Posts Tagged ‘medical practice recruiting’

Physician practices are all-too-often the target of embezzlement. Physicians’ own traits of compassion, humanitarianism and a desire to help patients, are exploited, causing crippling of financial and morale status within the practice.

During our long career in healthcare, as clinic managers, administrators, CEOs and medical practice consultants, we’ve borne witness to the emotional and financial tragedy embezzlement takes on physicians, their staff and their medical practice’s well-being. It never fails to appall us that those who propagate such crimes are frequently the very individuals the physician entrusts with decision-making authority. Practice managers are, sadly, often major offenders – because a successful embezzler needs access to funds, such as the checkbook, patient accounts and cash. Sometimes it’s the receptionist, handling co-pays, or billing personnel, with the ability to siphon monies easily, who are the culprits.

Embezzlement isn’t always dramatic – like the administrator who lifted original business checks and wrote on duplicate copies names of the clinic’s larger medical vendors, eventually taking nearly $300,000, or the manager who fabricated a night-time employee to “pay.” Because physicians are often (and understandably) more focused on patient care than the business side of medical practice, tales like these are common.

Top 10 Embezzlement Warning Signs

1. Missing inventory (office and medical supplies, such as eyeglass frames)
2. Changes in practice revenues
3. Increased refunds, write-offs and adjustments
4. Checks that lack supporting documentation
5. Unusual medical practice staff relationships with vendors (kickbacks)
6. Fluctuations in the general ledger expense accounts
7. Increased patient complaints about billing issues
8. Increased practice clerical errors
9. Unusual employee behavior (suddenly showing signs of living beyond their means, not taking vacations, taking work home frequently)
10. Questionable purchases (petty cash variances, items unaccounted for, personal expenses found on company credit cards)

Prevent Overwhelming Loss – Bonding & Backgrounds

To help protect your physicians medical practice, consider bonding, a type of insurance that reimburses medical offices for losses. Health plans and other payers follow this practice already, due to a federal law that requires bonding of all staff with financial responsibilities. Unfortunately, small practices may not think to take this simple precaution, because the physicians may feel they “know” their employees too well and that it would be indicative of mistrust. But it’s just good business. Also, be certain to have fraud insurance.

Always conduct a thorough reference and criminal background check on any potential new medical practice employees. We often recruit for billing management and practice management during medical practice consulting engagements that involve interim practice management, and this common-sense step is standard operating procedure for us. Whether working with a medical recruiter or doing it yourself, take the time for this important follow-through. When you speak to a potential staff member’s former employer, pay close attention to what they don’t say as well as what they say. For instance, ask if they’d consider re-hiring the person if the opportunity arose; if they hedge…well.

Physicians want to focus on patient care, and the administrative headaches often seem as though they take time away from that. So think of it this way: The well-being of your medical practice is important to the continued care, and well-being, of your patients. If the business side is taken care of, then through it, you will be able to provide patient care for years to come!

For Further Reading
Minimizing the Risk of Financial Fraud
Busting Embezzlers

Medical practices: For more information about good audit practices, medical practice staff recruiting, and avoiding embezzlement, contact Derry, Nolan & Associates.

When a local six-bed Sleep Disorders specialty practice found itself without a manager, they asked us to work with them as interim management and recruiters. They also wanted to correct workflow inefficiencies and expand the sleep beds by two.

Crystal Nolan, (principal) and Dee Collins, RN, stepped in as interim managers over a four-month period. In addition to daily operational oversight, the two helped recruit the new manager, plus performed an operational and financial assessment. Concurrently, fellow consultant Julie Titus conducted an in-depth coding analysis. After the assessments and analyses, the team recommended and helped implement several major process improvements.

Patient Schedules

• Decreased follow-up visits from 30 minutes to 20 minutes and patient consult visits from 45 to 40 minutes to help increase volume. The appointment time change alone resulted in over 100 more consults per year.
• Installed Murphy beds in two of the sleep rooms, allowing them to double as consult rooms, thereby negating space limitation concerns.

Front Office

• Instructed staff to fully use the internal e-mail system for communications, e.g. incoming messages for physicians were stored in an e-mail folder in the sleep clinic file, which also saved time and reduced errors.
• Recommended the use of an automated reminder call system, rather than individual confirmations, to alleviate individual appointment reminder calls, freeing up front desk to help with more administrative duties.

