Physician Solutions March 2016

PHYSICIAN SOLUTIONS magazine

March 2016

ICD-10 Coding –

Three Major Areas of Impact for Healthcare Practices pg. 24

the

ICD-10 Coding Medical issue

10 Funny, But Valid, ICD-10 Codes

Or, Yes, There’s a Code For That pg. 30

Questions and Answers on CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities pg. 28

contents features

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24 ICD-10 CODING – Three Major Areas of Impact for Healthcare Practices 28 QUESTIONS AND ANSWERS ON CMS/AMA JOINT ANNOUNCEMENT AND GUIDANCE REGARDING ICD-10 FLEXIBILITIES 30 10 FUNNY, BUT VALID, ICD-10 CODES Or, Yes, There’s a Code For That

PRACTICE OPTIONS; Closing, Expanding, Selling

practice tips 6

PRACTICE OPTIONS; Closing, Expanding, Selling

10 12 MISTAKES TO AVOID WITH EMAIL MARKETING

28

Q&A REGARDING ICD-10 FLEXIBILITIES

12 AVOID MAKING YOUR WAITING ROOM “THE WAITING GLOOM” 14 HIRING THE RIGHT EMPLOYEE FOR YOUR MEDICAL PRACTICE 16 TELEMEDICINE MOMENTUM PICKING UP STEAM

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Physician Solutions March 2016 Publisher Creative Director Contributors

Philip Driver Thomas Hibbard Naren Arulrajah Amanda Chay Eli Greenspan Barbara Hales, MD Alexander Hecht Thomas Hibbard Denise Price Thomas Vikas Vij Rodney L. Whitlock

contributors Naren Arulrajah is President and CEO of Ekwa Marketing, a complete Internet marketing company which focuses on SEO, social media, marketing education and the online reputations of Dentists and Physicians. If you have questions about marketing your practice online, call Naren direct at 877-249-9666.

Amanda Chay serves as the Director of Physician Liaison & Affiliate Programs at WhiteCoat Designs, a company that specializes in marketing solutions for the healthcare industry. With a healthcare marketing background spanning 13 years, Amanda has a strong understanding of the challenges faced by doctors and their practices in this competitive market.

Barbara Hales, M.D.

Physician Solutions is a national monthly magazine committed to providing insights about the health care profession focusing on practical advice for physicians and practices.

We are currently accepting articles to be considered for publication.

For more information on writing for Physician Solutions, please email us at physiciansolutions@gmail.com.

P.O. Box 99488 Raleigh, NC 27624 medmedia9@gmail.com Online 24/7 at medmonthly.com

is a skilled expert in promoting your health services. As seen on NBC, CBS,ABC and FOX network affiliates as well as Newsweek, Dr. Hales writes all the content you need to promote your medical services.

Her latest book is on the best seller list and she can do the same for you. Check out her site at www.TheWriteTreatment.com

Denise Price Thomas retired in 2009 as a surgical practice administrator where she was employed for 32 years. She is certified in healthcare management through Pfeiffer College. Speaking invitations have taken her from NC to SC, Georgia, Florida, Chicago, Alaska and more. Website: www.denisepricethomas.com

practice tips

Practice Options;

Closing, Expanding, Selling

By Naren Arulrajah with Vikas Vij Ekwa Marketing Introduction The decision to close, expand, and or sell a healthcare practice is a tough one to make for any physician.

In most cases physicians decide to close their practices because they have reached retirement age or because of other life decisions. The decision to close a practice due to the regulatory policies, the Patient Protection and Affordable Care Act although rare is not completely uncommon. On the other hand there are also a number of instances where physicians have sold their practices to corporate health groups or to other physician practice groups because of economic pressures. Regardless of the reason, when either closing or selling a practice, physicians have to carefully plan and 6

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move forward to avoid any inconvenience primarily to their patients while also safeguarding their own personal interests.

The decision to expand a practice again is a challenging situation and needs to be planned for and managed carefully. However, before each of these moves, it is important that physicians plan for change in compliance with federal and state laws, organize and get their practice books and finances in order, and make the necessary adjustments to ensure their patients are not unnecessarily inconvenienced. Understanding the legal and financial implications of closing, expanding and selling a practice are thus absolutely necessary.

Closing a Practice Physicians who decide to close their practice need to carefully consider several important issues such as practice valuation, handling of medical records, informing patients and staff, and the role and level of involvement of the physician with the practice post closing.

The first step begins with making a plan covering critical issues such as tentative end date, setting a time-frame for informing staff and patients, as well as time to seek legal advice. A few other things to plan for include; • Management of the estate and or time for negotiating the termination of the lease with a landlord in case you don’t own the building.

• You will be required to keep a few business-related items such as insurance claims and financial statements - check with the American Medical Association for more detailed information on the kind of business-related items you need to store as well as the duration.

• Inform the agencies such as the Drug Enforcement Agency (DEA), the Internal Revenue Service (IRS) and the state licensing board as well as any medical society that you belong to about the closing of your practice.

• Contact an appraiser regarding valuation of your dental equipment and check environmental laws in your area pertaining to the disposal of chemicals.

• Get all your books in order. You can contact a Certified Public Accountant (CPA) to help sort out all accounts receivables and payables and to figure out if any money is owed to you or if any money needs to be refunded to a patient. Clear any outstanding balances; make sure you pay off creditors and send billing notices to all concerned parties with a new mailing address for any payments that are due to the practice.

• Ensure that all work-related insurance policies such as worker’s compensation are terminated.

Selling a Practice As with closing a practice, the selling process also includes a lot of planning and preparation, and completion of specific tasks. It is important to ensure that the negotiations for the sale of the practice, the related documents, which include the Buy-Sell agreement, are

complaint with the applicable state and federal laws such as HIPPA. A few other things to consider; • Get in touch with a valuation firm for carrying out valuation of the practice and for providing a detailed report on the tangible and non-tangible assets such as equipment, supplies, furniture, and goodwill of your practice.

• During the sale of a practice, an important issue to cover pertains to the ownership of the patient records. As per state and federal regulations, a patient has the choice of selecting a different physician as well as the option of having a copy of his or her medical records sent to that physician. Medical records cannot be simply transferred to a different physician without the consent of a patient.

• Spruce up your office, waiting room, and reception area as a potential buyer will be appreciative of a clean and professional environment.

• Clean up your books; it is best to get rid of any old collectibles while also collecting all dues up to 90 days.

• Try not to change/cancel any medical insurance programs both before and during the selling process; this can impact your patient base as well as your source of income.

• Re-look your expenses and find ways to cut down on material costs and money drainers while also identifying ways in which you can optimize on staff productivity.

• Showcase and promote your practice strengths as a way of showing buyers additional value in buying your practice.

Expanding a Practice If you are considering expanding your practice, then you most definitely are doing something right!

You might be looking at opening a new facility or adding new staff or even introducing a new service as a way of expanding your practice base and revenue.

Regardless of how big or small the expansion, without a robust plan in place it can become difficult to navigate and process all the details that go into making such a move. Also keep in mind that you will need to continue focusing on your patients while managing the various aspects of an expansion. So the need for a rock solid plan cannot be ignored as it is the only way you can balance both acts. continued on page 8 PHYSICIAN SOLUTIONS MAGAZINE

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continued from page 7

Important things to consider include the following; Infrastructure Whether you are looking at adding a new facility to your practice, adding a new doctor or service, or even expanding your current facility, you will need to take into account the need for added infrastructure. This can be in the form of an additional room, office space, restrooms, a bigger reception area, or a whole new facility with all of these. In each of these instances you are looking at additional infrastructure.

Technology Bandwidth If you are considering adding a new doctor(s) or staff at your present location you have to give serious thought to your current technology bandwidth. Do you have the required IT support needed to support a new doctor(s) and or staff as well as support for any required accompanying technology?

If not, then you will have to look into addressing this issue.

And while you are re-looking your IT capacity, you might also want to investigate the value of adding additional new software or hardware such as hand-held devices to improve staff efficiency and patient experience.

Introducing New Services One of the most common ways of expanding your medical practice is by introducing new services that can add to the value of your brand while also helping improve patient experience. Sometimes adding to your hours of operation (morning/ evening/weekends) or introducing

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simple treatment changes such as a preventive care package, or a new cosmetic service can help expand your practice revenue.

Capital Investment Required capital investment is perhaps one of the most brow breaking considerations for any practice.

