THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 116 / NO. 5
September / October 2017
Coding, Billing, and Reimbursement MAXIMIZING REIMBURSEMENTS, MINIMIZING MISTAKES AND AVOIDING DELAYED PAYMENTS
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FEATURES & CONTENTS September / October 2017
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Shared Nationwide Interoperability Roadmap: The Journey to Better Health Care Contributed by HealthIT.gov
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The Faintest Ink BY CAROL MURRAY, RHIA, CPHRM, PATIENT SAFETY/RISK MANAGER II Contributed by The Doctors Company
COLUMNS 04 President's Perspective
BY CHERYL GIBSON FOUNTAIN, MD
06 Ask Our Lawyer
BY DANIEL J. SCHULTE, JD
08 MDHHS Update
BY COURTNAY LONDO, M.A.
14 Ask Human Resources
BY JODI SCHAFER, SPHR, SHRM-SCP
30 WealthCare Advisors
COVER STORY
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BY JIM NIEDZINSKI, AIF®
DEPARTMENTS 15 Welcome New Members 15 In Memoriam 22 MSMS Medical Opportunities 26 MSMS Educational Courses
CODING, BILLING AND REIMBURSEMENT BY NICK DE LEEUW FOR THE MICHIGAN STATE MEDICAL SOCIETY
Dealing with insurance companies and third party payers is part of the job. Getting it right matters, and getting it wrong can be expensive. What are the keys to maximizing payments and minimizing mistakes? (Story on page 16.)
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MICHIGAN MEDICINE Chief Executive Officer JULIE L. NOVAK
perspective
Managing Editor KEVIN MCFATRIDGE KMcFatridge@msms.org Marketing & Sales Manager TRISHA KEAST TKeast@msms.org Graphic Design STACIA LOVE, REZĂœBERANT! INC. rezuberantdesign@gmail.com Printing FORESIGHT GROUP staceyt@foresightgroup.net Publication Office Michigan Medicine 120 West Saginaw Street East Lansing, MI 48823 517-337-1351 www.msms.org All communications on articles, news, exchanges and advertising should be sent to above address, ATT: Trisha Keast. Postmaster: Address Changes Michigan Medicine Hannah Dingwell 120 West Saginaw Street East Lansing, MI 48823
Michigan Medicine, the official magazine of the Michigan State Medical Society (MSMS), is dedicated to providing useful information to Michigan physicians about actions of the Michigan State Medical Society and contemporary issues, with special emphasis on socio-economics, legislation and news about medicine in Michigan. The MSMS Committee on Publications is the editorial board of Michigan Medicine and advises the editors in the conduct and policy of the magazine, subject to the policies of the MSMS Board of Directors. Neither the editor nor the state medical society will accept responsibility for statements made or opinions expressed by any contributor in any article or feature published in the pages of the journal. The views expressed are those of the writer and not necessarily official positions of the society. Michigan Medicine reserves the right to accept or reject advertising copy. Products and services advertised in Michigan Medicine are neither endorsed nor warranteed by MSMS, with the exception of a few. Michigan Medicine (ISSN 0026-2293) is the official magazine of the Michigan State Medical Society, published under the direction of the Publications Committee. In 2017 it is published in January/February, March/April, May/ June, July/August, September/October and November/December. Periodical postage paid at East Lansing, Michigan and at additional mailing offices. Yearly subscription rate, $110. Single copies, $10. Printed in USA. Š2017 Michigan State Medical Society
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CHERYL GIBSON FOUNTAIN, MD, MSMS PRESIDENT
By Cheryl Gibson Fountain, MD, Michigan State Medical Society President
®
Documentation. Coding. Billing. Reimbursements. For the overwhelming majority of Michigan physicians, dealing with insurance companies and third party payers is part of the job. Getting it right matters, and making mistakes can be expensive. Physicians’ livelihoods and, increasingly, their reputations depend on mastering the process, and the stakes couldn’t be higher for getting it wrong. So what’s the key to maximizing reimbursements, minimizing errors, and avoiding delayed payments? In this edition of Michigan Medicine we’re taking a look at the process and getting back to basics. Understanding the life of the claim. Documenting what you do. Coding what you’ve documented. Billing what you’ve coded and carefully tracking
In this edition of Michigan Medicine we’re taking a look at the process and getting back to basics. Understanding the life of the claim. Documenting what you do. Coding what you’ve documented. Billing what you’ve coded and carefully tracking your reimbursements.
your reimbursements. No one goes to medical school because they feel a call on their life to master the appropriate way to data-enter 140,000 or more lines of reimbursement code. Nevertheless, with their livelihoods on the line, that’s a responsibility facing every physician in the nation. Even after mastering the billing and coding process, physicians face a rapidly changing health care marketplace where patients are taking on a greater responsibility for their own payments. We asked the experts to help us unpack the process, highlight best practices and discuss common mistakes. You’ll read experiences from a family physician in private practice, a multi-provider practice’s billing department at the top of its game, and one of the state’s leading medical consultants. We’ll also break down some of the biggest challenges practices face across the health care spectrum. From start to finish, the Michigan State Medical Society is committed to helping physicians navigate the process.
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ASK OUR LAWYER
Consider National Practitioner Data Bank Reporting Prior to Settling Licensing Complaints and Medical Staff Peer Review Actions By Daniel J. Schulte, JD, Michigan State Medical Society Legal Counsel
Q: I recently settled a licensing complaint with the State of Michigan during a compliance conference. In my view the complaint lacked merit but I did not want to pay to go through an administrative hearing. To buy my peace and move on I agreed to a reprimand and a $500 fine. After I signed off someone mentioned that I may be reported to the National Practitioner Data Bank. This never came up at the compliance conference. My lawyer never mentioned this in our discussions and is not sure if this is the case or not. I would not have settled had I known a report would be made to the NPDB and assumed I was settling this quietly. Can you tell me if a NPDB report must be made
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A lawyer not experienced in health care law likely would not be aware of the NPDB, when the State of Michigan is required to report and the impact a report can have on a physician (when applying/reapplying for medical staff membership, a job or a medical director position, seeking to be engaged as an expert witness, etc.). The NPDB was created by the federal Health Care Quality Improvement Act, 42 U.S.C. 11101 et seq. (“HCIA”). It requires state licensure authorities and certain other entities (including organized medical staffs) to report “any adverse action” taken by them against a physician. These adverse actions include the revocation or suspension of a medical license, a reprimand, censure, probation or any other “negative actions” taken against a physician. Negative actions is defined broadly by HCIA to include anything placing a limitation on a physician’s scope of practice (e.g. agreeing to cease providing certain services, a limitation on prescribing authority, etc.). HCIA does provide that certain actions are not reportable to the NPDB. These nonreportable actions include administrative fines, citations, corrective action plans and monitoring (as long as it is does not restrict the physician’s ability to practice). It appears that you could have avoided the risk of a NPDB report by negotiating a sanction that did not include a reprimand. Unfortunately the possible sanctions available under Michigan’s Public Health Code include only denial of licensure, limitation, suspension, revocation, reprimand, fine, restitution and probation. It may have been possible to pay a higher fine in lieu of a reprimand or accept a corrective action plan that does not restrict your license as a limitation.
When possible it is worthwhile to avoid a NPDB report. Whenever you are being considered for a job the potential employer will query you and discover reports. A report may adversely affect your ability to get the job you are seeking. The same is true when you are applying for privileges at a hospital, clinic etc. It is also worth noting that some state medical boards have policies on reporting to the NPDB that are not consistent with the regulatory requirements. For example, a medical board may have a policy of reporting anytime a fine is levied as a sanction even though fines are not reportable. When in a compliance conference or subsequent negotiations your lawyer should ask what the medical board’s policy is. To the extent a NPDB report is made contrary to the law you may appeal to have it removed. The appeal process is beyond the scope of this column but is another process that a lawyer experienced in health care matters can assist you with. A final note on your goal of settling the case “quietly”. This is not entirely possible since Michigan’s Public Health Code (MCL 333.16241) requires all licensing sanctions to be published by the Department of Licensing and Regulatory Affairs (“LARA”) and further requires you to notify your employer and medical staff. Currently LARA satisfies this requirement by making available consent orders and stipulations on its website. You should carefully review these documents knowing that they will be seen by the public.
DANIEL J. SCHULTE, JD, MSMS LEGAL COUNSEL IS A MEMBER AND MANAGING PARTNER OF KERR RUSSELL.
Save the Date 60TH ANNUAL ALLEN SILBERGLEIT, MD CLINIC DAY
Genomic Medicine for the Practicing Physician November 8, 2017 Anthony M. Franco Communications Center Continental Breakfast & Program: 7:15 a.m. -12:30 p.m. Luncheon will immediately follow the program For more information, contact Via Barias, Via.Barias@stjoeshealth.org or call 248-858-6017.
