Banner
Home → Best Practices

Best Practices
Florida's Top Group Practices Print E-mail
Written by Jeffrey Herschler   
Tuesday, 13 September 2011 15:59

According to the South Florida Business Journal, the Top Five Group Practices in the region are Holy Cross Medical Group, Cleveland Clinic Florida, Phoenix Physicians LLC, University of Miami Health System - UHealth and University of Miami Hospital.   The Top 25 list, was published in their annual Guide To Health Care on Aug. 19 and is ranked by number of physicians.  Holy Cross Medical Group (at #5) boasts 135 docs while University of Miami Hospital (at #1) employs a whopping 1300. 

By comparison, Florida Physicians Medical Group (FPMG) claims to be the Orlando area's largest multi-specialty medical group practice with 252 board-certified physicians and surgeons. In Tampa that honor goes to the USF Physicians Group with more than 350 physicians.  Meanwhile,  the University of Florida Physicians (operating in Gainesville and Jacksonville) is a medical group practice comprised of more than 640 doctors.

The South Florida region has long held a reputation for smaller groups, duo's and solo's.  Any Detail Man (or Detail Woman) can tell you that. Often S Florida docs "pose" as groups but are really separate P/A's or LLC's sharing office space.  That said, SFBJ's latest list provides fresh evidence that economic forces, accelerated by HCR, appear to be changing this traditionally small group market. Click to view:  SFBJ's Top Five South Florida Group Practices.

submit a READER RESPONSE for possible publication.

_________________

Every Picture Tells a Story:   Highest Paying Job in U.S.

You guessed it.  Doctors and Surgeons occupy the number one spot in 2011.  

Presented by MF Healthcare Solutions via CNBC (photo by Getty Images)

Last Updated on Tuesday, 13 September 2011 16:10
 
Many cheap Med Mal offers are coming my way. How can I go wrong when I am saving so much? Print E-mail
Written by Matt Gracey   
Tuesday, 13 September 2011 15:47

MED MAL Q & A

Florida doctors are now enjoying a very "soft" buyer-centered market cycle, although I believe this is close to ending.  Back in 2000 we were in a similar market cycle, which led to many insurers pulling out of the state and the others dramatically increasing their malpractice-insurance rates a year or two later.  My advice as we enter the end of this soft market is to find a stable, well-funded, Florida-committed malpractice insurer so that you will lessen the chances of your coverage being canceled by your insurer when the going gets tough soon. 

When deciding which insurer will handle your coverage, remember that not all malpractice insurers are created equal, by any stretch of the imagination.  This is contrary to what you might read and hear from slick marketing folks and what you might like to believe so you feel can feel more comfortable and secure just price shopping. As with every important purchase decision, a risk/reward calculation is useful.  If a new, unrated insurer is promising great coverage and superb defense against claims, all for a price much below the rest of the marketplace, then there is a very high probability that they are just luring you in with unsustainable marketing promises.  In the last malpractice-insurance crisis of the early 2000s, over 50 insurers stopped insuring Florida doctors and left many facing expensive "tail" purchases, so choose very carefully as we come to the end of this buyers'-market part of the never-ending cycle.

                          Comment on this Story  

Matt Gracey is a Medical Malpractice Insurance Specialist in Delray Beach with Danna-Gracey, Inc. He actively lectures and writes educational material to help doctors and legislators around the state understand the malpractice insurance issues facing doctors today. You can reach him at (800) 966-2120 or matt@dannagracey.com

Last Updated on Thursday, 22 September 2011 09:47
 
Revenue Cycle Management: Enhance Cash Flow with Improved Efficiency Print E-mail
Written by Todd D. Demel, MBA   
Wednesday, 24 August 2011 17:45

LOST REVENUE

While healthcare providers typically rely on conventional revenue cycle management methods to ensure financial performance, most are not collecting all of the potential revenue they have earned. Whether due to pricing, charges, or coding, considerable amounts of reimbursement are being lost daily. Today, providers must do more with fewer resources. Therefore, it is critical that practices effectively identify and address the root causes of lost revenue.   

THE BUSINESS OF HEALTHCARE

All of this comes down to establishing a better way of managing the business of providing healthcare. And accomplishing this requires the proper processes, tools, and related expertise. While there has been an increased emphasis placed on technology and automating part of the revenue cycle management process, improved financial performance must also incorporate proper compliance measures and appropriate documentation.

Technology can certainly improve efficiencies and reduce some administrative burdens, but the reimbursement ultimately received by the practice correlates with and is a reflection of the data that was initially entered into the system. Just as important, if a practice is cited for noncompliance due to inappropriate or inaccurate documentation, cash flow could be reduced to the point of devastating a practice due to a review or audit that entails a hold being placed on payments. 

GETTING IT RIGHT THE FIRST TIME

Rather than backend processes, the source of inadequacies is typically people and technology on the front-end. Accounts receivable decreases in value as it ages. Therefore, in cases where a claim is not paid the first time it is submitted, the chances of the practice ever receiving payment drops significantly. This is why it is so important to catch potential denials before claims are submitted.  