However, if you have a sound business plan, a good reputation and the backing of market feasibility to support practice expansion, securing a lender should not be a very big challenge.

Adding a New Facility Things to consider and evaluate when adding a new location, include capital investment, market feasibility and market competition as well as your target patient base and ROI (return on investment).

Legal Considerations Most importantly, ensure your legal framework is complete and in full compliance with any state laws and federal laws. Contact a legal expert to ensure you meet all the regulatory laws regarding your practice expansion.

Conclusion The closing, selling and expansion of a medical practice takes place in stages. The transformation in each case must be in accordance with all state and federal laws while also taking into account the financial and legal implications that come with making a closing, selling, and or expansion decision. Most importantly, the transformation must ensure that care delivery is seamless. All of this can only happen with careful planning and management.  About the Author: Naren Arulrajah is President and CEO of Ekwa Marketing, a complete Internet marketing company which focuses on SEO, social media, marketing education and the online reputations of Dentists and Physicians.

With a team of 130+ full time marketers, www.ekwa. com helps doctors who know where they want to go, get there by dominating their market and growing their business significantly year after year. If you have questions about marketing your practice online, call Naren direct at 877-249-9666.

practice tips

12 Mistakes to Avoid With Email Marketing (And Becoming a Medical Rock Star)

By Barbara Hales, M.D. www.thewritetreatment.com

Have you implemented email campaigns?

Email marketing is one of the most effective and least costly tools available to you today. While providing a multitude of benefits, the cost is minimal.

behavior that either ignores you or deletes your messages.

Then you will have actually induced harm because they are no longer receptive to you and what you need to communicate with them.

Benefits of Emails

2. Not Segmenting Your List

By simply utilizing email marketing, you can: • • • •

Go viral Attract more patients Retain current patients Raise yourself well above your colleagues in your patients’ eyes • Become appreciated by your patients • Show more involvement and approachability as you provide solutions to their health problems • Become the “talk of the town”

Damage Control

Don’t set yourself up for failure before you’ve begun.

It’s great that you are ready to dive into the marketing pool! There is however some strategies that will determine whether you are successful or ineffective.

Make the most of your email marketing by avoiding these costly mistakes.

1. Being Irrelevant

When patients provide their email address to you along with permission to use it, they are expecting you to use it with discretion and not “sell” to them or sell their names.

They expect to get messages that are relevant and important to them. Sending out email that is uninteresting and inappropriate will tarnish your image and foster a 22 || DECEMBER 2013 10 MARCH 2016

Separate your patients based on gender, age and conditions that they may suffer from. Then gear your messages or solutions to them. They will appreciate this more and the open rate will increase exponentially.

An example of this would be to restrict age-related conditions to those over 50. A 25-year old individual would not be interested in reading about this, more than likely.

3. Long and Complicated Copy

Keep it Short and Simple.

Time is a precious commodity and one that people don’t have much of. Keep the message to the length needed to convey the information. For more detail, provide a link where patients can read more about it if they are interested.

4. Being Inconsistent

If you send out your messages the first Monday of the month, then patients will look for your emails. If you are not consistent, you will disappoint them initially and then they won’t look for your emails again. Train them to expect your messages.

5. Timing is Everything

When is the most likely time for a patient to open your email? If it is to new parents, they are most apt to read their email after the children are in bed so sending the blast

out in the evening makes the most sense. On the other hand, business professionals may view their emails during Monday through Friday during working hours.

6. Dull, Old Subject Lines

Subject lines should evoke emotion.

Your subject lines, like headline news, should captivate your patients’ attention. The words should lure them in with the promise of a great story, solutions or benefits. No one wants to open up “the same old, same old”, regardless of who it’s from.

7. No images

A Picture is worth 1000 words.

Add a video to the mix. If you are describing a new medical device or technique that you do, let them see it as you explain the procedure. This will not only captivate and engage patients, it will help facilitate their understanding of what you are trying to convey.

take a look at who is opening them. This information is readily available with your analytics program.

Remove the email addresses that lead to bounces over time and ones where patients never opened your messages.

Decide whether emails that went ignored are because the messages were not new, or not relevant to the patient receiving them. This will enable you to target future messages better or to revise your content.

Contact these patients by phone. Are they still your patients? Do they use their computers? Are the messages too frequent? Try to understand them better on a personal level.

Email List -

The New Backbone of Your Business

8. Time Sucker

You are getting your patients’ email addresses, aren’t you?

If you haven’t, you are leaving money on the table and losing out on a golden resource! You can always start now.

Send for your free gift at: Barbara@TheWriteTreatment. com Get our Exclusive Report “15 Easy Ways to Leverage Your Content For Successful Marketing” 

9. Viral Spread

About TheWriteTreatment.com The Write Treatment, LLC has helped promote medical practices and health professionals with fresh website content, blogs, newsletters, email campaigns and social marketing.

Your email campaigns need not force you into taking time out of each day to create and send. A series of emails can be done at one time and then automated to go out on scheduled days or months in advance.

Viral spread is a good thing.

Encourage your patients to spread your emails with a link at the bottom to click and forward to their friends.

Attach social media buttons so that your message can be sent to their list of friends and fans on social media sites, allowing you to be seen by a much larger audience.

Send your emails to your social media groups and Facebook Page so that they are seen and forwarded from these sites as well. Your emails enable you to promote new followers and interact with current “friends”. Linking back to your website will drive more views to your online site as well.

10. Not Knowing What Works

Implement an analytical program.

There are many tools available to see how effective a specific message is and how much interest was evoked.

One of the easiest tools to implement is Google Analytics which will help you test each email to see opening rate, bounce rate and amount of time spent as well as how many times a person clicked onto your website. (I.e. All helpful information for future emails).

11. Ignoring ROI

Figure out how much return of investment you acquired by your email campaigns. Consider how many patient appointments your messages brought in vs. the time that it took for you to create them.

The Write Treatment

Ezines and NewslettersCost Effective Powerful Tools • Drive traffic to your business website • Build relationships between yourself and patients • Get new patients • Announce a new service or product • Give great impact Have you got a newsletter yet or want to spread a message?

Contact Barbara Hales, M.D. for a free consultation.

Barbara@TheWriteTreatment.com 516-647-3002

12. Out With The Old, In With the New

After you have been sending out your emails for a while, PHYSICIAN SOLUTIONS MAGAZINE

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practice tips

Avoid Making Your Waiting Room

“THE WAITING GLOOM”

By Denise Price Thomas

H

opefully, most of us learn from our mistakes and the mistakes of others. When performing practice assessments, I always enjoy spotlighting all the right things and shedding a light where polish is needed. For instance, one facility had just completed patient surveys and one in particular grabbed my attention...

Patient Survey Question #7: What did you most enjoy about our facility?

Patient’s Answer: I enjoyed waiting most of all. When I called for an appointment, I was placed on hold so long that I almost forgot why I had called. After scheduling, I was told to arrive 15 minutes early on the day of the appointment and I followed your rules. Upon arrival, I signed in and

22 || DECEMBER 2013 12 MARCH 2016

waited over 45 minutes before anyone called my name.

Once in the exam room, I waited once again. No one checked on me, however I overheard several great conversations from your hallway while I waited “patiently.”

My physician arrived and no one had even apologized for my wait. In fact, it was never mentioned. After my exam, the doctor said “wait right here on the nurse, she’ll be right back in with your paperwork.” I followed your rules again and I waited. When she brought my paperwork, she said they would need to call me back when they had everything scheduled and for me to give it a couple days and call back if I haven’t heard from them.

Thank you so much for inquiring about my visit with this survey. Perhaps you really do care, but were just too busy to ask me while I was there. No worries, I am now one less patient you will have to worry about.

No one enjoys waiting. Most times patients have no idea what is going on behind the scenes which is a good thing, let’s keep it that way. However, I am a firm believer that communication is the key. Starting with the first telephone call. I strongly encourage management to regularly pick up the phone and call your office to schedule an appointment. See just how long it takes to follow the entire process. I also suggest that someone keeps an eye out on what I refer to as your “lobby.” I dislike using the word “waiting room” because think of it, “have a seat in the WAITING ROOM” already sounds as if you should settle in with a book and a cup of hot tea.

