Getting Things Done

It occurred to me today how much I have accomplished this week on the road.  By ‘on the road’, I don’t mean work that occurs from a location remote from my primary residence in Boise.  I literally mean ‘on the road’.  I left Boise on Tuesday morning for the Tri Cities and have burned up the highway between Kennewick and Prosser all week.  I’ve had more things to accomplish this week than hours available and so I’ve maximized my road time with a little GTD tip that I learned from our own Brad Turpen.

Each morning, I have taken an inventory of the priorities on my @Calls list in Outlook.  That’s where I store the tasks that I am responsible for completing that require me to use a phone, but not necessarily a computer.  Brad taught me to put the telephone number in the subject line of the task so that as I pull it up, I need only click on the 10 digit number (which Outlook recognizes as a telephone number) and it automatically asks me to confirm that I want to call.  My Bluetooth allows me to keep my hands on the wheel while I conduct business from behind a windshield instead of a desk.

So this week I’ve initiated a special meeting of our Board, conducted a reference check on one of our recruitment candidates, done a screening interview with another potential candidate, negotiated details of the compensation package that our client is offering one of our candidates, and more.  As a matter of fact, I didn’t get in to my car one time this week without the name and number of my next call already prepared on my smart phone.  As I arrived at my hotel room each night, I could at least feel good that the work before me was work requiring me to use a computer – the person to person stuff was already out of the way.

Technology isn’t making my workload any lighter but it sure is helping me to get stuff done.

Project Management Never Seemed So Cool

One of our newest “MedMan Ways” is mind mapping.  We’re rolling MindManager9 software from MindJet out to our entire company this week after early adopters decided they couldn’t live without it.  Once when I was on the phone with a MindJet technical support representative, she pitched it as the “missing piece” of the MS Office suite and I’d say all of us at MedMan would agree.

Why do we like mind mapping so much?  Here are my top three reasons:

  1. Project Management – our corporate team uses MindManager for our annual operating plan.  We can add tasks, task information like resources and due dates, attach documents, link to websites, and move things from one area of our plan to another with the click of a mouse.  Once you add your information you can view it in an integrated Gantt Chart or filter by resources.  For example, anytime I want to see what has been assigned to me (and make sure my due date isn’t creeping up) I just do a power filter on my name and less than two seconds I have what I’m looking for.

    Annual Op Plan

  2. Presentations – we recently used a map for the first time to give our marketing presentationto a new client.  I think everyone was a little nervous at first to change from our trusty ol’ Power Point, but the whole idea of a map just makes sense.  You can see the starting point and ending point at the beginning, but as you move through the map, you can focus on a bit of information at a time with the “walk through” view.

    Presentation Map

  3. Visual organization – my personal use is where I really get the most out of mind mapping.  I am one of those people that has to get the crazy, disorganized thoughts out of my brain before I can start to make sense of it all – from “operationalize technology plan” to “tell husband to pick up dog food.”  Which leads me to another MedMan Way – GTD, or Getting Things Done (based on the book of the same name by David Allen).  But that is a topic for another day…

    Personal Brain Dump Map

CMS Audits & Complexities of Infusion Services

Infusion coding continues to be a “hot spot” for CMS and private payor audits.  The evolution of these codes has created several vulnerabilities.   First, within a 5 year time frame, infusion CPT codes have been revised, transitioned into Level II HCPCS codes and then re-categorized within the 90,000 series of CPT services.  Beyond this, the rules have continued to change with respect to bundling edits, supervision and general use of the codes depending on the site of service.

No surprise, most of the RAC’s have issued audits focusing on infusion services and specifically hydration.  Although the RAC has defined the audit as a review of “units” per patient per date of service, clinics and facilities should realize that other types of audits may look deeper into other issues surrounding infusion/hydration billing.  Likewise, some of the other RAC issues may incidentally create opportunities to find overpayments.  One example is blood transfusions.  Although both hydration and blood transfusion are defined as “automated audits”, it may create a complex review opportunity if both services were billed and paid at the same visit.  Coding rules dictate that although these services may be performed together, hydration services are bundled as part of the overall transfusion service and therefore should not be paid separately.

