Friday, October 12, 2018

Announcing: "Tweets, Likes, and Liabilities: Online and Electronic Risks to the Healthcare Professional," by Michael Sacopulos and Susan Gay

Electronic medical records, websites, cellphones, email, and social media have created tricky new legal problems for healthcare practices. The digital world, namely social media, offers healthcare practices a vehicle to attract patients and potential employees but also presents risk to healthcare providers. This book will give practices the knowledge and tools to reduce liabilities and provide a “roadmap” to that world.
Although physicians, practice managers, administrators, and risk managers of practices and health systems know these issues are important, there is a dizzying array of issues (and interpretation) on the Web. Staff member have difficulty in identifying areas of potential risk, lack of a strategy to address electronic risks, and lack of tools to address electronic risks.
This essential book will give you peace of mind by flagging areas of risk – and then provide guidance and templates to address the risk.
Find out what’s important, and what’s not, in this easy-to-use guide. Selected topics include:
  • No more guessing: a Social Media Policy for Your Employees
  • Reviewing the social media profiles of employment candidates? We'll give you state by state guidelines.
  • Train Your Employees on Cyber Security Basics
  • Don't Let Your Website Turn Into a Law Suit
  • The only Mobile Device Policy you'll need
  • How you can be hacked through your website, “Contact Us” feature.
  • I know the perfect guy for you. He put together the website for our church.” How to select a website designer
  • The skinny on SSL Certificates and why you need one
  • Who Owns the Content in our website?
  • Patient photos on your site
  • Astroturfing – Fake Reviews, Real Consequences
  • Are generic HIPAA training models enough?
  • Focus on the Biggest Cyber Risks First – we'll give you the roadmap
  • BONUS! Templates for your mobile device policy, social media policy, business associate agreement, photo and video release, plus others!
Table of Contents
Section I
Introduction: Patients, Physicians, and Social Media: The State of the State
  • Social Media and the Hiring Process
  • Social Media Use and Policies in the Healthcare Practice
  • Cybersecurity
  • Your Practice Website
  • Online Reviews and Ratings
Section II
Social Media and the Ghost of Employees, Present and Future
  • Equal Employment Opportunity Commission and Federal Antidiscrimination Laws
  • State Laws on Social Media Policy in the Hiring Context
  • Best Practice Advice for Using Social Media When Hiring
  • Best Practices for Employers When Conducting Online Social Media Searches
  • Social Media Policies for Employees: The Illusion of Control
Section III
The Content You Create – Internal Risks and Management
1. Don't Let Your Website Turn Into a Law Suit
  • How to Minimize Risk and Improve Compliance
  • Hacking is Not Limited to Networks
  • Cents and Sensibility
  • Where Oh Where Can I Find a Good Web Developer?
  • Conduct a Risk Assessment with Vendors
  • Contract Terms
  • The Business Associate Agreement (BAA)
  • Disclosures, Consents, and Terms...Oh My
  • Website Content and the Role of the Federation of State Medical Boards
  • Site Security, HIPAA Compliance, and You
  • Specialty Vendors Requesting Access to Your Website
  • Accessibility for All
  • Risk Assessment Questions for Web Developers
  • Checklist
2. Licensing Boards: Ethical Duties in the Cyber World
  • HIPAA Considerations and Best Practices to Avoid Breaches
  • Case Studies: Misguided Mistakes and Egregious Errors
  • Overview of the Federation of State Medical Boards’ Model Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice
3. Practical Cybersecurity for Physicians: How to Develop Policies, Procedures, and Effective Training
  • Why Preparedness is Worth the Effort
  • Focus on the Biggest Risks First
  • Develop/Update Policies
  • Security Policy
  • Social Media Policy
  • Mobile Device Policy
  • Written Procedures Are a Must
  • Design an Effective Training Program
  • Ongoing Training and Monitoring are Critical
Section IV
Patient Satisfaction and Online Reviews—Managing Risk and Your Online Presence
  • Patient Satisfaction is a Vital Metric
  • Taking Charge of Your Online Presence
  • Embracing Online Ratings
  • Monitor Yes. Respond? Maybe, Maybe Not
  • Economics of Good Reviews
  • Correlation with Clinical Outcomes
  • Patient Satisfaction Tips
Section V
Template Gallery/Resources
1. Business Associate Agreement
2. Pop-Up Notice on Website Prior to a Patient Communicating with Your Office
3. Terms of Use for Your Website
4. Healthcare Practice Security Policy
5. Photograph and Video Release
6. Social Media Policy for the Healthcare Practice
7. Mobile Device Policy
8. Data and Electronic Sanitation and Disposal Policy

(800) 933-3711 

Authors Mike Sacopolus and Susan Gay

Tuesday, September 25, 2018

Good Documentation and a “Clean” Firing can Help Protect your Practice

Without being mean and cold-hearted, a manager needs to keep communications with the terminated employee short and simple. The more you talk, the more trouble you can stir up. Firing an employee is never easy. You have to be careful and thorough to make sure you haven’t said or done something that could be used against the practice in a wrongful-termination lawsuit. It’s important that you clearly document the history that led up to the termination, and it’s critical that the record shows that you have treated the terminated employee the same as you treat everyone. Lawyers look for evidence of discrimination—especially if the worker is part of a “protected” class. 

