Merging or integrating a practice with a larger health system or hospital means an increased chance for organizational silos and decreased collaboration. Matrix reporting structures, which involve employees reporting to more than one supervisor to provide more effective management, are a remedy for streamlining information and improving communication after integration. Although matrix reporting can help eliminate the miscommunication and inefficiencies that arise in larger, more complicated organizations, it isn't just for large systems; small and mid-size private practices can implement aspects of matrix reporting to enhance communication among staff and ultimately improve patient care.

Direct line supervisors vs. dotted line supervisors
Direct line supervisors are traditional supervisors who manage the performance of their direct reports and who determine job responsibility and compensation. Dotted line supervisors are horizontal connections between two staff members, and one may not technically report to another. Horizontal connections usually imply mutual reporting, with both people working together to achieve similar goals. Examples of horizontal connections could be two front-office staff members or two nonphysician providers. One doesn’t report to the other, but they’re accountable to each other to improve their areas.

Identify where dotted line supervisors reside in your practice. Direct line supervisors should be aware of their employees’ dotted line supervisors to understand the scope of their staffs’ workload and accountability.

Miscommunication and accountability concerns are common when staff members get direction and feedback from their direct line supervisor, their dotted line supervisors and other staff members. For example, your billing personnel may work regularly with the front-office staff on patient payment plans, but you, the administrator, may not know that.

They may each report to you, but they’re each others’ dotted line supervisors. Make sure they communicate to you the protocols they establish together. You can accomplish this through regular staff meetings, huddles, or one-on-one appointments between you and individuals.

Staffs of smaller medical practices are more to likely to have jobs that overlap with one another since there are fewer internal resources and staff members often have to cover for one another. In larger groups or integrated delivery systems, however, staffs tend to have more clearly defined positions and less opportunity to understand their colleagues’ roles. If time allows, have staff members train, or shadow, staff from other areas of the practice for a day.

By experiencing first-hand what their co-workers do every day, staff members may be able to identify new solutions for common problems and reduce interdepartmental misunderstandings. This could be especially true for schedulers and front-office staff to learn more about the clinical processes in a practice, and vice versa. It’s also a chance to see how their two jobs intersect and find out ways to work together more effectively.

For more information on matrix reporting structures, read “Gearing up for change” in the May/June issue of MGMA Connexion magazine. View a diagram of a matrix structure online on virtual Connexion.

What are examples of dotted line supervisors in your practice? Share in the comments section below.

When managing patient flow, dealing with staff issues and figuring out how to get paid, every minute counts. By making a few small changes in your day-to-day operations, you can free up provider time, streamline your front office processes and create an opportunity to chip away at your own to-do list.

Do you have more cancellations on Fridays or more no-shows around lunch time? If you can determine when cancellations, no-shows or last-minute rescheduling happens most frequently during the week, you can double book or overlap appointments, eliminating open space in the schedule.

Before patients arrive, gather your administrative and clinical staffs together to review the day’s schedule. This is an opportunity for staff to give share details about patients that may affect other staff members’ time. For example, if a patient mentions on the phone that she's bringing a list of questions, the front office staff employee who took the call will be able to communicate that to the clinical staff in the morning huddle so that they can manage their time appropriately.

As an administrator, you wear many hats. This also means your staff comes to you for help and answers on just about anything. Unless it’s an emergency, encourage them to save questions and discussions for daily huddles or weekly meetings. A quick question can turn into an hour-long discussion, which, over the course of a week, can take up a lot of your work day.

Some providers may prefer a heavy schedule at the beginning of the day, while others may want a steady stream of back-to-back patients all day. Train your front office staff to schedule accordingly so providers don’t get over or underwhelmed by a schedule that doesn’t fit their needs.

Train front office staff to get as many details as possible from patients' about why they're booking an appointment. When appropriate, NPPs may be able to handle appointments and free up physicians to treat more time-consuming, complicated patient cases, potentially generating more revenue for the practice.

Clear expectations reduce duplications and confusion and ultimately save time. This is true whether you're dealing with expectations in employee performance plans or the expectations of day-to-day tasks. 

How do you improve your practice’s (or your own) time management? Share in the comments section below.

Visit our solutions pages for resources on staffing and   patient flow.

Before Google, hypochondriacs had to flip through books or drill their physicians about what their symptoms could mean. Now anyone, not just hypochondriacs, can type their symptoms into a search engine and get a list of potential diseases and conditions they could be suffering from.

A February 2011 study indicates that eight out of 10 people use the web to search for health information, but only 25 percent of these searchers verify the credibility of the information they are reading. This can potentially spark arguments between providers and patients, extra-long appointment times because patients arrive with a stack of website print-offs and the potential for non-compliant patients who trust the web over their provider.

Here are a few ways to deal with self-diagnosers in your practice:

• Remind providers to be empathetic with cyber- or hypochondriacs. To them, their symptoms are real, and not taking their concerns seriously will frustrate them more. Praise patients for staying informed and be willing to discuss the information they bring with them.
• Recognize that patients are bombarded with mentions of potential medical problems through social media and advertising. It is not unreasonable for them to reference Facebook or Wikipedia during an appointment.
•  Encourage your providers to ask patients at each visit how they use Internet resources for their health. These questions could include:
  • “There are a number of ways to treat psoriasis. What medications or treatments have you heard or read about?”
  • “When you first noticed these headaches, did you do any research before scheduling an appointment?” 
• Provide resources for your patients that will ensure they go to your practice for advice instead of to a search engine. Or, teach your patients to search correctly using credible websites and sources, and share with them ways to identify unreliable sources. For example:
  • Pharmaceutical websites, medical device websites or websites with a lot of testimonials but little scientific information are all warning signs that you’re looking at an unreliable source.
  • Website advertisements can be disguised as content, so watch out for mentions of products or links to websites outside of the original source.
• Patients might seek information from the web because they don’t trust their provider’s advice or they feel as though their concerns were not taken seriously. Evaluate the provider-trust relationship in your practice, and encourage the front office and clinical staff to show trust in the providers.
• Be clear with patients about any potential side effects of new medications — or any symptoms they might experience as part of a condition you’ve already diagnosed. If your patients are warned that they might experience dizziness on a certain medication, then they will be less likely to Google their symptoms to see what pops up.

Read more about cyberchondria in last month’s issue of MGMA Connexion magazine.

How do you handle self-diagnosing patients in your practice? Share with us in the comments section below.

A clinic in New Jersey reduced its overall spending by 12 percent – all by putting the patient first.

A New Jersey organization that provides health benefits for Atlantic City’s 14,000 union workers was experiencing rising costs as a result of chronic disease care among members. In an attempt to lower healthcare costs by helping patients better manage their own conditions, the organization partnered with AtlantiCare, the largest healthcare provider in southern New Jersey, to create a clinic to serve the city’s union workers. In 2007, the Special Care Center (SCC) opened its doors.

