Although we were absent from your inbox last week, we were not idle!   There are some great new additions to FootZine this week, which means there are changes and additions to the FootZine web site.   The "Feeture Articles" since the first issue of FootZine have been Mr. Ray Posa's invaluable series about HIPAA.  Because we have gathered so much HIPAA information in this way, we have created a specific HIPAA section with a direct link on the FootZine web site.  It will take you to the pages containing all of Ray's HIPAA segments.  The "HIPAA Q & A" will continue to be accessed from the "HIPAA FAQ" links on the bottom of the HIPAA pages.  Check the new location at  http://www.footzine.com/FZ_H.htm

You have seen letters from Dr. John Guiliana in previous issues.  He is a well-known speaker and writer about practice management, often focusing on the business aspects of that area.   Dr. Guiliana has agreed to write a regular series of Practice Management Pearls, as well as answer specific practice management questions.  (You can email your questions to me at FootZine and I will pass them along.) Read on for his first FootZine Feeture Article.

Coding often seems a murky, muddled mess!   Dr. Phill Ward, who regularly shares his coding expertise with the American Academy of Podiatric Practice Management, has generously agreed to help clear all that up for us with his new FootZine series, "Coding Made Crystal Clear".   Dr. Ward's first installment is below, and his page on the FootZine site will be :
http://www.footzine.com/FZ_C.htm

This week's Gem owes much to Alison DeWaters, PMAC, a third year student at the Temple University School of Podiatric Medicine.  Like Dr. Guiliana, Mr. Posa, Dr. Ornstein and Lynn Homisak, Alison is also a member of the FootZine Advisory Board.

How lucky I am to have the opportunity to share all this great information with you!!   Thanks to our new contributors, and to Dr. Hal Ornstein, who is so skilled at bringing people together with terrific results!

 ~  Gayle

From:  Jen Drew, PMAC
re:      Need Direction / Networking

In response from an office manager, we only have 3 support staff for our 2 doctors and see about 50 patients a day between the two.  We have 1 assistant for both docs, a receptionist who checks the patients in and out, makes appointments, answers the phones, and collects co-pays and non-covered services and an office manager who does all of the billing to patients and insurances and we do all of our own collections.  The office manager also pays all of the bills for the company and does payroll, keeps track of CME's and the doctors' licenses etc.  It works for us even though it is hectic at times.  Everyone chips in with the filing of the charts and x-rays and we have an off-site transcription service.  We did used to have a 4th part-time person but when she left the docs decided we could do it on our own and we have managed so far.

Jen Drew, PMAC

Hello!  Dr. Scanlan suggested that I contact you - I have a space in the Mill Creek/Martha Lake area [north of Seattle, WA] that is perfect for a podiatry office.  In fact, it has only been occupied by podiatrists - first, my brother, Dr. John Garbe and then Dr. Rex Nilson.  I would prefer to lease the property to a podiatrist since it is configured to suit a podiatry office - complete with surgical suite, x-ray room and developer space, as well as a comfortable waiting room and reception.  I was hoping that I might post a small announcement of the property availability on your web page.

Best Regards,
Jode Garbe, DVM, JD

*_*   *_*    Dr. Garbe's notice with the specifics about her office space is posted on the Networking page of the FootZine web site.  See the link below.    *_*   *_*

Notices of positions wanted or positions available, as well as other "classified" information, are welcome. They are posted at the FootZine web site's Networking page. Have a look at http://www.footzine.com/FZ_6.htm

Recently, a subscriber of FootZine questioned how to go about determining if another billing employee would benefit the practice.  The "art" of making sound business decision such as this lies within the realm of "scientific management".  We can no longer simply rely on gut feelings.  We need to use the power of information to help increase the chances of a correct decision.  The information required to make this decision, along with its potential impact, would be as follows:

1. How many patients/week does the practice process?  A healthy podiatric practice performing in-house billing should have about three full time equivalent (FTE) employees per DPM.  FTE is calculated by taking total employee payroll hours and dividing by 40.

2. What is the payor mix of the practice (managed care/ Medicare/ PPOs)? - this impacts the level of difficulty in the collection process

3. What does the practice's current A/R distribution look like?  i.e., what percentage of the A/R fall into the 30 day range, what percentage is in the 60, 90, 120?  This provides information about the efficiency of the collection process.  "Current" should occupy greater than 60% of the A/R while the 120 day profile should be less than 20%.

4. What is the practice's monthly billing as compared to the total accounts receivable?  Total A/R should never be more than 3 months billing.

5. What is the practice's payroll expense as a percentage of total receipts?  Around 20% is ideal.  Much greater and we have over-staffing and inefficiency possibilities. Significantly less jeopardizes efficiency, quality and cash flow.