In trying to make a firing easier on the employee, many managers and physicians trip themselves up with legally clumsy mistakes. Here are five pointers for avoiding some of the common errors:

1. Keep the discussion short and direct. It’s tempting to unload on the failing staffer with a history of underperformance and mistakes. Each problem you raise gives the employee a chance to argue each point. If the worker tries to draw out the conversation, tell him or her that “there’s nothing left to talk about.”

2. Be clear that this is a termination. Trying to soften the blow can relay a mixed message—a firing sounds more like a last-chance warning. Leave no room for misinterpretation.

3. Tell the truth about your reason to fire the employee. If you’re firing the staffer “for cause,” don’t call it a layoff. Calling it a layoff (or eliminating a position) can affect unemployment claims. Worse, you can get in legal hot water if you then turn around and hire a replacement. Similarly, don’t call an economic elimination a performance-based firing. You likely won’t have the records to back up your claim.

4. Calm the remaining employees afterward. Don’t lie, but don’t divulge too much information either. Tell remaining staffers only what they need to know to assure them that the decision was fair and that their own jobs are not necessarily in jeopardy.

5. Take the former employee to the door immediately. Don’t let a terminated employee talk with other staff members. Have someone (probably yourself) accompany the worker back to his or her desk to collect personal items. While this can feel like you don’t trust the employee, it also protects him or her from being wrongfully accused of unprofessional conduct or theft.

Once you’ve made the decision, though, make sure the employee understands that there’s no room for discussion or negotiation. If you allow him or her to talk you into allowing one more chance, you will only extend the process and delay the inevitable firing. You’ll lose credibility with the under-performer and with other members of your staff.

Good documentation, fair practices, and a “clean” firing will help protect your practice and will remind the rest of your staff that you mean what you say about performing up to standard.   The Journal of Medical Practice Management   Fast Practice 

Thursday, September 20, 2018

Nothing in Your Revenue Cycle Takes Care of Itself. Five Mistakes Providers Make.

Healthcare providers with sub-performing accounts receivable will do well to take a close look at these five broad areas. This advice is especially important to high-volume billing offices affiliated with hospitals and healthcare systems. It’s not uncommon for institutional departments to falter in any of these five areas.

1. Not staying current with payer requirements. Payers often develop new tools and processes that can help you avoid slow payments and rejected claims. 
Make sure you have the latest technology (system updates), manuals, and contact information in place.

2. Failure to monitor the entire claims process: Without thorough monitoring of each step, staffers will waste countless hours analyzing denials and delays. The bottleneck that’s choking your cash flow may hide in a process you’ve inadvertently ignored.

3. Not resubmitting rejected claims: If you don’t feel you have access to data to support your claim, you might be reluctant to resubmit the rejects.

4. Failure to verify patient eligibility: Fully one quarter of practices never verify patient eligibility and copayment amounts. With constantly rising copayments, this can cost a practice dearly.

5. Not recognizing trends: Focusing on one claim at a time without stepping back to look at the
bigger picture will prevent you from seeing correctible errors in your processes.

Without a specific assignment, no one has time to analyze charges going out to make sure billing requirements have been met, and no one has time to analyze payments and adjustments coming in the door. The problems described in this article require analyzing trends and identifying where you’re missing out on revenue opportunities. 

The take-home lesson: Nothing in your revenue cycle “takes care of itself.” You must deliberately plan to analyze and evaluate your processes so that it becomes part of your routine. Otherwise, you could have a significant “leak” draining potential income from your practice.

Visit us at for The Journal of Medical Practice Management or our Abstracts and Commentary Newsletter, Fast Practice. 

Friday, September 14, 2018

Optimizing Your Reception Area (Waiting Room) – Time for a Reality Check

Patient satisfaction depends on more than how well you perform as a physician. The entire “patient experience” affects how patients feel about your practice. What they see, feel, hear, and even smell in the reception area has a significant impact on how they evaluate your practice’s performance. Often referred to as “the waiting room,” patients can spend a good deal of time there. We prefer to use the term, “reception area.” A well designed area can actually shorten patients’ perceptions of passing time—and the opposite of that is likewise true.

