SDCMS Medical Office Manager Bulletin Board (2011.08)

HELLO SDCMS MEDICAL OFFICE MANAGERS AND PRACTICE ADMINISTRATORS!

It’s hard for me to believe that a year has gone by, and that I’m working on this, our fifth-annual “Office Manager Advocacy” issue of San Diego Physician. I’m happy to report that I’m still enjoying serving our medical community as your medical office manager advocate. It is my sincere hope that you enjoy this issue, as I have worked hard to deliver a fresh new approach to the challenges we all face in healthcare management.

I would like to personally thank Andrea Trujillo, Judy Krueger, and Eleanor Robles for allowing me the time to step into their busy practices to gain an insider’s look at their individual roles in their offices. Along with their stories, we’ve compiled data on HIPAA 5010 Standards, Palmetto GBA E&M audit information, our tentative seminar/webinar calendar for 2012, registration information for the highly sought-after certification course offered at SDCMS (Certified Medical Compliance Officer), and, finally, information on our third-annual “Outstanding Medical Office Manager” contest.

Thank you for allowing us at SDCMS to be an extension of your practice. Rest assured we are doing our best to bring you the most relevant seminars/webinars and that we’re working hard to get you the answers you need right away. As I’ve said before, you are not alone! Simply pick up the phone and call me at (858) 300-2782 or send me an email at Sonia.Gonzales@SDCMS.org. I look forward to talking with you soon!

PRACTICE MANAGEMENT DEADLINES!

• BEFORE STARTING THE 2011–12 SCHOOL YEAR: [July 15 Note: Legislature Passes Bill To Delay Pertussis Vaccine Requirement]. All California middle and high school students entering or advancing into 7th through 12th grades will need proof of a Tdap booster shot.
• SEPT. 1, 2011: Changes to Anthem Blue Cross’ Prudent Buyer physician fee schedule take effect. Click here for details.
• OCT. 1, 2011: Last day for eligible professionals (EPs) to begin their 90-day reporting period in time to attest to/receive their 2011 Medicare EHR Incentive Program payments.
• DEC. 31, 2011: Reporting year ends for eligible professionals (eRx).
• JAN. 1, 2012: On Jan. 1, 2012, the HIPAA 5010 “implementation guide” standard will go into effect. This affects all of the HIPAA Standard Transactions, including the following pertinent transactions for most medical practices: electronic claims; electronic remittance advices; electronic requests for eligibility and benefit verification and the responses; electronic referral authorizations; and electronic claims status. The last major change was in October 2003, when the HIPAA transactions and code sets rule took effect. The 5010 changes reduce ambiguity in many of the transactions and provide for some very important new codes, such as ICD-10. They also eliminate many of the situational codes while implementing requirements such as taxonomy codes on all claims. Medical practices should be preparing now for this change by ensuring your vendors (billing software, billing services, and clearinghouses) are ready and that your software is capable of generating a 5010 transaction. If your practice management systems are not compliant with HIPAA Version 5010 standards by Jan. 1, 2012, you will risk not getting electronic payments from Medicare or private insurers.
• FEB. 29, 2012: Last day for eligible professionals to register and attest to receive incentive payment for calendar year 2011 (eHR).

SDCMS DEADLINES!

• ONGOING: The Doctors Company (TDC) Participation Requirement: TDC-insured SDCMS member physicians need to satisfy their participation requirement once every two years in order to continue receiving their TDC medical professional liability insurance premium credit.
• NOV. 1, 2011: SDCMS-CMA 2012 Early Bird Dues Discount Deadline
• JAN. 1, 2012: SDCMS-CMA Membership Dues for 2012 Due
• APRIL 1, 2012: SDCMS-CMA Membership Dropped If Dues Not Paid for 2012
• APRIL 1, 2012: SDCMS 2012–13 Pictorial Membership Directory Photo Submission Due Date

MARK YOUR CALENDARS!
Remaining SDCMS Seminars & Webinars for 2011

• AUG. 18: Focus on Payor Contracts with ACO Guidelines (seminar/webinar)
• AUG. 20: Financial & Legal Life Skills for (Financially & Legally Clueless) Docs (seminar)
• SEPT. 1: Changes to Medicare Regulations (seminar/webinar)
• SEPT. 8: Depositions for Doctors (seminar/webinar)
• SEPT. 10: Microsoft Outlook for Crazy Busy Docs (seminar/webinar)
• SEPT. 15: HIPAA and HITECH Act Updates (seminar/webinar)
• SEPT. 17: Succession or Transition Planning for Your Practice (seminar/webinar)
• SEPT. 22, 23, OCT. 19, 20, 21: Certified Medical Compliance Officer Course (see page X for details)
• OCT. 13: 10 Strategies for Economic Survival
• OCT. 27: How to Oversee Your Biller(s)
• NOV. 16: Litigation Traps for Surgical Practices
• NOV. 17: Litigation Traps for Surgical Practices

ASK YOUR OFFICE MANAGER ADVOCATE

Question: Is Palmetto GBA going to conduct E&M audits?

Answer: Yes. The Palmetto GBA medical review department will be performing a prepayment review of CPT code 99214 billed by physician specialties in cardiology, family practice, and internal medicine. Palmetto identified that California physicians are two to three standard deviations above the norm as compared to other jurisdictions. This is not an audit of the individual physicians but a random sampling of three to four for each provider selected. If you are selected for sampling, requests for medical records will be sent to your practice. Physicians must respond to the requests for medical records, or the claims will be denied. It is suggested that physicians personally review the records returned to Palmetto in order to assure that there are no clinical errors. Records should include:

• legible copy of the patient’s medical record for the listed date(s) of service
• physician signature and credentials, or an attestation statement to authenticate if the signature is not legible
• medication list
• patient name and date of service on each office note
• consultation report or progress notes
• any diagnostic test results that help substantiate the level of service

Common problems that have accounted for 50 percent of claim denials are the result of missing signatures and illegible records. Lack of response from physicians is also a leading cause of denial. Physicians in the specialties mentioned above should look for letters from Palmetto in the mail in the coming weeks.

If you have any further questions regarding these audits, please contact me at Sonia.Gonzales@SDCMS.org or call me at (858) 300-2782.

SPECIAL FOCUS ITEM

Be sure to plan ahead and check out the seminar/webinar calendar on page X. If there’s a seminar topic you don’t see listed, let me know!

IMPORTANT!

Please share this issue with your physician, and encourage his or her participation in entering YOU in our third-annual “Office Manager of the Year” contest.