The SCC’s mission to connect with patients and make them the center of their own health reduces duplication, improves compliance issues and streamlines patient care. Here’s how they do it:

Team huddles
Each morning all providers, health coaches, front office staff and administrators have a team huddle to discuss that day’s patients, including their care plans and all medical and psycho-social issues. Each provider reviews the patient’s chart in the EHR and they discuss the patient together.

Team huddles make it easier for providers to care for each other’s patients if someone is out or if they’re taking call, says Ines Digenio, MD, medical director, Special Care Center. They’re aware of each other’s cases and care plans. Discussing patients as a group prevents miscommunication and repetition of treatment plans later in the day.

Prescription drug management
The AtlantiCare pharmacy director is also an active member of the SCC team and provides ongoing support and communication to the clinical staff during morning huddles.

“The SCC couldn’t operate without the relationship with the pharmacy,” Digenio says. “The feedback they give us is invaluable.”

Every week the in-house pharmacy runs a report that shows how many patients failed to refill their medication on time, or did not pick it up at all. For example, if a patient receives a 30-day prescription for blood pressure medication but only refills it every 60 days, the pharmacy will alert the patient’s care team. The staff will work with the patient to find out why he or she is not taking the medication every day.

“Maybe they need home delivery or they’re experiencing a side effect that is causing them to avoid their medication,” Digenio says.

Regular communication with the pharmacy allows the care team to address medication compliance issues sooner, rather than just communicating with the patient, who may not be upfront about skipping doses or not picking up refills.

“If you ask a patient if they’re taking their medication, the answer is always, ‘yes’,” Digenio says. “In a traditional setting, the doctor may then think the medication isn’t working so they may prescribe a new, possibly more expensive one.”

Psychological services
Each SCC patient is assigned a health coach who works alongside the providers and guides patients through their care plans. The health coaches develop relationships with patients and their families, which make it easier for patients to discuss potential mental illnesses, too. The SCC provides mental health services to its patients as a part of its overall care and can set the patient up with an in-house counselor immediately.

Sandy Festa, administrative director, Special Care Center, says incorporating psychological services into patients’ care plans is important because unaddressed mental illness can cause patients to be noncompliant about other health issues.

“Patients can’t get better if they’re depressed or anxious,” Festa says. “It just prolongs care and uses more resources.”

The outcome
Since 2007, the SCC has seen positive patient outcomes, including:

• A 40 percent decrease in emergency room visits and hospitalization
• A 98 percent medication compliance rate
• An estimated $208 in payer savings per patient, per month

Payers join the capitated SCC program with the understanding that they will cover appointment co-pays and prescription medication.

“Covering that is cheaper than, say, a $20,000 hospital admittance,” Digenio adds. “It’s an incentive for the payer to join the program.”

The CEO of AtlantiCare will present the Special Care Center in a case study at the Forum on Innovation in Healthcare, May 22-23 in Dallas. 

Your billing staff ultimately controls the success of your revenue cycle. The most successful billing staff understands their individual expectations and those at the practice level. For you, the administrator, this means creating a detailed performance management plan and conducting regular skill assessments.

Before hiring new billing staff, ask potential hires to complete competency assessments in your practice management system (PMS). Most PMS software offers a test environment that doesn’t use actual patient data so potential employees can perform basic functions. It’s also helpful to assess their knowledge of general, insurance-related tasks, which may include:

• Determining eligibility
• Interpreting an insurance card
• Explaining a statement to a patient

Conduct periodic competency assessments for current staff, as well. Changes in billing and collection regulations, updates to your PMS and revisions in payer requirements all necessitate ongoing training. Incorporate these assessments or additional training in staff performance management plans.

As a part of the performance management plan, regularly monitor employee-specific performance indicators. Common indicators to track on a weekly or monthly basis include:

• Aged accounts receivable (A/R) by payer
• Percentage of A/R by payer greater than 90 days
• Bad debt percentage by collector responsibility
• Account adjustments by category

You may also want to establish specific expectations for indicators that align with practice goals. For example, keeping the percentage of A/R greater than 90 days at less 20 percent. At the end of the quarter or year, conduct a performance review with each billing staff member and discuss how he or she performed on these indicators throughout the allotted time period.

Creating incentive plans for billing staff may seem simple since their back-office work is based on data and is easier to track. However, it does not recognize that all practice staff contribute to the success of the revenue cycle. Instead, you may want to implement a revenue cycle incentive plan that involves the entire staff of the practice.

In one practice-wide incentive plan, you set of goals or results you want staff to achieve with certain parameters (e.g., daily patient volume) and attach a number of points for each one:

              Source: The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting Paid

Set a dollar amount for the number of points earned and communicate that to staff each quarter based on the profit from the previous quarter. See other examples of revenue cycle incentive plans in The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting Paid.

How do you keep your staff accountable? Share it in the comments section below.

More from the In Practice Blog:
The thief in your practice is most likely your most trusted, loyal employee
Increase revenue by improving billing functions

Businesses can spend thousands (if not millions) of dollars every year attempting to capture information about their customers, efficiency and bottom line. But you don't have to do that. Widespread adoption of EHR and practice management software means that many medical practices have this information at their fingertips – they just don’t use it.

 “The data you have in your practice is an asset,” says Nate Moore, CPA, MBA, CMPE, president of Moore Solutions Inc., Centerville, Utah. “Practice management and EHR software are going to capture the information, and it’s going to spit back the data you need to attest and get meaningful use measures for the Health Information Technology for Economic and Clinical Health (HITECH) Act. The software’s sitting on all that data — and a ton more.”

In "Using data wisely," an article in the April 2012 MGMA Connexion magazine, Moore mentions several ways you can use this data to help improve your practice’s level of efficiency, your patient care and even your bottom line. Just crunch these numbers:

• “The low-hanging fruit is the financial-related information,” Moore notes. How long does it take to collect from certain payers? What are their rates of denial? How many days do claims stay in accounts receivable (A/R)? Are there patterns you can trace for the claims that stay in A/R for the longest amount of time?
• Look at your appointment information. “If you understand appointments, you can understand where your no-shows are coming from and where new patients are coming from,” Moore says. “Is a patient less likely to show up if they made the appointment yesterday? Or are they less likely to show up if they made the appointment two months ago?”
• Have physicians slice and dice the clinical data. “What treatment protocols are you using?” Moore asks. “Which protocols are more effective in terms of curing the patient? What side effects might occur from different protocols?” As you gather this data over time, you can start to compare how different protocols measure up – and learn which protocols are most effective in terms of outcomes.
• Moore advises practices to think about how you can integrate what you know about your patients with what you know about the clinical side and the financial sides. For example, cross-reference your phone records with your payer information: How much time do you spend on the phone with various payers?  Compare that information with the level of reimbursement you receive from each payer. Analyze whether you should consider re-negotiating your contract with a particular insurance company.