There are so many legitimate reasons why healthcare professionals can run behind….you know them all too well. Of course, now you can throw in learning all the new ICD-10 codes which is a breeze, right? You’re probably running late because you are looking up codes for YOURSELF ~ codes like….disgusted, burned out, slow, and exhausted to name a few.

Emergencies and delays happen causing schedules to run behind. What can we do about it? Address it, don’t ignore it. When patients feel as if they are not kept informed, anger sets in. I’ve observed recently and have had conversations with patients who felt they had to get mad before they got the attention they needed.

Patients appreciate being kept informed. When a physician is running late, let patients know as soon as possible. In our surgical practice, there were times that a surgeon was called away for an emergency. We informed the patients, we apologized and we offered choices.

For fun, the super heroes at the front desk would call me because they knew how much I loved doing this. I would fill up the stainless steel cart with crackers and drinks. Assuming the role of a flight attendant, I wheeled the cart out to the lobby. I announced that the physician was called to the hospital for an emergency.

We should have an update soon however, if you need to reschedule, we can do that for you now. If you are able to stay, we’d like to offer you something to drink (I always apologized there was no alcohol and they loved it) and of course, offered crackers or chips. One day, we found out it was a lady’s birthday…..we just so happened to have a cake so we cut the cake and wheeled it out singing “Happy Birthday.” The entire lobby joined in.

I know, you’re saying, “You are behind schedule and taking time for THIS NONSENSE!?!?” Yes, we did….

and the best part is, it WORKED for us. I’m not saying you should provide drinks, crackers and chips, however I am suggesting that you brainstorm with your team to see what might work best within your facility in keeping your patients informed. Whether it is by phone or in person, people appreciate clear communication. In fact, some are longing to have someone to talk to. It’s fun to step up and stand out to make a difference. Humor can help break the ice, but keep in mind to only use it when it’s appropriate.

If uncomfortable issues are treated like a hot potato, no one will want to address them. Roadblocks such as these mentioned are the simplest ones to prevent, however many times they go unnoticed and unaddressed.

When employees see leadership putting a positive spin on the sometimes uncomfortable situations, they will respect the example we are setting and carry the torch in the same manner.

Many patients are anxious and it’s up to us to remember this during their visit. Healthcare might be our profession, but when they are at our practice, we are their hosts and they are our guests. We can make the difference, because together, we shine brighter. 

“Training Wheels in Heels” Denise Price Thomas Trainer for Health Care Professionals Focusing on Exceptional Customer Service, Effective Communication & Exemplary Compassion 34+ year career in health care and certified in health care management Undercover Patient Providing Insight to Your Practice Through the “Eyes of a Patient” Conference Speaker Presenting also as “Gladys Friday”, Health Care Comedienne

Home Grown/Nationally Known www.denisepricethomas.com denisepricethomas@gmail.com 704-747-8699 PHYSICIAN SOLUTIONS MAGAZINE

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practice tips

Hiring the Right Employee For Your Medical Practice

By Amanda Chay Director of Physician Liaison & Affiliate Programs WhiteCoat Designs

As a medical marketing company, we often hear the frustration medical practices face when looking to hire skilled individuals.

Taking shortcuts for new hires only hurts the practice in the long run despite the best of intentions.

To ensure a smooth process, here are recommendations for finding the right individual who can make an immediate impact at your medical practice: 14

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Work Experience Over Education As the saying goes “don’t judge a book by its cover”- this applies for hiring as well. Stanford, UNC, and Columbia are all wonderful colleges that provide excellent education. But by using education alone as a factor in selecting job candidates, a complete picture will not be reached. In place of education, review the candidates work

experience and consider the associated work skills present in these job roles. Keep an eye out for keywords and phrases that match your job description.

Skill Set Over LinkedIn While the number of skills and endorsements candidates have on LinkedIn may appear initially impressive, under close analysis, these numbers mean little to their

work potential. One personal example that will demonstrate this is when my neighbor endorsed me for project management despite never learning of any of my work experiences. Instead of LinkedIn, carefully review the individual’s skill set through Q&A in the interview process along with an analysis of their work experiences to determine his/her future potential.

Face to Face Over Phone Interviews After you have completed an initial phone screening of the job candidates, narrow down the list to your top 10% to interview directly. In most cases, a direct interview is preferred over a phone interview. While there may be additional expenses that your practice would incur from bringing the candidates in, the benefits of this type of interview would greatly offset these costs in the form of an experienced hire. In a direct interview, look closely for the following: l make note of your first impression (it’s important to trust your instincts on this) l observe the non-verbal communication presented (posture, eye contact) l look for discrepancies in what was said during initial screening to the questions asked in the interview l ask open-ended questions, as compared to closed questions, that will show off the candidates talents and experiences .

Examples of strong open-ended questions include: t tell me about an important goal you have set in the past and how successful you were in accomplishing it and t describe a situation when you might find it justifiable to break company policy or alter standard procedure.

Confirm Credentials Before extending the position to your selected candidate, it is essential to review and confirm the candidate’s qualifications.

Performing a criminal background check is the first step to the final review process. This is particularly true for positions where the employee will be interacting with patients, has access to medication and/or interacts with vital medical or business information.

Confirm the education, credentials and license(s) held by the selected candidate. Several of these items can be found online, such as through state licensing boards. In addition, a quick phone call to a select college or university can verify the college degree. Finally, ask for three professional references from the candidate and call each one to gather additional information.

Selecting the right candidate is the first and most important step in ensuring your investment in additional practice growth.

If the task of hiring this candidate is overwhelming, there are outside agencies that specialize in a medical staff hiring service to help you find the right person for the job. 

practice tips

Telemedicine Momentum Picking up Steam as New Legislation Introduced in U.S. Senate

By Eli Greenspan, Alexander Hecht and Rodney L. Whitlock Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C. A bipartisan group of Senators led by Senator Brian Schatz (D-HI) and Senator Roger Wicker (R-MS) have unveiled legislation that would expand the use of telemedicine and remote patient monitoring under Medicare. The CONNECT for Health Act (S.2484) is not seeking to overhaul telemedicine statutes overnight. Rather, it’s creating an opening for providers to incorporate telemedicine into their practices in a way that enables the federal government to further study and evaluate its application in health care delivery.

The CONNECT for Health Act would establish a program to help providers who would be subjected to new payment restrictions under the Medicare Access and CHIP Reauthorization Act (SGR-repeal) transition – through the use of telemedicine and remote patient monitoring services – into the new Merit-Based Incentive Payment System. Those providers who are eligible would be able to use telemedicine and remote patient monitoring services without the restrictions currently placed on telemedicine reimbursement in Medicare (42 U.S.C. 1834(m)).

This legislation would also allow stakeholders utilizing alternative payment models to use telemedicine and remote patient monitoring services, on the condition that it is budget-neutral and certain reporting requirements are met. It would also expand the use of these services for those with chronic conditions, a particular focus of the Senate Finance Committee this year, by allowing individuals with two or more covered chronic conditions that have a recent history of two or more hospitalizations in the preceding 12 months to be eligible for telemedicine services for 90 days, with a possibility for renewal.

Two interesting quick initial observations about the 16

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measure. First, this bipartisan measure has attracted a host of stakeholder support from across the spectrum – including from groups like the American Telemedicine Association and American Medical Association, which haven’t exactly seen eye-to-eye on previous efforts to address telemedicine-related issues.

Second observation is the “score” of the bill – or how much it would potentially cost to enact. According to the bill’s proponents, an analysis by Avalere of the bill’s major provisions (mentioned above) show $1.8 billion in savings over 10 years. If true, that’s a significant development. For years, telemedicine advocates have heaped praise on the potential cost savings associated with telemedicine through increasing access to care, whether it be through video conferencing or remote patient monitoring services.

While the Avalere score is optimistic, the legislation will have to undergo scrutiny from the Congressional Budget Office (CBO), which has consistently and steadfastly expressed skepticism that expanding the use of telemedicine would cut costs for Medicare, often citing the potential for increased utilization of services – and thereby increased costs to the taxpayer.