There are several weak points in reception area environments that could be improved. Areas needing attention include:

• Waiting times. Patients who experience long waiting times have a greater tendency to be dissatisfied with the actual doctor consultation. Practice operations must be streamlined to minimize wait times, but every effort must also be made to help patients feel that time passes quickly, too. A comfortable environment is key, as is an attentive, compassionate staff.

 • Welcome companions. When calculating seating requirements, be generous enough to
accommodate patients’ companions comfortably. Companions affect patient perceptions as well, so various amenities, decorative details, and a pleasant atmosphere elevate everyone’s impressions. The he presence of anatomic pictures, illness information, and medical “educational” materials in the reception area has a tendency to elevate anxiety levels.

 • Patient confidentiality and respect. Patients have been sensitized to their right to privacy. Make every effort not only to guard personal health information, but to make sure patients feel protected. Details such as bathrooms that do not open directly into the reception area help patients feel more comfortable on a personal level. 

Regardless of your best efforts on the phone or in the exam room, patients are deeply affected by their impression of your reception area. Conducting an objective investigation at your own practice is an excellent first step to elevate patient satisfaction. Just about every medical management professional already knows this: An optimized waiting area raises patient satisfaction and can even boost practice efficiency. But sometimes we can be blinded by common wisdom. 

It’s very difficult to step back and take a fresh look at the things with which we are most familiar. We don’t even notice the worn furniture in the reception area, but new patients scowl at the “dingy décor.” Patients stare at the water-stained ceiling, the cracked bathroom tile, and the scuff marks on the reception counter. We walk right past them. The conversation between a nurse and patient at the clinic entrance bounces off our ears—but patients in the waiting room squirm to hear about Mrs. Jones’ urinary tract infection. Familiarity really does breed contempt. 

So how do we gain the objectivity we need? We suggest a three-pronged approach:

 • Ask. Forget about what you “already know” for a moment. Find out what patients really want in a reception area. Google “patient reception area” for a couple million hits with general advice and design tips. Better yet, design your own patient survey with specific questions about their impressions and preferences. Consider forming a focus group of several patients to meet one evening and discuss their impressions and experiences in your reception area. Ask them how you can improve.
 • Assign. Hire someone from outside the industry to assess your reception area. Provide an evaluation guide that directs them to look at everything from décor to cleanliness and maintenance, from staff attitudes and performance to patient confidentiality. 
• Assume the patients’ point of view. Spend some time in your reception area. Take some simple work—and go sit with your patients for about an hour. Be aware of what’s going on. Look around at the furniture, the artwork, the floor, and the windows. Listen to conversations—especially at the reception desk. You can learn a lot. 

Until you make a conscious effort to overcome familiarity, your practice will not likely make the improvements your patients want.

Thursday, September 6, 2018

Before You Invite Colleagues to a Staff Meeting, Ask This One Question

No matter how many times we read management articles suggesting that we cut down on meetings, they still seem to, well, happen before we know it. That’s in part because there’s something reassuring about seeing the faces of your colleagues and reading their body language and tone when discussing key issues. That doesn’t make holding needless gatherings a good idea, though.

It’s worth bearing in mind the maxim cited in one of our favorite articles in The Economist, to wit: “80% of the time of 80% of the people in meetings is wasted.” Very few organizations can afford to waste that much of their staff and management time.

The question is, it’s time to have a face-to-face discussion on an issue, how do you decide who should participate? Are the people that must be included as a matter of course? Is it possible that by leaving a lower status person out, you’re missing a vital perspective?

One way to process this is to start by asking yourself “who has the best understanding of this issue?” rather than “who needs to be in the meeting?” When you ask who needs to be there you may be obeying unwritten rules that don’t really serve your organization. But if you ask yourself who understands the issue you might draw on knowledge sources that are otherwise neglected.
Another way to think your meeting strategy through is to ask yourself whether the key issue to be discussed is related to company policy or company operations. While the two overlap, as well the people who should be present to address them, it helps figure who has the biggest stake in the matter.
For example, if you make a major policy decision it’s likely that all of the executives or leadership members should attend. On the other extreme, if you’re deciding how to organize your sales team, that’s a purely operational issue.
You may even want to mix it up to some degree, holding one meeting to solicit feedback from your executive team and another to learn what your staff has to say on an issue. Then, everyone is in synch with little time wasted.

Few office workers like to attend meetings. Reasons for this include their inefficiency, the tendency to run to groupthink and the likelihood that many who attend public have little to contribute. These meetings can drag on for hours.

