Physiatry Billing – No Magic Bullet

What is a magical way to improve your billing and collection function? Unfortunately, there is none – no hidden secret, no “silver bullet.” However, adherence to several fundamentals will work just as well.

How to maximize upfront billings:

Capture all performed services! For outpatient services, medical offices usually employ a pre-printed superbill which can easily be misplaced. Suggestion: Match each patient on the appointment schedule to a corresponding superbill.

For each patient admitted to a rehab facility, there is usually an initial charge, regular followups, and ultimately a discharge code. Suggestion: Any gap in inpatient billings should be brought to the provider’s attention.

Simple data entry errors can cost the practice thousands of dollars. Suggestion: Have a second person, not the data entry person, check all data entry.

How to maximize collections:

Followup, followup, followup!

Pursue vigorously by telephone or in writing all insurance denials, and non-responses. Many billing personnel find calling insurance companies to be stressful and time-consuming, when in reality they are usually helpful in resolving problem claims. TELEPHONE FOLLOWUP IS A KEY COMPONENT OF THE COLLECTION FUNCTION. Suggestions: When calling the insurance carrier to reprocess the denied claim, get a reference number. When calling about a claim with no response, try to fax the claim.

If a telephone call cannot resolve the denied claim, then a written appeal should be sent. Suggestion: Design a preprinted Appeal Form which can be filled in with the necessary information.

Sometimes, the patient’s insurance information is incorrect. Although it is very easy to simply send a bill to the patient, it is not the most effective way. You have a better chance of collecting money from the insurance company than from the patient. Suggestion: Research thoroughly the insurance problem by calling the patient, and by calling the insurance company. Billing the patient should be the last resort.

As has been demonstrated, billings can be maximized by capturing all services performed.

Bruno Stillo,CPA is the owner of Physiatry Billing Specialists, 800-835-4482, physiatrybillman@aol.com

Who Owns the Practice?

The answer to this question will guide your practice life with any group. For several years, while managing physician relations for a local hospital, I recruited physicians for the hospital and affiliated medical practices. It game me an opportunity to view physician recruitment from both sides of the contracts negotiated. I think it beneficial to share some of my experiences and personal insights from those times. I once tried to recruit a physician who was moving back to her hometown. In the world of physician recruitment, we might call this “a perfect geographic match.” Ironically, she chose to sign-on with a local group rather than the hospital I was recruiting for because she said she wanted to go into “private practice” which seemed to represent an idealized practice autonomy. I asked her who owned the practice group. She didn’t know.

*Private practice refers to a privately-owned practice, especially one operating under s system of free enterprise or laissez-faire captalism. It describes a physician-owned practice, one that is not owned by an entity such as a hospital, and it is broadly used today to refer to solo and/or partnership practices of varying structures. Unless you hold some level of practice ownership, you are an employee and you need to identify your employers before you sign a contractual agreement.

* Identify the group’s short-term and long-term goals. This will help you decide if your goals match the goals of the group. If you want a busy outpatient practice then you must step in to fill a vacancy in a busy, established practice or your must build it. How will the group help you to do that?

I brought in one physiatrist who interviewed with the hospital CEO and administrators to consider an opportunity to either take over an established hospital-based and staff-supported inpatient/outpatient practice or to become a hospital employee with benefits. Benefits were the dealmaker, but at dinner the CEO offered an unplanned glimpse into the practice environment when he asked the physician her thoughts about his idea to restructure the inpatient unit. It was a very astute physician who later told me that the CEO wasn’t really asking for an opinion;he was simply trying to determine if she would buck him.

* You are primed to be an employee in a system when you can identify and happily live within an organizational structure that neither seeks nor desires your input.

I met with a physician who had just given notice to his group that he was leaving. He was extremely frustrated and had no alternative practice plan in place. Two years earlier he had signed a contract to join that group with the understanding that he would be offered a partnership. Time passed with minimal partnership discussion and he became so disgruntled that he finally made the decision to leave. As I spoke with him, it became clear that the particulars of that partnership had never been provided.

* A well-organized group will provide you with key information even before you ask. A group that is not organized will barely be able to respond to your questions. All groups fall somewhere along that continuum and you will want to gauge the level of the group’s organization since it will play a major role in your practice satisfaction.