However, last July, CBO indicated that the lack of extensive data hinders its efforts to understand how expanding coverage would affect federal spending in Medicare, and that “having more evidence about how the telemedicine coverage affects spending would thus be useful,” and that the results of a demonstration project could be particularly helpful.  Source: http://www.natlawreview.com/article/telemedicine-momentum-picking-steam-new-legislation-introduced-us-senate

Practices for Sale Medical Practices Primary Care specializing in Women’s Practice Location: Morehead City, N.C. List Price: Just reduced to $20,000 or Best Offer Gross Yearly Income: $540,000 average for past 3 years Year Established: 2005 Average Patients per Day: 12 to 22 Building Owned/Leased: MD owned and can be leased or purchased Contact: Philip at 919-848-4202

Family Primary Care Practice

Location: Minutes East of Raleigh, North Carolina List Price: $15,000 or Best Offer Gross Yearly Income: $235,000 Average Patients per Day: 8 to 12 Total Exam Rooms: 6 Physician retiring, Beautiful practice Building Owned/Leased: Owned (For Sale or Lease) Contact: Philip 919-848-4202

Family Practice/Primary Care

Location: Hickory, North Carolina List Price: $425,000 Gross Yearly Income: $1,5000,000 Year Established: 2007 Average Patients Per Day: 24-35 Total Exam Rooms: 5 Building Owned/Leased: Lease or Purchase Contact: Philip at 919-848-4202

Med Spa

Location: Coastal North Carolina List Price: $550,000 Gross Yearly Income: $1,600,000.00 Year Established: 2005 Average Patients Per Day: 25 to 30 Total Exam Rooms: 4 Building Owned/Leased: Leased Contact: Philip at 919-848-4202

Practice Type: Mental Health, Neuropsychological and Psychological Location: Wilmington, NC List Price: $110,000 Gross Yearly Income: $144,000 Year Established: 2000 Average Patients Per Day: 8 Building Owned/Leased/Price: Owned Contact: Philip at 919-848-4202

Practice Type: Internal Medicine Location: Wilmington, NC List Price: $85,000 Gross Yearly Income: $469,000 Year Established: 2000 Average Patients per Day: 25 Building Owned/Leased: Owned Contact: Philip at 919-848-4202

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PHYSICIAN SOLUTIONS MAGAZINE

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THE DECISION IS YOURS Physician Solutions, Inc. P.O. Box 98313 Raleigh, NC 27624 Scan this QR code with your smartphone to learn more.

phone: 919-845-0054 fax: 919-845-1947 www.physiciansolutions.com physiciansolutions@gmail.com

U.S. OPTICAL BOARDS Alaska P.O. Box 110806 Juneau, AK 99811 (907)465-5470 http://www.commerce.state.ak.us/dnn/ cbpl/ProfessionalLicensing/DispensingOpticians.aspx Arizona 1400 W. Washington, Rm. 230 Phoenix, AZ 85007 (602)542-3095 http://www.do.az.gov Arkansas P.O. Box 627 Helena, AR 72342 (870)572-2847 California 2005 Evergreen St., Ste. 1200 Sacramento, CA 95815 (916)263-2382 http://www.optometry.ca.gov/ Colorado 1560 Broadway St. #1310 Denver, CO 80202 (303)894-7750 http://www.dora.state.co.us/optometry/ Connecticut 410 Capitol Ave., MS #12APP P.O. Box 340308 Hartford, CT 06134 (860)509-7603 ext. 4 http://www.ct.gov/dph/cwp/view. asp?a=3121&q=427586 Florida 4052 Bald Cypress Way, Bin C08 Tallahassee, FL 32399 (850)245-4474 http://www.pof.org/opticianry-board/ Georgia 237 Coliseum Dr. Macon, GA 31217 (478)207-1671 http://sos.ga.gov/index.php/licensing/ plb/20 Hawaii P.O. Box 3469 Honolulu, HI 96801 (808)586-2704 http://hawaii.gov/dcca/pvl/programs/ dispensingoptician/

Idaho 450 W. State St., 10th Floor Boise , ID 83720 (208)334-5500 http://www.ironforidaho.net/

Oregon 3218 Pringle Rd. SE Ste. 270 Salem, OR 97302 (503)373-7721 http://www.oregonobo.org/optque.htm

Kentucky P.O. Box 1360 Frankfurt, KY 40602 (502)564-3296 http://www.opticiantraining.org/optician-training-kentucky/

Rhode Island 3 Capitol Hill, Rm 104 Providence, RI 02908 (401)222-7883 http://sos.ri.gov/govdirectory/index.php? page=DetailDeptAgency&eid=260

Massachusetts 239 Causeway St. Boston, MA 02114 (617)727-5339 http://1.usa.gov/zbJVt7

South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4665 www.llr.state.sc.us

Nevada P.O. Box 70503 Reno, NV 89570 (775)853-1421 http://nvbdo.state.nv.us/

Tennessee Heritage Place Metro Center 227 French Landing, Ste. 300 Nashville, TN 37243 (615)253-6061 http://tn.gov/health

New Hampshire 129 Pleasant St. Concord, NH 03301 (603)271-5590 www.state.nh.us New Jersey P.O. Box 45011 Newark, NJ 07101 (973)504-6435 http://www.njsop.org/aws/NJSOP/pt/sp/ home_page New York 89 Washington Ave., 2nd Floor W. Albany, NY 12234 (518)402-5944 http://www.op.nysed.gov/prof/od/ North Carolina P.O. Box 25336 Raleigh, NC 27611 (919)733-9321 http://www.ncoptometry.org/ Ohio 77 S. High St. Columbus, OH 43266 (614)466-9707 http://optical.ohio.gov/

Texas P.O. Box 149347 Austin, TX 78714 (512)834-6661 http://www.tob.state.tx.us/ Vermont National Life Bldg N FL. 2 Montpelier, VT 05620 (802)828-2191 http://vtprofessionals.org/opr1/ opticians/ Virginia 3600 W. Broad St. Richmond, VA 23230 (804)367-8500 http://www.dpor.virginia.gov/Boards/ HAS-Opticians/ Washington 300 SE Quince P.O. Box 47870 Olympia, WA 98504 (360)236-4947 http://www.doh.wa.gov/LicensesPermitsandCertificates/MedicalCommission. aspx

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U.S. DENTAL BOARDS Alabama Alabama Board of Dental Examiners 5346 Stadium Trace Pkwy., Ste. 112 Hoover, AL 35244 (205) 985-7267 http://www.dentalboard.org/ Alaska P.O. Box 110806 Juneau, AK 99811-0806 (907)465-2542 https://www.commerce.alaska.gov/web/ cbpl/ProfessionalLicensing/BoardofDentalExaminers.aspx Arizona 4205 N. 7th Ave. Suite 300 Phoenix, AZ 85103 (602)242-1492 http://azdentalboard.us/ Arkansas 101 E. Capitol Ave., Suite 111 Little Rock, AR 72201 (501)682-2085 http://www.asbde.org/ California 2005 Evergreen Street, Suite 1550Â Sacramento, CA 95815 877-729-7789 http://www.dbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7800 http://www.dora.state.co.us/dental/ Connecticut 410 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/cwp/view. asp?a=3143&q=388884 Delaware Cannon Building, Suite 203 861 Solver Lake Blvd.

Dover, DE 19904 (302)744-4500 http://1.usa.gov/t0mbWZ Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://floridasdentistry.gov/ 20

| MARCH 2016

Georgia 237 Coliseum Drive Macon, GA 31217 (478)207-2440 https://gbd.georgia.gov/ Hawaii DCCA-PVL Att: Dental P.O. Box 3469 Honolulu, HI 96801 (808)586-3000 http://cca.hawaii.gov/pvl/boards/dentist/ Idaho P.O. Box 83720 Boise, ID 83720 (208)334-2369 http://isbd.idaho.gov/ Illinois 320 W. Washington St. Springfield, IL 62786 (217)785-0820 http://www.isds.org/LawsLegislation/ boardOfDentistry.asp Indiana 402 W. Washington St., Room W072 Indianapolis, IN 46204 (317)232-2980 http://www.in.gov/pla/dental.htm Iowa 400 SW 8th St. Suite D Des Moines, IA 50309 (515)281-5157 http://www.state.ia.us/dentalboard/ Kansas 900 SW Jackson Room 564-S Topeka, KS 66612 (785)296-6400 http://www.dental.ks.gov/ Kentucky 312 Whittington Parkway, Suite 101 Louisville, KY 40222 (502)429-7280 http://dentistry.ky.gov/ Louisiana 365 Canal St., Suite 2680 New Orleans, LA 70130 (504)568-8574 http://dentistry.ky.gov/

Maine 143 State House Station 161 Capitol St. Augusta, ME 04333 (207)287-3333 http://www.mainedental.org/ Maryland 55 Wade Ave. Catonsville, Maryland 21228 (410)402-8500 http://dhmh.state.md.us/dental/ Massachusetts 1000 Washington St., Suite 710 Boston, MA 02118 (617)727-1944 http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/dhpl/ dentist/about/ Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650 http://www.michigan.gov/lara/0,4601,7154-72600_72603_27529_27533---,00. html Minnesota 2829 University Ave., SE. Suite 450 Minneapolis, MN 55414 (612)617-2250 http://www.dentalboard.state.mn.us/ Mississippi 600 E. Amite St., Suite 100 Jackson, MS 39201 (601)944-9622 http://bit.ly/uuXKxl Missouri 3605 Missouri Blvd.