Moore will speak at the MGMA 2012 Annual Conference in San Antonio. Registration opens April 17.

Read Moore’s article, “Using data wisely” online on virtual Connexion.

When assessing the best way to evaluate, track and report accounts receivable (A/R) in your practice—and how that metric fits into the larger financial picture—some professionals debate the value of re-aging accounts, says Sarah Holt, PhD, FACMPE, who spoke at the MGMA 2011 Financial Management and Payer Contracting (FMPC) Conference in Scottsdale, Ariz. in February.

“To do it effectively you have to be an interactive problem solver,” explains Holt, administrator of several healthcare organizations in Cape Girardeau, Mo.  She cited a lively debate on the MGMA Member Community about re-aging accounts and how that fits into the larger A/R umbrella.

Questions posed on the thread include how and when to re-age accounts, when to write off collections and when something should be classified as bad debt vs. contractual allowances.  The article “Don’t be deceived by billing metrics” in the April issue of MGMA Connexion magazine delves into these issues.

And while Holt says “there is no magic bullet” to creating a positive financial picture there are different opinions on how accounts should be classified once transferred from different payer buckets. And when collecting from patients, customer service issues should be a priority.  

 As soon as a patient appointment is complete, that claim enters into the aging process. Each section of the aging process, or aging bucket, holds claims that have been in existence for a certain number of days. This graph shows how a practice may divide its aging buckets of unpaid claims by payer:

Source: MGMA Medical Office Billing: A Self-Study Training Manual

Some practices “re-age” outstanding patient bills to zero days when they are shifted to patients for payment, which can avert patient confusion and frustration, Holt says. For example, if you do not re-age invoices, patients may receive bills that show overdue balances of 90 days or more.  

“Patients can become furious,” she adds. In addition to concerns over how the bill will affect their credit rating, patients may start to question how a practice is run. “You don’t want to do anything that jeopardizes the trust between the patient and the practice or the patient and the doctor,” Holt says, “and you do not want to deal with a patient who begins to think, if I can’t trust this practice’s finances, how can I trust the medical advice?”

To avoid that scenario, Holt encourages front office professionals to talk with patients before they leave the building about how outstanding balances will be paid, and explain how the billing system works so they are not surprised when they receive bills.

“It’s a patient-friendly thing to do,” she adds.

The aging metric should also be seen as one piece of the A/R puzzle, says Holt, who wrote Get the Money in the Door: Physician Billing Basics. It’s a quantitative process that should be considered within the context of other benchmarks, including RVUs, collection rates and denial rates that are checked against the practice and compared with other practices.

It’s also helpful to trend payers and see which companies are not paying large sums. Holt meets weekly with collections staff to, as she says, “find out what went down, what went up and why.”

For more advice on A/R, read the online exclusive article “Capitalize on the time value of money: Fine-tune your A/R” in the April issue of MGMA Connexion  written by Deborah Walker Keegan, PhD, MBA, FACMPE; and Elizabeth Woodcock, MBA, FACMPE, CPC.

Visit  our billing solutions page for articles and free downloads to improve your practice’s A/R.

Web-based patient portals that interface with your EHR can further improve your practice’s productivity, streamline patient communication and ultimately improve patient satisfaction.

Involving your patients in their own care means enhancing communication and accessibility. Web-based patient portals provide a secure way to connect patients to your practice 24 hours a day and have the potential to cut down on patient call volume.  Here’s what you need to know:

Connecting to your EHR

Cherie Stutesman, MGMA-ACMPE member and director of operations, Mt. Baker Planned Parenthood, Bellingham, Wash., implemented her practice’s patient portal two years after implementing an EHR.

Stutesman’s portal has the functionality for patient-clinic communication, lab results, medication lists, problem lists, online bill pay and prescription renewal requests. Once an item in the EHR is electronically signed by a provider, it’s available for viewing on the patient portal in a summarized format.

“It’s changed the way we look at communicating with patients,” she says. “It’s learning about what they want and how they want to get it.”

Stutesman says her practice’s portal allows patients to manage their health on their own time.

”We found right away that most of our patients are on the portal from 10 p.m. all the way to 3 or 4 a.m. making payments, sending messages and requesting appointments,” she says. “It works for them because they don’t have to wait until we’re open and risk sitting on hold.”

Avoid information overload

Stutesman’s portal summarizes notes from the EHR, so patients only see a limited amount of their health information, but other systems have the ability to upload a duplicate of the patient’s chart to the portal.

Robert Tennant, senior policy advisor, MGMA Government Affairs, says practices should be careful when determining what information to allow patients to access from the portal.

“There can be issues with giving unfiltered information to patients,” he says.

Giving patients too much information without explanation from a clinician, such as negative test results, can unnecessarily worry them and may encourage more phone calls, Tennant says, which is the opposite goal of a patient portal.

“Give your patients plenty of context for the information you provide,” he adds. This may include providing high, normal and low guidelines for measures such as blood pressure or cholesterol.

Establish a process for informing patients about portal

Once you implement your patient portal, the next challenge is to get patients to use it regularly.

Wendy Peterson, MGMA-ACMPE member, practice administrator, Women’s Health Specialists, Yuma, Ariz., randomly offers a gift card to a portal user every month as an incentive for people to submit their patient paperwork online.

To help market her portal, Stutesman plans to include messaging about the portal in all patient communications, including appointment reminders, follow-up letters for annual exams and immunizations and bills.

Stutesman also says implementing a portal included establishing the practice protocol for all of the portal features.

“We had to look at every step that a patient could take on the portal and make sure there’s someone on the practice end to facilitate that request,” she says.

This means developing a way to triage messages from the portal (front office vs. clinical), manage prescription refills from the portal and accommodate appointment requests.

Patient portal functions may include:

• Appointment requests
• Appointment pre-registration
• Prescription renewals
• Access to lab results
• Access to medical records
• Patient education and self-management tools
• Medication lists
• Pre-screening and surveys
• Bill paying
• Secure online communication
• Online office visits

Also, be sure to explain to patients that while the portal is a secure environment, access to their health information is now available outside of the practice.

“We have a lot of patients seeking confidential services,” Stutesman says. “So it was important that we explained that someone could access their health record if they reset their password via email and someone else read it.”

Stutesman has each patient sign a consent form before setting them up in the portal that explains all potential risks associated with the portal as well as what information is available to them. She also includes portal audits in her practice’s risk management plan and established “lock out” protocols for entering an incorrect password too many times.

Consider ROI

The proposed rule for Stage 2 of the meaningful use EHR incentive program includes providing patients with the ability to view online, download and transmit their health information within four business days of the information being available to the eligible professional (EP). Utilizing an online patient portal is one option for meeting this requirement.

Practices may see this as an incentive to implement a patient portal by the 2014 deadline. However, Tennant recommends that practices take a close look at the cost-benefit of implementing a patient portal.