Workflows

• To speed up MA’s work, we transitioned several tasks to the Front Desk, as well as making process changes that allowed the MA sufficient time to complete room turnover.
• Reception would do the download while the MA roomed the patient. Additionally, reception would add the previous Weight and BMI (body mass indicator) to the chart form when doing chart prep work.
• Implemented the use of automated Blood Pressure, oxygen saturation, temperature and pulse machines, instead of using a manual BP, second device for oxygen saturation and pulse, and a third for temperature, saving MA’s time.
• Recommended physicians complete dictation immediately after patient visit. This gave the MA an additional five minutes to handle download handoff and complete rooming processes, ensuring the physician gets out on time.

Financial Analysis

• The internal coding audit undertaken based on results from a CMS peer review showed one physician in particular was default and under coding. Rather than base coding on time, we recommended it be based on examination elements to reflect the study and treatment more accurately.

Derry, Nolan and Associates worked in tandem with the leadership team to place the new manager. Crystal helped ease the transition, providing a comprehensive report to help the new manager decide how to focus her energy and best use staff resources. As the team continues its workflow improvement tasks under the guidance of the new manager, the Sleep Disorders Clinic is on the path to further its expansion goals, as well as positively affect its bottom line.

Client Testimonial
“Derry, Nolan & Associates performed an operational and financial assessment leading to coding opportunities, streamlining scheduling, improving workflow processes and assisting in the recruitment of a new sleep center manager. Also, the interim management they provided was exactly what we needed to help identify internal issues.” — Mitch Weinberg, MD PhD, Vice President, Medical Affairs, Evergreen Healthcare

Remember in our first blog entry, we told you that one part of our blog is about being true to yourself and taking risks? It’s part of being a successful entrepreneur. Well, some of our setbacks, and successes, are attributable to very personal stories that led us to quit our jobs and pursue the dream of owning our own business.

In 2002, hit with serious health issues, as well as personal loss, we each took a step back to re-examine our lives and reconsider our careers. Barbara, dealing with the stress of ever-increasing responsibilities in a new position and new boss stress, learned she had “pre” breast cancer. After a painful stereotactic breast biopsy, surgery and several months’ regimen of Tamoxifin, she was miserable. Severe hot flashes, depression, anxiety and loss of concentration – all supported her breast oncologist’s very clear message: If you want to prevent getting breast cancer, you need to remove the major stressor in your life. When leaving her doctor’s office one day, her husband turned to her and said, “Barb, you make a great salary, but no job is worth your life. I think it’s time you start your own business.” That was seven years ago, and Barbara has had no further episode.

Around the same time, Crystal’s right leg began swelling to the point she could barely walk, plus she was having chest pain and difficulty breathing. Unknown to her, a life-threatening deep vein thrombosis and pulmonary embolism was brewing. Told there was a very real possibility she would not survive more than 48 hours, she was hospitalized for a week, but all she could think of was relieving the excruciating pain. Both sons were called to her side, one flown in by naval aircraft carrier. When released, instead of resuming her customary healthy lifestyle, she went to months of doctor’s appointments, strictly monitored Coumadin levels, and dealt with chronic leg swelling. So when her younger brother, dying of lung cancer, told her that “people who don’t take risks, don’t have shit!” she listened.

Very scary incidences paired with heartfelt advice from loved ones. What more catalyst did we need? So in March 2003, Derry, Nolan & Associates, Healthcare Medical Practice Consulting Services, became a reality. We’ve never looked back.

Today, our client list includes Oncology, Cardiology, Multi-specialty, Family Practice, and Plastic Surgery Clinics, as well as Ambulatory Surgery Centers. We use a structured, consultative approach to eliminate waste, help clients become more profitable, more flexible in scheduling, and most importantly, happy in their daily work. Knowing how invaluable family time is, we help providers get home at a reasonable hour – that’s much more important than dictation or paperwork. Sometimes (one of our favorite roles) we act as healthcare interim executives and help healthcare organizations as they recruit for a permanent replacement.

In seven years of healthcare medical practice consulting, we learned to cherish our freedom to be creative, to laugh, to mentor others, and to help ensure our clients have the right people, doing the right work, in the right amount of time. We also learned – and take this to heart – never settle for less than your full potential!

Next time…our approach to marketing and how we launched Derry, Nolan & Associates!

You’ve measured loyalty, not just satisfaction, in your medical practice. You have a responsive, patient-service oriented staff. Your practice staff is happier than they’ve ever been; retention is solid. Now what?

In an earlier post, we mentioned how airlines, retail stores and luxury hotels – such as the Ritz-Carlton* – can and should drive loyalty through courtesy, but that healthcare’s differentiator is the use of empathy. Empathy, caring and compassion through acknowledgement of patient’s feelings.