In some cases, involving people in a meeting can be important, including when significant events such as a change of leadership or strategy, or with the announcement of job losses. Also, it may be beneficial to hold a very brief team meeting each morning to share progress updates. However, if a meeting is meandering and ineffective it’s probably not worth holding.
To improve meetings, experts say, it’s important to see that everyone involved as well prepared and has seen the agenda. People can react badly if they don’t know what to expect and get caught off guard. A good agenda will put the most difficult items at the beginning of the meeting and tackle them right away.  It also helps to decide whether the meeting is designed to gain buy-in for a management decision to collect feedback from workers.

Meetings that push a management objective should be rare in a well-run firm, but if such a meeting must be held it’s best if allies of the meeting leader speak first and drive the agenda.
Meanwhile, the meeting’s goal is to learn what people think, it’s best to start with low status employees and encourage them to speak. For best results, enforce a “no interruption rule” to be sure they are not intimidated. It’s also an option to let people submit their views anonymously in advance.
Once a meeting has been held and decisions made, it’s important that everyone else finds out what has been decided. Sometimes even people who are present leave the room without being sure what has been agreed upon.

Finally, if you can avoid a meeting avoid it. When possible, use electronic messaging groups or private message exchange tools to keep management and employees in touch. These venues allow everyone to impart messages in succinct form. They also make it easy for those who aren’t involved to ignore the messages and keep working.

Thursday, August 30, 2018

Get and Stay on Track with MIPS 2018

Now available!
Our 60-minute timely webinar recording on MIPS with Joy Rios. PDF handout, audio recording and a terrific Q&A session with Joy Rios.
Call (800) 933-3711 or

Need multiple copies?  Send an email to for discounted pricing.

Thursday, August 23, 2018

Happy 35th Birthday to The Journal of Medical Practice Management

In celebration of The Journal of Medical Practice Management's 35th birthday, I post the visionary "Letter from the Editor," by Marcel Frenkel, MD, MBA, from the inaugural issue of JMPM.  In many ways, this letter could be written today. The mission of JMPM is still the same. Thank you too to our authors and subscribers!
Nancy Collins
President & Publisher

"A Journal for a Time of Change"
from July 1985, Vol. 1, No. 1

It is now commonplace to state that the healthcare system of the United States is in the midst of a major change. This restructuring will greatly alter the substance, character, and style of the practice of medicine. The concept of this publication grew out of the desire to present in one journal a comprehensive approach to these changes, directed specifically to the practicing physician.

Rather than the gradual and evolutional developments which have characterized past progress, a great many organizational changes are underway. Differing systems of medical practice are now in place with competition emerging among these modes. The financing of medical care and the internal structure of the organizations of delivery present a bewildering complexity. Government regulation, fiscal constraints, local factors, and demographic trends all influence the fabric and future of medical practice.

The individual is now confronted with perplexing vistas. In past and simpler times, completion of a training program brought a modicum of assurance of the attainment of professional goals. The practitioner, individually or as member of a grouping, may now find difficulty in gauging the future and his or her new role in the new scheme of medicine. It now becomes imperative to develop an awareness of business methods socioeconomic trends in order to chart a sensible course for one's professional career.

Philosophically, the Journal is not wedded to any theory of healthcare structuring but wishes to provide an authoritative background to help physicians reach important decisions in the conduct of their affairs. This nation is large and varied, its population being diverse and requiring differing answers to its medical needs. During the transition phase that we foresee in the next decade, a variety of patterns of healthcare delivery will likely coexist and provide means for experimentation. This will allow the emergence or retention of practice patterns which are most useful in terms of economy and patient acceptance. Once can visualize the existence of fee for service alongside preferred provider organization (PPO) mechanisms and health maintenance organization (HMO) participation, all in one practice. As a private practitioner as well as an academician, I view the maintenance of a viable private sector of individual practitioners as a valid counterpoint to the emerging corporate groupings. It will provide patients with an alternate system with its own characteristics. Additionally it would allow both the individual and the corporate sectors to react to each other, refine their methods, and evolve in competition to provide better, more equitable, and economical care.

In spite of the rhetoric, it is important to remember that the art and science of healing remain the province of physicians who can also exert considerable influence on the course of events. Therein lies an opportunity. Informed physicians can help mold the future of the healthcare system in general and their own fate in particular, by participating in a dialogue within their own communities and assuming a leadership role. In instances where communications between medical leaders and the business and consumer sectors have been active, physicians have been able to maintain their traditional and pivotal role.