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MDHHS UPDATE
Your Vaccine Recommendation Is A Critical Factor In Protecting Patient Health By Courtnay Londo, M.A., Adolescent & Adult Immunization Coordinator, MDHHS Division of Immunization
Patients trust you to give them the best counsel on how to protect their health. You know that immunization is an important preventive measure – but it’s unlikely that getting vaccinated is on the radar for your adult patients. Your strong recommendation is critical in ensuring that they get the vaccines they need to help them stay healthy. Vaccine-preventable diseases are serious. Every year, tens of thousands of adult Americans suffer serious health problems, are hospitalized, and even die from diseases that could be prevented by vaccines. These diseases include shingles, influenza, pneumococcal disease, hepatitis A, hepatitis B-related chronic liver disease and liver cancer, HPV-related cancers and genital warts, pertussis (whooping cough), tetanus and more. Adults are not getting the vaccines they need. Adult vaccination coverage rates for the majority of vaccines are well below 50 percent. In Michigan, only 46.7 percent of 19-64 year olds have received one or more doses of Tdap vaccine and 24.3 percent of individuals 60 years of age and older have received one or more doses of zoster vaccine. Vaccination protects vulnerable individuals. Vaccination is important because it not only protects the person receiving the vaccine, but also helps prevent the spread of certain diseases, especially to those that are most vulnerable to serious complications, such as infants and young children, the elderly, and those with weakened immune systems. Cancer patients and their caregivers should be appropriately immunized in
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order to shield these vulnerable individuals from serious illness. Immunizing adults creates healthier communities and protects the places in which we live, work, and play. Most adults don’t realize that they need vaccines. Adult clients may be recommended up to 13 vaccines. A recent national survey revealed that most adults were not aware of recommended vaccines beyond influenza. Your patients are likely to get the vaccines you recommend to them. Clinicians are the most valued and trusted source of health information for adults. Your patients rely on you to let them know which vaccines are necessary and right for them.
The Michigan Department of Health and Human Services (MDHHS) is calling on all healthcare professionals to make adult immunizations a standard of routine patient care in their practice by integrating four key steps: ASSESS immunization status of all your patients at every clinical encounter. This involves staying informed about the latest Centers for Disease Control and Prevention (CDC) recommendations for immunization of adults and implementing protocols to ensure that patients’ vaccination needs are routinely reviewed.
Strongly RECOMMEND vaccines that patients need. Key components of this include tailoring the recommendation for the patient, explaining the benefits of vaccination and potential costs of getting the diseases they protect against, and addressing patient questions and concerns in clear and understandable language. ADMINISTER needed vaccines or REFER your patients to a provider who can immunize them. It may not be possible to stock all vaccines in your office, so refer your patients to other known immunization providers in the area to ensure that they get the vaccines they need to protect their health. Coordinating a strong immunization referral network will reduce a substantial burden on your adult patients and your practice. If your adult patients do not have insurance, or if their insurance does not cover any of the cost of an immunization, check with your local health department to see if your patient qualifies for publicly-purchased vaccines. DOCUMENT vaccines received by your patients. Help your office, your patients, and your patients’ other providers know which vaccines they have had by documenting in the Michigan Care Improvement Registry (MCIR). And for the vaccines you do not stock, follow up to confirm that patients received recommended vaccines. Keep your patients and their caregivers healthy by recommending timely and appropriate adult immunizations. Also, make sure the staff in your office are doing their part to protect vulnerable patients by being vaccinated themselves. To find out more, please visit www.cdc.gov/ vaccines or www.aimtoolkit.org.
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CONTINUE ON PAGE 11
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… CONTINUED FROM PAGE 10
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The Faintest Ink By Carol Murray, RHIA, CPHRM, Patient Safety/Risk Manager II
An old Chinese proverb says, “The faintest ink is more powerful than the strongest memory.” This adage has great applicability when discussing the best ways to document your medical care.
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he Doctors Company closed claims studies frequently cite uses electronic signatures, be certain that it conforms to state and/or inadequate or lack of documentation as a risk factor. Weak, federal requirements. flawed, or absent documentation can have a powerful imEven the best systems can lose dictation. Ironically, the loss is somepact if you are called upon to defend patient care. More times discovered when a malpractice suit is filed. In these types of often than not, a jury will consist entirely of people with no medsituations, the best practice is to document the date and time that ical background. The medical record can reinforce or destroy your you became aware of the missing document, credibility, and it can be a significant factor in then dictate a report containing what you can determining the outcome of a complex malpracremember, and indicate that its brevity is due to tice case. Poor documentation practices can also Detrimental have a deleterious effect on any individuals or enprior dictation being lost. It is important to acdocumentation practices tities that survey your records—ranging from inknowledge in the appropriate timeline when the include gaps or delays surance companies to accrediting bodies or state dictation was lost and when the second dictation medical boards. occurred. in documentation, illegible Detrimental documentation practices include gaps or delays in documentation, illegible entries, dictation with blanks, unflattering patient descriptions that appear judgmental, entries that appear to vent negative feelings, altered records, and records missing documents or entries.
Ensure Quality Documentation
entries, dictation with blanks, unflattering patient descriptions that appear judgmental, entries that appear to vent negative feelings, altered records, and records missing
Dictation Many physicians are choosing to dictate in the presence of the patient to create a contemporaneous record of the encounter. This can be accomplished by actual dictation or, in some offices, with an electronic health record (EHR), which the physician or scribe uses when entering information into a template. Physicians who are involved in dictating reports that interpret medical information are also responsible for reviewing and signing those reports. Avoid having physicians sign for each other. If your system
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Correcting an Entry
documents or entries.
We encourage physician groups to assess the quality of documentation routinely. Set up a system for monitoring medical records that is based on specific policies and procedures. For example, you may want to define acceptable time frames and protocols for completing records, correcting entries, authenticating entries or reports, and documenting late entries.
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From a risk perspective, it is not acceptable to include “dictated but not read” statements in dictation. It does not relieve the author of responsibility for the accuracy of the transcription, and it only calls attention to questions about the quality of care.
It is often necessary to correct erroneous information in a medical record document. Corrections should never be made after a claim or suit has been brought forward. If you need to correct a record in the normal course of care, it is appropriate to mark the original entry with a notation of error without obliterating the erroneous information. It is important to be familiar with the proper method of making corrections as required by the specific EHR software in use.
Forms and Templates Documentation can be enhanced by using forms or templates effectively. In the electronic record environment, documentation can be accomplished by integrating forms and templates into the software. Patient health histories capture important information to assist in documenting a thorough history and physical examination. The forms should be signed by the patient and, when complete, initialed by the physician after review.
Problem Areas Some of the problem areas identified through chart audits: Missing signatures. Using unclear or nonstandard abbreviations. Correcting erroneous entries incorrectly. Logging allergy information in multiple areas of the chart – which creates opportunities for conflicting information. Lacking documentation of physician review of results of diagnostic studies. Lacking documentation that patients are informed about the results of diagnostic studies.
A New Patient’s Journey Can Start Anywhere.
Including late entries in the patient’s chart. Missing or inadequate documentation of follow-up plans. Missing or limited documentation of phone calls with patients. Missing documentation of a patient’s response to therapy or of non-adherent behaviors.
Benefits of a Well-Documented Record Benefits of thorough documentation include a decrease in errors related to miscommunication and an enhanced continuity of care. One of the best ways to strengthen the continuity of care for patients who are discharged from the inpatient setting is to include a complete discharge summary. A complete summary contains basic elements, such as diagnosis, pertinent physical findings, and the results of diagnostic studies (lab tests, for example). Additionally, it is helpful to include details of medications prescribed at discharge with the rationale, frequency, dosage, and the proposed length of the treatment regimen. You might also include post-discharge plans specifically relating to any consultants, planned testing, outstanding reports needing follow-up, and the discharge instructions given to the patient. A well-documented medical record is essential to providing quality care, and it supports the physician if litigation occurs. This can only happen with a personal commitment to the importance of clinical documentation. An informative medical record helps the practitioner make timely decisions predicated on all the information that can be assembled about the patient. It helps to ensure that members of the care team have the critical information they need to coordinate care efforts, and it provides subsequent caregivers with crucial information to support the continuity of care. Reprinted with permission. ©2017 The Doctors Company (www.thedoctors.com).
THE GUIDELINES SUGGESTED HERE ARE NOT RULES, DO NOT CONSTITUTE LEGAL ADVICE, AND DO NOT ENSURE A SUCCESSFUL OUTCOME. THE ULTIMATE DECISION REGARDING THE APPROPRIATENESS OF ANY TREATMENT MUST BE MADE BY EACH HEALTHCARE PROVIDER IN LIGHT OF ALL CIRCUMSTANCES PREVAILING IN THE INDIVIDUAL SITUATION AND IN ACCORDANCE WITH THE LAWS OF THE JURISDICTION IN WHICH THE CARE IS RENDERED.
