down in price, but be careful – often times paying a little more may get you a whole lot more. Consider outsourcing your IT hardware, especially server needs!nnCall us! We can help with all of the above. Spending money is okay if it is done with strategy and with a plan to bring down overall Expenses. You don’t have to just increase revenue to increase your profitability!
The payer and provider communities are still dealing with HIPAA 5010, and trying to shift attention to ICD-10 is tough,” says Craig Collins, division chair for revenue cycle and administrative lead of the ICD-10 transition at the Rochester, Minn.–based Mayo Clinic. “We put together a strategic plan and process map because we’re trying to be first to the plate to do the ICD-10 testing with the payers. Our hope is that in early 2013 we can begin testing with larger payers.”nnThe Mayo Clinic, like many other healthcare organizations, is making strides to prepare for the largest overhaul of healthcare codes in the past 30 years. The process—regardless of Health and Human Services’ decision to extend the ICD-10 transition deadline to October 2014—includes a process map of the revenue cycle in the hopes of keeping this project revenue neutral.nnAlthough the code set change is intended to be revenue neutral, ICD-10 includes more than 155,000 codes, a significant expansion from the current 17,000 codes in ICD-9. The transition touches nearly every member of a hospital or health system: physicians, clinicians, coders, IT, HIM, and finance. The mandated coding expansion influences documentation, productivity, contracts and business processes, HIM, practice management, budgets, payment conversions, claims edits, and disease and utilization management.nnICD-10 is expected to have significant impact on the revenue cycle. Nearly half of healthcare leaders (46%) expect to lose money while shifting to the new system, according to the July 2011 HealthLeaders Media Intelligence Report, ICD-10 Puts Revenue at Risk. An important step to avoid revenue hits is completing a process map that digs into the effect the transition will have on the revenue cycle.nnThe process map is work flow plan driven by multiple repositionable notes created to give an accurate picture of all the activities connected to the current and future processes at an organization. It is a full structural analysis of how all processes flow and connect to each other. The map can show gaps in specific areas that are preventing optimal performance or, in the case of ICD-10, areas that will require special attention to prevent an impact on the organization’s revenue.nnWith some 212 IT systems and 80 geographical sites across Minnesota, Arizona, and Florida that include physician practices and several hospitals, the Mayo Clinic finds the process map to be essential for a successful ICD-10 conversion—and that starts with the right team and clear accountability. 
he right to withhold payment and request refunds for improperly coded services.nn99211 is a minimal level service, but it is still governed by the same billing and documentation rules that ALL E&M codes have.nnAs with all services billed to Medicare, code 99211 services must be reasonable and necessary for the diagnosis or treatment of an illness or injury. Unlike the other E/M CPT codes, the CPT book does not specify completion of particular levels of work for code 99211 in terms of key components or contributory factors. Also, unlike the other E/M codes, CMS did not provide documentation requirements for CPT code 99211 in the “E&M Documentation Guidelines”.nnAmong other reasons, code 99211 should not be used to bill Medicare/Secure Horizons:n
Medicare Revalidation – Medicare requires that ALL enrolled providers and Suppliers to revalidate enrollment information every 5 years. The revalidation initiative is currently in process and will continue through March 2015. You have 60 days from the date of the revalidation notice to submit your application(s).nnProviders are required by regulation to submit updates and changes to enrollment information in accordance with specified time frames. Reportable changes include: 1) Change in legal business name, 2) Practice location, 3)Ownership, 4) Authorized/delegated official, 5) Changes in payment information such as changes in EFT information and, 6) final adverse legal actions.nnFailure to comply with any of these requirements in a timely manner may result in Medicare billing privileges being deactivated.nn nn
nnIn order to power this increased resolution, the new iPad has an A5X processor which is quad-core meaning apps will run quicker. Initial reports suggest that this iPad will ship with 1GB of RAM which means the overall ease of use, multitasking and switching between apps will be improved. Furthermore, the faster processor could help with screen sharing and remote control apps (e.g. Citrix) and remote virtual apps (e.g.OnLive) which could open up more tablet EHR options. The improved graphics processing capability will help improve 3-dimensional modelling such as that seen in the Visible Body or the NOVA anatomy apps.nnThe next major feature which will impact physicians is the introduction of voice dictation. Whilst Siri is noticeably absent from the new iPad, there is now a button which allows the user to dictate. This obviously has numerous medical applications from recording patient notes and entering data into EMRs to dictating letters. It will be interesting to see if the voice dictation feature can cope with medical terminology although regardless, data entry speed is sure to be enhanced. This introduction of voice recognition also paves the way for Siri integration in a future update.nnThere is an enhanced five MegaPixel camera in the new iPad which is similar to the one found in the iPhone 4S. The enhanced resolution of this camera combined with the improved graphics processing in the A5X chip means that the iPad has the potential for improved integration and usage in telehealth care. The new iPad has the ability to record video in 1080p HD resolution which would offer increased resolution in a telehealth care setting.nnAnother major feature announcement is that the new iPad will have high speed 4G LTE internet available on both major carriers, Verizon and AT&T, although you will have to purchase a specific iPad depending on your carrier. High speed internet combined with the increased graphics capability and camera resolution is sure to have numerous applications in telemedicine and mHealth in general.nnIn adnnThe iPad model allows healthcare providers to connect to Bluetooth-enabled medical home monitoring devices that collect patient data. Specifically, Bluetooth-enabled medical devices such as stethoscopes, blood pressure monitors and pulse oximeters can measure a patient’s diagnostics and securely transfer the data to the iPad.nnData from these medical devices can also be quickly added to a patient’s electronic health record or to a personal cloud-based health record such as Microsoft’s HealthVault, either or which can now be monitored remotely by a physician with an iPad.nnSource: www.imedicalapps.com; Tom Lewis; March 7, 2012; www.beckersasc.com
PAHCOM Shares Knowledge!nFounded in 1988, PAHCOM is a national organization dedicated to promoting professionalism in physician office practice management by providing professional development opportunities including continuing education, networking, online tools & resources, and nationally recognized certification (CMM) for health care office managers.nnOctober 16, 17, 18, 2012 Susan and Todd speak at PAHCOM’s national meeting in Clearwater Beach FloridannPAHCOM