P.O. Box 1367 Jefferson City, MO 65102 (573)751-0040 http://pr.mo.gov/dental.asp Montana P.O. Box 200113 Helena, MT 59620 (406)444-2511 http://bsd.dli.mt.gov/license/bsd_ boards/den_board/board_page.asp

Nebraska 301 Centennial Mall South Lincoln, NE 68509 (402)471-3121 http://dhhs.ne.gov/publichealth/Pages/ crl_medical_dent_hygiene_board.aspx

Ohio Riffe Center 77 S. High St.,17th Floor Columbus, OH 43215 (614)466-2580 http://www.dental.ohio.gov/

Nevada 6010 S. Rainbow Blvd. Suite A-1 Las Vegas, NV 89118 (702)486-7044 http://www.nvdentalboard.nv.gov/

Oklahoma 201 N.E. 38th Terr., #2 Oklahoma City, OK 73105 (405)524-9037 http://www.ok.gov/dentistry/

New Hampshire 2 Industrial Park Dr. Concord, NH 03301 (603)271-4561 http://www.nh.gov/dental/

Oregon 1600 SW 4th Ave. Suite 770 Portland, OR 97201 (971)673-3200 http://www.oregon.gov/Dentistry/

New Jersey P.O Box 45005 Newark, NJ 07101 (973)504-6405 http://njpublicsafety.com/ca/dentistry/

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)783-7162 http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Dentistry/ Pages/default.aspx#.VbkfjPlPVYU

New Mexico Toney Anaya Building 2550 Cerrillos Rd. Santa Fe, NM 87505 (505)476-4680 http://www.rld.state.nm.us/boards/Dental_Health_Care.aspx New York 89 Washington Ave. Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/prof/dent/ North Carolina 507 Airport Blvd., Suite 105 Morrisville, NC 27560 (919)678-8223 http://www.ncdentalboard.org/ North Dakota P.O. Box 7246 Bismark, ND 58507 (701)258-8600 http://www.nddentalboard.org/

Rhode Island Dept. of Health Three Capitol Hill, Room 104 Providence, RI 02908 (401)222-2828 http://1.usa.gov/u66MaB South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4599 http://www.llr.state.sc.us/POL/Dentistry/ South Dakota P.O. Box 1079 105. S. Euclid Ave. Suite C Pierre, SC 57501 (605)224-1282 https://www.sdboardofdentistry.com/ Tennessee 227 French Landing, Suite 300 Nashville, TN 37243 (615)532-3202 http://tn.gov/health

Texas 333 Guadeloupe St. Suite 3-800 Austin, TX 78701 (512)463-6400 http://www.tsbde.state.tx.us/ Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 http://1.usa.gov/xMVXWm Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 http://governor.vermont.gov/boards_ and_commissions/dental_examiners Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 http://www.dhp.virginia.gov/dentistry Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/Dentist.aspx West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-877-914-8266 http://www.wvdentalboard.org/ Wisconsin P.O. Box 8935 Madison, WI 53708 1(877)617-1565 http://dsps.wi.gov/Default. aspx?Page=90c5523f-bab0-4a45-ab943d9f699d4eb5 Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529 http://plboards.state.wy.us/dental/index.asp

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U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://www.medlicense.com/alaskamedical-license.html Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 http://www.dora.state.co.us/medical/ Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/cwp/view. asp?a=3143&q=388902 Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 http://doh.dc.gov/bomed 22 | MARCH 2016

Florida 2585 Merchants Row Blvd.

Tallahassee, FL 32399 (850)245-4444 http://www.stateofflorida.com/Portal/ DesktopDefault.aspx?tabid=115

Louisiana LSBME P.O. Box 30250 New Orleans, LA 70190 (504)568-6820 http://www.lsbme.la.gov/

Georgia 2 Peachtree Street NW, 36th Floor Atlanta, GA 30303 (404)656-3913 http://bit.ly/vPJQyG

Maine 161 Capitol Street 137 State House Station Augusta, ME 04333 (207)287-3601 http://bit.ly/hnrzp

Hawaii DCCA-PVL P.O. Box 3469 Honolulu, HI 96801 (808)587-3295 http://hawaii.gov/dcca/pvl/boards/medical/

Maryland 4201 Patterson Ave. Baltimore, MD 21215 (410)764-4777 http://www.mbp.state.md.us/

Idaho Idaho Board of Medicine P.O. Box 83720 Boise, Idaho 83720 (208)327-7000 http://bit.ly/orPmFU

Massachusetts 200 Harvard Mill Sq., Suite 330 Wakefield, MA 01880 (781)876-8200 http://www.mass.gov/eohhs/gov/departments/borim/

Illinois 320 West Washington St. Springfield, IL 62786 (217)785 -0820 http://www.idfpr.com/

Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918 http://michigan.gov/lara/0,4601,7-15472600_72603_27529_27541-58914--,00. html

Indiana 402 W. Washington St. #W072 Indianapolis, IN 46204 (317)233-0800 http://www.in.gov/pla/ Iowa 400 SW 8th St., Suite C Des Moines, IA 50309 (515)281-6641 http://medicalboard.iowa.gov/ Kansas 800 SW Jackson, Lower Level, Suite A Topeka, KS 66612 (785)296-7413 http://www.ksbha.org/ Kentucky 310 Whittington Pkwy., Suite 1B Louisville, KY 40222 (502)429-7150 http://kbml.ky.gov/Pages/default.aspx

Minnesota University Park Plaza 2829 University Ave. SE, Suite 500 Minneapolis, MN 55414 (612)617-2130 http://bit.ly/pAFXGq Mississippi 1867 Crane Ridge Drive, Suite 200-B Jackson, MS 39216 (601)987-3079 http://www.msbml.state.ms.us/ Missouri Missouri Division of Professional Registration 3605 Missouri Blvd.

P.O. Box 1335 Jefferson City, MO 65102 (573)751-0293 http://pr.mo.gov/healingarts.asp

Montana 301 S. Park Ave. #430 Helena, MT 59601 (406)841-2300 http://bsd.dli.mt.gov/license/bsd_ boards/med_board/board_page.asp Nebraska Nebraska Department of Health and Human Services P.O. Box 95026 Lincoln, NE 68509 (402)471-3121 https://www.nebraska.gov/LISSearch/ search.cgi Nevada Board of Medical Examiners P.O. Box 7238 Reno, NV 89510 (775)688-2559 http://www.medboard.nv.gov/ New Hampshire New Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 (603)271-1203 http://www.nh.gov/medicine/ New Jersey P. O. Box 360 Trenton, NJ 08625 (609)292-7837 http://www.medlicense.com/new-jerseymedical-license.html New Mexico 2055 S. Pacheco St. Building 400 Santa Fe, NM 87505 (505)476-7220 http://www.nmmb.state.nm.us/ New York Office of the Professions State Education Building, 2nd Floor Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/ North Carolina P.O. Box 20007 Raleigh, NC 27619 (919)326-1100 http://www.ncmedboard.org/

North Dakota 418 E. Broadway Ave., Suite 12 Bismarck, ND 58501 (701)328-6500 http://www.ndbomex.com/

Texas P.O. Box 2018 Austin, TX 78768 (512)305-7010 http://www.tmb.state.tx.us/

Ohio 30 E. Broad St., 3rd Floor Columbus, OH 43215 (614)466-3934 http://med.ohio.gov/

Utah P.O. Box 146741 Salt Lake City, UT 84114 (801)530-6628 http://www.dopl.utah.gov/licensing/physician_surgeon.html