The purpose of “The Journal of Medical Practice Management” is to present, principally, to the medical practitioner, but also to the health administrator and others interested in this extraordinarily large system of healthcare, an overview of events and trends affecting medical practice. While there has been a proliferation of journals related to health policy, practice, and specialty issues, reading such publications with varying emphases requires the expenditure of considerable time and money. Few are directed to the practicing physician in an analytical way. Assembled in this journal, we propose to offer scholarly analyses and practical items to aid in the conduct and progress of medical practices. These will include articles on techniques of office management, computer technology, the marketing of medical services, reviews on developments in legislation, and government regulation. We will follow legal, legislative, and litigation trends affecting practitioners and also survey the constant changes in taxation that bear on practice management. Each issue will review an important facet of healthcare policy and also describe some some the varied modes of healthcare delivery, organizational structure, and the dynamics within healthcare groupings. Continuing article will consider medical education and manpower issues because of their great importance on the supply side of the medical economics equation. While our society cannot be compared with any other political entity, there is much written that we can learn from patterns of health care in nations which have already altered their systems. A regular “Letter from Abroad” will help familiarize the reader with developments throughout the world.

In addition to analyses of important issues, we will offer shorter reviews of current topics, all written by experts in their respective disciplines. These will include:
  • a review of the Washington scene
  • computers in review
  • a taxation update
  • abstracts of important medico legal decisions
  • a survey of the HMO and PPO industry
  • selected healthcare statistics
  • abstracts of the relevant literature.
Other features will profile the structure and financing of individual for-profit healthcare systems, followed by reviews of not-for-profit organizations.

Together with the regular Journal reviews, the Editorial Board hopes the continuing analyses will provide a comprehensive and practical approach to the varied factors which bear on medical practice.

Marcel Frenkel, MD, MBA
Founder and Editor
July, 1985
(800) 933-3711

Thursday, August 16, 2018

Trends in Compensation Structures for NPs (Nurse Practitioners) and PAs (Physician Assistants)

Now Available on CD - Trends in Compensation Structures for NPs (Nurse Practitioners) and PAs (Physician Assistants)

Setting up compensation structures for NPs and PAs causes a lot of confusion and there are a number of models that healthcare practices employ. If you are setting up compensation plans for the NPs or PAs in your practice, listen to this webinar and let Erin Tolbert help you to do it the right way!

Now is the time to review your practice management business operations and to confirm that the compensation structure you have in place is the most fair, the most efficient, and aids in staff recruitment and retention.
If you have PAs or NPs in your practice, this is the webinar for you.

or (800) 933-3711 or

Thursday, August 9, 2018

Hierarchical Condition Categories (HCCs) by Nicoletti

Excerpt from The Field Guide to Physician Coding, 
4th Edition
By Betsy Nicoletti, MS, CPC

If you find this sample chapter educational, review the book Table of Contents at the link below, order the print or eBook, or order multiple copies for your staff members at discounted rates.  

Every entry for the coding "rule" has a citation "proving" the rule. 

Sample Chapter:
Hierarchical Condition Categories

Definition: HCCs is a risk adjustment model developed by Medicare to pay Medicare Advantage plans. It estimates the expected health care costs for individuals for the next 18 months.

Explanation: In fee-for-service medicine, diagnosis coding establishes medical necessity, and may be the reason for a denial, particularly for diagnostic tests or procedures. Services with national or local coverage policies often have specific diagnosis codes that are required for payment. In risk-based contracts or shared savings programs, payers assess the acuity of a panel of patients, and use that acuity along with age/gender distribution, cost, quality and outcomes, to provide incentive payments or decrease payments at the end of a contract year.

Codes: Selected International Classification of Diseases, 10th Edition (ICD-10) codes.

Coverage: This is the system the Centers for Medicare and Medicaid Services (CMS) uses to adjust payments to Medicare Advantage plans. Some medical groups are part of shared savings programs with Medicare or have risk adjusted contracts with commercial payers. Some private payers use proprietary systems to estimate risk and future payments, and some use HCCs. Using this system in medical practice payment is part of moving from volume-to-value.

Billing and Coding Rules: The risk for an individual is determined by two things: demographics and diagnoses. A 65-year-old living at home has a lower demographic risk score than an 80-year-old living in a long-term care facility, who is dually eligible for Medicare and Medicaid. Demographic factors included in HCC calculations are age/gender, living at home or in an institution, End-Stage Renal Disease (ESRD) patient, and dual eligibility for Medicare and Medicaid. Diagnosis codes assigned on a claim form during a calendar (or contract) year reported on an inpatient claim, outpatient hospital claims, or physician and certain other health professionals’ claims are counted in determining the total risk score. Not all ICD-10 codes have a risk adjustment assigned to them. Those that do are assigned to groups, and groups have a specific weight.

