It seems like at any given time I’m reading up to five different books. Most of them are specific to either healthcare or have a general management theme. I pick them up – I put them down – I move to another book – and the cycle perpetually continues. I’ve been doing this for years but there is one book that I come back to far more often than any other: Crucial Conversations: Tools for Talking when the Stakes are High. This valuable resource was presented for discussion at my first ever “MedMan University” in the Spring of 2009. As a mostly management/sometimes consulting company, we often find ourselves in the position of having to deliver a difficult message to a hospital board, a group of physician owners, an under-performing manager and more. Crucial Conversations has been the most relevant ‘read’ for me in the past several years as it has provided me with the right focus (“Start with Heart”) and easy-to-use tips on starting and managing a difficult conversation. I’m of the mind that just about every conversation we have in the business arena is a ‘crucial conversation’ and I frequently pull my book off of the shelf and flip to the pages that I have tabbed before starting a difficult talk. I’m reminded over and over that it’s not what we say but how we say that it distinguishes us and ultimately impacts whether or not our message is heard at all. If you haven’t yet read (or re-read) Crucial Conversations, I encourage you to do so – it’s well worth the read.
Archive for the ‘Training’ Category
MedMan U – The power of relationships
On our long drive home from the biannual retreat, I had time to reflect on the experience. The scheduled educational opportunities were great but that wasn’t the most meaningful thing that I was taking away from the three days. It reminded me of when I was in school getting my MBA from the University of Washington. The course content was great but the more valuable learning opportunity came for the in class discussion with all of the other executives. And this opportunity was no different; you can’t help but to be impressed as you look around the table at the number of years of medical management experience and the participation and engagement from the group. That was the most valuable and meaningful take away for me and I feel fortunate to have all of them as a resource.
MedMan University – My Freshman Year
WOW! I had no idea what to expect when I headed toward McCall on Tuesday after a long day’s work. My biggest concern was the need to bring a sleeping bag, and I hadn’t asked if there was indoor plumbing! (I was so pleased to find there was!). I arrived around midnight, found that breakfast was at 7:30, met my roommate Jennifer from Alaska, and fell onto the plastic mattress for a great night’s sleep!
In our first session in the morning, Jason put us in groups based on the results of our DiSC personality tests. I was so excited to be in a group with all the social “I” people! It was comforting to know there is a whole group of people, who overcommit, like to work in groups, avoid aggressive behaviors, and love to be appreciated. On a practical note, I can’t wait to get back to the office and arrange to send the DiSC survey to the two new doctors we have signed, which should help me know how to communicate with them. I also plan to have my manager’s take the survey and use it as a training tool with them.
It was eye opening to see that the MedMan team has many in each category. This is good for me to know, so that I didn’t assume that great managers need to fit in one or two of the categories. I have also decided that I am going to have my family take the DiSC survey and use the results to have fun over the holidays. Now that my kids are grown, and we have added a daughter-in-law, it would be a great exercise to talk about our personality styles and it may help them as they choose their future career paths.
It was just the first session….and already I found that MedMan University is offering a curriculum beneficial to my professional and personal life. I’d say this is a world class institution!
It’s Not About the Enchiladas
Having had time to reflect on a recent practice assessment in Pocatello, Idaho, I now know that I did learn something very valuable while working with Jason and Nicole……the cream cheese and crab enchiladas at Mama Inez are as good as I remember!
Actually, what I learned was much more important than that…see if you can guess:
What do accountability, discipline problems, self-motivation, employees spread too thin, process improvement, and financial analysis all have in common?
You’re right if you guessed that these are all issues that medical practice administrators deal with every day. But what if we didn’t have administrators or managers? Think about the structure at your current organization and, if your position was not available, who would perform these tasks? Would they get done at all? It is so important that you know clearly who you report to, and who reports to you, allowing you to define roles, maintain expectations, and hold others accountable in your organization. Without good managers leading organizations, things tend to fall apart.
Similarly, in a restaurant everyone knows their roles and expectations. The waitress, cook, and dishwashers all made those enchiladas an unforgettable experience.
Each person in the process is important, and what you do every day is invaluable. The need for quality practice managers is more important in today’s healthcare environment than ever.
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.
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.