Word of mouth and insurance compatibility are only half of the story. MSMS members can get the full picture with a free downloadable guide at Officite.com/Sept/MSMS.
Websites and Online Marketing Solutions for Healthcare Practices
(888) 791-1737 SEPT / OCT 2017 |
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ASK HUMAN RESOURCES
Taking the Sting out of Performance Appraisals By Jodi Schafer, SPHR
Q I know I am supposed to conduct employee evaluations on a regular basis. I understand why they are important
and I have the best intentions of doing them each year. However, I struggle to complete them. In fact, I dread it! Do you have any tips to make this process less painful and more productive for me and my staff?
You are not alone in your mixed feelings about performance reviews. The benefits of a review far outweigh the negative aspects, but only if the evaluations are done properly. By that I mean that the reviews are consistently administered, the measured performance objectives are job-related and the feedback given is honest and objective.
the responsibility for remembering everything between the two of you. As an interesting side note, employees are often times harder on themselves then you would be, so allowing them to participate in this process can help diffuse defensiveness when discussing areas of weakness.
To help your evaluations rise to the occasion, I recommend focusing on three things: (1) frequency, (2) process, and the (3) delivery mechanism. Let’s start by looking at frequency.
Delivery
Frequency A typical review cycle requires us to remember and regurgitate an entire year’s worth of information at once, which is wrought with pit-falls. The most common of these is a psychological phenomenon known as the “Recency Effect”. Even if you haven’t heard of it, you have more than likely succumbed to it. The “Recency Effect” describes when you focus on the most recent event as the basis for analyzing the entire year. It’s not that you do it on purpose, but without good documentation throughout the year you have very little to base your evaluation on except what you have observed/ heard most recently. To combat this, consider breaking the review process into bite-sized pieces. Instead of conducting a performance evaluation once a year, it might make sense to hold more frequent sessions with your employees. Now I know what you’re thinking… you already dread this process and I’m telling you to do it MORE often?! But trust me on this. If you are meeting with your staff on a regular basis, say once per quarter, you don’t have to remember as much. The topics you discuss will be in the forefront of your mind and the feedback will be more timely; allowing for more coaching opportunities with staff.
You might ask about: Accomplishments and areas of strength, Weaknesses or areas of concern, Review of previously set goals and reasons/roadblocks for uncompleted tasks, Development of future goals, and
Process A second area worth discussing is your current review process. If you are not already doing so, I would strongly encourage you to add a self-review element. Allowing employees a chance to evaluate their own performance is a more collaborative approach and splits
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The final area I urge you to analyze is the delivery mechanism you use to record and evaluate performance objectives. Is your evaluation form working for you or against you? I have seen (and been guilty of creating) evaluations that are more than 5 pages long! The anxiety caused by just looking at all of those blank boxes is enough to make even the most well-intentioned manager save it for another day. It isn’t the formal document that is important – it’s the feedback contained in that document that counts. So tailor and streamline your delivery mechanism to meet your needs. Rather than creating a multi-page series of objectives and ranking criteria, consider a more conversational approach. Develop 4-5 questions that you and your employee can both answer regarding the employee’s performance, behavior and goals. Then meet to share your thoughts and develop future goals and a plan of action based on that conversation.
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Ways in which you can help them be successful. These are just a few ideas to help ease the pain of employee evaluations. Keep your focus on timely feedback and tailor your process around that.
In Memoriam
Center for Ethics and Humanities in the Life Sciences
MEMBERS OF THE MICHIGAN STATE
College of Human Medicine
MEDICAL SOCIETY REMEMBER THEIR COLLEAGUES WHO HAVE DIED.
Clinical Ethics Consultation Services Helping health professionals optimize the delivery of ethically sound care.
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Develop and enhance your clinical ethics consultation skills in an interactive small-group environment.
SAGINAW COUNTY MEDICAL SOCIETY 6/7/17 TO MAKE GIFT OR BEQUEST
For detailed information visit bioethics.msu.edu
TO THE MSMS FOUNDATION CONTACT: REBECCA BLAKE, DIRECTOR, MSMS FOUNDATION
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Coding, Billing, and Reimbursement MAXIMIZING REIMBURSEMENTS, MINIMIZING MISTAKES AND AVOIDING DELAYED PAYMENTS
T
he town physician was a staple of the golden age of television. Someone would make a call or run to fetch him, he’d show up with a little black bag, examine his patient, make a quick diagnosis and offer some advice. As he headed for the door, another character would see him out and put a coin or a couple dollars in his hand. “Thanks, Doc.” Times have changed! Full cash payment at the time of service has largely gone the way of house calls and black and white TV. Free market, pay-as-you-go practices, clinics, and hospitals still offer patients the option to pay for the cost of their procedures, labs, and other services without going through a third-party payer, but they represent only a small fraction of providers in an incredibly deep and diverse pool of delivery models.
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For the overwhelming majority of physicians in Michigan and across the United States, dealing with insurance companies and third party payers is part of the job. Getting it right matters, and getting it wrong can be expensive. So what’s the key to maximizing reimbursements and minimizing mistakes?
Jill Young, CPC, CEDC, CIMC is the founder and President of Young Medical Consulting, LLC in East Lansing, Michigan. She’s built a career and a thriving company advising physicians, billing departments, hospitals, practices, physician organizations and more on medical billing, coding, and reimbursement. One of the state’s top experts in her field, she’s seen it all. Her advice? Like so much else in life, success often comes by slowing down and getting back to basics. “Understand the ‘life of the claim’,” says Young. “Document what you do. Code what you’ve documented. Bill what’s coded. Verify your reimbursements.” Avoiding errors each step of the way leads to more timely and complete reimburse-
ments, higher patient satisfaction, and fewer audits and other headaches for providers and their staffs.
The life of the claim RevCycle Intelligence, which specializes in the health care revenue cycle, claims reimbursement, and medical billing for providers, last year published a discussion highlighting four of the most problematic medical billing issues affecting the health care revenue cycle. Not surprisingly, the experts identified a failure to adequately capture patient information as one of the key factors leading to claims reimbursement delays. “A claim starts when the patient walks through the door – or even calls to make an appointment,” Young teaches her clients. “When you’re collecting patient information, you’re beginning the claim process. Everything that happens is a part of that claim at some level, because it’s a part of the service patients receive. The life of the claim ends when it has a zero balance.”
Documenting what you do Christopher Dehlin, MD, is the President of Singletrack Health in Marquette where he shares a practice with his wife, Jennifer Dehlin, MD. The Dehlins spent seven years employed by a hospital group with its own billing department, before starting their
own practice last May, hiring their own biller, and taking on the responsibility for themselves.
These details are critical, and proper documentation is made more complex by the fact that each payer may define “medical necessity,” a significant factor in determining “There’s one step that happens before anyclaims payment, slightly differently. Luckily, thing else,” says Doctor Dehlin. “Getting there are resources out there that practices valid insurance information. If you haven’t can turn to for reference as they navigate done that work on the front end, particuthe landscape including the larly with Medicaid patients, you risk essentially doing that MSMS online resource center visit for free.” with information on medical When you’re necessity, and a free MSMS collecting patient Even for patients with private insurance, failing to diligent- information, you’re webinar on the topic that can be accessed at any time. ly verify patients’ insurance information at the first point of contact can lead to delays in the payment process and additional costs associated with re-billing the visit to additional insurers.
beginning the claim process. Everything that happens is a part of that claim at some level, because it’s a part of the service patients receive. The life of the claim ends when it has a zero balance.
Getting the details right, and right from the beginning, is an essential first step in the reimbursement process. But fully recording a patient’s personal and insurance information is only the first step when it comes to documentation. Accurate documentation of a patient’s condition, the severity of that condition, time spent with the patient, and discussions with the patient that extend beyond the primary cause of the visit are all critical in ensuring practices avoid delays and maximize reimbursements.
“Many physicians still fail to fully document their patients’ diagnosis,” says Young. “Failing to adequately reflect the severity or duration of a patient’s symptoms can lead to problems justifying ‘medical necessity’ later in the process.”
Accurate documentation can also lead to higher levels of reimbursement. A patient may have come in presenting with a sore throat and received treatment, but the long discussion between she and her physician about the importance of smoking cessation that happened during the same visit also represents a high value service with its own billable code. Reimbursement for that service is more likely with appropriate documentation at the point of contact. CONTINUED ON PAGE 18
Four Steps to a Smoother Reimbursement Process 1
2
3
4
Document what you do.
Code what you document.
Bill what was coded.
Monitor reimbursements.