Transparency
is also a key factor and therefore staff should be aware of:
 
  • Whether the claim has been transmitted;
  • Where the claim is in the process;
  • Whether the claim is complete;
  • Whether there are any factors that may delay transmission of the claim;
And, when the practice can expect payment to be made.

PATIENT RECEIVABLES

While less emphasis has been placed historically on patient receivables (as opposed to insurance receivables), annual increases in health insurance premiums have caused consumers to search for plans that require higher out-of-pocket responsibility in order to offset costs. Since this trend is likely to continue, equal attention must be given to this area of the revenue cycle as well. 

GOALS

The goals for the practice administrator should include:
  • Increasing the first pass resolution rate;
  • Speeding-up the collections process;
  • Reducing workload and increasing efficiencies of staff;
Other factors to consider include the chargemaster or fee schedule, and payer contract management. Establishing a team environment at the practice where everyone is clear on their functions and responsibilities will go a long way towards creating efficiencies. Work distribution should be well thought out, and staff should be educated on best practices for pricing, charging, and coding. There must also be an awareness of compliance risks, accountability, and the possible consequences of noncompliance. 
ABOUT THE AUTHOR:  Mr. Demel is Senior Executive of Physician Management Services at MF Healthcare Solutions.  Possessing both operational and financial backgrounds, the MF Healthcare Solutions management team has vast experience in a range of healthcare industry settings. Combined expertise enables the firm to offer specialized physician practice managementservices. For more information, please visit: www.mfhealthcare.com or contact Todd Demel at (954) 475-3199.
Last Updated on Wednesday, 31 August 2011 17:26
 
Pay-Per-Call Marketing: Twenty First Century Marketing Programs Impeded by Twentieth Century Rules Print E-mail
Written by Jeffrey Segal, MD, JD and Michael J. Sacopulos, JD   
Wednesday, 17 August 2011 12:53

Remember the days when a doctor took out a half page ad in the Yellow Pages - and we quaintly called that marketing. The world has changed. One 21st century marketing program, pay-per-call, is being embraced by doctors across the country.

Here's how it works. Internet marketing companies create a platform which either markets to patients (push) or serves as a magnet for prospective patients (pull). This might include an email blast to a proprietary list. Or a search-engine optimized web site with rich information.  Once a prospect is interested in the services being promoted, the company directs those prospects to healthcare providers participating in a designated geographic area. The provider pays a fee for each substantive lead - the lead being measured as a phone call to the doctor's office lasting longer than a few seconds. It's up to the office staff to convert the phone lead into an office appointment. Sounds great. A lead on the telephone is probably more valuable than an email inquiry. If the phone's ringing, what's not to like?

We hate to be the skunks at the garden party, but legacy statutes are not particularly supportive of 21st century marketing programs. The federal government has laws on its books which prevent "kickbacks" or fee-splitting. These laws predate pay-per-call marketing by many years, but these laws are still valid. The laws say a kickback is a payment designed to induce a referral for health care. On the surface, pay-per-call programs seem to contain the ingredients referenced in anti-kickback statutes.  Fortunately, there are safe harbors which don't trigger enforcement of fee-splitting penalties - such as when a doctor refers to another doctor in his multi-specialty practice - and they are both employees in the same facility. If they split profits at the end of the year, then, in a sense, the referral has generated extra fees split by all. As a safe harbor, this does not trigger any action.

On the other hand, if two unrelated doctors have a handshake agreement whereby referrals will be paid a cool $300 for every surgery - that's likely against the law. No safe harbor there. We should note that the federal anti-kickback rules apply only to Medicare-Medicaid providers. Those physicians they do not participate in Medicare-Medicaid are outside the scope of these laws. Also the laws apply to professional services. It may be possible to structure pay-per-call to fall outside the scope of federal law by limiting the scope of offers to products only. However, as these pay-per-call marketing plans typical operate, they would be in violation of federal law. Many states, though, have parallel statutes affecting fee-splitting; such as California Business and professional Code Section 650 which bars licensed physicians from offering or receiving any form of consideration in return for patient referrals.

WWDHHSD (or What Would Dept. Health and Human Services Do)...The Office of Inspector General for U.S. Dept. Health and Human Services ("OIG") issued an Advisory Opinion on a pay per call program. There, OIG concluded that a pay per lead program did indeed violate the plain language of the Anti-Kickback Statute. And, such a program did not qualify for any statutory safe harbor. That said, OIG concluded they would not enforce the statute against participants in those programs, because such programs did not promote the type of abuse the statute was meant to curtail. The federal government opined pay-per-call, as outlined in the Advisory Opinion, was kosher. 

