7 Tips for Avoiding Potential Billing Disputes

frugalcheapwebBilling disputes are a common complaint that medical practices face today. While many physicians are trained in medicine, few do not how to run a business properly. Oftentimes, if you can clearly communicate your billing policies ahead of time and educate your patients on how their insurance plan works, you can often avoid any potential conflict.

We spoke with two billing experts who offered some helpful advice on how to better interact with your patients so you can minimize patient complaints about billing errors.

Help your patients understand their bill

According to Joshua Greenberg, chairman and President of San Mateo, Calif.-based HealthCPA, a provider of personal health care financial advocacy services, many billing disputes are due to the fact that medical bills are hard to read and most people do not understand how their insurance plan works. Because of this they could become confused by the various numbers they see on their bills and insurance statements.

“Therefore, many times billing disputes can be easily cleared up when billing office staff walks patients through the numbers they see on their bills, using plain language,” he says.

Additionally, many patients see the billed amount on the invoice and think that is what they are being charged. Greenberg advises that your billing office staff can explain to patients that they receive a discount through their insurance company and then explain any insurance payments that were made and why the patient owes the final amount charged. [Read more…]

Lynn George Named Inaugural Dean of Carlow University’s College of Health and Wellness

Lynn George, PhD, RN, CNE, has been named inaugural dean of the College of Health and Wellness at Carlow University effective July 1, 2015. She has been serving as Associate Dean of the School of Nursing and Health Sciences at Robert Morris University since 2006 and as a faculty member there since 2003.

“It’s Carlow’s vision to build on the excellence of our nursing programs and extend our reach into new health care careers needed for the workforce in this region and beyond. Key to our success is the founding dean of the College of Health and Wellness,” said Carlow University President Suzanne Mellon, PhD. “Dr. George is an exceptional leader and educator who has a firm understanding of the landscape of health care and health care education needed to address this critical area in our region.”

A passion for high quality education that is transformational and learner focused, George was instrumental in growing enrollment and providing academic leadership and direction for all programs in the School of Nursing and Health Sciences during her tenure at Robert Morris University. Her many accomplishments include the development and administration of the RN-to-MSN online program and the curriculum revision for the Master of Science in Nursing (MSN) program. Additionally, she was part of the administrative team that launched the Doctor of Nursing Practice (DNP) program, worked to transition a hybrid undergraduate program in Health Services Administration (HSAM) to a fully online program, and secured funding for student scholarships and research.
[Read more…]

Could Highmark, UPMC Health Plan be in play down the road?

While the nation’s largest publicly traded health insurers continue an elaborate five-way mating dance, physicians groups worry that a winnowing of the carrier field will lead to lower payments for hospitals and higher premiums for patients.

“Everybody should have serious concerns about that,” said Dennis Olmstead, chief strategy officer and medical economist at the Pennsylvania Medical Society, the state physicians’ lobbying group. “Competition is usually good … that’s why we have federal antitrust laws.”

The combination of any two of the “big five” public insurers — UnitedHealth, Anthem Inc., Aetna, Humana and Cigna — could indeed invite the scrutiny of the U.S. Federal Trade Commission and the U.S. Department of Justice, particularly any merger involving UnitedHealth, which is already the largest health insurer in the country with more than $130 billion in 2014 revenues.

Read more.

How Health Care Organizations Implement Change is Crucial to Sustainability

Experts’ new book pushes integration of quality and safety in nursing curriculum and practice

Today’s health care environment is constantly evolving to reflect changes in the world around us. When your organization isn’t flexible or responsive enough to incorporate those changes into the current culture, your organization will ultimately suffer. Gwen Sherwood, PhD, RN, FAAN, ANEF, and Sara Horton-Deutsch, PhD, RN, PMHCNS, FAAN, ANEF, want to share the principles and strategies they found beneficial to empower others to successfully affect change and create reflective organizations for the benefit of their patients and staff in their own working or educational environment.

Changing an organizational culture requires more than a simple introduction to new activities or tasks, so these two experts in reflective practice and Quality Safety and Education for Nurses (QSEN), hope to make quality and safety adjustments less complex for nurses with their new book Reflective Organizations: On the Front Lines of QSEN & Reflective Practice Implementation. [Read more…]

The inclusive nurse: Improving patient care through cultural sensibility

New STTI book encourages addressing personal biases for positive patient interactions

As a result of a rapidly changing health care environment, nurses may be confronted by cultural differences and certain subconscious personal prejudices. In a health care environment, recognizing and confronting these prejudices are critical to excellent patient care.

Written by an expert clinical nurse researcher, Cultural Sensibility in Healthcare: A Personal & Professional Guidebook is a comprehensive handbook that helps health care professionals become aware of their prejudices and address them in order to foster positive interactions with their patients.