Ensure your records reflect a patient’s illness, its severity, and duration will help prevent red flags with private insurers and Medicare over Medical Necessity.
With 140,000 lines of code in ICD 10 alone, coding can get very specific. Avoid “unspecified” codes, and take advantage of that specificity.
Having the right documentation and codes will ensure a practice is able to fully bill for the services provided each patient. A physician’s expertise, time, and treatment are valuable. Don’t short sell your practice.
A practice should keep its eyes on electronic reimbursements, as well as patient copays, to avoid costly delays in payment.
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“The better you can document, the easier you make it for your biller,” says Dehlin. “If you’re using EMR and using it well, and you use your templates well, you can tee up the right codes for your biller so they’re not missing potential reimbursements, and they’re getting the right codes.”
Code what you’ve documented Of course, no one said coding was easy. In October 2015, the U.S. Department of Health and Human Services formally transitioned to the use of ICD 10, a new international classification of diseases. ICD 10 features roughly 140,000 different codes. Young often presents before practices and organizations, and highlights the thoroughness of the latest reporting requirements. For instance, under the previous coding iteration, ICD 9, physicians could choose between two codes when treating a patient for an insect bite – one if they presented with an infection, and another if they were uninfected. Under ICD 10, there are over 90 distinct codes related to insect bites, reflecting differences in the bite’s location on the patient’s body and the number of times the patient has been seen for the bite. No one goes to medical school because they feel a call on their life to master the appropriate way to data-enter 140,000 or more lines of reimbursement code. Nevertheless, with their livelihoods on the line, that’s a responsibility facing every physician in the nation. Experts say best practice is to have ancillary staff in a review role before claims are submitted, but many practices and physician groups continue to go it alone.
Michele Luokkala, CMC, CMIS, is a certified coder and the Billing Lead at Partner in Internal Medicine, in Ann Arbor. She and her department oversee all billing, coding, and related oversight at the practice, which includes seven physicians and a nurse practitioner. “We’ve got a big hand in making sure the revenue comes into the practice – and comes in correctly,” says Luokkala. “A well-oiled billing process creates well-oiled reimbursements.”
Additionally, it is important to understand which providers can submit which codes. Navigating the coding requirements for different nurses on staff, for instance, can help a practice maximize reimbursements. In today’s
environment, it is essential that practices have skilled billers on staff committed to staying educated and up-todate on billing and coding procedures, and we believe these resources can help on that front.
“That’s the hardest part in today’s (health care) world,” said Young. “Computerization has turned physicians’ jobs into things they weren’t intended to be.”
A specialized billing staff can make a real difference in a practice “As medical coding and billing has become increasingly complex, we have done our
18 michigan MEDICINE
best to keep pace by providing tools and resources, including webinars, that physicians can reference as they work to successfully navigate through coding and billing procedures at their practice,” said MSMS Reimbursement Advocate, Stacie Saylor, CPC, CPB. “In today’s environment, it is essential that practices have skilled billers on staff committed to staying educated and up-to-date on billing and coding procedures, and we believe these resources can help on that front.”
| SEPT / OCT 2017
Nurse practitioners code and bill at the provider level. They do their own documentation that generates its own codes, and leads to their own reimbursements. The work performed by RNs and LPNs is billed under the physician issuing the orders.
“When a physician performs a service, it’s typically billed at a higher rate,” says Mary Bondie, LPN, the Practice Manager at Partners in Internal Medicine. “When a patient comes in for a nurse visit, whether it be checking levels, administering vaccines or doing a dressing change, that’s a lower-level visit code that we would bill under the physician. “Nurse practitioners can bill as a provider, just like a physician. A nurse’s services are billed under the direction of the physician and under the physician’s name. A NP can
MSMS Billing and Coding Resources On-Demand Webinars available at http://MSMS.org/OnDemand Billing 101 Claims Appeals Compliance in the Office ICD 10 (2017) & Routine Waiver of Copays ICD 10 What We Have Learned & What We Need to Know Managing Accounts Receivable Reading Remittance Advice Tips and Tricks on Working Rejections Other Resources available at http://MSMS.org/BillingAndCoding
do orders on her own, but the RN or LPN has to have a physician issue the order.” Understanding the limitations imposed by each insurer can help a practice put the patient with the appropriate provider from the start, and maximize reimbursements. Getting the codes right also keeps practices out of trouble.
Bill what you’ve coded Billing the right codes is a high stakes business, and mistakes are costly. Long ago, accidentally typing in the wrong code – or worse, guessing at an incorrect code without the appropriate documentation—could result in a simple fine. Under reforms in HIPAA, practices audited by Medicare could face penalties of $100 to $50,000 for every line of code they billed incorrectly based on cause and intent. Not only can mistakes lead to penalties, not billing for services or billing for lower-cost, inappropriate codes can also hurt the bottom line. “If a physician is billing a high level of service code, but his diagnosis codes doesn’t show a level of severity, and documentation isn’t reflective of a high level of MDM and service, it may raise red flags,” says CONTINUED ON PAGE 20
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SEPT / OCT 2017 |
michigan MEDICINE 19
Young. “The order of steps along the way to a diagnosis, the severity of the diagnosis, all of these issues should be reflected in the documentation and in the codes.” Properly billing insurance companies is completely intertwined and dependent on getting the previous steps in the process right. “We do regular internal documentation audits, to make sure we’re capturing the highest level of diagnosis codes and office visit codes, so everyone is compensated accurately for what they’re doing,” says Luokkala. “A big reason providers have billing staff is so that we can review what has been documented and coded before we submit it to the payers. Payers have so many different rules and regulations about what they’ll accept, and making sure all of our coding and claims are correct based on those rules ensure our practice sees the appropriate reimbursements.”
Reimbursement The patient’s been seen. The documentation is done and the right codes have been prepared. The claim finally goes off, and if a practice put numbers in the right box, physicians are reimbursed. Right? Not always.
20 michigan MEDICINE
| SEPT / OCT 2017
bursements that are coming back,” encourThe end of the process can be problematages Dehlin, the family medicine physician ic too, according to the RevCycle analysis. in Marquette. “It’d be great to say, I’m just The publisher found that failing to clearly going to wear my doctor hat and not worry explain to patients their own personal fiabout that all day, but if you’re running a nancial responsibility in the claims process small practice unit where the has also led to increasing rebottom line matters for your imbursement problems. The employees’ salaries, we have analysts point to a report from Have a process to to attend to changes in reimMcKinsey and Company that pay attention to bursement.” found providers only expect the charges that are to collect 50 to 70 percent of going out and the Billing professionals and anaa patient’s balance after a visit. lysts urge practices and billing reimbursements that departments to invest extra Lower patient-collection rates are coming back… time with patients to ensure are happening at the same they understand their persontime high-deductible plans are al financial responsibility, and to follow-up on the rise. RevCycle cites data from CMS with those who may have simply not realindicating 90 percent of the 12.7 million ized they had to write a check. individuals participating in the 2016 open enrollment period selected a high-deductProactively monitoring electronic reimible plan. bursements can also help quickly identify hiccups in the claims process before they In other words, a larger share of a physician’s become major delays. reimbursement is dependent on the group of payers – the patients themselves – least Billing, coding, and reimbursement grow likely to drop a check in the mail on time. more complicated and cumbersome every This new reality puts a premium on office year. Focusing on the basics, physicians, oversight, follow-up, and communication. groups, and practices can ensure the process delivers as well for them as they deliver for “Have a process to pay attention to the their patients. charges that are going out and the reim-
www.MSMSInsurance.org
Committed to protecting Michigan physicians, MSMS Physicians Insurance Agency knows it’s your life. Your family. Your dreams. We focus onPhysicians you firstInsurance and foremost, Committed to protecting Michigan physicians, MSMS Agency knows it’sthe yournovel life. Your family. dreams. We on you firstMichigan. and foremost, because we have idea thatYour protecting youfocus is protecting because we have the novel idea that protecting you is protecting Michigan.