“For example, if a patient portal costs $25,000, it might not be cost effective for the practice to implement a portal. They might be better served exploring other options of meeting this meaningful use requirement,” Tennant says.

Tennant also encourages practices to assess their patient demographics before considering implementing a patient portal.

If you have a significant elderly patient population, he says, do you anticipate that they will take advantage of online portal functionality? Be sure to ask your patients if a portal is something they would benefit from and whether it’s worth pursuing.

Know the difference between a PHR and a patient portal

The key difference between a patient portal and personal health record (PHR) centers around ownership of the data. Typically, once data is entered into a PHR from a patient or provider, it belongs to the patient in a system of the patient’s choosing, whereas patient portals are managed by the medical practice and they continue to control ownership of the data.

MGMA-ACMPE partnered with several healthcare organizations to create two brochures, one for patients and one for clinicians, to educate them about the benefit of PHRs. The brochures include screen shots of PHRs and testimonials from patients and industry organizations. 

The challenge

Before we moved to an EHR our practice stored more than 22,000 paper charts on active patients. We also had 570 boxes of inactive-patient records stored at an off-site document management facility, which freed up office space but was not a solution for handling long-term records storage. We spent $6,000 a year on maintaining and retrieving charts from the off-site storage space. In addition to the efficiency and financial incentives of implementing an EHR, eliminating paper records would:

• Allow the practice to convert the chart storage room into three additional exam rooms
• Eliminate the cost of maintaining the off-site storage of inactive records

The practice needed to build the electronic medical record for existing charts as quickly as possible and retire the paper charts. This would minimize the amount of time the practice would operate in a hybrid paper-electronic environment.

First steps

1. Four months before our EHR go-live date we developed a multidepartment team consisting of a physician, myself and other key staff to define the paper chart transition strategy
2. The team reviewed the process flow of paper charts and staff access to them, as well as the definitions for active and inactive patient records
3.  The team determined that the electronic charts should be organized a way that was intuitive for providers

Alternatives considered

This seemed like the easiest option since there would be no additional costs with keeping the charts in the current file room, just the ongoing costs of maintaining an off-site storage facility for inactive records.

Scan the entire paper chart
Benefits of scanning the paper chart included:

• Minimizing or eliminating the need to pull the paper charts for viewing historical data, enabling the chart to be retired sooner
•  All records would be maintained in the same location, reducing the risks associated with a hybrid paper/EHR environment
• Once we scanned the medical records they could be destroyed, freeing up space in the file room for other purposes

This option would eliminate scanning costs, but the paper chart would still be necessary for reviewing historical data. It also would not allow for one complete medical record and would require the practice to continue to maintain paper charts for active patients. Lastly, data entry could require additional staff.

Chosen solution

The physician partners and I decided to have staff members scan the charts as patients came in for appointments, which would reduce the number of charts that need to be converted at one time. Charts for infrequent patients would be stored for the appropriate retention period and then destroyed.

This option would:

• Reduce risks associated with a hybrid paper/electronic record by having the entire medical record in one place
• Retire the paper charts as patients came in for services, thereby reducing paper chart handling costs
• Allow old charts to be professionally shredded, clearing out much-needed space in the practice

Staff started patient account entry two months prior to EHR go-live by active patients. The practice information technology (IT) staff and EHR vendor programmed and established how and where the scanned data would be stored and managed. The document management vendor provided protocols for what to expect in terms of access to the paper chart during scanning, how the record could be accessed after scanning and quality control methods. Practice management established written scanning protocols.

Lessons learned 

• The practice should have allowed more time for the chart transition planning and preparation prior to the EHR go-live date
• Work flow for each provider is different, which resulted in different methods for entering the information into the EHR
• We trained staff to prep and scan the paper chart two days prior to the scheduled appointment. This is not always possible since the practice offers same-day and walk-in appointments. In those cases, the paper chart was used.
• We found that EHR vendors only educated the practice on costs associated with their part of the EHR implementation. By interviewing evaluating and comparing costs, conversion methods and references for multiple document management vendors, we selected one who is local and helped us manage costs.

Removing the paper records from their storage space in the practice gave us room for three additional exam rooms, which could potentially result in $481,950 in additional gross revenue based on provider productivity.

More from the MGMA In Practice Blog:
How ‘better-performers’ use their EHRs

Simplify your EHR implementation

Practice administrators have the unique challenge of managing the work of their staffs and managing their bosses, who are often practice owners. While dealing with the ups and downs of physician behavior is an assumed part of the job, inappropriate or disruptive behavior from physicians can cause decreased morale and low staff retention. And some of the problems may be related to unwieldy egos, says Rosemarie Nelson, principal, MGMA Healthcare Consulting Group.

The good news is that you can have a positive impact. Altering the way you approach disruptive physicians can lower their defenses and set a good example for your staff.

Identify disruptive behavior
Disruptive physician behavior, which can take different forms, may include:

• Abusive language
• Unnecessary sarcasm or cynicism
• Blaming or shaming others for possible adverse outcomes
• Defiant or uncooperative approach to problems

Assess your own behavior
Nelson suggests putting a physicians’ needs first is the best way to achieve success.

“If you have physicians who need to have the last word, let them have it,” she says.

In other words, do not let your need to assert yourself get in the way. As long as the physician’s vision aligns with what’s best for the practice, be on his or her side, Nelson adds. As owners of the practice, they have a much larger stake in its success, which also adds stress. Acting defensive or critical toward them will just exacerbate the negative behavior.

Read Nelson’s article, “When dealing with ego problems, start with your own” in the April 2012 issue of MGMA Connexion magazine.

See it from their perspective
Let’s say a physician is dealing with the stress of a newly-implemented EHR, just finished a busy overnight call shift at the hospital, recently found out about a patient who is threatening a malpractice suit and arrives at the office to see the front office manager texting on her cell phone. A simple “please don’t use your cell phone during busy hours” request could turn into a scolding from the physician.

While there is not always (or ever) a valid  excuse for disruptive behavior, understanding it may give staff insight into what the physician is dealing  with, which can soften the blow.  Communicate those sometimes invisible factors to staff so they’re sensitive to the physicians’ needs and stress levels.

Understand their style
If a physician regularly asks for data to justify purchases, come to meetings prepared with estimates that outline return on investment or benchmarking information. If a physician enjoys participating in strategy planning and identifying long-term goals, allow them that creativity instead of asking them to focus on day-to-day operations, such as call schedules or dictations.

Create incident protocols
Some disruptive behavior can be managed, but if it escalates and crosses the line into harassment territory, it is important to have a process for documentation, including an incident report and a verbal warning report form. Below is an example of the latter:

Find examples of incident report forms in Physician Policies: A Practical Guide to Governance Issues.