For Medicare patients to Medicare Advantage plans:

Patient demographics + HCC diagnosis codes = Risk adjustment factor × CMS capitation rate
Diagnosis codes ➡ Diagnosis Groups
Diagnosis groups ➡ Condition Categories, and assigned a risk adjustment factor (RAF)

• Related conditions are assigned in one category and only the most serious is counted.
• Conditions in the same group are counted once. For example, morbid obesity and body mass index (BMI) of 42 are in group 22. The risk score associated with these conditions will only be counted once in calculating the RAF. Clinicians shouldn’t assign all diagnoses assessed at the time of the visit that require or affect patient care or treatment.
• A higher ranked condition causes lower ranked conditions in the same category to be ignored. (There are a few exceptions to this.)
• Unrelated conditions in different categories are both counted, and their effect is additive in assigning a score.

Clinicians should follow ICD-10 rules:

1. Use the ICD-10 Clinical Modification (ICD-10-CM) codes that describe the patient’s diagnosis, symptom, complaint, condition, or problem.

2. Use the ICD-10-CM code that is chiefly responsible for the item or service provided.

3. Assign codes to the highest level of specificity.

4. Do not code suspected diagnoses in the outpatient setting. Code only the diagnosis symptom, complaint, condition, or problem reported. Medical records, not claim forms, should reflect that the services were provided for “rule out” purposes.

5. Code a chronic condition as often as applicable to the patient’s treatment.

6. Code all documented conditions, which coexist at the time of the visit that require or affect patient care or treatment. (Do not code conditions which no longer exist.)

A clinician should document underlying medical problems that require or affect treatment even if it’s not being treated the problem at this visit. For example, a surgeon sees patient with kidney disease, diabetes, and heart disease, sending the patient for preoperative clearance. The patient’s underlying medical conditions affect the surgeon’s treatment of the patient. The surgeon should report these underlying conditions that affect the patient’s treatment. Do not report problems listed in the problem list or past medical history, which are not treated or which do not affect patient care. Related issues: Individual medical practice claims continue to be paid based on the fee associated with the Current Procedural Terminology (CPT®) or Healthcare Common Procedural Coding System (HCPCS) code. Groups that are part of an accountable care organization or other Medicare shared savings program or that have risk-adjusted commercial contracts will see an adjustment in their fees at the end of the contract year, partially based on the acuity of their patient population.

Key points:

• Follow ICD-10 rules when submitting diagnosis codes on claim form.

• Document those conditions treated, assessed, managed, or reviewed and submit the diagnosis codes for those on a claim form.

• Document those conditions that affect the care of the patient, and submit those on the claim form.

• Do not submit diagnosis codes for conditions that no longer exist. Use “personal history of” codes, when accurate.

See also in The Field Guide for Physician Coding, Chapters on Diagnosis coding, ICD-10-CM

All physicians can increase their revenue and improve their compliance through accurate coding.This book tells you how.” –Betsy Nicoletti, MS, CPC

 or call (800) 933-3711 or send an email to for bulk copy information. 

Thursday, August 2, 2018

8 Steps to Have Those Difficult Conversations

Originally appeared at July 7, 2018.