Oklahoma P.O. Box 18256 Oklahoma City, OK 73154 (405)962-1400 http://www.okmedicalboard.org/ Oregon 1500 SW 1st Ave., Suite 620 Portland, OR 97201 (971)673-2700 http://www.oregon.gov/OMB/ Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)787-8503 http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/ Pages/default.aspx#.Vbkgf_lPVYU Rhode Island 3 Capitol Hill Providence, RI 02908 (401)222-5960 http://1.usa.gov/xgocXV South Carolina P.O. Box 11289 Columbia, SC 29211 (803)896-4500 http://www.llr.state.sc.us/pol/medical/ South Dakota 101 N. Main Ave. Suite 301 Sioux Falls, SD 57104 (605)367-7781 http://www.sdbmoe.gov/ Tennessee 425 5th Ave. North Cordell Hull Bldg. 3rd Floor Nashville, TN 37243 (615)741-3111 http://tn.gov/health

Vermont P.O. Box 70 Burlington, VT 05402 (802)657-4220 http://1.usa.gov/wMdnxh Virginia Virginia Dept. of Health Professions Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4400 http://1.usa.gov/xjfJXK Washington Public Health Systems Development Washington State Department of Health 101 Israel Rd. SE, MS 47890 Tumwater, WA 98501 (360)236-4085 http://www.medlicense.com/washingtonmedicallicense.html West Virginia 101 Dee Dr., Suite 103 Charleston, WV 25311 (304)558-2921 http://www.wvbom.wv.gov/ Wisconsin P.O. Box 8935 Madison, WI 53708 (877)617-1565 http://dsps.wi.gov/Boards-Councils/ Board-Pages/Medical-Examining-BoardMain-Page/ Wyoming 320 W. 25th St., Suite 200 Cheyenne, WY 82002 (307)778-7053 http://wyomedboard.state.wy.us/

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features

ICD-10 Coding –

Three Major Areas of Impact for Healthcare Practices

By Naren Arulrajah with Vikas Vij Ekwa Marketing The benefits of ICD-10 are numerous for healthcare and dental practices. While the ICD-9 code set limited coding for several innovative procedures, the scope of expanding and adding new codes with ICD-10 is much more extensive. Important areas that ICD-10 has an impact on include; • • • • • •

Reimbursement Healthcare IT Clinical Coding Quality Measurement Monitoring & Performance Patient Care

Because treatment options and techniques have been constantly 24

| MARCH 2016

evolving, the need for a new code set which could ensure more accurate coding was required and this is why ICD-10 Procedure Coding System (PCS) was introduced.

ICD-9- Clinical Modification (CM) limitation on expanding also affected approval for new procedures. It is also impossible to accurately code any new advanced treatments using the ICD-9 code set. However, with ICD-10-PCS, diagnostic codes available for coding healthcare services will increase from a mere 13,000 to 68,000.

Furthermore, if other separate procedures can and need to be coded, it will become possible to differenti-

ate between simple and complex procedures.

Migrating from ICD-9 to ICD10 – Transition Challenges The healthcare industry in general has been concerned about the challenges that will surface when migrating from ICD 9 to ICD 10 code set. The biggest area of concern for most practices centers around billing and payment issues.

ICD codes were introduced for the purpose of healthcare claims billing between healthcare providers and health plan/insurance providers. The use of the code set allowed the insurance companies

to quickly understand what procedures were performed on a patient.

Any healthcare practice that does not migrate to ICD-10 codes or in the event that an incorrect code is used in a claims submission, that practice runs the risk of not getting paid by the insurance company. The same goes for insurance companies that do not make the shift to ICD-10.

While most large hospitals and health care groups as well as large physician groups will find it easier to migrate to ICD-10, the biggest challenge to the transition for these big healthcare bodies is in the form of temporary cash-flow issues caused by ICD-10 specific payment delays.

The small physician practices however, are the ones that face an uphill battle with migrating to ICD-10. The new code set will have an impact on Health Insurance Portability and Accountability Act-covered bodies which includes a vast number of healthcare providers, claims handlers and payers. Billions of dollars in payments from leading insurers such as Medicare, Medicaid, Tricare and the Veterans Health Administration will be calculated based on the new set of codes to the associated hospitals, physician groups and practices. So the possibility of the revenue streams of a number of healthcare providers being impacted by the new code set is very real.

ICD-10: Three Important Areas of Impact for Healthcare Practices Reimbursement Claims Process The advantage of migrating from ICD-9 to ICD-10 code sets for continued on page 26

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continued from page 25

healthcare practices is that it will lead to more accurate payments for new procedures. It will also lower the instances of rejected claims as well as reduce the chances of incorrect reimbursement claims.

All of which of course can help in improving the billing and reimbursement process of healthcare practices to a large extent.

Also because ICD-10 code set is so detailed and specific, the instances of claims being investigated or rejected due to insufficient information will also drop. Any issues that arise because of lack of specific and necessary information included in the diagnosis and procedure code will be effectively resolved with ICD-10. For practices this means a substantial reduction in any rework which will not only improve the efficiency of the reimbursement process for the healthcare practice but also bring about substantial reduction in administrative costs.

And as healthcare practices become more apt at clinical care documentation, it increases the likelihood of accurate claims being submitted the first time around with easy clearing of reimbursements for wide a range of procedures; this in turn can have a positive impact on the revenue cycle of a practice.

Healthcare IT – New Vs Old Platforms Healthcare practices that still use inflexible and/or aging technology will need to look into the adoption of new technology to support ICD-10 transition. It is best to look at healthcare IT systems that allow

26

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easy implementation of new code sets and redundant applications over a single practice-wide platform. Another factor to consider here is that return on investment with ICD-10 can only happen in the long term.

Any healthcare technology transition should only be implemented after careful consideration and also after taking into account the capability of the current technology platform to support new opportunities that ICD-10 will present. If however, the current platform can be aligned with the new business model then it eliminates the need for a complete re-haul of IT platform used by a healthcare practice.

Improved Patient Care Enhanced patient care is at the core of the ICD-10-CM and-PCS code set which allows for detailed clinical documentation and accommodation of new technologies and procedures. The codes enhance better data capture which helps in improved assessment of complications and can lead to improved evaluation of patient healthcare outcomes.

Furthermore, ICD-10-CM effectively improves and addresses coding for medical complications as well as medical safety concerns.

Personal health records (PHR) will also include a more detailed level of understanding and description which can result in improved awareness and understanding of the disease and the diagnosis by the patient. As patients become more involved in their healthcare it can lead to improved sense of health condition management.

The enhanced focus on detailed clinical documentation that ICD-

10 offers will help both healthcare providers and insurance providers to accurately and easily identify patients who need specific disease management. This level of information can then be used to offer more customized plans and programs.

Implementation of ICD-10-CM will also help in streamlining the process of capturing public health diseases which again can help in improving patient care in the community.

Conclusion ICD-10 is a vast improvement over ICD-9. The shift in the code sets will help in ensuring greater accuracy in payments for new procedures and a substantial reduction in rejected claims and improper reimbursement claims. ICD-10 will effectively reduce the need for additional documentation to support claims. The new code set will also help in furthering analysis and medical research as well as support greater interoperability and exchange of healthcare data between the U.S and other countries.  About the Author: Naren Arulrajah is President and CEO of Ekwa Marketing, a complete Internet marketing company which focuses on SEO, social media, marketing education and the online reputations of Dentists and Physicians. (See Ekwa’s ad on page 9 of this issue of Physician Solutions.)

With a team of 130+ full time marketers, www.ekwa.com helps doctors who know where they want to go, get there by dominating their market and growing their business significantly year after year. If you have questions about marketing your practice online, call Naren direct at 877-249-9666.

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features

Questions and Answers on CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities

By Centers for Medicare & Medicaid Services

Question: What is a valid ICD-10 code?

Answer: All claims with dates of service of October 1, 2015 or later must be submitted with a valid ICD10 code; ICD-9 codes will no longer be accepted for these dates of service. ICD-10-CM is composed of codes with 3, 4, 5, 6 or 7 characters. Codes with three characters are included in ICD-10-CM as the heading of a category of codes that may be further subdivided by the use of fourth, fifth, sixth or seventh characters to provide greater specificity. A three-character code is to be used only if it is not further subdivided. While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 28

| MARCH 2016

implementation, if a valid ICD-10 code from the right family is submitted, Medicare fee-for-service will process and not audit valid ICD-10 codes.