MS Physicians Insurance Agency is uniquely qualified to offer our insurance portfolio to Michigan physicians, their families MSMS Physicians InsuranceAgency Agency uniquely qualifiedByto toknowing offer our our insurance theirday, families MSMS Physicians Insurance qualified offer portfolio Michigan physicians, families, d office staff. We make it our business to knowisisuniquely your business. the unique issuestophysicians face every MSMS and office staff. We make it our business to know your business. By knowing the unique issues physicians face every day, MSMS and office staff. We make it our business to know your business. By knowing the unique issues physicians face every day, MSMS ysicians Insurance Agency: Physicians Insurance Agency: • • • •
Physicians Insurance Agency: • Eliminates thefor need foror your practice contact insurers for billing Eliminates you your practice topractice contact forpurposes. billing purposes; •the need Eliminates the need for you ortoyour toinsurers contact insurers for billing purposes; • Hasaccess access the insurer's systems to add, terminate change aasubscriber's information withinwithin 24 hours, which • directHasto direct access to the insurer’s to add, terminate or change a subscriber’s information within 24hours, hours, Has direct thetoinsurer’s systems to systems add, terminate oror change subscriber’s information 24 removes the administrative burden from you and your staff; removeswhich the administrative burden fromfrom you and which removes the administrative burden youyour andstaff. your staff; Will research claims and benefit questions forthe yousubscriber, or the subscriber, which will eliminate thefrustration frustration Will research claims inquiries andinquiries benefit questions forforyou the subscriber, which will eliminate the • Will• research claims inquiries and benefit questions you or or which will eliminate the frustration of of contacting a complex customer service center; and, contacting a complex customerservice service center; center. and, of contacting complex • a Handles allcustomer COBRA administration for groups with more than 20 employees, free of charge, thus removing Handles all COBRA administration forburden. groups with 20employees—free employees, freeofofcharge—thus charge, thusremoving removing • Handles all COBRA administration for groups withmore morethan than 20 another another administrative another administrative administrative burden. burden.
You always get more with MSMS Physicians Insurance Agency because we focus on you. You always getwith moreMSMS with MSMS Physicians Insurance Agency because we focus on YOU. You always get more Physicians Insurance Agency because we focus on you. For more information or to request a quote for affordable, high-quality health For more information or to request a quote for affordable, high-quality health insurance, please connect with Ty at 877-742-2758 or tliggons@msms.org. insurance, please connect with Ty at 877/742-2758 or tliggons@msms.org.
For more information or to request a quote for affordable, high-quality health www .MSMSInsurance .orgTy at 877/742-2758 or tliggons@msms.org. insurance, please connect with
SEPT / OCT 2017 |
michigan MEDICINE 21
MSMS Medical Opportunities msms.medopps.org
msms.medopps.org
MSMS Medical Opportunities has been connecting physicians with employers since 1944. It is a nonprofit program through the Michigan Health Council designed to simplify your job search by posting jobs that match your practice preferences. Learn more at msms.medopps.org.
Henry Ford Allegiance Health Palliative Hospice Medical Director, MD/DO Jackson, MI
Henry Ford Allegiance Health Rheumatology, MD/DO Jackson, MI
Medical Opportunities ID # 3899
Medical Opportunities ID # 1007
Join a very reputable, well-established (2002) and rapidly expanding employed group practice. Currently 1-1/2 board-certified geriatricians/ hospice & palliative medicine, 4-NPs, 1-RN, 1-MA, 1-LMSW and clinical support staff. Allegiance Senior Health Center is an outpatient clinic which offers primary geriatric care, comprehensive geriatric assessment, home care, inpatient and outpatient palliative care as well as coverage for our freestanding Hospice Residence and our Inhome Hospice Program.
Henry Ford Allegiance Health seeks a fourth BE/ BC Rheumatologist to join well-established and reputable practice (20 years). See the following:
PRACTICE INFO:
We offer a very competitive salary, productivity bonus and signing bonus.
• Hours are M-F, 8-5p • No acute care or skilled nursing home involvement • Patient volume varies averaging 10-18 patients/day per provider • Palliative care certification/experience is a plus • Primary call 1:4 with backup call for mid-levels. All incoming calls are triaged via RN staffed messaging service. Henry Ford Allegiance Health is a 475-bed, Regional Hospital and Health System located in Jackson, just minutes from Ann Arbor with easy access to two Big Ten schools and Detroit Metropolitan Airport. We are consistently growing with an emerging community-based, post GME program inclusive of: GS, IM, FM, EM and Transitional year; our newly developing Level II trauma program with expected certification in 2016 and an average of 100,000 patient visits and over 18,000 inpatient admissions in our newly renovated ED. Allegiance Health is a Thompson Reuters 100 Top hospital.
COMPENSATION PACKAGE: We offer a competitive compensation package with full benefits including: full health, dental, life and retirement benefits. Excellent recruitment incentives include: signing bonus, student loan repayment, $30K relocation incentive, CME time & allowance, paid moving expenses and more.
Current board-certified Rheumatologists see an average of 24 patients/day and are scheduling new patients up to 6 months out. Office equipped with 8 exam rooms and fully staffed with 2 LPN's, office manager and receptionist / medical assistant / medical biller. Limited call of 1:4.
Paid benefits include: medical, dental, short and long term disability, life insurance, pension and 403b plan, four weeks vacation, one week CME. Recruitment Incentives include paid interview expenses, moving expenses, malpractice insurance, student loan repayment up to $50K, a $30K relocation stipend if you purchase a home in Jackson County. EEO/AA.
Henry Ford Allegiance Health Employed ENT opportunity, MD/DO Jackson, MI Medical Opportunities ID # 9888 Henry Ford Allegiance Health is seeking to employ a BE/BC, general Otolaryngologist to join two board-certified otolaryngologists in a well-established and thriving, broad-based practice offering an immediate patient base. Common procedures include: Audiogram, Adult Ear Tubes, Biopsy of Skin and Oral lesions, Cauterization of nose bleeds, Cerumen removal, Frenulectomy (tongue tie), Nasal Endoscopy and Laryngoscopy, Removal of Ear and Nasal Foreign Bodies. State-of-the-art microscopes and audio booths in office. EMR: EPIC being installed August 5, 2017.
Are You An Employer? Add Med Opps to your list of trusted recruiting resources. Access candidate profiles, contact information and CVs. Let us give you a head start on your recruiting efforts with new candidates registering each month. Search and contact physicians, physician assistants and nurse practitioners who are actively seeking an opportunity near you.
22 michigan MEDICINE
| SEPT / OCT 2017
Henry Ford Allegiance Health Psychiatry: Core Faculty / Substance / Geriatrics, MD/DO Jackson, MI Medical Opportunities ID # 11775 Henry Ford Allegiance Health is looking for Core Faculty. The faculties are clinical psychiatrist responsible for supervision of the psychiatry residents and other trainees on psychiatry rotations. We have opportunities focusing on substance abuse, and geriatrics as well. We are redesigning behavioral health in our community and need to be sure candidates are interested in helping to build a ‘new’ academic program. Program is focusing on population health management, integration. Clinical duties include a combination of inpatient, outpatient, and consult liaison work in psychiatric service and will include participation in research. Core Faculty will model professionalism, collaboration and teamwork with staff and other health professionals. The faculties are expected to engage in any or all areas of scholarship – discovery, teaching, integration, and application. Faculty members will contribute to the advancement of the discipline of Psychiatry as demonstrated by peer-reviewed funding; publication of original research or review articles in peer reviewed journals, or chapters in textbooks; publication or presentation of case reports or clinical series at local, regional, or national professional and scientific society meetings; or, participation in national committees or educational organizations.
ADMINISTRATIVE: All faculty members will participate in some administrative activities as a function of other elements of the job (e.g., leading curriculum committees or task-forces, organizing education, QI teams, etc.) While the Program Director has primary responsibility for administration of the residency, the faculty will participate in resident and faculty or staff recruitment activities, program evaluation, accreditation work, as delegated.
Making MACRA Work for You Tuesday, October 24, 2017
While it may seem difficult to embrace MACRA, MSMS will dig into the details and provide practical guidance every step of the way. Beginning with an overview of MACRA and practical steps to help you move forward, this conference will delve into aligning quality initiatives, technology, documentation, the use of tools such as Qualified Clinical Data Registries and key components of future Medicare payments. Helpful resources will be provided.
Speakers Leland Babitch, MD – What You Should Know About MACRA Holly Standhardt – Roadmap for Getting Started Stacey Hettiger – Aligning Quality Initiatives Jill Young, CPC, CEDC, CIMC – The Role of Documentation Under MACRA Dara Barrera – Technology Survival Tips to Tackle MACRA TBD – Using Qualified Clinical Data Registries to Your Advantage Stacey Hettiger – Navigating Need to Know Resources
The MACRA rates are: Member: $195; Non-Member: $275. Statement of Accreditation: The Michigan State Medical Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. AMA Credit Designation Statement: The Michigan State Medical Society designates this live activity for a maximum of 5.25 AMA PRA Category 1 CreditsTM. Physicians should claim only credit commensurate with the extent of their participation in the activity.