Most recently, the OIG issued a report dated July 28, 2010 on payments received by Princeton Community Hospital from its Medicare contractor for outpatient infusion therapy services. The OAS (office of Audit Services) found that Princeton Community Hospital billed for infusion services during surgical services and received payment over and above the global package. The report stated that “Payments received by the hospital from its Medicare contractor for 762 claims were not appropriate because they were for outpatient infusion therapy services provided as part of a surgical procedure and therefore were not separately payable by Medicare.”

A few suggestions on conducting internal reviews to detect potential problems

  • Cross check physician/nursing time against unit value time on claims. As per CPT, time under 31 minutes may not be billed as a separate service.
  • Cross check multiple infusion services for facilities as CPT has specific hierarchies based upon structural algorithms.
  • Cross check surgical services and items billed “over and beyond” on the same date of service.  Multiple procedures should have modifier -51 appended (unless exempt).  Review modifier -59 criteria and non-surgical services billed and paid on the same date as a surgical service.
  • Review infusion services performed “concurrently” as services such as hydration are bundled into other infusion services.
  • Review “start” and “stop” times of infusion as time is only calculated when medication/hydration is going into the patient.  Prep and observation time are NOT a part of infusion time.
  • Review billed equipment and supplies associated with infusions.  Items such as local anesthesia, IV access, flushes and standard tubing, syringes and supplies are bundled into the infusion service.

Jana Gill is a Certified Professional Coder and MedMan’s Coding and Compliance Director.   Jana offers audit, coding, training webinars, and other services for MedMan clients. For more information, contact us at 208-333-0000.

Learn More By Doing

This week I learned that the bathrooms on flights are international.  When you enter you’re Russian, when inside European and when you leave you’re Finish. 

I was exposed to more important things this week but that seemed to stick in my memory.  And, so I wondered why.   I’ve heard it takes over 20 repetitions for something to be remembered or for something to become a habit.  While that is hardly scientific it does illustrate that it takes many times over for something to become ingrained in one’s memory.  So, why then am I able to remember a silly joke after one repetition but many other more important things I have to hear over and over again to internalize?

Often it is because we choose to recall some things we hear shortly after we hear them while others we just put in our reserve memory to tap at a later time.  As an example, in my sophomore year in college one of my jobs was to tutor students in accounting.  While that may not seem like a stretch today, as a sophomore in college there were other extracurricular activities that demanded my attention than being scholarly.  I learned more about accounting through my tutoring experience than I did in all the accounting classes during my undergraduate combined.  So, I am suggesting that we should do more instead of just studying more.  We learn much faster that way.

The Power of the Network

Sometimes you need someone from outside your circle to come in to your world and remind you how good you have it.  When I first ‘met’ MedMan I was working in an independent medical practice here in Boise.  We were one of the biggest games in town and the management team that had been formed to run this enterprise was smart and diverse.  Still, we had our share of challenges to face and obstacles to overcome and I distinctly remember not really having anyone outside of that group to reach out to.  As much as I hate to admit it, there were times when I felt like we were isolated (either by geography or competition) from a bigger world out there that had the knowledge and experience to deal with the issue at hand.

One of our newer MedMan colleagues visited Boise recently.  It was gratifying to hear him talk about how impressed he was with our business model and how excited he was to have instant access to over thirty years worth of resources, knowledge and experience.  I guess I took notice of this because his words sounded so familiar.  I remembered having that very same sense of amazement and wonder when I joined MedMan.  I’ve been with MedMan long enough now that I’ve grown accustomed to the power of our network, the accessibility of information, and the willingness of my colleagues to aggressively transfer information amongst the team.  It is quite amazing that almost 30 people in 4 different states can liberally share information with absolute confidentiality and trust.  So, it is no accident that Sharing made the short list of core values.  But seeing it through someone else’s eyes last week reminded me not to take it for granted.  I don’t want to ever step outside of this family to know what it’s like to go home.