Most physicians have a primary desire to practice medicine. Most would choose to forego the cumbersome paperwork and the persistence required to advocate for the patient when arguing with insurers. One physiatrist told me of the time spent in justifying the need for a wheelchair for a quadriplegic patient.

One physiatrist expressed an interest in building a part-time practice performing only EMGs. That physician was obviously well-informed about medical billing and he desired to build a practice with only high-level billable codes. If you entered into practice with this physiatrist on production-based compensation, what type of practice could you expect to build and how much money might you earn monthly?

- Determine the primary needs of the patient population in the practice area.

As an employee, you will receive financial compensation based on a salary guarantee, production, or a combination of both. A salary guarantee is an amount you can bank on, literally, and it may be a great way to start up your practice. However, no group will want to continue to pay you more than you earn. It just isn’t good business. That means it is expected that your gross charges will increase as you build your practice. Your earning potential will typically be tied to the revenue you generate (production-based) for your group and this is an important point to consider as you begin your contract negotiations.

Production is typically not the best option for a start-up practice for several reasons. It takes an investment of time and money to build a practice and this may be one of the most underestimated aspects of medical practice start-up.

Retirement benefits within a group practice may exceed those available in hospital-owned practices, a notable advantage. Group practices tend to invest the maximum allowable amount, $30,000 annually, into each retirement plan for each physician in the group. In some groups that money is self-directed so each physician can elect his or her own investment options independently of the group. Hospitals, however, have a different set of governmental guidelines as not-for-profit or for-profit entities, and are thereby limited in the amount that they can invest in the retirement plan for their employed physicians. In addition, there may be limited investment options for physicians in those plans. This is an important point to include in physician compensation when comparing practice opportunities and negotiating salary compensation.

By Kathy Jeffries, MyraPhyx A Physician Resource Group, myraphyx@mchsi.com, 573-680-3105

National Provider Identifier

NPI, stands for national provider identifier. CMS initiated this reform to simplify filing claims. The rest of the carriers are being forced to follow suit. The NPI will replace all numbers that you were previously using to file claims, i.e., your Medicare numbers, BC/BS numbers, etc.

The website NPPES (https://nppes.cms.hhs.gov?NPPES/Welcome.do) is where you go to create your login and password, and get your NPI number(s) issued. If you enter your information incorrectly, you will get denied on every claim you submit. The NPPES site has to match what your local intermediary has on file for you. Your clearinghouse has to match everything in their electronic file to send to the local intermediary.

Article contributed by Ken Lee, PRS, Inc., a physiatry practice management company to include billing services, kenlee@prsinc.com, 1-800-324-4777

Will Physiatry Employers Negotiate?

Yes, most physiatry employers will negotiate. That’s the obvious answer; everything is negotiable! Some items you can negotiate are the start date, some aspects of the work schedule and fringe benefits.

Some contract provisions are non-negotiable as all the doctors in the practice/hospital abide by these same provisions and it would be unfair to them and the practice/hospital to bend them just for you. These may include the productivity incentives and issues about termination.

Please note that some large organizations have standard contracts and will not negotiate.

Checklist for Preparing to Negotiate a Physiatry Doctor Agreement

PHYSIATRY CONTRACT NEGOTIATION

o Practice negotiation in daily life and for your contract negotiation
o Consider the contract terms from the employer’s perspective
o Set targets/goals for what would be the features of the best negotiation outcome (salary, benefits, etc.), the features of your
expected negotiation and the features of the least acceptable negotiation outcome
o Make a list of the strong points of you for the position
o ID how much risk you’re willing to take in the negotiation
o Do you have something special to offer, e.g. a business background, moonlighting, marketing activities?
o Is the compensation competitive?
o What is the compensation and incentive based on, e.g. productivity, quality, cost, etc.?
o How will the compensation data be collected and submitted?
o Does the sign-on bonus have pay-back requirements?
o When do the benefits (health insurance, etc.) start?
o What is the call schedule?
o Is there a basis e.g. payor for what patients you will see?
o What if any resources (PA, tech, etc.) will I be provided?
o Is the incentive attainable?
o Is there a restrictive covenant and, if so, what is its length, geographic limitation, etc.?
o What are the terms of terminating the contract?
o What type of malpractice will be provided?
o What is the contract term? Is it renewable? By whom is it renewable?

