More on Operations

Mon, 27 Jul 2015 15:35:55 GMT

Good morning and happy Monday (we hope). This week we will be covering more on operations including guidelines for retention of records of all kinds not just medical. How long to keep medical records and why, what to keep, what is included now in your medical record as the rules have changed somewhat.

Also, we have guidelines on compliance, global billing guidelines for example. Also we will cover compliance for all the above guidelines. Sound like fun? Actually you probably know all of this just form your day to day work. Think of operations as everything you do to keep the practice running smoothly.

And don't forget Risk Management!

Take a look at the key objectives for Chapter 7 and review those objectives that you may not deal with on a daily basis. We will start the week on medical record retention requirements. Lets just try a sample question to start it off

Whose guideline should you follow in determining how long to keep medical records:

A: Federal

B: CMS

C: State

D: OIG

Answer: C State

although all of the above have rules, the state in which the records are kept has the final say.

More on retention and compliance will follow

Wed, 29 Jul 2015 18:44:48 GMT

Back again and so sorry--office stuff as we all know. with more operations and compliance. Of course the resource manual is referencing ICD10 and we hope that by now everyone is familiar and testing as we speak. This all leads us into the area of operations for coding your services. Just make sure you are familiar with the terminology such as ICD, CPT, global periods (never hurts to know the global period or lack of global period for your most common procedures such as T&A, etc.)

An example would be:

Which of the following procedures has no global period?

A: Removal of foreign body-ear

B: Myringotomy

C: Tonsillectomy

D: Laryngoscopy

Answer is D

Also included in operations are your modifiers so review the basics or ones used most commonly--such as bilateral, reduced service etc

Wed, 29 Jul 2015 19:05:13 GMT

The modifier to report an unusual procedural service is:

A: 25

B: 50

C: 22

D: 57

answer: C

You should also review your documentation guidelines which we all love to do. Of course the diagnoses reporting is all changing for ICD10 but the guidelines for reporting E&M codes and surgeries are the same for 2015. Review the basics of what the requirements are for Levels 1 through 5 for New Patients---
do you know what constitutes a consultation?

Fri, 31 Jul 2015 07:27:54 GMT

Revenue cycle management is basically making sure we get paid for what we do.

The revenue cycle begins when

A: The patient checks in for their appointment

B: The patient calls for an appointment

C: When the doctor starts his examination

D: When the patient checks out of the visit

Answer: B

The revenue cycle starts with your first encounter with the patient--whether they call for an appointment or happen to stop in personally to schedule This is the point when you start getting their demographics, insurance information and other pertinent data. It ends with each patient when we fully collect for the services rendered and encompasses everything in between. To review on this area just mentally follow the processes you have in place in your office--taking information from the patient, verifying insurance, coding the procedure, sending in the claims all the way to collecting from the payor and/or patient.

Think about the different types of insurance plans--HMO, PPO, Indemnity, capitation and so forth---do you know what each term means--at least a basic description?

Fri, 31 Jul 2015 07:40:47 GMT

Another part of operations is Meaningful Use. This falls under the HITECH act and hospitals and physicians who are eligible can qualify for incentive payments when they adopt certified EHR technology and meet specific criteria or objectives.

Currently meaningful use consists of

A: Two stages

B: Three stages

C: Four stages

D: Five stages

Answer: B

Although the timelines have altered somewhat familiarize yourself with the basic definitions which apply to meaningful use. There are numerous websites who offer lots of information.

do you know what HITECH stands for?

Fri, 31 Jul 2015 07:51:55 GMT

Risk Management is another area of operations we all deal with every day. Take a minute to review your malpractice policy and the basic terms such as "claims made" and "occurrence made" These are the two basic types of malpractice coverage.

Do you know what "tail coverage" is?

Risk management is not only what malpractice insurance you have but also anything relating to how you deal with patients quality of care, their rights as a patient and their safety as a patient.

Fri, 31 Jul 2015 07:56:22 GMT

How is it going with your review for the assessment? Let us know if there are questions you have or if you have specific areas you want more information on or perhaps some more resources to review. By the end of the 12 weeks we will have covered the core subjects but as we go along let us know what more we can do to assist!. More tomorrow