Although the ability to initiate difficult conversations is part of good leadership, I’ve never met a leader who enjoys it. Whether your conversation is about body odor, rude behavior, dress code, personal conduct or performance issues, difficult conversations are something that most of us avoid. In reality, the primary reason we avoid difficult conversations is that many of us lack the skills we need to handle such situations. As a health care leader, your intention must be about improving performance for the betterment of the practice, period. Anything else is just drama.
I’m going to give you an overview of the steps to use in initiating a difficult performance conversation. This advice comes from years of observing all types and all levels of leaders who have struggled to give valuable performance feedback to their employees until it was too late. If you use this process correctly, 90 percent of the time, employees shape up and get better, or they leave before you have to fire them.
Step 1: Set the right intention
The intention should be twofold: to help the employee and to help your health care practice. Even good leaders have hidden intentions without realizing it. If you have let a problem go on for too long, your hidden intention may be to embarrass the employee, fire her or put her on a difficult rotation. Know your intention before the conversation commences.
Step 2: Articulate the observable behavior
You need the skill to clearly articulate the problem while differentiating between assumptions and observable behaviors. When coaching leaders on this step, I hear a lot of generalizations and assumptions, such as:
  • He has a bad attitude.
  • My colleague doesn’t care about the practice.
  • My employee thinks he can get one over on me.
  • She doesn’t respect her coworkers.
These statements point to your labels, assumptions, and judgments but not necessarily to the facts.
The difference between your perception (your story) and the observable behavior is this:
  • “He has a bad attitude.” Evidenced by frowning, eye-rolling and interrupting.
  • “My colleague doesn’t care about the practice.” Evidenced by consistent tardiness; not volunteering for overtime during the holiday rush.
To get to the observed behavior, see if you can answer these two questions:
1. What is the employee doing that you want him or her to stop?
2. What is the employee not doing that you want him or her to start?
Here is the script: “Karyn does not use eye contact or smile at patients when she greets them, and I want her to start smiling when she greets the patients.”
Step 3: State the business case
There’s a reason you want Karyn to change. That reason is not just because you get irritated when Karyn doesn’t smile. That’s your personal issue. You want her to change because on the last survey you got a low score on patient satisfaction. That’s the business case.
The point I’m making here is that you have to connect the dots about how the observed behavior affects the business results, not your personal life. When you make it clear that your focus is on improving the practice, it’s easier to get alignment from employees, owners, and physicians.
Step 4: Speak to the vision
Now that you know the observable behavior and the business case, you have to be able to ask for what you want. Asking for what you want is difficult because most of us focus on what we don’t want. Many times we say things like, “I don’t want to have to tell you a thousand times,” or “I don’t want to argue.” Asking for what you want is the starting place for speaking the vision.
Instead of saying, “I don’t want to hurt your feelings but…” You say:
“I want our practice to get higher patient satisfaction scores. I want to give you information that will help you to grow. I want you to hear what I have to say and then think about it over the weekend. I want all of us to align with our value of patients first fully, and that includes you smiling at the patients, making eye contact and making them feel welcome. I want you to fully be able to use your gifts and to be happy in your work here.”
Step 5: Diagnose the root cause
Before meeting with your colleague or employee, you may not know for sure how to get to the root of the problem. Even if you know how to articulate the observable behaviors clearly (e.g., the employee misses documentation, frowns, interrupts or fails to ask the patient the correct questions), you still may not know why they do it.
Makayla is making errors with patient records. Makayla may not be aware of how her behaviors affect the team. But let’s say Makayla continues to make errors when documenting patient info, after the conversation to correct has taken place. The errors could be occurring because she was not trained properly. Maybe Makayla is confused because there are too many bosses and she doesn’t know which one takes priority. Maybe Makayla gets overwhelmed, and instead of checking patients in she starts straightening up the reception area because that relieves her stress.
Step 6: Identify resistance
If you’ve ever had a difficult performance conversation and you thought you got through to the employee, but you saw no change, it is either because the employee resists your leadership, or you resist implementing measures of accountability.
You can hear resistance in the following language:
I would but…
I’ve already tried that.
You don’t understand.
Let me tell you what Kim did.
It’s not fair.
But I have seniority.
It’s going to be difficult.
That’s impossible.
My coworkers won’t like it.
Distractions are sidebar conversations intended to get you off topic so that you are no longer in charge of the conversation.
Step 7: Initiate change by removing obstacles
It’s fairly easy to identify obstacles. Where we get hung up is when we fall into distractions and verbal ping-pong. The discussion should go like this:
“If I could reduce the difficulty would you?”
“Yes, it will be difficult. Will you do it anyway?”
“Yes, I may not fully understand. Are you willing to take my direction anyway?”
Until there is a willingness on the part of the employee to change nothing is going to happen. You have to be able to address their resistance, but you also need to look at your own resistance to holding them accountable.
Step 8: accountability
Once you have made an agreement with the employee about what the problem is and what you need the employee to do, the last step is to follow up. Here, you simply put on your calendar a check-in date to discuss his or her progress. The feedback system keeps a focus on improvement while increasing your credibility and trustworthiness.
Marlene Chism is the author of 7 Ways to Stop Drama in Your Healthcare Practice and can be reached at her self-titled site, Marlene Chism.

Thursday, June 21, 2018

Life’s Work: Kareem Abdul-Jabbar. How Does this Translate to a Healthcare Practice?

This was an interesting piece to come across in the venerable Harvard Business Review, a magazine that caters to a business audience. Profiling a sports star is a bit out of the box, but the lessons offered are useful in a number of ways for business leaders. Some of Abdul-Jabbar’s insights apply to managers and “captains of industry” in the C-suite, but many of them apply to workers at any level.