6. How often are invoices sent out on patient balances?  This should be monthly.

7. Do they currently use electronic claims submissions?

8. Does the staff work overtime to achieve the current level of collections?  Routinely paying time and a half for staff overtime is usually an economic indicator that additional personnel is required.  Hiring may actually save money as well as preclude the
devastation of staff burnout.

With this information, a practice can benchmark itself and increase the chances of making a sound decision regarding hiring additional personnel.  Information such as this is available through the American Academy of Podiatric Practice Management.

John V. Guiliana, DPM, MS
Fellow and Trustee, AAPPM

Dr. Guiliana's article can be found on the FootZine web site on the "Feeture Article" page:
http://www.footzine.com/FZ_5.htm

The Question:

I read a post in PM-News that made reference to having transcription done by email, and the likelihood of needing a "business associate" document from the transcription service.  If that is the case, would you not need the same document from any transcriptionist who is not part of your regular office staff?  For that matter, should there be something in the office policy manual about confidentiality that all staff would need to sign?  It seems to me that in the past, many offices had the policy that "what you see here/hear here, stays here", but it may not have been in writing, or at least not required employee signatures to acknowledge it.  What rules are there on this aspect?

The Answer:

The answer to the question of whether or not you need a Business Associate Agreement from a transcription company .... is yes.  Any outside person or organization, not a member of your practice, who handles PHI in the course of their work for you must have a Business Associate Agreement with you.  The exception would be a transcriptionist who maybe works part time at home.  As long as they are on the payroll they are treated just like an employee and don't need a Business Associate Agreement; they would, however, be covered by an employee confidentiality statement.

As for employees, you must now have an office Privacy and Policy Manual, which spells out in detail all of your policies (which should address all of the requirements of HIPAA). They must be educated on these policies and they must sign a form stating that they have been trained and abide by the confidentiality requirements of HIPAA.

This is not as difficult as one would think.  Most offices already conduct themselves in a very responsible manner regarding patient information.  HIPAA just wants the process formalized and put in writing.  This way it is very clear what the policies are and what the expectation are of the employee.

These questions and their answers will be archived on the FootZine web site on the "HIPAA FAQ" page, at http://www.footzine.com/FZ_50.htm
Email your HIPAA questions to: gaylepmac@attbi.com

One of the most common errors seen relating to billing is improper linking of procedure and diagnosis codes.  This causes a significant amount of work for the billing office when they receive a denial due to this error.  The best advice to limit this error is diligent review of the super-bill by the doctor before it is given to their staff, as well as examination by the staff to double check.  For example, different diagnosis codes need to be used for office visits and for surgical (procedure) codes, including debridements, casts, injections, strapping.  Surgical codes do not include x-rays, orthotic devices and DME items (L-codes).

A suggestion to help reduce errors with linking is to have the doctor make a list of the most common twenty-five procedure codes and corresponding diagnoses used.  These should be posted at the front desk as well in the billing office.  An example to begin your list is a patient with a calcaneal spur (726.73) and plantar fasciitis (728.71) with an injection given:
 
     99213-25  Dx: 726.73
     20550  Dx: 728.71
     J code Dx:  728.71

Knowledge is power!

Crystal-Clear Coding tips are posted on the FootZine web site on this page:
http://www.footzine.com/FZ_C.htm

Balancing your personal and professional life is often very demanding.  Way too often you find yourself running from one activity to another.  Trying to catch Johnny’s soccer game after a busy day in the office will often make you feel tired and ragged at the end of the day.   Bill Cosby stated, “I don't know the key to success, but the key to failure is trying to please everybody”.   After years of running around and driving myself crazy I have realized how true that statement is.  When you overextend yourself in trying to accomplish promises to everyone else there is no winner.  One must prioritize their responsibilities.  In prioritizing, your personal health and sanity must be number one.  You cannot truly commit to someone and sacrifice your own health and well-being because the net result will not be positive.  It is very important to set goals and to keep these priorities in mind while establishing them.   If you have ever tried to pack a suitcase, things go much easier and you can fit a lot more if your most important items are packed first and done correctly.  You will be able to fit a lot more on your plate and accomplish a lot more goals when you are at your most healthy and balanced.  The end result will lead you to a much happier and productive lifestyle.

(Thank you to Alison DeWaters, PMAC, a third year student at Temple University School of Podiatric Medicine for your contribution to this Gem.)

Previous "Gems" can be found on their own pages of the FootZine.com web site, at
http://www.footzine.com/FZ_90.htm

We have been very fortunate to add such knowledgeable contributors to FootZine.  Now, of course, we'll need your questions and comments to keep them busy!  We look forward to hearing from you!

  ~  Gayle

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