An example is C81 (Hodgkin’s lymphoma) – which by itself is not a valid code. Examples of valid codes within category C81 contain 5 characters, such as: C81.00

C81.03

C81.10

Nodular lymphocyte predominant Hodgkin lymphoma, unspecified site Nodular lymphocyte predominant Hodgkin lymphoma, intra-abdominal lymph nodes Nodular sclerosis classical Hodgkin lymphoma, unspecified site

C81.90 Hodgkin lymphoma, unspecified,

unspecified site During the 12 months after ICD-10 implementation, using any one of the valid codes for Hodgkin’s lymphoma (C81.00, C81.03, C81.10 or C81.90) would not be cause for an audit under the recently announced flexibilities.

In another example, a patient has a diagnosis of G43.711 (Chronic migraine without aura, intractable, with status migrainosus). Use of the valid codes G43.701 (Chronic migraine without aura) or G43.719 (Chronic migraine without aura, intractable without status migrainosus) instead of the correct code, G43.711, would not be cause for an audit under the audit flexibilities occurring for 12 months after ICD10 implementation, since they are all in the same family of codes.

Many people use the terms “billable codes” and “valid codes” interchangeably. A complete list of the 2016 ICD-10-CM valid codes and code titles is posted on the CMS website at http://www.cms.gov/Medicare/ Coding/ICD10/2016-ICD-10-CM-and-GEMs.html.

The codes are listed in tabular order (the order found in the ICD-10-CM code book). This list should assist providers who are unsure as to whether an additional 4th, 5th, 6th or 7th character is needed. Using this free list of valid codes is straightforward. For more information about acknowledgement testing, contact your Medicare Administrative Contractor, and review the Medicare Learning Network articles on testing, such as SE1501.

Question: What should I do if my claim is rejected?

Will I know whether it was rejected because it is not a valid code versus denied due to a lack of specificity required for a National Coverage Determination (NCD) or Local Coverage Determination (LCD) or other claim edit?

Answer: Yes, submitters will know that it was rejected because it was not a valid code versus a denial for lack of specificity required for a NCD or LCD or other claim edit. Submitters should follow existing procedures for correcting and resubmitting rejected claims and issues related to denied claims.

specific information on the type of condition. For instance, category H25 (Age-related cataract) contains a number of specific codes that capture information on the type of cataract as well as information on the eye involved. Examples include: H25.031 (Anterior subcapsular polar age-related cataract, right eye), which has six characters; H25.22 (Age-related cataract, morgagnian type, left eye), which has five characters; and H25.9 (Unspecified age-related cataract), which has four characters. One must report a valid code and not a category number. In many instances, the code will require more than 3 characters in order to be valid.

Another example, K50 (Crohn’s disease) has codes within the category that require varying numbers of characters to be valid. The ICD-10-CM code book clearly provides information on valid codes within this, and other categories. And if in doubt, providers can check the list of valid 2016 ICD-10-CM codes to determine if all characters have been selected and reported.

Examples of valid codes within category K50 include: K50.00 Crohn’s disease of small intestine

without complications K50.012 Crohn’s disease of small intestine with

intestinal obstruction K50.90 Crohn’s disease, unspecified, without complications To include the Crohn’s disease diagnosis on the claim, a valid code must be selected. If the paid claim were to be selected later for audit by a Medicare review contractor, the Guidance makes it clear that the claim would not be denied simply because the wrong code was included, so long as the code was in the same family. As long as the selected code was within the K50 family, then the audit flexibility applies.

Question: Do the ICD-10 Medicare fee-for-service audit and quality program flexibilities extend to Medicare fee-for-service prior authorization requests?

Question: What is meant by a family of codes?

Answer: No, the Medicare fee-for service audit and quality program flexibilities only pertain to post payment reviews. ICD-10 codes with the correct level of specificity will be required for prepayment reviews and prior authorization requests. 

Answer: “Family of codes” is the same as the ICD-10 three-character category. Codes within a category are clinically related and provide differences in capturing

Source: https://www.cms.gov/Medicare/Coding/ICD10/ Clarifying-Questions-and-Answers-Related-to-the-July6-2015-CMS-AMA-Joint-Announcement.pdf PHYSICIAN SOLUTIONS MAGAZINE

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features

10 Funny, But Valid, ICD-10 Codes Or, Yes, There’s a Code For That

By Thomas Hibbard, Creative Director, Physician Solutions While the ICD-10 transition was no laughing matter, the federal government, with their exceptional ability to over-document everything, has created a series of diagnosis codes that will bring a smile to your face. There are several websites online that point out these humorous, yet actual ICD-10 codes.

1 2

4 7 5

BURN DUE TO WATER-SKIS ON FIRE, INITIAL ENCOUNTER Code - V91.07XA

SUCKED INTO JET ENGINE, SUBSEQUENT ENCOUNTER Code - V97.33XD

STRUCK BY MACAW, INITIAL ENCOUNTER Code - W61.12XA

ANIMAL-RIDER INJURED IN COLLISION WITH STREETCAR, INITIAL ENCOUNTER Code - V80.730A

6

8

INJURED WHILE KNITTING OR CROCHETING Code - Y93.D1

3 30

PROBLEMS IN RELATIONSHIP WITH IN-LAWS Code - Z63.1

| MARCH 2016

HEADACHE ASSOCIATED WITH SEXUAL ACTIVITY Code - G44.82

UNSPECIFIED SPACECRAFT ACCIDENT INJURING OCCUPANT, INITIAL ENCOUNTER Code - V95.40XA

9

PARENTAL OVERPROTECTION Code - Z62.1

10

WALKED INTO LAMPPOST, SUBSEQUENT ENCOUNTER Code - W220.2XD

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

NC MedSpa For Sale MedSpa Located in North Carolina We have recently listed a MedSpa in NC This established practice has staff MDs, PAs and nurses to assist patients. Some of the procedures performed include: Botox, Dysport, Restylane, Perian, Juvederm, Radiesse, IPL Photoreju Venation, fractional laser resurfacing as well as customized facials. There are too many procedures to mention in this very upscale practice. The qualified buyer will be impressed with the $900,000 gross revenue. This is a new listing, and we are in the valuation process.

Comfortable seeing children. Needed immediately.

Call 919- 845-0054 or email: physiciansolutions@gmail.com www.physiciansolutions.com

Contact Medical Practice Listings today to discuss the practice details.

For more information call Medical Practice Listings at 919-848-4202 or e-mail medlistings@gmail.com

www.medicalpracticelistings.com

PRIMARY CARE PRACTICE East of Raleigh, North Carolina We are offering a well established primary care practice only minutes east of Raleigh North Carolina. The retiring physician maintains a 5 day work week and has a solid base of patients that can easily be expanded. There are 6 fully equipped exam rooms, a large private doctor’s office, spacious business office, and patient friendly check in and out while the patient waiting room is generous overlooking manicured flowered grounds. This family practice is open Monday through Friday and treats 8 to a dozen patients per day.

Currently operating on paper charts, there is no EMR in place. The Gross revenue is about $235,000 yearly.

We are offering this practice for $50,000 which includes all the medical equipment and furniture. The building is free standing and can be leased or purchased.

Contact Philip at 919-848-4202 to receive details and reasonable offers will be presented to the selling physician.

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202 32 | MARCH 2016

Primary Care Specializing in Women’s Health

Located on NC’s Beautiful Coast, Morehead City

Practice established in 2005, averaging over $540,000 the past 3 years. Free standing practice building for sale or lease. This practice has 5 well equipped exam rooms and is offered for $20,000.

919.848.4202 medlisting@gmail.com medicalpracticelistings.com

Internal Medicine Practice for Sale Located in the heart of the medical community in Cary, North Carolina, this Internal Medicine practice is accepting most private and government insurance payments.

The average patients per day is 20-25+, and the gross yearly income is $555,000.

Listing Price: $430,000

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com

MD STAFFING AGENCY FOR SALE IN NORTH CAROLINA The perfect opportunity for anyone who wants to purchase an established business.

l One

of the oldest Locums companies client list l Dozens of MDs under contract l Executive office setting l Modern computers and equipment l Revenue over a million per year l Retiring owner l Large

Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

PHYSICIAN SOLUTIONS MAGAZINE

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Eastern North Carolina Family Practice Available Well-appointed Eastern North Carolina Family Practice established in 2000 is for sale in Williamston, NC. This organized practice boasts a wide array of diagnostic equipment including a GE DEXA scanner with a new tube, GE case 8000 stress testing treadmill and controller and back up treadmill, Autoclave and full set of operating equipment, EKG-Ez EKG and much more. The average number of patients seen daily is between 12 to 22. The building is owned by MD and can be purchased or leased.