“Using VoIP in a medium-size practice call center”

Nicole Brown, MedMan’s Operations Director, recently partnered with David Kirk of St. Alphonsus Regional Medical Center to author “Using VoIP in a medium-size practice call center,” featured in the May/June 2010 edition of MGMA’s Connexion magazine.  To read the full article, click the image below.

Using VoIP in a medium-size practice call center

MGMA's May/June 2010 Edition of Connexion Magazine

Samaritan Physicians – Introduction

Dr. Cole Hemmerling of Samaritan Physicians in Moses Lake, Washington.

Corporate aviation, a great way to travel

What a great couple of days. I got to fulfill my job description to a T. Working for MedMan I get to utilize a passion passed down from one Boggess to the next. I was raised in an aviation family with the joy of flight embedded in my DNA. Combine that with a creative artistic side and you have a pilot with a laptop who can get stuff done just about anywhere. It’s hard to believe my Monday morning started at 7am in downtown Boise for a management team meeting and the day ended in Whitefish, Montana.

The perks of corporate aviation. Considering Jim and I were able to be in Boise for a meeting bright and early, work til 2 o’clock and then be airborne and heading for Montana paints a pretty good picture of how a company like MedMan can use a tool like Columbus. Such a trip on the airlines would have been an all day affair with a pretty good chance of a significant delay in there somewhere. We even arrived in time to accomplish and afternoon meeting at the hospital in Kalispell followed by a dinner with doctors.

The second half of a 33 hour and 47 minute tour of the Northwest started bright and early today with breakfast, a meeting with senior level management and  a CEO who we wanted to impress, a hospital tour and a then nice flight over to Moses lake. Non-stop 1 hour and 18 minutes at a cruising altitude of 12000 on top of a cloud layer in the crystal clear blue sky. On the ground by 1:45pm.

So, now here we are in Moses Lake, WA. This stop is a quick one. Long enough for a bite to eat at my old stomping grounds, Big Bend Community College. Jim and I seemed to accomplish a lot over a turkey sandwich and a salad. Out come the Blackberry’s and we have ourselves a productive session about up coming projects and what I have on my plate.  He goes one way and I go another.  I take off for Boise after the C-17 clears the traffic pattern. Crazy to see one of the biggest airplanes in the world doing touch-and-goes.

1 hour and 20 minutes later I touchdown in Boise with a decent landing by pilot standards. The airplane gets put away and I take a minute to reflect on a productive round trip via Montana and Washington. No luggage lost, no stale peanuts you had to pay for and no unexplainable delays. Columbus treats us right again with an efficient, productive and safe trip through familiar MedMan stomping grounds.

PNWU’s Pulse Newsletter Highlights Partnership

From PNWU’s Winter 2009 Pulse Newsletter:

PNWU and MedMan Form Collaboration

PNWU is located in Yakima, WA

Pacific Northwest University of Health Sciences and Medical Management (MedMan), a medical group management business based in Boise, Idaho, have strikingly similar missions – to improve and create access for quality healthcare throughout the Northwest, particularly in rural and underserved communities.

MedMan achieves this by managing medical groups (hospital and doctor owned practices); PNWU is achieving this through programs that increase the number of physicians practicing family medicine in rural communities.

For this reason, PNWU and MedMan are teaming up to provide College of Osteopathic students with core rotation and residency sites in MedMan managed clinics and hospitals. Currently, MedMan has clinics and a site location in every community PNWU anticipates sending students for core rotations.

“There is incredible synergy between PNWU and MedMan,” Vice President for Advancement and Development Gretchen Eickmeyer said. “We have been looking for this kind of a partnership because it integrates students into the communities they are practicing medicine in. Our students have the opportunity to go from their core rotations into residencies and ultimately practice medicine in the communities they have been immersed in.”

The College of Osteopathic Medicine requires core rotations in family medicine, general internal medicine, emergency medicine, pediatrics, general surgery, women’s health (OB/GYN), osteopathic manual medicine, radiology and anesthesiology.