________________  (cont. after sponsor message)  

Sponsor Showcase

gsk logo blue

Audit, Tax, Valuation, Fraud Detection & Prevention, Forensic Accounting

Healthcare service team led by:

Jeffrey B. Kramer, CPA, Partner
 jeff.kramer@gskcpas.com or 954-989-7462 ext. 427
________________

(Pay Per Call Mktg:  continued from top of page)  

The policy is similar to choice the federal government exercises to "tolerate" medical marijuana purchases. Medical marijuana is legal under a number of state statutes. But, medical marijuana still violates federal law. Nonetheless, the current federal policy is to look the other way.  While the above is helpful in giving a doctor comfort, a doctor making a decision whether or not to participate in a pay-per-call program must also pay attention to policies of their state professional licensing board. Most licensing boards have explicit prohibitions against "fee splitting."  

It's unclear whether state licensing boards would follow the lead of the federal government, Would they acknowledge, as Dept. H.H.S. does, that such programs violate criminal statutes with no safe harbor - but opt against enforcement? Nobody knows. We can all agree that no physician wants to be the test case. The reality today is that many Board investigations are complaint-driven. So, if patients complain to the Board for any number of reasons, an investigation might broaden to include allegations fee-splitting. Doctors who want to test the waters with pay-per-call programs would be well advised to proactively lobby their licensing bodies to update their decades-old fee-splitting policies. Medical Justice can provide you with a template of model language for revising the policy.                  

Comment on this Story

Jeffrey Segal, MD, JD, is founder and CEO of Medical Justice Services. Mike Sacopulos, JD, is general counsel for the organization. Run by physicians for physicians, Medical Justice, is a membership-based organization that offers services and proprietary methods to protect physicians' most valuable assets - their practice and reputation. The company offers proactive services to deter frivolous medical malpractice lawsuits, prevent Internet defamation and provide strategies for successful counterclaim prosecution. Medical Justice works as a supplement to conventional professional liability insurance.

Last Updated on Wednesday, 24 August 2011 17:57
 
Why Ratings Matter in Evaluating Medical Malpractice Insurance Companies Print E-mail
Written by MATT GRACEY   
Wednesday, 27 July 2011 16:40

MED MAL Q & A    
                     

Q. Why is a rating of a malpractice insurance company so important?  Are some rating agencies considered better than others?

A.  An insurer with a high rating from A.M. Best could be considered the equivalent of a doctor being board certified, experienced, and considered competent in their chosen specialty by an outside peer review group.   For some years now, many doctors and their administrators seem to have forgotten the vital importance of their malpractice insurer having a solid financial rating from one of the major rating agencies, including A.M. Best and Fitch.  Malpractice insurance is one of the most important purchasing decisions doctors make each year.  With such a potentially long time between deciding on an insurer and a potential multimillion-dollar payout to satisfy a judgment, the stakes are high for making an astute decision.  Insurance is a strange beast in that policyholders are essentially purchasing a promise from an insurer to pay an undetermined amount of money at an undetermined future date.  With Florida's bad-faith laws the payout could be many times the policy limits purchased, and in a multidefendant, complex lawsuit a judgment could be awarded up to ten plus years after a claim is first filed.  The significance of that is that an insurer that looks marginally healthy today when a doctor is making a decision on his or her insurer could well be gone in those ensuing years, and in Florida such seems to happen with rather regular frequency.  Unrated, financially fragile insurers also tend to settle more lawsuits, thus providing compromised claims defense.  That is why doctors must get back to fundamentals of financial decision making by determining which prospective insurers hold a high rating from A.M. Best or Fitch.  Some doctors with serious claims histories, however, might not have the luxury of being insured with a highly rated company, but most still do, particularly in our present "soft" market conditions when underwriting is much looser than in "hard" market conditions.  In previous times, Florida's widely variable malpractice insurance cycles have resulted in doctors having few choices and ratings at times had to be overlooked, but in the current market's conditions doctors with good claims histories and normal practice profiles have the ability to find fair pricing from highly rated insurers without taking the risk of purchasing coverage from unrated insurers. 

Other rating agencies have been formed in recent years to help newly formed insurers or those who choose for strategic reasons not to ask the more highly regarded agencies for a rating, so be diligent to ask about and understand the rating agencies' differences.   Some unrated insurers also tell their prospects that their reinsurers are all highly rated, but reinsurers are only a backup to the insurers' risk and can decide not to continue their participation with any insurer in any given future year at their own reinsurance policy's renewal.   
                                   Comment on this Story

Matt Gracey is a Medical Malpractice Insurance Specialist in Delray Beach with Danna-Gracey, Inc. He actively lectures and writes educational material to help doctors and legislators around the state understand the malpractice insurance issues facing doctors today. You can reach him at (800) 966-2120 or matt@dannagracey.com.

Last Updated on Wednesday, 03 August 2011 13:14
 
<< Start < Prev 51 52 53 54 55 56 57 58 59 60 Next > End >>

Page 55 of 60


Banner
Website design, development, and hosting provided by
Netphiles