The owning physician is relocating and will assist as needed during the transition period. The gross receipts for the past three years average $650,000 and the list price was just reduced to $185,000. If you are looking to purchase a well equipped primary care practice, please contact us today.

919-848-4202 medlisting@gmail.com medicalpracticelistings.com

Women’s Health Practice in Morehead City, NC

Pediatrics Practice Wanted Pediatrics practice wanted in NC

Newly listed Primary Care specializing in Women’s care located in the beautiful coastal city of Morehead City. This spacious practice has 5 exam rooms with one electronic tilting exam table and 4 other Ritter exam tables. Excellent visibility and parking make this an ideal location to market and expand. This practice is fully equipped and is ready for a new owner that is ready to hit the ground running. The owning MD is retiring and will be accommodating during the transition period. This medical building is owned and is offered for sale, lease or lease to own. The gross receipts for the past 3 years exceed $540,000 per year. If you are looking to purchase an excellent practice located in a picturesque setting, please contact us today.

Medical Practice Listings Buying and selling made easy

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com 34 | MARCH 2016

Considering your options regarding your pediatric practice? We can help.

Medical Practice Listings has a well qualified buyer for a pediatric practice anywhere in central North Carolina.

Contact us today to discuss your options confidentially.

Medical Practice Listings Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com

Adult & pediAtric integrAtive medicine prActice for sAle

Med Spa in the Raleigh-Durham, NC Area

This Adult and Pediatric Integrative Medicine practice, located in Cary, NC, incorporates the latest conventional and natural therapies for the treatment and prevention of health problems not requiring surgical intervention. It currently provides the following therapeutic modalities: • • • • •

Conventional Medicine Natural and Holistic Medicine Natural Hormone Replacement Therapy Functional Medicine Nutritional Therapy

• • • • • •

Mind-Body Medicine Detoxification Supplements Optimal Weigh Program Preventive Care Wellness Program Diagnostic Testing

There is a Compounding Pharmacy located in the same suites with a consulting pharmacist working with this Integrative practice. Average Patients per Day: 12-20

Beautiful Med Spa located in the Raleigh-Durham is among our newest listings.

This very upscale facility is established and boosts consistent gross revenues of a million plus. Some of the procedures performed are: Botox, Dermal Fillers, Minimal light based treatments, laser hair removal, cool sculpting (external cooling treatment that freezes the hair and the body metabolizes the fat). This practice is ideal for the Plastic Surgeon or Dermatologist.

Gross Yearly Income: $335,000+ | List Price: $125,000

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com

Established: 2010 l Annual Revenue: $1,000,000 Average Patients per Day: 15 to 25

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com

PRIMARY CARE PRACTICE - Hickory, North Carolina This is an outstanding opportunity to acquire one of the most organized and profitable primary care practices in the area. Grossing a million and a half yearly, the principal physician enjoys ordinary practice income of over $300,000 annually.

Hickory is located in the foot-hills of North Carolina and is surrounded by picturesque mountains, lakes, upscale shopping malls and the school systems are excellent. If you are looking for an established practice that runs like a well oiled machine, request more information.

The free standing building that houses this practice is available to purchase or rent with an option. There are 4 exam rooms with a well appointed procedure room. The owning physician works 4 to 5 days per week and there is a full time physician assistant staffed as well.

For the well qualified purchasing physician, the owner may consider some owner-financing. Call us today.

List price: $425,000 | Year Established: 2007 | Gross Yearly Income: $1,500,000

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202 PHYSICIAN SOLUTIONS MAGAZINE

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Primary Care Practice For Sale

Practice for Sale in Raleigh, NC

Wilmington, NC

Primary care practice specializing in women’s care

Established primary care on the coast of North Carolina’s beautiful beaches.

Fully staffed with MD’s and PA’s to treat both appointment and walk-in patients.

Excellent exam room layout, equipment and visibility.

The owning physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however, that could double with a second provider. Exceptional cash flow and profit will surprise even the most optimistic practice seeker. This is a remarkable opportunity to purchase a well-established woman’s practice. Spacious practice with several well-appointed exam rooms and beautifully decorated throughout. New computers and medical management software add to this modern front desk environment.

Raleigh, North Carolina

List price: $435,000

Contact Medical Practice Listings for more information.

Medical Practice Listings 919.848.4202 | medlistings@gmail.com www.medicalpracticelistings.com

Call Medical Practice Listings at (919) 848-4202 for details and to view our other listings visit www.medicalpracticelistings.com

PHYSICIANS NEEDED: Mental health facility in Eastern North Carolina seeks: PA/FT ongoing, start immediately Physician Assistant needed to work with physicians to provide primary care for resident patients. FT ongoing 8a-5p. Limited inpatient call is required. The position is responsible for performing history and physicals of patients on admission, annual physicals, dictate discharge summaries, sick call on unit assigned, suture minor lacerations, prescribe medications and order lab work. Works 8 hour shifts Monday through Friday with some extended work on rotating basis required. It is a 24 hour in-patient facility that serves adolescent, adult and geriatric patients.

FT ongoing Medical Director, start immediately The Director of Medical Services is responsible for ensuring all patients receive quality medical care. The director supervises medical physicians and physician extenders. The Director of Medical Services also provides guidance to the following service areas: Dental Clinic, X-Ray Department, Laboratory Services, Infection Control, Speech/Language Services, Employee Health,

Pharmacy Department, Physical Therapy and Telemedicine. The Medical Director reports directly to the Clinical Director. The position will manage and participate in direct patient care as required; maintain and participate in an on-call schedule ensuring that a physician is always available to hospitalized patients; and maintain privileges of medical staff.

Permanent Psychiatrist needed FT, start immediately An accredited State Psychiatric Hospital serving the eastern region of North Carolina, is recruiting for permanent full-time Psychiatrist. The 24 hour in-patient facility serves adolescent, adult and geriatric patients. The psychiatrist will serve as a team leader for multi-disciplinary team to ensure quality patient care/treatment. Responsibilities include:

evaluation of patient on admission and development of a comprehensive treatment plan, serve on medical staff committees, complete court papers, documentation of patient progress in medical record, education of patients/families, provision of educational groups for patients.

Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624 PH: (919) 845-0054 | email: physiciansolutions@gmail.com 36 | MARCH 2016

Modern Med Spa Available

Located in beautiful coastal North Carolina Modern, well-appointed med spa is available in the eastern part of the state. This Spa specializes in BOTOX, facial therapy and treatments, laser hair removal, eye lash extensions and body waxing as well as a menu of anti-aging options. This impressive practice is perfect as-is and can accommodate additional services like; primary health or dermatology.

The Gross revenue is over $1,500.000 during 2012 with consistent high revenue numbers for the past several years. The average number of patients seen daily is between 26 and 32 with room for improvement. You will find this Med Spa to be in a highly visible location with upscale amenities. The building is leased and the lease can be assigned or restructured. Highly profitable and organized, this spa POISED FOR SUCCESS. 919.848.4202 medlisting@gmail.com medicalpracticelistings.com

Urgent Care Practices Wanted We have several qualified MDs seeking established Urgent Care Practices in North Carolina.

NC Opportunities DENTISTS AND HYGIENISTS

If you have an urgent care practice and would like to explore your selling options, please contact us. Your call will be handled confidentially and we always put together win-win solutions for the seller and buyer.

Physician Solutions has immediate opportunities for dentists and hygienists throughout NC. Top wages, professional liability insurance and accommodations provided.

Call Medical Practice Listings today and ask for Philip Driver 919-848-4202.

Call us today if you are available for a few days a month, on-going or for permanent placement. Please contact Physican Solutions at 919-845-0054 or physiciansolutions@gmail.com PHYSICIAN SOLUTIONS MAGAZINE

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Physician Solutions, Inc. Medical & Dental Staffing

The fastest way to be $200K in debt is to open your own practice The fastest way to make $100K is to choose

Physician Solutions

THE DECISION IS YOURS Physician Solutions, Inc. P.O. Box 98313 Raleigh, NC 27624 Scan this QR code with your smartphone to learn more.

phone: 919-845-0054 fax: 919-845-1947 www.physiciansolutions.com physiciansolutions@gmail.com