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July - August 2011 •
Volume 16, Issue 4
Cultivating Relationships
Message from the President
By Jackie Willett, CHBME
I don't know about you, but I often find myself having to remember that not only does building strong relationships take time and effort, but that time and effort are critical to enjoying successful friendships, marriages and creating a healthy family. Positive relationships are the key to success in business as well. Click for more

HBMA News
News from Around the HBMA
By Madelon Berger, CHBME
Being Pro-Active in the Face of EHRs; Welcome New HBMA Members Click for more

SPOTLIGHT ON! EHR Committee
Committee Profile
By Patrick Lukas, CHBME
The mission of the EHR Committee is to further educate members and provide resources for opportunities which exist within third party medical billing companies, and to provide value added services to the practices they serve. Click for more

SOUND OFF!
HBMA Members Sound Off on Billing Issues
Billing Editors
Topic: Pros and Cons of Hiring Home Based Employees Click for more

Fall 2011 Conference Preview
Program Highlights
By Conference Guest Speakers
The 2011 HBMA Fall Annual Conference will provide a plethora of information to billing companies, putting attendees on the cutting edge of our industry. Professional speakers will address key issues such as ACOs, ICD-10, employee relations, patient payments, personal leadership, mergers and acquistions, Washington updates and much more. Get a sneak preview from five of our speakers on pages 11–14. Click for more

Aftermath
Disaster Preparedeness
By Rebecca V. Light, MBA
The only words to describe the last few weeks after the tornado are surreal and heartbreaking. Living in the central states, you become accustomed to tornadoes and a spring filled with tornado sirens. Sunday, May 22nd was like any other weekend day. I planned on spending time with family; we decided to take advantage of a beautiful day and go golfing. At the end of our outing we heard thunder and checked the weather to find a not-so-untypical tornado warning. However, I was not prepared for what would happen to my friends, neighbors and clients in the next couple of hours. Click for more

More HITECH Changes on the Horizon
HHS Issues Proposed Rule on Accounting of Disclosures
By Stacy L. Cook, Esq.
When the Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law in early 2009, it made many significant changes to the privacy and security provisions of the Health Insurance Portability and Accountability Act (HIPAA). The HITECH Act requirements become effective on different dates and some requirements become effective only after the Secretary of Health and Human Services (HHS) promulgates a rule addressing the requirements... Click for more

ACOs: Potential Issues for Billing Services
Feature Story
By Catherine I. Hanson, Esq.
By now, everyone has heard something about ACOs. Narrowly, these are organizations of physicians or physicians and hospitals that will contract with the Medicare program to take responsibility for a minimum of 5,000 Medicare patients pursuant to a relatively prescriptive set of standards in the hope they will obtain bonuses for providing care more efficiently. Since draft rules have engendered significant opposition and the ultimate rules for Medicare ACOs are still unclear, this article will talk more generally about the move to new health care delivery models and the impact that is likely to have on billing services. Click for more

Administrative Clarity Advances Provider Operations
Operating Rules Take the Guesswork Out of Point-of-Service Transactions
By Gwendolyn Lohse
How much should I collect? It is critical question that should be easily and reliably answered for every provider encounter with insured patients. Click for more

Insurers' Efforts to Prevent Health Care Fraud
Research Brief
By Dan LaVallee and Lisa Carpenter, Center for Policy and Research, AHIP
The issue of fraud prevention has emerged with a new sense of urgency among administrators of public health insurance programs. In January 2010, the Department of Health and Human Services and Department of Justice launched a series of Regional Health Care Fraud Prevention Summits aimed at increasing awareness for health care fraud... Click for more

Are Remote Deposit Services Safe?
There are business and legal risks in this arrangement – be careful
By Mark A. Cunningham, Esq. and James L. Catanzaro, Esq.
In recent months, many billing companies have heard or learned about "remote deposit" service arrangements through which third party vendors offer to convert paper checks into digital form and, with electronic routing, speed the process of depositing checks. Vendors promote this service as an easy way to expedite the payment process and reduce billing company costs. Click for more

Do You Help or Hinder Your Workplace Productivity?
Does This Sound Familiar?
By Kimberly Medlock, CPO
"Never assume to malice what could be explained by stupidity." I'm sure this will come as no surprise - if you have co-workers you will annoy and be annoyed from time to time. Such is life. To be clear, however, most people really do not mean to irritate others, or even have a clue that their behavior is doing so. Click for more

5 Tips for Getting the Most Out of Revenue Cycle Technology
Use Revenue Cycle Technology to Increase Your Company's Efficiencies
By Charlotte Martin, President and COO, Gateway EDI
With the growing demands of healthcare reform, getting appropriate reimbursement has become a bigger challenge. Many billing services look to revenue cycle management solutions to simplify claims processing and to meet new standards, such as the version 5010 format and ICD-10 code set requirements. Click for more

Staying on Target with Trigger Point Injection
Coding Corner
By Jackie Miller, RHIA, CCS-P, CPC, PCS
A trigger point is a localized hypersensitive area in a muscle. If you have one, you may be able to feel a firm, tender "knot" when you run your fingers over the area. It's called a trigger point because pressing on it triggers a pain response. The patient may experience pain in the trigger point, pain radiating into nearby muscles, and muscle twitching. Trigger points may be caused by trauma or by repetitive muscle strain. They can occur in the neck, shoulders, pelvic area, or legs. Pain management specialists routinely treat patients with trigger points, but many primary care physicians also treat these patients... Click for more

Using Microsoft Excel's® Pivot Table Feature to Turn Medical Billing Data into Actionable Practice Knowledge
Excel Pivot Tables
By Nate Moore, CPA, MBA, CMPE
Anyone who has ever entered a claim in a medical billing software package knows that it takes a lot of information from a variety of sources to file a clean claim. Most practice management systems store all of that information, but out of necessity only offer a limited number of canned reports. Because of their unique role, medical billing offices accumulate a tremendous amount of valuable data that could really help physicians manage their practices. .. Click for more

If Services Are Not Paid by a Health Plan, Can You Bill the Patient?
Operations
By Penny Noyes
If a service is denied because it is not a "covered service" or the patient is not eligible for benefits, yes, you can bill the patient. But what about other circumstances? If you are contracted as a participating provider with insurers and networks, pay close attention to the patient hold harmless sections of the agreements. Many agreements prohibit you from billing the patient for services that are unpaid due to the insolvency of a payer which may be the insurer or a self-funded employer... Click for more

EHR: Assisting Clients in Their EHR Efforts
EHR Issues
By Ron Sterling
When your clients are not worrying about the switch to ANSI 5010 and the introduction of ICD-10, they may be thinking about their electronic health record (EHR) situation and strategy... Click for more

Compliance with Medicare's Anti-Markup Rule
Compliance Issues
By John R Outlaw, CHC
The Anti-Markup Rule represents Medicare's latest efforts to address its longstanding concerns about the growth of certain abusive arrangements over the years which have permitted referring physicians to profit on their own referrals for diagnostic tests. Medicare has been concerned that allowing a physician who is in a position to profit on his own referrals by billing for a test performed by someone else leads to over-utilization of these diagnostic testing services and increased costs to the Medicare program. Click for more

Is Exhibiting at Trade Shows Right for You?
From the Road
By Dave Jakielo, CHBME
Now that summer has almost ended and autumn is approaching, there will be a ton of conventions, association and trade show meetings taking place. I often get asked the question, "Should I be an exhibitor at a specific trade show?"... Click for more

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