Register online today at www.msms.org/eo
CONTINUED ON PAGE 24
SEPT / OCT 2017 |
michigan MEDICINE 23
MSMS Medical Opportunities (continued)
Henry Ford Allegiance Health Neurologist, MD/DO Jackson, MI Medical Opportunities ID # 12101 Henry Ford Allegiance Health is seeking BC/BE Neurologist to join a reputable practice with 2.75 outpatient providers, 1 nurse practitioner and 1.75 inpatient neurology hospitalist. The Neurology Hospitalists cover 44 of 52 weeks, and the eight weeks remaining are split among four (one private practice) providers. The Hospitalist is the feeder system for follow up care for our outpatient Neurologist. Benefits, Compensation & Incentives: The compensation package includes a base salary with bonus opportunity, malpractice and health insurance, CME, PTO, and a 403(b). Henry Ford Allegiance Health also provides a housing incentive to any physician that relocates his/her primary residence to Jackson County within the first year, student loan forgiveness, moving allowance, and a signing bonus.
McLaren Cardiology, MD/DO Petosky, MI Medical Opportunities ID #11558 The Heart and Vascular Center at McLaren Northern Michigan is recruiting a non-invasive cardiologist to join a unique practice which performs TAVRS, WatchMan and nationally recognized research protocols located in a beautiful community setting. The ideal candidate will be board certified in cardiology and sub-specialty certified to support diagnostic testing, exercise stress testing and RPVI in addition to outpatient clinic and inpatient consultative service. Call coverage will be a 1:5 - 1:6 rotation. The nationally recognized and award winning program includes a dedicated team of top tier specialists recognized for excellence, publications, leading edge research, advanced techniques and utilization of the latest industry technology. Enjoy working with a progressive and dedicated group which includes General Cardiology, Interventional Cardiology, Electrophysiology, Vascular Surgery and Cardiothoracic Surgery. The Heart and Vascular Center team are actively engaged in on site research and clinical trials as a necessary component of modern health care. The group serves an expansive geographic area of northern Michigan resulting in an established patient base to build a successful practice. Candidates interested in supporting these programs are desired.
24 michigan MEDICINE
| SEPT / OCT 2017
THE HEART AND VASCULAR CENTER AT MCLAREN NORTHERN MICHIGAN OFFERS: • A Robust structural heart program including minimally invasive procedures such as TAVR, mitraclip and watchman. • Advanced electrophysiology, the WatchMan, pulmonary venous ablation treatment options and a superior heart failure program. • Innovative diagnostic techniques, advanced treatment modalities and dedicated specialists. • A revitalized STEMI program featuring new initiatives and intensified focus reducing doorto-balloon time well below the <90 minute goal set by the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. • Outstanding specialty clinics: Arrhythmia Clinic, Heart Failure Clinic, Structural Heart Clinic and a Vein Clinic The program is seeking candidates who want to make a difference in people’s lives while being the best in their profession in a non-academic tertiary setting with world class research and technologies. Compensation package includes a competitive income guarantee, comprehensive benefits with multiple investment options, medical malpractice, CME fund, relocation and additional financial incentives.
Medical Clinic of Northville Family Practice or Internal Medicine Opportunity MD/DO Northville
rotate the Friday afternoon shift and Saturday. Call is taken the week a practitioner works on a Saturday. All practitioners mutually agree to a vacation and holiday schedule each year. Practitioners equally cover for absent coworkers due to illness. We are open to talking to both a newly graduated specialty physician as well as a physician with a current practice in the area. Must be board eligible or board certified in Family Practice, Internal Medicine or Emergency Medicine and have an unrestricted license to practice medicine in the State of Michigan. Computerized Patient Records experience. DEA license.
MidMichigan Health Hospital Medicine, MD/DO Alma, MI Medical Opportunities ID #9485 Practice Hospital Medicine in the Ann Arbor of the North Hospital Medicine Package in excess of $320,000! $290,000 guaranteed salary Generous bonus package that averages $30,000 403b matching funds Long term stable group
MidMichigan Health Internal Medicine, MD/DO Gladwin, MI
Medical Opportunities ID #12381
Medical Opportunities ID #6797
Physician owned Family Practice and Internal Medicine practice with walk in urgent care component is looking for a full-time/part-time Physician to work along three full-time Family Practice and Internal Medicine Physicians. Opportunities include a variation of full-time, part-time and weekend schedules ranging from 20 - 40 hours a week. We provide care and services to a broad spectrum of patients of all ages. We are located in Northville Michigan, a safe and friendly upscale community with a top ranked public school system. Our physicians and staff are very friendly and cohesive.
This could be a BANNER year for you!
Our clinic is equipped with 10 exam rooms, on site lab and diagnostic testing including x-ray, ultrasound and nuclear medicine. We use Cerner software for our EMR and billing systems. The office is open 7:30 am - 6:00 pm Monday thru Friday and 8:00 am-1:30 pm on Saturday. Currently each practitioner works four morning shifts and one afternoon shift each week. We equally
Internal Medicine Residents - START GETTING PAID NOW Training stipend available, up to $36,000 $240,000 guaranteed salary for two years, plus more than $100,000 in bonuses available Flexible schedule to accommodate work-life balance Physician-led organization with formal mentorship program MidMichigan Health, an affiliate of the University of Michigan Health System. Moonlighting opportunities available in Hospital Medicine
MSMS Board of Directors Disclosures
Statement of Ownership, Management, and Circulation (All Periodicals Publications Except Requester Publications)
1. Publication Title
2. Publication Number
Michigan Medicine
0
Bi-monthly
Six (6)
4. Issue Frequency
0
2
_
6
3. Filing Date
2
9
2
3
5. Number of Issues Published Annually
7. Complete Mailing Address of Known Office of Publication (Not printer) (Street, city, county, state, and ZIP+4 ®)
7/27/17
6. Annual Subscription Price
$110.00 Contact Person
Kevin McFatridge
120 West Saginaw Street, East Lansing, MI 48823
Telephone (Include area code)
517-336-5745
8. Complete Mailing Address of Headquarters or General Business Office of Publisher (Not printer)
120 West Saginaw Street, East Lansing, MI 48823
9. Full Names and Complete Mailing Addresses of Publisher, Editor, and Managing Editor (Do not leave blank) Publisher (Name and complete mailing address)
H
ouse of Delegates Resolution 25-13 states that “MSMS annually provide Michigan physicians with a list of all officers, officials, candidates and staff who receive money as salary or non-patient care compensation from Blue Cross Blue Shield of Michigan (BCBSM) or any other insurer, medical product company or its affiliates annually in Michigan Medicine.” Following are the disclosures of the MSMS Board of Directors, officers and staff.
Kevin M. McFatridge, 120 West Saginaw Street, East Lansing, MI 48823 Editor (Name and complete mailing address)
Kevin M. McFatridge, 120 West Saginaw Street, East Lansing, MI 48823 Managing Editor (Name and complete mailing address)
10. Owner (Do not leave blank. If the publication is owned by a corporation, give the name and address of the corporation immediately followed by the names and addresses of all stockholders owning or holding 1 percent or more of the total amount of stock. If not owned by a corporation, give the names and addresses of the individual owners. If owned by a partnership or other unincorporated firm, give its name and address as well as those of each individual owner. If the publication is published by a nonprofit organization, give its name and address.) Full Name Complete Mailing Address
Michigan State Medical Society
120 West Saginaw Street, East Lansing, MI 48823
Rohit Abraham – None Anita R. Avery, MD – Physician reviewer, Priority Health
11. Known Bondholders, Mortgagees, and Other Security Holders Owning or Holding 1 Percent or More of Total Amount of Bonds, Mortgages, or None Other Securities. If none, check box
Robert H. Blotter, MD – None
Full Name
Complete Mailing Address
T. Jann Caison-Sorey, MD, MSA, MBA – Did not disclose by print deadline Adrian J. Christie, MD – None Betty S. Chu, MD, MBA – None Sandro K. Cinti, MD – None Stephen N. Dallas, MD, MA – None Talat Danish, MD, MPH, FAAP – Medical Director for Utilization Management, Aetna Better Health of Michigan
12. Tax Status (For completion by nonprofit organizations authorized to mail at nonprofit rates) (Check one) The purpose, function, and nonprofit status of this organization and the exempt status for federal income tax purposes: Has Not Changed During Preceding 12 Months Has Changed During Preceding 12 Months (Publisher must submit explanation of change with this statement) PS 3526, Title July 2014 [Page 1 of 4 (see instructions page 4)] PSN: 7530-01-000-9931 13. Form Publication
Michigan Medicine
PRIVACY NOTICE: our policyData on www.usps.com. 14. IssueSee Date forprivacy Circulation Below
May/June 2017
15. Extent and Nature of Circulation
Average No. Copies No. Copies of Single Each Issue During Issue Published Preceding 12 Months Nearest to Filing Date
Amit Ghose, MD – None Cheryl Gibson Fountain, MD – None James D. Grant, MD – MSMS representative to the Board of Directors, Blue Cross Blue Shield of Michigan Bryan W. Huffman, MD – None Jeffrey E. Jacobs, MD – None Theodore B. Jones, MD – None Mark C. Komorowski, MD – None David M. Krhovsky, MD – None P. Dileep Kumar, MD – None Samuel J. Mackenzie, MD, PhD – None
8624
a. Total Number of Copies (Net press run) (1) Mailed Outside-County Paid Subscriptions Stated on PS Form 3541 (Include paid distribution above nominal rate, advertiser’s proof copies, and exchange copies) b. Paid Circulation (By Mail and Outside the Mail)
(2)
Mailed In-County Paid Subscriptions Stated on PS Form 3541 (Include paid distribution above nominal rate, advertiser’s proof copies, and exchange copies)
(3)
Paid Distribution Outside the Mails Including Sales Through Dealers and Carriers, Street Vendors, Counter Sales, and Other Paid Distribution Outside USPS®
(4)
Paid Distribution by Other Classes of Mail Through the USPS (e.g., First-Class Mail®)
S. “Bobby” Mukkamala, MD – None
f. Total Distribution (Sum of 15c and 15e)
Bassam H. Nasr, MD, MBA – Did not disclose by print deadline
g. Copies not Distributed (See Instructions to Publishers #4 (page #3))
Donald R. Peven, MD – None
h. Total (Sum of 15f and g) i. Percent Paid (15c divided by 15f times 100)
b. Total Paid Print Copies (Line 15c) + Paid Electronic Copies (Line 16a)
M. Salim Siddiqui, MD – Did not disclose by print deadline
c. Total Print Distribution (Line 15f) + Paid Electronic Copies (Line 16a)
Herbert C. Smitherman, Jr., MD, MPH – Did not disclose by print deadline
d. Percent Paid (Both Print & Electronic Copies) (16b divided by 16c Í 100)
Thomas J. Veverka, MD – None John A. Waters, MD – None Phillip G. Wise, MD – None
0
8059
0
0
0
0
0
0
0
0
0
0
8334
8059
8624
8300
290
241
Each Issue During Preceding 12 Months
a. Paid Electronic Copies
J. Mark Tuthill, MD – None
0
*16. If you are claiming to line 17 on page 3. Electronic Copyelectronic Circulationcopies, go to line 16 on page 3. If you are not claiming electronic copies, skipAverage No. Copies
John J. H. Schwarz, MD – None
F. Remington Sprague, MD – MSMS representative to the Board of Directors, Blue Cross Blue Shield of Michigan. Currently serving as Vice Chair.