Burn-out among physiatrists high

A recent slideshow on MedScape says that burn-out is a major issue for physicians. 44% of physicians report burn-out. Believe it or not, physiatry is the third highest specialty reporting burn-out. It is only preceded by urology and neurology.

For more information, visit https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056#4

Action needed by 12/31/18 – MIPS Reporting for Physiatrists Working in Free-Standing Facilities

As part of MIPS reporting, providers are required to report under the “Promoting Interoperability” category (formerly known as Advancing Care which was formerly known as EHR(Electronic Health Records)). For most hospital-based providers, whose practice is in a free-standing rehab facility (such as Healthsouth), there is no capability of using an EMR system which satisfies CMS’ physician requirements – Healthsouth’s system does not meet physician reporting requirements.

In order to avoid losing 25% of points in the MIPS Scoring system, these providers can submit a very simple Hardship Exception indicating “Lack of Control over the availability of CEHRT.” If approved, the application will move the 25% scoring from “Promoting Interoperability” to “Quality,” thus avoiding a loss of 25% scoring in the MIPS program.
The Promoting Interoperability Hardship Exception application can be found at:
https://cmsqualitysupport.service-now.com/exception_application.do
The deadline is December 31, 2018, so there is still time to submit this simple application.

This information has been provided by Bruno Stillo, CPA, MBA, President, Physiatry Billing Specialists, 800-835-4482,
www.physiatrymedicalbilling.com
physiatrybillman@aol.com

What to Expect in a Physiatry Contract

Physiatry contracts may have many provisions such as the:

Term of the agreement
Termination terms – the number of days for notification of termination
Duties
compensation terms and how collection will occur
Benefits
Exclusive Employment, non-competition, restrictive covenant
Powers of the Hiring Entity
Relationship Between you and the hiring entity
Assignment terms
Amendments-how they’re handled
Confidentiality and medical records
Professional Policies and Procedures
Requirement to have hospital privileges
Admissions decisions

Physiatry Interview Questions That Reveal What Type of Person Will Get the Job

There are so many questions that you can ask during your physiatry job interview. Some of these questions can be found on my website under the Practice Search Tips tab. However, some of the most important questions are those that you ask that are ultimately about how well you fit the job and the job fits you.

During the interview you certainly want to be keen to listen to what is being said by the interviewer(s). However, you also want to use the interview to get the information that you want that isn’t being said. Of course, this requires preparation on your part.

Some of the information you want to obtain is about the nuts and bolts of the job. However, as much if not more important than the nuts and the bolts of the job are the subjective aspects of the job such as the type of person that the interviewer thinks will best fit it. The personality nature of the position is equal to and almost more important than the job itself.

Some potential questions to ask about the subjective nature of the job are:

What personal qualities are you seeking for in this position?
What type of person will best be able to fulfill the job responsibilities?
As you’ve come to learn more about me during this interview, is there anything about me that you have questions or even a concern about?
What type of person has been most successful in this position in the past?

How to Use LinkedIn™ to Build Your Professional Network

LinkedIn™ isn’t just another social media platform — it’s designed for individuals to make professional connections with each other. This interactive website allows you to expand your professional network to include colleagues you know and others in your field all from the ease of your laptop or PC. Forbes says it’s “the most advantageous social networking tool available to job seekers and business professionals today.”

Posting on LinkedIn™ is free. You can use it on your home computer or your cell phone.

LinkedIn™ was co-founded in 2003 by Reid Hoffman, the same man who was involved with PayPal. It has 500 million members from 200 countries, representing 170 industries. It was acquired by Microsoft in June, 2016 by Microsoft for $26.2 billion. It is the 34th most popular website. 27% of LinkedIn™ subscribers are recruiters. Hence, most of its revenue comes from selling access to information about its members to recruiters and sales professionals. Many Fortune 500 executives are on LinkedIn™. Now U.S. high school students are creating LinkedIn™ profiles to include on their college applications!