Satisfied patients are loyal patients. Dissatisfied patients can verbalize their dissatisfaction to anyone who will listen, such as a practice review website, so it’s important to stay on top of how your practice is (or isn't) satisfying the people who walk in the door.

Here are a few tips for improving your patients' experience:

• Consider ways to garner their feedback. Your patients could be dissatisfied with your practice, and you might not even know it. Suggestion boxes, follow-up phone calls and patient surveys are all ways to measure how you’re doing – and what areas of your practice could use some polishing. According to the MGMA Performance and Practices of Successful Medical Groups: 2011 Report Based on 2010 Data, 61 percent of better performers used survey results to evaluate and improve practice operations, making this information a powerful weapon in your arsenal to increase patient satisfaction.
  Read Tips for creating a patient satisfaction survey
• Improve access to your practice. This might mean expanding or shifting your hours for patients' convenience, opening the practice one Saturday a month, or perhaps providing a (secure) patient portal where patients can book appointments and download their medical records. (A portal could come with the added bonus of freeing up some time for your front-office staff to  improve patient flow.)
• Examine how your practice could be better organized. When staff members spend time tracking down small details, it stresses everyone out – and the patient often has to wait, which is never ideal. Make sure your charts and appointment logs are well-organized, and that any vital pieces of information are easy to find and retrieve.  For example, asking a patient for his or her demographic information over the phone, then asking the patient to repeat that information when he or she presents to the appointment, is an inefficient use of your time.
• Expedite the check-in process. The waiting room is usually the last place a patient wants to be, especially if he or she is not feeling well. Verify insurance coverage in advance via a patient portal or over the phone. Anything you can do to decrease the time your patients spend waiting around will help improve their overall satisfaction with their visit.
• Teach your staff to apologize. This seems like something everyone knows intuitively, but assigning blame (“Sorry for the inconvenience; that lab is notorious for losing test results” or “I’m sorry you have been waiting – your physician is always late”) is not productive. Apologies should be sincere without shifting blame elsewhere. “I am very sorry we did not meet your expectations today. Thank you for bringing this issue to our attention!” is a good, catch-all way to smooth ruffled feathers.

The March issue of MGMA Connexion magazine featured an article by Robert C. Bohlmann, FACMPE, principal consultant for MGMA Health Care Consulting; in the article, Bohlmann discusses how investing in staff morale can improve patient satisfaction. In a follow-up article that can be read only online via virtual Connexion, Bohlmann outlines how MGMA-ACMPE member Jan Reid, chief executive officer of the Orthopaedic Center in Tulsa, Okla., has invested in team members to foster outstanding patient relationships. Read the articles for more insight on how your practice can follow in Reid’s footsteps.

Check out our patient flow solutions page for more articles and resources.

Whether you're interviewing for a new position, got a promotion or it's just time for a raise,  making a plan before you approach your superior about compensation plan or a pay raise is crucial. This includes bringing industry data, such as peer benchmarks, to the negotiating table.

“Your position won’t be ‘you know, the cost of gasoline has gone up, so I probably need to make more money,’” says Ken Hertz, FACMPE, principal consultant, MGMA Health Care Consulting Group. “But rather, ‘here’s what my colleagues in this profession are earning’.”

Before requesting an increase in salary, there are a few things you should know and be aware of.

Know your local market

How difficult is it to find people with your education, background and skill set? This may depend on where you work (a large city, suburb or rural area) and the organization in which you work. If a position like yours is in high demand, take that into consideration when asking for a new salary.

It’s also important to know your organization’s raise and bonus practices. Hertz says it’s appropriate to ask about this in the interview process. Some questions to consider:

• How is compensation handled for this position?
• Is there a board evaluation involved?
• What is the typical range for bonuses or raises?
• What have the raises been for this position in the past three years?

Know your benchmarks

“Whether your boss is an accountant or a physician, they always want data to back up what you’re asking for,” says Jeff Smith, MBA, CPA, CMPE, CEO, Pottstown [Penn.] Medical Specialists Inc.

The MGMA Management Compensation Survey: 2011 Report Based on 2010 Data (look out for the new survey report this summer) provides national compensation benchmarks for medical practice executives and senior managers. The report also gives data on the differences in compensation among titles, such as administrator vs. CEO, and how they vary across geographic regions and years of experience.

For example, a CEO/executive director of a single-specialty or multispecialty practice with 25 or fewer full-time equivalent (FTE) physicians in the eastern section of the United States has a median compensation level of $180,110 vs. an administrator of a single-specialty or multispecialty practice with seven to 25 physicians in the same region who earns $104,600, according to the MGMA Management Compensation Survey: 2011 Report Based on 2010 Data.

Additionally, taking a close look at your organization’s overall financial situation will give you a better idea as to whether a raise is possible based on revenue and other factors.

The Management Compensation survey report also takes education level into consideration when determining median compensation.  If you’re education level is not reflected in your compensation, this is something to bring up with your superior.

“This gives you a much better case to present to your doctors,” Smith says. “It provides you some ability to move from the median to the 75^th percentile.”

Read Title is just one factor in determining compensation from MGMA Connexion magazine for more management compensation comparisons.

MGMA-ACMPE members, use our Management Compensation Finder Tool to find median compensation based on region, education and experience.

Consider incentives

Negotiating your salary may include determining performance incentives in addition to a new salary. Your physicians or supervisor may ask you to create your own incentive plan, which is often based on practice revenue or profit.  Other incentive plans include:

• Maintaining accounts receivable days below a certain number
• Employee retention
• Reducing patient wait times

For more advice on negotiating your salary using MGMA survey data, download our new on-demand webinar, Management Compensation-Using MGMA Data to Negotiate your Salary, which is free for MGMA-ACMPE members.

While most health practitioners know that patient safety is paramount, there is room for improvement, says Robin Diamond, MSN, JD, RN.

Diamond, who is senior vice president for the Department of Patient Safety at the Doctors Co., Napa, Calif., identifies safety and risk management loopholes in “Practice managers play key role in patient safety,” an online exclusive article in the March issue of MGMA Connexion magazine. In the article, she discusses a recent study by the Doctors Co. that identified medical record documentation, lab tests and referrals, patient scheduling and follow-up as areas where medical practices and hospitals can improve patient safety.