0
Statement of Ownership, Management, and Circulation 100% Publications) 100% (All Periodicals Publications Except Requester
Richard C. Schultz, MD – None
James H. Sondheimer, MD – None
0
0
Free or Nominal Rate Distribution Outside the Mail (Carriers or other means)
James C. Mitchiner, MD, MPH – None
Kimberly Lovett Rockwell, MD, JD – None
0
d. Free or (1) Free or Nominal Rate Outside-County Copies included on PS Form 3541 Nominal Rate Distribution (2) Free or Nominal Rate In-County Copies Included on PS Form 3541 (By Mail and Free or Nominal Rate Copies Mailed at Other Classes Through the USPS Outside (3) (e.g., First-Class Mail) the Mail)
e. Total Free or Nominal Rate Distribution (Sum of 15d (1), (2), (3) and (4))
James J. Rice, MD – None
8059
8334
c. Total Paid Distribution [Sum of 15b (1), (2), (3), and (4)]
(4)
8300
8334
No. Copies of Single Issue Published Nearest to Filing Date
I certify that 50% of all my distributed copies (electronic and print) are paid above a nominal price. 17. Publication of Statement of Ownership PS Form 3526, July 2014 (Page 2 of 4) If the publication is a general publication, publication of this statement is required. Will be printed
Publication not required.
Sep/Oct 2017 in the ________________________ issue of this publication. 18. Signature and Title of Editor, Publisher, Business Manager, or Owner
Kevin M. McFatridge
Date
Digitally signed by Kevin M. McFatridge DN: cn=Kevin M. McFatridge, o=Michigan State Medical Society, ou=Marketing, Communications and Public Relations, email=kmcfatridge@msms.org, c=US Date: 2015.09.11 09:09:44 -04'00'
7/27/17
I certify that all information furnished on this form is true and complete. I understand that anyone who furnishes false or misleading information on this form or who omits material or information requested on the form may be subject to criminal sanctions (including fines and imprisonment) and/or civil sanctions (including civil penalties).
SEPT / OCT 2017 |
michigan MEDICINE 25
2017 Educational Courses MSMS On-Demand Webinars: CME When You Want It!
Educational Conferences REGISTER TODAY!
Balancing Pain Management and Prescription Medication Abuse Billing 101 The CDC Guidelines* CDL – Medical Examiner Course Choosing Wisely Part 1: Stewards of Our Health Care Resources Choosing Wisely Part 2: Change Strategies to Implement Choosing Wisely Claim Appeals Compliance in the Office Conscientious Objection Among Physicians* Credentialing From Physician to Physician Leader Health Care Providers’ Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities HEDIS Best Practices HIPAA Security and Meaningful Use Compliance Human Trafficking* ICD-10 (2017) and Routine Waiver of Copays ICD-10: What We Have Learned & What We Need to Know In Search of Joy in Practice: Innovations in Patient Centered Care Inter-professionalism: Cultivating Collaboration Legalities and Practicalities of HIT – Cyber Security: Issues and Liability Coverage Legalities and Practicalities of HIT – Engaging Patients on Their Own Turf: Using Websites and Society Media MACRA Webinar Series Managing Accounts Receivable Michigan Automated Prescription System (MAPS) Update* Opioids and Michigan’s Compensation Webinar Pain and Symptom Management* Patient Portals as a Tool for Patient Engagement Physician On-line Rating and Reviews: Do’s and Don’ts Preparing for the Medicare Physician Value-Based Payment Modifier Reading Remittance Advice The Role of the Laboratory in Toxicology and Drug Testing* Section 1557: Anti-Discrimination Obligations Understanding and Preventing Identity Theft in Your Practice Tips and Tricks on Working Rejections Treatment of Opioid Dependence* What’s New in Labor and Employment Law Year-End Wrap Up
Regional Scientific Meeting
*Fulfills Board of Medicine Requirement
Visit www.msms.org/OnDemand for complete listing of On-Demand Webinars. 26 michigan MEDICINE
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Date: Saturday, September 16 Time: 8:30 – 11:45 am Location: Prince Auditorium at Calvin College, Grand Rapids Note: Continental breakfast and lunch provided Intended for: Physicians and all other health care professionals Contact: Beth Elliott 517-336-5789 or belliott@msms.org
Symposium on Retirement Planning Date: Saturday, September 16 Time: 12:30 – 3:45 pm Location: Prince Auditorium at Calvin College, Grand Rapids Intended for: Retired physicians, physicians planning for retirement, spouses, and office managers Contact: Caryl Markzon at 517-336-5755 or cmarkzon@msms.org.
Lunch and Learn Webinar : Bullying - A Health Care Imperative Date: Wednesday, September 27 Time: 12:00 – 1:00 pm Intended for: Physicians and all other health care professionals Contact: Beth Elliott 517-336-5789 or belliott@msms.org
Making MACRA Work for You Date: Tuesday, October 24 Time: 9:00 am – 3:45 pm (Lunch provided) Location: Sheraton Detroit Novi Hotel, Novi Intended for: Physicians, PO Administrators, practice consultants, office administrators, students, other health care professionals. Contact: Caryl Markzon 517-336-7575 or cmarkzon@msms.org
Michigan's New CME Licensure Requirements As previously reported by the Michigan State Medical Society, the State of Michigan, Department of Licensing and Regulatory Affairs announced in December of 2016 revised Medical Rules. With these new rules came new requirements for Continuing Medical Education. Significant changes to be aware of include:
Training Standards for Identifying Victims of Human Trafficking – This is a one-time training
MSMS 152nd Annual Scientific Meeting Morning, afternoon and evening clinical courses available.
Date: Wed., October 25 - Sat., October 28 Location: Sheraton Detroit Novi Hotel, Novi Intended for: Physicians and all other health care professionals Contact: Marianne Ben-Hamza 517-336-7581 or mbenhamza@msms.org
21st Annual Conference on Bioethics Date: Saturday, November 11 Time: 9:00 am – 4:30 pm Location: Sheraton Detroit Hotel, Ann Arbor Intended for: Physicians, bioethicists, residents, students, other health care professionals, and all individuals interested in bioethical issues Contact: Caryl Markzon at 517-336-5755 or cmarkzon@msms.org.
Practical Guidance for Health Care Compliance Date: Wednesday, December 6
that is separate from continuing education.
Education on Pain and Symptom Management – Starting in December 2017, a minimum of
three- hours of continuing education must be earned in the area of pain and symptom management.