Published by the Honor Society of Nursing, Sigma Theta Tau International (STTI), author Sally N. Ellis Fletcher, PhD, RN, FNAP, offers the first book geared toward helping health care professionals recognize and confront cultural biases through thoughtful reasoning, responsiveness, and considerate actions. Fletcher uses vignettes, exercises in critical thinking, and journaling to illustrate her points.

The book highlights not only racial diversity, but also other differences that exist from individual to individual, such as gender, sexual orientation, and religious beliefs. Cultural Sensibility in Healthcare offers solutions to promote inclusivity and avoid any use of “us” and “them” mentalities.

“We owe it to ourselves and to health care consumers to be present during encounters and hear from the patient’s perspective the health and illness issues they are confronting,” said Fletcher.

By embracing cultural issues and situations through thoughtful reasoning and considerate interactions, health care providers can supply patients of all races, colors, and creeds with the care they need.

The book is available at www.nursingknowledge.org/sttibooks.

The Rise of the “-ists”: A Model Offering New Opportunities and Challenges for Locum Tenens Physicians

Turner Bio PicBy Joseph Turner

The hospitalist model of care has spread like wildfire since its introduction 20 years ago. In the mid-1990s, there were fewer than 1,000 hospitalists practicing in the United States; today, there are more than 44,000 in approximately 72 percent of U.S. hospitals. Hospitalist programs have been shown to more than pay for themselves by improving outcomes, reducing length of stay and enhancing hospital efficiency. Primary care physicians like them because hospitalists reduce their rounding responsibilities, and patients like them because they receive greater focus and attention during their hospital stays.

This model has proven so effective that it has sparked another trend: the rise of other “-ists.” Laborists, for example, are obstetrician/gynecologist physicians who work full-time in a hospital, delivering babies, rather than seeing patients in an office setting like a traditional OB/GYN.

In a 2011 survey by Today’s Hospitalist, more than 75 percent of the hospitalists interviewed said they worked in hospitals exclusively, but there was a significant segment that branched out into other settings such as skilled nursing facilities (SNFs), long-term acute care (LTAC) and hospice/palliative care services. In particular, transitionalists as they’re known—hospitalists who work part of the time outside of acute care in LTAC or SNFs—are drawing attention for their potential not only to help hospitals improve patient care, but also to help them reduce length of stay and avoid financial penalties for preventable readmissions.Subspecialties in neurology, orthopedics, and general surgery are other areas in which the hospitalist model is being applied beyond the role of primary care.
[Read more…]

Using Technology to Reinforce Best Practice Care

By Marsha Knapik, Director
Brian Keller, Senior IT Applications Developer
Corazon, Inc.

Not so long ago, scribbled nurse’s notes and physician orders, along with paper medication requisitions and numerous other handwritten documents dominated the healthcare system.  The gradual move to electronic clinical documentation as an initial step, and now (at advanced organizations) a completely electronic health record, has gained rapid momentum in recent years.  In fact, such a movement can now be considered the only way to encourage complete and fully-integrated medical records… a desirable goal for hospital administrators, clinicians, physicians, and perhaps even patients who know the benefits that optimized technology in the healthcare setting can bring. 

While rapid advances in technology make it possible to ensure documentation is provided electronically, this technology, if used correctly, can also identify gaps or deficiencies in care, serve as a means to guide best practices, and provide a platform for efficient and effective data collection and reporting.  Corazon believes that using IT to its fullest potential is a worthwhile effort that can bring both short- and long-term value to a hospital – clinically, operationally, and financially.

For example, Corazon’s CEREBROS® software provides a documentation template for the required neurological assessments and specific evaluations for a known/suspected stroke patient. This template system ensures that the patient receives all components of the appropriate evaluation; if data to that end is not provided within a specific timeframe, a prompt appears to notify the clinician that an important component of care was missed.  Just consider the possibilities if numerous care paths were motivated and tracked and by standardized “steps” – the right patient receives the right care at the right time…EVERY TIME. [Read more…]

Overcoming Obstacles in Pennsylvania’s Rural Health Care System

rural healthcare in Pennsylvania, nursing, rural Pennsylvania

By Brian Neese on behalf of Alvernia University Online

Although Pennsylvania is the sixth most populous and ninth most densely populated state in the Union, based on information from the United States Census Bureau from 2010 and 2013, it also is home to a significant amount of rural areas. According to the Pennsylvania Rural Health Association, 48 of the 67 counties in the state are classified as rural, and all but two counties have rural areas. Approximately 27 percent of Pennsylvanians lived in rural counties in 2010, The Center for Rural Pennsylvania reports.