Out of 525 respondents in a variety of practice environments, 51 percent of them indicated that medical record documentation was a prevalent risk, Diamond notes. Some of the other top risks identified by the 2010 study include failure to document allergy status consistently and a dearth of lists chronicling patient problems or current medications. The good news sprinkled throughout the piece is that there are several ways practice managers can help lower that risk whether the practice uses electronic health records or a paper record:

• Document allergy information in the same place on all medical records. If the patient has no known allergies, then document no known allergies with the acronym NKA;
• Maintain a current list of medications patients are on, including herbal supplements and over-the-counter medications;
• Maintain a current problem list with dates of problem identification, review and resolutions;
• Use the patient’s own words in documentation;
• Ensure that all pages are organized and all forms are completed; do not use sticky notes or other loose papers for charting;
• Indicate in writing or electronically that all results of tests, consultants and referrals were reviewed, and maintain the reports in the same place in all medical records and
• Document all after-hours patient calls in the medical record

Forty-five percent of respondents also indicated that lab tests, referrals, scheduling and follow-up are further areas of risk. This could include providers failing to sign and review test results, not having a tracking system to ensure that ordered tests were performed and reports were received, or a lack of follow-up for missed appointments. To reduce your practice’s risk in these areas:

• Ensure that front office and clinical staff members know how to reconcile tests and referrals, and how to consult orders with the results when received. Establish a process to remedy discrepancies promptly;
• Communicate all test results to patients, including "normal" results;
• Tell the patient to contact your office if he or she does not receive results by the specified date;
• Use a recall system for patients who are regularly seen;
• Send letters to patients who fail to follow up and cannot be reached by phone; document correspondence in medical records and
• Use the test tracking capability in electronic medical records

The doctor’s office is one of the last places where patients should worry about their safety, so implementing procedures to ensure your patients are receiving top-quality care is important. To learn more about other risk categories our respondents identified and how those risks are broken down across selected specialties, as well as more tips on mitigating risk in your practice, see “Practice managers play key role in patient safety,” an online exclusive article from the March 2012 issue of MGMA Connexion magazine.

For articles, tools and free white papers on patient safety, visit our patient safety solutions page.

Mistakes made early in the revenue cycle can cause denied claims before they’re even submitted, and most of these oversights can be prevented before the patient leaves the waiting room.

Transposing account numbers

A billing staff member may transpose digits on an account number and post a payment to the wrong account, possibly causing a credit balance on one account.

“You should be recording your check numbers so you can find which account the check was posted to,” says Nancy Wilkes, vice president of revenue cycle management at UCI Medical Affiliates, Inc. in Columbia, S.C. She says practices should have the ability to search their systems by charge amount, which makes it easy to find the inaccurate charges and move them to the correct accounts.

Browse our billing resources.

Creating duplicate accounts

Wilkes says patients may intentionally create a duplicate account with your practice by changing their Social Security number (SSN) by a digit or giving you a new date of birth on their intake forms. This could be because they’ve already been sent to collections or they’re an addict trying to obtain prescriptions, but still want to be seen by a provider. A patient could also unintentionally prompt the front office staff to create a duplicate account, such as if a woman gets married and changes her last name without alerting the practice.

“Many practice management systems (PMSs) may not have the ability to determine what fields to key off of that may let you know there’s a duplicate account,” Wilkes says.

“Some PMSs alert duplicate accounts by SSN, but a lot of people don’t want to provide theirs.” Therefore a combination of name and address is the best indicator of a duplicate account. Run a monthly report in your PMS based on those factors to determine duplicate accounts.

Blending accounts

Transposing digits in account numbers can also cause two accounts to merge.  If your practice has two patients who are twins, running a report that alerts duplicate accounts may prompt your staff to blend twins’ accounts, since the date of birth is the same for each.

When running monthly reports to extract duplicates, run the report off of address and first and last names.

Incorrect demographic information

Wilkes says inserting incorrect demographic information (i.e., addresses and SSNs) is the most common billing oversight. This can be caused by illegible handwriting or missing fields on the patient intake forms.

“This can be especially true for urgent care practices since there aren’t a lot of return patients,” she says. “There’s not an opportunity to double-check an address or an insurance card policy number.”

Another possibility is when a friend or family member brings in a patient and tells the front office to bill someone else; this is especially true with children. Demographic information may be inputted incorrectly if the caregiver is giving information that’s not their own.

Giving patients the option to submit their intake forms online or via email will lower the chance of illegible handwriting and staff can more easily enter patients’ information into the PMS.

Wilkes spoke at this year’s Financial Management and Payer Contracting Conference in Scottsdale, Ariz. Her sessions, CSI Reporting – Unlocking the Secrets Behind Your Data, and CSI: Reporting Lab, outlined what crucial reports your practice may be missing and how to analyze those reports to improve your bottom line.

More from the In Practice Blog:

4 A/R problems and how to fix them
Increase revenue by improving billing functions

Last year we left you with an assessment of how the airline industry’s business decision-making parallels that of the healthcare industry in Does your practice offer complimentary peanuts? Now we’re looking at how, paradoxically, increased government regulation of the healthcare industry is producing results similar to those that arose from deregulation of the airline industry.

In 1978, the U.S. airline industry faced major changes thanks to deregulation. Before then, airlines were only allowed to serve direct routes as mandated by the Civil Aeronautics Board (CAB), established in 1938. After deregulation, new business models emerged, like the hub and spoke system, and consolidation and competition put the industry in rapid change mode.

Unlike the airline industry of the late-70s, today’s healthcare industry faces significant change because of increased government regulation. Oddly enough, though, it finds itself in a similar situation to the airline industry. No matter what type of practice you're in, you can learn many lessons from the airline industry in the 34 years since it was deregulated and apply those lessons to your situation today.

In the hub-and-spoke model that emerged after dergulation, an airline sets up a central hub (or several hubs) in an airport, and all flights travel through that hub to allow the airline to serve more cities with fewer routes.  For example, any time you fly with Delta, you will most likely fly through Atlanta, Cincinnati, or Salt Lake City on your way to your final destination. In healthcare, an integrated delivery system (IDS) operates under a similar model by offering care at multiple locations for the gamut of ailments. This model has the added benefit of centralized operations and staffing to afford operational efficiencies. For airlines, this equates to an operational savings of 15-20 percent over direct-route carriers. In medical group practice, the operational savings can be even greater. According to the MGMA Cost Survey for Multispecialty Practices: 2011 Report Based on 2010 Data, the median operating cost per full-time-equivalent (FTE) physician for non-hospital/IDS-owned multispecialty practices was $521,548, while it was $364,106 for hospital/IDS-owned multispecialty practices – nearly 30 percent less.

As important as the centralized business structure of hub-and-spoke and IDS models have been to their respective industries, keep in mind that five of the 10 largest airlines, all hub-and-spoke models, filed for bankruptcy in the last 15 years. The one consistently profitable airline since deregulation has been direct-route Southwest – it recorded its 33^rd consecutive profitable year in 2005, according to the Pandora Group – just as many medical groups today have successfully remained independent. It’s not just your business model that matters; operational successes and failures contribute to a successful practice.

For example, in 2007,Alaska Airlines ranked among the lowest in customer service among their peers, but with some thoughtful operational changes, it made the top of the list in 2011. They created a 50-point checklist that outlined service timelines and collected data on each point on the list. The checklist includes:

• Flight attendants must to be on board 45 minutes before scheduled departure
• Customer-service agents board the first passenger 40 minutes before departure
• 90 percent of passengers need to be boarded 10 minutes before departure

By virtue of tracking these metrics, they gained visibility and importance, and Alaska Air was able to go from worst to first in only four years.