Medical Ethics – A minimum of one-hour of continuing education must be earned in the area of medical ethics.
MSMS will offer these required CME at the 152nd Annual Scientific Meeting (www.MSMS.org/ASM) this fall. Additionally, CME modules are available online in the On-Demand Webinars (www.MSMS.org/ OnDemandWebinars) section of the MSMS website. Visit the LARA CME Requirements document at www.MSMS.org/LARACERequirements for more information.
New Categories of Continuing Medical Education The Board of Medicine has updated the previous six Categories of Credit into two categories. As before, each medical doctor is required to complete 150 hours of continuing medical education approved by the board of which a minimum of 75 hours of the required 150 must be earned in Category 1 activities. The following is a breakdown of the two Categories for licensure: CATEGORY 1 A. Activities with accredited sponsorship – Maximum 150 hours B. Passing specialty board certification or recertification – Maximum 50 hours C. Successfully completing MOC that does not meet requirements of (A) or (B) above – Maximum 30 hours D. Participation in a board approved training program - Maximum 150 hours CATEGORY 2 A. Clinical instructor for medical students engaged in postgraduate training program – Maximum 48 hours B. Initial presentation of scientific exhibit, poster or paper – Maximum 24 hours C. Publication of scientific article in a peer-reviewed journal – Maximum 24 hours
Time: 10:00 am – 3:00 pm
D. Initial publication of a chapter or portion of a chapter in a professional health care textbook or peer-review textbook – Maximum 24 hours
Location: MSMS Headquarters, East Lansing
E. Participation in any of the following as it relates to the practice of medicine – Maximum 18 hours
Intended for: Physicians, PO Administrators, practice consultants, office administrators, students, other health care professionals. Contact: Caryl Markzon 517-336-7575 or cmarkzon@msms.org
Register online at msms.org/eo or call the MSMS Registrar at 517-336-7581.
1. Peer Review Committee dealing with quality of patient care 2. A Committee dealing with utilization review 3. A health care organization committee dealing with patient care issues 4. A national or state committee, board, council or association
F. Until December 6, 2019, attendance at an activity that was approved by the Board of Medicine prior to December 6, 2016 - Maximum 36 hours G. Independently reading a peer-reviewed journal prior to December 6, 2016, that doesn't satisfy the requirements of Category 1, subdivision (A) - Maximum 18 hours H. Prior to December 6, 2016, completing a multi-media self-assessment program that doesn't satisfy the requirements of Category 1, subdivision (A) - Maximum 18 hours
More Information If you have questions regarding the new CME requirements or the new categories of Continuing Medical Education, please reach out to Brenda Marenich (bmarenich@MSMS.org), Director Physician Education and Leadership, MSMS at 517/336-5780. SEPT / OCT 2017 |
michigan MEDICINE 27
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SOLID ADVICE.
REAL SOLUTIONS. FOR HEALTH CARE BUSINESS.
At The Health Law Partners, our unparalleled knowledge of the business of health care is coupled with timely, practical solutions designed to maximize value. The HLP attorneys represent clients in substantially all areas of health law, with particular emphasis on: • Licensure & Staff Privilege Matters • Health Care Litigation • Health Care Investigations • Civil & Criminal False Claims Defense • Stark, Anti-Kickback, Fraud & Abuse, and Other Regulatory Analyses • Physician Group Practice Ancillary Services Integration and Contractual Joint Ventures • Appeals of RAC, Medicare, Medicaid and Other Third Party Payor Claim Denials and Overpayment Demands • Health Care Contractual, Corporate, and Transactional Matters • Compliance & HIPAA
TheHLP.com [284.996.8510] 28 michigan MEDICINE
| SEPT / OCT 2017
Practices for Sale Rochester Hills Walk in Clinic
Reasonable monthly rent, successful business, current Physician is looking at going back into Industrial Medicine. History of over 1 million dollar gross. Very nice insurance mix, mostly internal medicine practice is up for best offer since the plan is to sell by June. Dearborn – General Practice
Semi Retired Physician has a 2-3 day practice 20-30 patients per week, $20,000 for practice or free when you lease or buy building. Jackson – Well Established Practice, Mostly Medicare
Nice 2700sq.ft building, large parking lot, favorable location. Good insurance mix, equipment. Will offer terms of all kinds on this $425-500K grossing business with good loyal patients. Conservatively operated for years. Reasonable offer for business, $160K building on land contract. ENT with mostly Allergy Patients, Westland
Hearing aid tenant in building, small general medicine tenant, buy practice (asking $25K) and rent on short or long term agreement, very reasonable rates. Plenty of room and parking. White Lake Primary Care Practice
On busy corner of M-59. Grosses $700,000 - $800,000 a year. Doctor has medical conditions needs to sell. Good insurance mix. Plenty of parking, nice facility, a must see if you are looking to expand your practice. Asking $200,000. Pediatrics in Westland near Canton
30 years, high volume, yes it does a big gross. A Pediatrician Physician can work into the practice and take over EARN and purchase transaction. Only a Boarded Pediatrician, potential to earn substantial income. Call Joe for details, Cell: 248-240-2141. The Good Doctor Suddenly Died
St. Clair Shores near 9 Mile, 2500 sq.ft. clinic, 4 exam rooms, 180 active Internal Medicine Patients Medicare Patients. The heirs wish to make a win win deal for you. All the equipment including vascular/doppler/echo/ UltraSound. Call and ask about this one!
Looking for Part time/Full time Work as a Provider? Different locations available. Call Joe Zrenchik.
Joe Zrenchik, Broker 248-240-2141 (cell) • 734-808-0147 (eFax) bestdoctors@yahoo.com 248-919-0037(office) www.michiganmedicalpractices.com Thinking about retirement, relocation or expansion of your SEPT / OCT 2017 |
michigan MEDICINE 29
WEALTHCARE ADVISORS
Prepare Your Portfolio for What’s Next: A Seven-point Checklist By Jim Niedzinski, AIF®, Wealth Advisor Confirm the risk level of your portfolio.
Investors around the world are concerned about the uncertainty of U.S. politics and global investment markets.
What is our president going to tweet next?
Rebalance your accounts.
What policies will be implemented? How will the economy and markets react? While answers to these questions matter, they aren’t issues over which you have control. What can you control? You can clarify, align and strengthen your financial position. Complete this seven-point checklist to prepare your portfolio for whatever direction the markets go next. You'll feel confident that you’ve addressed what is under your control and have wisely prepared for the unknown. 30 michigan MEDICINE
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Assure the target risk level of your portfolio continues to fit you and your plan. This is arguably the largest single factor influencing your portfolio’s performance, so be sure to verify that your risk level is appropriate before the stock market turns sour. Contact us if you’d like our assessment—we’ll analyze your portfolio, show you in clear terms the risk level of your portfolio on a scale of 1-10, and help you determine if that is the right level for you. Stocks have significantly outperformed bonds over the past year, so a moderate risk portfolio that started with a recipe of 50% stocks and 50% bonds might now be 55% stocks and 45% bonds. Consider rebalancing your mix of investments back to the original target (50/50, in this example). This is a disciplined way to “sell high” and “buy low” and it keeps your risk level in alignment with your plan.
Address concentrated holdings.
Perhaps you inherited shares of a stock several years ago…or you bought Tesla for a song and you’re still holding it…or you’ve continued to accumulate shares of your company’s stock. With the market at all-time highs, now is a good time to review these holdings and consider trimming your exposure.
Prepare for anticipated withdrawals.
Farmers harvest crops in summer and store them for winter. In the same way, investors ought to prepare for upcoming withdrawals now, while their portfolio has ripe gains to harvest. Our solution for taking regular withdrawals from a portfolio—called the Cash Distribution Strategy (CDS)—is designed to extend the life of a portfolio by avoiding the sale of stocks in a down market. Even if you aren’t quite ready to start taking withdrawals, we advise that preparations begin several years in advance. Contact us to learn more.
Replenish your emergency cash reserve.
Every investor should have a reserve of cash. The classic rule of thumb is to maintain a reserve of between 3-9 months of essential living expenses, though the appropriate amount depends on your situation. Now may be an opportune time to review and shore up your cash reserve to your target amount. Want to earn more on your cash? Contact us to learn where savvy investors are storing their reserves.
Change the channel.
Buy this, sell that. The market is going to crash. No, it is going to soar. The mainstream financial media makes their money by gathering an audience, not by consistently and prudently stewarding capital. For your own sanity, don’t be their audience.
Maintain perspective.
It can be easy to lose the forest for the trees. Refresh your short-term perspective with a long-term view: since 1980, the U.S. stock market was positive in 28 of the 37 years—that’s nearly 76% of the time—yet the average intra-year market drop was more than 14%. So don’t let the market’s zigs and zags tempt you to abandon your long-term plan.
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