So what can your medical practice learn from a world-class hotel? World-renowned service standards. After all, the Ritz-Carlton and healthcare are similar in the way they both deliver a product/service that the customer wants defect-free, when and how the customer wants it, and through providing genuine care and concern for that customer.

Then there’s benchmarking, also familiar to healthcare organizations, the Ritz-Carlton’s leadership constantly seeks out businesses to benchmark, always looking for the best metrics to ensure that their employees find work meaningful.

Last but not least is staff satisfaction, hugely important to success. Management recognizes that helping employees as they seek to deliver genuine care to guests, or swiftly fix breakdowns in a compassionate manner, gives employees satisfaction (hence, retention and happy customers). How do they help employees? By acknowledging what they learn, data-wise, and sharing it.

• Objectives are manageable and anchored to the company’s core values, always open to refinement.
• Corporate storytelling demonstrates how staff can personally make a difference and deliver “Wow” experiences.
• Leadership and staff view the entire business as a two-way relationship – with mutual accountability.
• Corporate values and financial objectives align, clearly showing how living the values results in business success.

Mutual accountability and transparency works – whether in the luxury hotel business or in your medical practice. Think about how you help your staff deliver genuine care and swiftly fix breakdowns. Do you share good and bad feedback? Look for the best in competitors and measure against it? Live the values you promote at work?

We know that achieving Platinum Level Customer Service is one thing, but that keeping it takes practice. It’s definitely do-able, so persevere! If you need an objective, professional helping hand, Derry, Nolan & Associates is here to help you reach and sustain your customer service goals.

DNA Snippet
“Achievement is largely the product of steadily raising one’s level of aspiration and expectation.” —Jack Nicklaus

Read the rest of this entry »

Things are changing in 2010 and our Oncology coding expert, Derry, Nolan & Associates’ medical practice consultant Gwen Davis, CPC, put together a few tips for our Oncology medical practice clients. It’s a good Evaluation and Management coding guidelines hotlist, so read on. Then, see today’s DNA Snippet for resources regarding Medicare Consults in 2010.

Manage Your Documentation (think EMR, Fee Tickets, MAR, Flowsheets & Coding)

• Keep updated tools and databases current
• Provide ongoing education to billing as well as clinical staff
• Hire certified coders and ensure regular interactions with physicians

Time-Based Billing Accuracy
Routinely, Oncologists have intense, sensitive “Life and Death” counseling sessions with patients and family members. For correct time-based billing, remember the following:

• More than 50% of the time you’re with a patient must be spent on counseling or coordination of care
• Face to face time counts, ancillary service provider time doesn’t – such as when a nurse is drawing blood. Also, should you leave Patient A to go check on Patient B and then return to Patient A, the time out-of-room does not count as Patient A time.
• Document clearly the time you spent and what was discussed, ensuring it is plausible and accounts for time claimed. No “cloning” from a previous patient or simple pasting of a generic statement about drugs and side effects, or using a blanket “spent 30 minutes counseling patient” statement.
  Suitable Documentation Example: Patient was here for 50 minutes; 30 minutes consisted of face-to-face counseling on end of life issues regarding his current diagnosis X, treatment options X, and side effects. Additional counseling discussing lifestyle changes (hospice, long term care) also took place.

Oncology Reimbursement Recommendations
Gwen mentions the importance of documentation as related to Oncology reimbursement and its associated regulations, “I routinely navigate complex regulations regarding expensive chemotherapy treatments. Right now, I’m developing tools that will help Oncology offices with the 2010 RAC and OIG regulations.” (Thanks, Gwen!) Her five quick recommendations are:

1. Know current FDA Indications (use the compendia!)
2. Document when you are going Off Label
3. Know current billing requirements
4. Watch those HCPCS Units
5. And finally, let your computer work for you. Flag your system to catch medically unlikely charges and work these audits prior to submitting claims. It will save time, money and headaches!

Understanding and Following Incident-to Requirements
This “last but not least” recommendation regarding documentation is about Incident-to criteria. Be sure to identify who rendered the service and that the direct supervision requirement was met. Show the physician’s initiation and continued involvement in the treatment, as well as showing that the services are reasonable and necessary. And be sure to show that the services are within the scope of practice for the non-physician practitioner.

Remember, correct documentation is the key to successful reimbursement!

DNA Snippet
Visit the Practice Resource Center at www.wsma.org for helpful guidelines to navigating Medicare Consults in 2010. Plus, the WSMA’s Coding Hotline gives great guidance on CPT, ICD-9 and HCPCS coding. Just call Michelle Lott, CPC at 1-800-552-0612.