If you are looking to improve operations in your practice, identify metrics that are important to the industry, your practice and your patients. These can include patient wait times, accounts receivable aging and patient satisfaction, among others. Once you’ve established those metrics, track where you are, benchmark against your peers, identify ways to improve your operations and service, and then start the process again to see if any measureable improvements were made.

Part one of this article explained many of the operations that help Southwest Airlines to be successful.  Even though they don’t have the inherent operational and service advantages of a centralized system, they are able to make up it with value-adds, such as “bags fly free.” Despite the fact that Southwest Airlines lost more bags than the industry average, their customer satisfaction scores continue to outpace their peers’. This shows that if you give your patients what they perceive as value, they will continue to be satisfied even when performance isn’t optimal.  This doesn’t mean that you can make up for leaving grandpa in the exam room all day by having a wider selection of magazines in the waiting room, but it does point to the fact that focusing on the right metrics, what your patients view as valuable, is a good place to start.

Do you think the healthcare industry compares to any other industry? Share it in the comment section below.

Julie Lineberger is the administrator of Idaho Urologic Institute in Meridian, Idaho, and her 10-physician practice was deemed a better-performer in the MGMA Performance and Practices of Successful Medical Groups: 2011 Report Based on 2010 Data.

The report highlights what makes a practice a "better-performer" in the areas of profitability and cost management; productivity, capacity and staffing; accounts receivable and collections; and patient satisfaction.

In Lineberger's practice's case, nine independent urologists came together in 2003 to take advantage of the resources and opportunity for specialization that group practice brings. Lineberger became the practice administrator during the group's formation and worked to create a cohesive culture and set of policies and procedures. All nine physicians brought their staffs into the group, so Lineberger was tasked with modifying benefits packages, salary structures and a creating new approach to staffing.

Nine years later, the Idaho Urologic Institute is a 25-exam room facility with an imaging center, stand-alone surgery center, 10 total physicians and two physician assistants. She and her staff pride themselves on having created an environment that is patient-focused and one that fosters staff recognition and opportunity.

Lineberger gave us some insight into her success that’s not featured in the survey report:

Q: What were the biggest challenges you faced with the group's formation?
A: We worked hard to address the structural challenges of creating policies and procedures, such as creating a medical records department and setting up a central billing office. The most difficult challenges we had to address centered on defining an organizational culture that would reflect the physicians’ values and create a cohesive and sustainable organization.

Q: Nine physicians who shared a call schedule with a larger group of physicians joined together to form your practice. How did they decide on each other? 
A: They picked each other based on how they treated each other’s patients while they were on call. So they already had a good baseline as to the level of care they could provide as a group, and that was the foundation for selecting each other. We had a meeting and it was a “Why are we here?” kind of meeting. My question was, “Who else do you want to see in this room?” and they looked around and said “everyone who we want to be here is here.”

Q: After merging, providers can be territorial about their patients and practice. Did you experience that?

A: Not entirely. Before the "integration," all of the physicians were general urologists, but as time passed, they each developed their own sub-specialties. One physician had a sub-specialty that was sacred to him before integration, so the rest of the physicians "gave" their patients needing that care to him. In turn, he gave the patients who didn’t fit into his specialty to his partners. It’s putting the patient first, even if it means it may hurt their bottom line.

Q: You mention the importance of culture in having a successful practice. Can you give an example of a staff member who is the right “fit” for your culture and how that affects morale and productivity?
A: Someone who contributes to a pleasant working environment, goes the extra mile to complete their duties and lends a hand to help coworkers. Someone who works collaboratively and cooperatively with others for the benefit of the patient and is always on the lookout for process improvement. When it works, effective and productive teams develop. Patients frequently comment to staff on our positive work environment.

Q: In the survey report you mention the importance of staff being able to “tattle” on themselves as a way to hold themselves accountable. Can you give me an example of this in your practice?
A: The other day I had a medical assistant (MA) who got busy and forgot to order a culture on a patient and then could not remember the name of the patient. He went directly to the physician and explained the situation and together they determined who needed the culture. Since the mistake was addressed quickly, the MA was able to contact the lab to complete the culture. In a less cohesive environment, this could have resulted in frustration on many levels.

To download a free copy of Lineberger’s practice case study, “like” us on Facebook.

If you transitioned to the HIPAA 5010 transaction standard and encountered few or no problems, congratulations. You're one of the lucky ones. Then again, you might have problems and not even know it yet.

MGMA reported last week that practices across the country have had a different experience, including New York Urological Associates.

“I have $100,000 worth of unpaid claims that I don’t know how to get a hold of,” says Janet Bernstein, MGMA-ACMPE member and practice administrator of the nine-physician urology group.

Bernstein, who transitioned to 5010 in September 2011, did not initially notice problems with her claims.

“We didn’t notice any problems right away because we weren’t getting rejection reports,” she says. “I thought everything was fine and didn’t understand what all the excitement was."

In early December she began receiving rejects on entire batches of Medicare claims. Other batches had partial payment.

“I couldn’t get anyone’s attention,” she says. “I really needed to talk to my clearinghouse, but my only contact was with my practice management system vendor.”

Bernstein eventually got in touch with the PMS vendor’s network director who assigned two staff members to her case. Her December claims were eventually paid in February.

“That ruined the end of my year,” she says. “Claims are usually paid within 14 days and I could have really used those funds by year-end.”

Providers and payers were required by federal mandate to use the HIPAA Version 5010 electronic transactions standards starting Jan. 1. However, the Centers for Medicare & Medicaid Services (CMS) announced last December that it would implement a discretionary enforcement delay until March 31. Version 5010, which replaces version 4010, is an updated standard used in healthcare billing software that can accommodate the more detailed ICD-10 codes, which are scheduled to take effect Oct. 1, 2013. The Association also submitted a letter to the Department of Health and Human Services detailing the problems many practices have encountered with 5010 and urging the CMS to take immediate action to solve them. MGMA encourages members to report their 5010-related problems.

Bernstein says her PMS vendor wrote a program for her that determined which claims had been partially paid and which ones hadn’t, stripped them of the billing control numbers that Medicare would recognize and rebuilt them.

“But I had to email them every day to get it done,” she says.

Bernstein says she is still gets regular denials for typical reasons, such as demographic or secondary payer issues. “When claims that are denied for a whole host of reasons, it's usually a problem with what’s going on between the clearinghouse and the carrier,” she says.

Bernstein says her problems are solely with Medicare. However, since only 25-30 percent of her claims are Medicare, her broader payer mix has prevented widespread financial problems for her practice. “If the commercial [insurers] start having issues, I may be speaking a different tune," she notes.