Although life in rural communities offers many advantages, according to the National Rural Health Association (NRHA), the rural healthcare system in America faces challenges not seen in urban areas. Population loss, poverty and access to healthcare have been problematic in recent years. Here are just a few of the initiatives that have been launched to improve the health needs and overall well-being of rural Pennsylvanians.

Healthcare Issues in Rural Pennsylvania

In general, residents of rural communities in the U.S. are less healthy than those in urban environments. According to Unite for Sight, “rural residents smoke more, exercise less, have less nutritional diets, and are more likely to be obese than suburban residents.” Already against the odds, residents in rural Pennsylvania face several specific problems that jeopardize the state of healthcare in the area. [Read more…]

The Story of Excellent Health Care

Hospitals are filled with doctors, nurses, and other health professionals: men and women with the utmost respect for science. At the illustrious Massachusetts General Hospital (MGH), these health care professionals also hold something in high regard that is presumably unscientific: storytelling.

MGH long esteemed for its rigorous science and technical excellence, takes time each day for something seemingly unscientific: telling stories. Why? Research has shown that in today’s high-tech, rapid-change environment.

Jeanette Ives Erickson, BNP, RN, FAAN; Marianne Ditomassi, DNP, RN, MBA; Susan Sabia, BA; and Mary Ellin Smith, MS, RN, share their model for creating, embedding, and fostering a narrative culture, ultimately creating a safer environment with improved patient care, interprofessional communication, and patient and staff satisfaction in their new book, “Fostering Clinical Success: Using Clinical Narratives for Interprofessional Team Partnerships From Massachusetts General Hospital.”

Etiquette is the Missing Link to Success in the Workplace

Second edition of widely acclaimed STTI book addresses business etiquette for nurses

Professional etiquette reaches far beyond which fork to use at a formal dinner. It is a necessity for personal and professional success. Author Kathleen Pagana, PhD, RN, has honed her skill as a business etiquette expert and in partnering that with her nursing background, presents an entertaining and informative read for building etiquette skills.

“I loved this topic and it resonated with what I believed was needed for professional nurses,” Dr. Pagana said. “When I reflected on my long and varied career in nursing, I was amazed at the numerous situations where business etiquette skills would have made me more confident and comfortable. I had been a nursing educator for almost 25 years and had never addressed etiquette as a career-enhancing tool.” [Read more…]

Doing Business with Medical Clients

Brian Shrift

Brian Shrift

How the HIPAA Security Rule Affects Your Business

By Brian Shrift, HCISPP

When most business people think about HIPAA, they often write it off as applying only to those in the healthcare industry. However, even if you are not in the healthcare industry yourself, your business could be subject to HIPAA if you work with clients in the healthcare industry or if your clients work with clients in the healthcare industry.

If you work with hospitals, physicians, pharmacies, therapists, dentists, chiropractors or any other business which is considered a “Covered Entity” under HIPAA, you may be considered a “Business Associate” and subject to the HIPAA Security Rule.  In addition, if your clients are considered Business Associates, you may also become a Business Associate, identified in the HIPAA rules as a “downstream vendor.”

If you are a Business Associate, either directly or as a downstream vendor, you must, among other things, comply with the HIPAA Security Rule (the “Security Rule”).  The Security Rule’s primary objectives are to ensure the confidentiality, integrity and availability of protected health information (“PHI”).  In plain English, the law was written to ensure that adequate safeguards are in place to protect patient information from unauthorized access and disclosure, improper alterations or deletions, and to assure it is accessible when needed. [Read more…]

Revenue Reality Check: Evaluating Where Your Money Comes From

revenue cycle, medical billing, revenue cycle management, Healthcare Billing & Management, generating revenue,This is the first of a four-part series on the revenue cycle. Our next installment will help you identify holes in your billing cycle and where revenues often leak.  In the third article of the series, we will discuss how to tune up your revenue cycle—how to identify the biggest issues in your revenue cycle and some insight on how to benchmark your revenue cycle against the competition. Our final article will discuss how to improve payer performance and better manage and monitor your contracts with payors. 

Physicians are always challenged to find ways to generate revenue from their medical practice.  Nearly every function in your hospital or practice can generate revenue, yet many are leaving money on the table. Smaller practices, in particular, do not have sophisticated practice management systems to help them see the big financial picture or not using a billing partner to assist them in collecting money.

“One way practices can be proactive in determining solutions that make sense to their specific need and their speciality is to look for a partner, such as billing company, that can focus on some of the challenges they are faced with so they can do what they do best—diagnose and treat patients,” says Jackie Willett, president of the Healthcare Billing & Management Association (HBMA) and senior vice president for Intermix. “The billing partners could help maximize reimbursements as well as ensure compliance in regard to coding and billing regulations.”