LinkedIn™ can be a fantastic resource to build your professional connections, even in an industry like physiatry. By connecting with the right people in this field, you can enjoy more business opportunities and add value to your professional credibility. LinkedIn™ is also useful when you’re on the hunt for new PM&R career options.

When you use LinkedIn™ to its full benefit, your name will begin popping up in other people’s professional networks, giving you more exposure in the physiatry field. However, you need to be selective on who you allow into your network.

Some Common LinkedIn™ Terms

A “connection” is someone who you know personally on LinkedIn™; in the real world, you call them colleagues. A “second-degree connection” is a connection that your connection has, said another way, a friend of a friend. A “third-degree connection” is a connection from your second-degree connection; said another way a friend of a friend of a friend.

A “profile page” is where you list your professional information. This replaces making personal contacts in the real world. You can include your education, work history, current and past projects, group and associations and more. All registered users can view it unless you set it as a private page. Users can forward your profile page to contacts on their lists. You can make your profile page public so that anyone (even people not on LinkedIn™) can view it.

“Recommendations” are just what it says, recommendations about you from others.

“Introductions” are when a third party introduces two people who weren’t currently connected.

“Professional network news feeds” are comments made by your colleagues. There are interest groups you can join on LinkedIn™. These news feeds are comments made by your colleagues in any of the professional groups that you’re a part of.

Pages on LinkedIn™

What are all of the pages and sections you might see when logged into LinkedIn™?

The Home Page shows recent posts from your colleagues (connections) and company pages you’re following.

The Profile page shows your name, photo, work, etc.

The My Network page lists all the people you’re connected with. If you hover over this option in the top menu, you’ll also be able to see a number of other options that will allow you to add contacts, find people you may know and find alumni.

The Jobs page is where LinkedIn™ recommends specific jobs to you based on your information.

The Interests page is where you can follow certain interests such as company pages and groups.

The Search bar allows you to filter your results down according to several fields. Click “Advanced” beside the search bar to find specific colleagues, companies, jobs and more.

The Messages page is where you can send a private message to a colleague. You can also add attachments, include photos and more.

The Notifications page is where LinkedIn™ notifies you when you’ve been endorsed by someone, invited to join something or welcomed to check out a post you might have an interest in.

The Pending invitations Page is when other people invite you to connect with them on LinkedIn™, you’ll get a note (invitation) that you’ll have to approve.

Why Build a Strong LinkedIn™ Network?

The value of an effective LinkedIn™ network is immeasurable. Connecting and engaging with the right people on LinkedIn™ will open doors for you and your business. Plus, your connections give you more exposure and put you in a position to add value to other members in your network.

To make LinkedIn™ an effective professional tool, it’s essential to give your account some time and effort. The results far outweigh the time invested in cultivating it. LinkedIn™ can provide you with exposure and access to talented people within your industry, allow you to attract new prospects and even help you to find the career of your dreams.

Tips on Making New Connections

Your LinkedIn™ network consists of connections you make with other professionals. You can create connections with colleagues and people you know in your field — or others who you connect with via LinkedIn™. However, to build your network of connections, you will need to put in some work.

Don’t stress. Finding new connections on LinkedIn™ doesn’t have to be difficult. After you’ve perfected your profile and it reflects you as a professional, you can build your network of connections in several ways. Here are some tips you can use to grow your network:

Start With Your Colleagues: The first people you should reach out to are your professional colleagues. These are people you have a good relationship within your industry. In the field of physiatry, this could include any doctors you may have met through conferences or meetings in the past.
Accept Requests From Others: As your network grows, you will inevitably receive requests from other professionals. This could be people you know or those you don’t. Be sure to accept these requests promptly — however, you don’t have to accept everyone. It’s okay to have criteria for the people you accept, such as they must have a profile picture and a certain amount of experience in your field.
Add Suggested Connections: LinkedIn™’s algorithm will help you find people who are appropriate for your network. You can use this algorithm to find people similar to those who you already have in your network.
Use Groups: Groups are made up of individuals interested in the same topics as you are. This is a considerable advantage, as you can look into groups of people that fit the criteria for those who you want to connect with. For example, if you are a doctor, then look for a group of doctors. You can even narrow this by specialty. Once you join a group, take time to see how the group works, introduce yourself and become an active and vocal member. However, don’t use the group to push yourself forward professionally.
Remember to Tailor Your Message: When you reach out, be sure to extend a personalized invite with an individualized greeting. Do not use LinkedIn™’s generic invitation, as it won’t reflect your relationship with this person.