One of the most celebrated basketball stars in history failed in his attempts to become a head coach in the NBA after he retired from playing. But he has successfully changed course and become a successful writer, historian, and filmmaker, specializing in telling the stories of unsung heroes in African-American history. The Harvard Business Review interviewed him about his philosophies and practices that have produced success on and off the basketball court. His life lessons include the following:
  • To really excel, it takes both talent and hard work, but a good work ethic trumps natural talent every time. A talented ball player won’t succeed unless he or she practices long and hard.
  • Abdul-Jabbar had a reputation in the NBA as a focused, but not very personable, player, and it followed him when he was trying to break into coaching. He notes that as he has matured, he has learned to be more sociable and outgoing.
  • He found success as a team captain as a leader by example. He stayed in shape and constantly worked on his fundamentals.
  • He earned a right to be heard by his managers and coaches by approaching them with due respect. They would then listen to his suggestions and criticisms.
  • He is often contrasted with his effervescent teammate Magic Johnson. Abdul-Jabbar learned to enjoy the moment from Johnson, and Johnson learned from Abdul-Jabbar to temper his reaction to each victory (or loss) by focusing on the long haul, a season of 80-plus games.
  • Abdul-Jabbar doesn’t see his career as a writer as a “transition,” but more as leveraging something he has always enjoyed. He was good at English and writing, and in recent years he has cashed in on it on the best-seller lists.

These concepts can prove helpful in managing people and in the environment of any business, including a healthcare practice. Abdul-Jabbar's philosophy that hard work trumps talent every time applies to hiring processes, personal self-discipline, and leading a work team. You may hire a very skilled or knowledgeable staff member, but if he or she doesn’t have a strong work ethic, you’ll be disappointed.

As he talked about himself, Abdul-Jabbar recognized his tight focus and imperfect social skills were both assets and liabilities. His focus helped him lead others by example when he might otherwise not have been an effective encourager. And he found that his personality worked well when teamed with someone very different—he and Johnson balanced each other out in some ways.

If your style is focus and hard work, it provides an example for your staff. If you are more open and sociable, you might be more encouraging and helpful. Just make sure you have some focused workers around, too. As one of the all-time great NBA players, Abdul-Jabbar was never quite able to become a head coach as he had hoped. A great player doesn’t necessarily translate into a great coach. By the same token, a great worker on your staff might not make a good candidate for a supervisory or management position. Keep that in mind when you think you might want to promote one of your star performers.

Thursday, June 14, 2018

Look to Your Employees for Innovative Ideas

Funny thing about the way physicians are trained and socialized in America: They’re taught to be independent thinkers. And while that may make them excellent clinicians, sometimes it can get in the way of creating and cultivating an organization that thinks, learns, and develops new ideas. Successful businesses—the superstars you read about in magazines—are invariably recognized as innovative organizations. Smart organizations tap into the collective brain power of entire business—from the “C” suite to the lowest-grade, common laborer.

We’ve caught glimpses of this principle inside top-performing medical practices, too. When you
walk through the front door of such practices, you’re not greeted by the general chaos that seems to plague many operations. There is a calm efficiency that is downright palpable. Everyone seems to know his or her job, and they’re discharging their duties with poise and confidence. Underlying many of these operations you’ll find dozens—perhaps hundreds—of little ideas and innovations that have made the practice run smoother. And a good deal of the ideas came from the staff workers—not the physicians or the administrator. The practice leaders were smart enough to recognize that the people who actually do these jobs know a great deal about the problems and challenges they face every day.

The leaders have encouraged, recognized, and rewarded innovation from their staff members,
and it pays off in improved operations, higher staff morale, and a culture that consciously looks
for ways to learn and improve.

Innovation and its inspirations aren’t really as mysterious as they seem. The really great performance-enhancing ideas don’t come from the research lab or the executive suite. They come from the people who daily fight the company’s battles—those who serve the customers. Successful corporations that have developed a culture and reputation for innovative ideas have found ways to harness the creative energies and insights of employees across all functions and ranks. These companies have cultivated “innovation communities”—work groups that tackle projects and problems in place of the traditional strategy to engage a team of expensive consultants. These groups provide the opportunity to give new shape and purpose to knowledge already possessed by those employees. Companies establishing successful innovation communities share key characteristics and strategies:

• Creating the space to innovate. They designate time and organize effective meetings and
communication mechanisms.
• Getting a broad variety of viewpoints. They deliberately cross horizontal boundaries to get
input from all management (and non-management) levels, and they cross vertical boundaries
to break down information “silos” and allow knowledge to spread among even unrelated departments.
• Creating conversation between senior management and participants. They require senior
management to pay attention to what participants are saying.
• Pulling, not pushing, participants to join. They recognize that they can’t force anyone to share
the knowledge they have.
• Keeping development costs low by tapping unused talent. Participants usually continue to perform their regular roles even while working on the innovation project.
• Recognizing collateral benefits that sometimes equal or exceed the innovations themselves.
Developing a “learning-organization” culture yields benefits that improve morale and company
• Recognizing that measurement is key. A company can sustain an innovation community
only if it can produce demonstrable value.

Successful companies keep track of how many innovative ideas make it from the communities’
drawing boards to actual implementation—and measure the results.