Other than the headaches the transition has induced in her billing personnel, no one in Bernstein’s practice, in particular her doctors, has been affected by the issues with the transition to 5010. That could change, though.

“To them, this is my problem, not theirs,” she says. “Unless it shows up in their paycheck.”

What has your 5010 experience been like? Is your story similar to the one above? Share it in the comments section below.

Read more about the Association’s stance on 5010.  

5010 action steps for your practice

We’ve compiled a few apps under five dollars to consider for your patients, physicians and yourself.

1) Sermo
Physicians can collaborate with their colleagues to swap opinions on patients, medications and devices in an online 120,000-physician community. Users can upload images and pose questions about specific cases or diagnoses and get feedback from their peers with the “iConsult” function. The company verifies credentials when physicians create free accounts, and they can begin interacting with other physicians.

2) MIM Mobile
This app is intended for remote diagnostic imaging when clinicians don’t have access to  computers. Clinicians can view their patients’ X-rays and ultrasounds from their phones or tablets. This is especially handy for physicians who travel offsite for surgeries or to follow up with patients. All health information is encrypted during transfer to meet HIPAA compliance, according to company information.

3) My Meds
The online drug resource drugs.com offers a medication reminder app and personal medication record. Users can store customized information, such as pharmacy contact information, photos of medications and prescription notes. The app’s database includes medical information on side effects, pregnancy warnings and drug interactions, and the interface allows you to set up scheduled reminders for each medication. The app can be used to help manage drug regimens, especially for chronic disease patients, and improve patient compliance.

4) ICD-10 HD 2012
This app allows users to access details for ICD-10 diagnostic codes and ICD-10 procedure codes, including all sub-codes and long descriptions. Users can add an unlimited number of common codes to a "favorites" list for easy access and search by code, diagnosis or category. Learn more about the Association’s policy on ICD-10.

5) ROI calc
This app from Legacy Data Access allows you to assess costs associated with the initial purchase and ongoing maintenance of technology systems. Costs are categorized by software support, internal support, environmental cost and disaster recovery. The calculator can determine overall return on investment by month or year, depending on how you customize it. This can be helpful in determining long-term costs of EHRs, computers for staff or new medical equipment.

Download the MGMA-ACMPE Member Community mobile app for your iPhone, Android or Blackberry smartphone. Use the app to interact with your peers by contributing to discussion threads, posting questions and accessing the member database. Instructions for downloading the app are available on “featured benefit” section of the Member Community home page.

Are there any valuable healthcare apps that we missed? Let us know what you use in the comments section below.

According to the new MGMA Performance and Practices of Successful Medical Groups: 2011 Report Based on 2010 Data, 82.6 percent of better-performers felt that their practices relied on electronic information systems to help provide effective care. Here are a few ways how.

63.54 percent of better-performers use problem lists as a part of their EHR functionality
If you’re in the process of trying to meet meaningful use requirements, or looking to start that process, maintaining an up-to-date problem list is a part of the stage one criteria of the Centers for Medicare & Medicaid Services’ (CMS) meaningful use EHR incentive program. This includes a list of current and active diagnoses, as well as past diagnoses, that are relevant to the current care of the patient.

Different EHR platforms offer different styles of problem lists. If you’re shopping for a new EHR, consider these questions:

• Are you able to link a problem with a CPT or ICD-9/ ICD-10 code?
• Does the EHR force you to use a code instead of a text entry?
• Does the EHR’s problem list link to the patient’s assessment and plan? This allows you to easily complete the encounter and bill for it. 

56.25 percent of better-performers have EHRs that integrate with their practice billing and claims systems
Integrating your EHR with your practice management system (PMS) can be incredibly challenging, especially with limited training time and room for error.

However, this integration improves front and back office efficiency, decreases errors and can eventually improve your bottom line. Integrated systems prevent having to enter patient demographic information twice (once in the PMS and again in the EHR) and automated alerts in the EHR encourage more complete claims without missing information. This diminishes the chance of denied claims and improves reimbursement rates.

Before purchasing and implementing an EHR, make sure it interfaces with your current PMS and any other devices or equipment in your office. If you have already implemented an EHR, talk to your vendor about integration with your PMS. There may be a separate interface you can purchase that will link your systems.

55.21 percent of better-performers have drug formularies available in their EHRs
EHRs that offer functionality for drug formularies, the list of prescription drugs that are covered by a specific healthcare plan, enable users to electronically check if drugs are in a patient’s plan’s formulary.

Similar to problem lists, stage one of meaningful use requirements asks that practices have access to at least one internal or external drug formulary during their EHR reporting period.

Learn more about better-performing practices and how they operate in the MGMA Performance and Practices of Successful Medical Groups: 2011 Report Based on 2010 Data.

Preparing for ICD-10 and 5010? Read five 5010 questions to ask your vendor and check out our meaningful use resources.

Have you implemented any of these EHR functionalities? How have they improved your practice? Let us know in the comment section below. 

• Accounts receivable aging report 
• Cost reports by department, provider and location 
• Income statement 
• Balance sheet 
• Statement of cash flow 

Practice management reports: 

• Collections system summary analysis 
• Untracked encounter forms report 
• Unbilled revenue report 
• Billing summary 
• Procedures analysis 
• Managed care plan profitability (capitation analysis) 

Q: I am interviewing for a group practice administrator position and would like some advice on evaluating the employment agreement they offered. What should I look for?

A: Signing an employment agreement is a good way to avoid surprises down the road and to start your position with a clear understanding of expectations, both from you and your direct supervisor. The major elements in the agreement should include:

Terms of employment

These confirm the position title, start date, period covered by the employment agreement, hours and reporting structure.

Duties and responsibilities

Make sure there is a list of position responsibilities. Pay special attention to any items that were not discussed in the interview or items discussed in the interview that were not included on the list. Consider adding duties or responsibilities that would fit the position and your skill set.

Compensation

Review any promises (bonuses, raises) made in the interview or offer process that are not included in the agreement.

Change of control and termination

Discuss termination arrangements in case the practice merges or is bought by a hospital and the administrator’s position is eliminated. This includes any severance pay and continuation of benefits.  

Q: How long do I need to retain medical records, especially if we convert to an EHR?

A: The American Health Information Management Association (AHIMA) recommends that adult patient records be retained for 10 years beyond the most recent encounter and that pediatric records be retained up to the age of maturity plus the statute of limitations. The AHIMA website provides state-specific information on records retention.

The Centers for Medicare and Medicaid Services (CMS) also has information about records retention for specific documents.

If you move to an EHR system, paper records can be destroyed. Electronic records should be retained for the length of time specified for paper records. Cloud computing and web-based software, instead of a hardware-based system at the practice, are a good option for storing space-heavy files, such as images.

For more answers to your practice management questions, read Experts Answer 95 New Practice Management Questions.

What are your top practice management questions? Respond in the comments section below.

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