Before you begin to worry about how to collect money, you first need to understand how to make money off your practice and where in your practice can you derive revenue.
[Read more…]

Celebrate National Nurses Week with three new STTI books

Happy National Nurses Week! To help celebrate this week, STTI has published three new books surrounding different areas within nursing.

  • Business Administration for Clinical Trials: Managing Research, Strategy, Finance, Regulation, and Quality is written by two leading clinical research coordinators and researchers, helping clinical research professionals who conduct research and performance improvement activities from getting burnt out professionally. This text additionally covers topics in research administration, finance, education, regulation, performance improvement, hiring and avoiding burnout. 
  • Karen Roush, PhD, APN, has written a new step-by-step guide for students to help them write a clear and well-organized dissertation or capstone project. A Nurse’s Step-By-Step Guide to Writing Your Dissertation or Capstone will help the student plan, document, organize, and write their dissertation or capstone. 
  • The future of nursing needs a reality shift and Dr. Leslie Neal-Boylan, Dean of University of Wisconsin, Oshkosh, is pointing out trends and issues that have been consistent in nursing throughout history in her latest book, The Nurse’s Reality Shift: Using History to Transform the Future. She offers great opportunities for nursing and health care professionals to understand the history of nursing.

These books are available at www.nursingknowledge.org/sttibooks.

STTI Releases New Disaster Preparedness Text

New book guides nurse educators in integrating disaster prep into curriculum

From natural disasters to infectious diseases to human conflict, disasters are occurring more frequently and with more impact than ever before. While it is almost impossible to prevent many of these crises, it is possible to prepare for them.

Written by nurses who have dedicated their careers to understanding and improving disaster preparedness in education and health care, Designing and Integrating a Disaster Preparedness Curriculum: Readying Nurses for the Worst is the first book of its kind — a how-to for incorporating disaster content into nursing education. Authors Sharon Stanley, PhD, RN, RS, FAAN, Col. (ret), and Thola A. Bennecoff Wolanski, MSN, RN, emphasize the importance of training future nurses to competently tackle disasters.

“The integration of disaster nursing content into a nursing curriculum is critical to our national preparedness,” said Stanley.

The book offers a blueprint for incorporating disaster preparedness education into an already crowded nursing curriculum. By ensuring that students know how to respond to potential disasters and that practitioners have the tools necessary to stay at the forefront of disaster preparedness, nurse educators and leaders can feel confident that their students and teams can competently confront disasters of all kinds.

The book is available at www.nursingknowledge.org/sttibooks.

Designing and Integrating a Disaster Preparedness Curriculum: Readying Nurses for the Worst
By Sharon Stanley, PhD, RN, RS, FAAN, Col (ret), and Thola A. Bennecoff Wolanski, MSN, RN

Book Information:

Published by STTI, 2015
ISBN-13: 9781940446042
EPUB ISBN: 9781940446059
PDF ISBN: 9781940446066
MOBI ISBN: 9781940446073
Price: US $59.95
Trade paperback, 416 pages
Trim size: 73/8 x 91/8

About the authors

Sharon Stanley, PhD, RN, RS, FAAN, Col. (ret) has served over 35 years in public health at local, state, and national levels and is an Army veteran with Vietnam, Desert Storm, and OIF/OEF service. Most recently she was chief nurse of the American Red Cross, providing leadership to over 15,000 Red Cross nurse volunteers and serving as a senior health policy and planning leader for the organization. Stanley is a 2013 recipient of the International Red Cross Florence Nightingale Medal and a Robert Wood Johnson Foundation Executive Nurse Fellow alumna.

Thola A. Bennecoff Wolanski, MSN, RN, is an assistant professor of nursing education at Elmira College and a Doctor of Nursing Practice candidate at Loyola University. She has worked in critical care and emergency/trauma nursing for nearly 25 years. A Johns Hopkins University grad, Wolanski has developed the leadership model for disaster preparedness training that is presented in this text.

5 Creative Ways to Gain Cooperation from a Senior with Dementia

cooperationAccording to the University of California’s Berkeley Wellness newsletter, “nearly all people experience some form of cognitive decline later in life.” Cognitive decline can cause memory impairment and loss of the ability to reason.

This may explain why elderly parents or other loved ones can become increasingly stubborn as they age. Of course, older people can become stubborn for a variety of other reasons as well—like simply being set in their ways. That stubbornness can do more than cause caregiver frustration, however. In certain situations, it can even lead to non-compliance with doctor’s orders. In fact, a study conducted for the Prevent Senior HospitalizationsSM program by Home Instead, Inc., franchisor of the Home Instead Senior Care® network, cited unwillingness to change as a top cause for not following doctors’ orders.

So how can you overcome your loved one’s constant refrain of “no”? Try these practical tips to gain cooperation and reduce your feelings of caregiver stress. [Read more…]