How to Find Jobs

You can use LinkedIn™ for more than just building a network, too. You can find jobs on your newsfeed or you can type the name of a company or organization. Recruiters can use LinkedIn™ to find potential candidates by using the Advanced search tools and then make contacts and join industry-based group to created connections.

It’s also an invaluable resource for finding new career opportunities. But, you need to know how to utilize the platform to find a job. Here are two quick tips to help you find a job using LinkedIn™:

Make Your Headline Count: If you are seeking a job, you can use your headline to show that you are not just looking for employment, but also what you can offer an organization. Your headline is what people see when you show up in a search, so make it count.

Broaden Your Network: By expanding your network, more professionals in your field will see you are looking for a job. In fact, headhunters utilize LinkedIn™ quite regularly to find prospective employees.

How to Research People/Companies

You can use LinkedIn™ to find out more about the people and organizations you do business with. You can search for second-degree connections who work at a company you have interest in and then search for first-degree connections for an introduction.

Often the first thing interviewers before interviewing someone is to look them up on LinkedIn™! Remember, too, that you can review the profile of hiring managers. And, you can follow different companies to keep an eye on who’s coming and going. When you see someone leave a company you want to join, it’s the perfect opportunity to reach out to their HR department.

Information to Include on Your LinkedIn™ Profile

A few essential components are crucial to include on your LinkedIn™ profile. This will make it stronger and more effective, but it will also make it more likely for you to get a job from your network. Be sure your LinkedIn™ profile includes a profile picture, education level, past work experiences, skills and accomplishments. If you’re not sure what else to add, don’t worry. LinkedIn™ will recommend what to have on your profile, as well as let you know how strong it is.

Here are the basics that should be included on any LinkedIn™ profile:

Professional Headline – This is a generic description of what you do. Label yourself as what you would like to be, not your current job title. The headline is the key.

Current Position – If you’re out of work, remove the Current heading. Before you do that, though, cut and paste your previous company and job title into the “Past” section. Then click “edit” and “delete” and make the “Current” heading disappear.

Summary – Think of it as a way of selling yourself. Use this space to highlight who you are, what your skills are, and what your professional goals are.

Experience – Use active verbs, show results. Include past jobs and skills – be as robust as possible!

Education – Be accurate in listing your education. The rule of thumb in professional social networking: it may seem like a vast network of strangers, but the world is truly much smaller than you think.

Contact – Your profile won’t be useful unless you include your contact information! To complete the Contact information section go to the top of your LinkedIn™ profile to the Contact section. To edit it, click on the “See contact info” and a popup window will appear which offers you contact information options. You can also edit this info on your smartphone; the basic information is there but in a slightly different order and layout. Do not make your home address visible. Do not share your birthday, it is a key element for identity thieves, they can guess the year, the month and day are the hardest to guess. Yes, you will receive fewer birthday greetings, but that’s better than having your identity stolen!

Photo – Include your photo, as profiles with photos are viewed 7 times more!

Skillset – Why should you list your skills? LinkedIn™ allows recruiters and employers to sort by skills, years in the industry and more. Be accurate in your listing of skills.

Privacy settings – Just sign in and then select “settings” from the drop-down menu, where your name appears in the upper right-hand corner. Make sure to be discreet in your privacy settings if you’re looking for a new position so that your boss does not know.

Include Farr Healthcare’s President in Your LinkedIn™ Network

Once your profile is established and you’ve built your network of connections, you will want to continue to update your account on a regular basis. You can do this by interacting through posts, likes, comments and continuing to add people to your network.

If you are a professional in the physiatry field or other medical practice, connect with Linda Farr on LinkedIn™ to start or increase your professional network. As president of Farr Healthcare, she brings more than 30 years of recruitment experience in healthcare — and specifically physiatry — making her an invaluable resource to connect with others in this ever-growing field.

*LinkedIn™, the LinkedIn™ logo and InMail are registered trademarks or trademarks of LinkedIn Corporation™ and its affiliates in the United States and/or other countries.