Contact Rick Fuelling at speccons@swbell.net
"Down to the Wire: the HIPAA Privacy Regulations"
Lee Spangler, JD, Assistant General Counsel with the Texas Medical Association, spoke on the myths and facts associated with the upcoming privacy regulations in HIPAA.
Mr. Spangler's
presentation documents are available
by clicking here
Download the ACMPE credit hour form by clicking here
No meeting this month
The January meeting of Gulf Coast MGMA convened in a new location, Trevisio Restaurant in the Texas Medical Center. New President Jim Keil introduced the current board of directors, and took a moment to honor outgoing President John Watson with a plaque and a gift from the board. He thanked John for his help in building on what had been done before by founding President Tim Thomas, and taking the organization to its present level. Jim introduced the sponsor and then the evening's speaker:
"Confessions and Observations of a Healthcare Consultant"
Reed Tinsley, a Houston-based CPA and healthcare consultant, addressed the January meeting. With Medicare and managed care fees continuing to drop, impacting total revenues, the number one complaint from physicians, according to Mr. Tinsley, is compensation. He recommends that doctors need to run their practices as a business, paying attention to the bottom line. He also advises practices to invest in their staff, through compensation and training. To secure the revenue stream, Mr. Tinsley advised doctors to properly code for their services. Making hard decisions about expenses will be the challenge for physicians and administrators. Mr. Tinsley expects to see doctors continue to consolidate their practices in order to share and reduce expenses.
For a copy of his presentation in PowerPoint format, click here
The January meeting
was sponsored by
Contact Rick Fuelling at speccons@swbell.net
Download the ACMPE credit hour form by clicking here
Donna Fraiche, JD, managing partner for the law firm of Locke, Liddell & Sapp, LLP, reviewed the history and evolution of Fraud and Abuse laws as they relate to the healthcare industry (Anti-Kickback, False Claims, and Stark Laws). She related many exceptions to these laws, including the permitting of certain referrals by physicians to entities in which they hold a financial interest. Ms. Fraiche also addressed the importance of having a compliance plan which covers both under- and over-coding, as well as unbundling and and dealing timely with overpayments. She also reviewed sample cases and advised the membership that the enforcement arms of the government were focusing primarily on conduct and intent, rather than the incidental or occasional violation of the regulations.
A copy of Ms. Fraiche's presentation may be downloaded by clicking here
The December meeting
was sponsored by Silver Affiliate:
To download the ACMPE credit hour form, click here
Kimberly Hlavinka,
Vice President of Marsh &
McLennan Companies, spoke on the �Medical Malpractice Crisis.� She
reviewed the reasons for the �hard� market and loss of market competitors,
which included: 1) catastrophic losses in the insurance industry, e.g.
terrorist attacks, natural disasters and Enron; 2) high claim frequency and
severity; and 3) large stock market losses. Many insurers over-leveraged
their investments and have had to pull out of the market after being unable to
meet regulatory requirements.
She warned of continued sharp premium increases until economic strength is regained and recommended looking for ways for physicians and practices to be attractive to the remaining carriers by showing the insured�s loss history and disclosing any and all steps taken to manage future risks.
Gulf Coast MGMA annual meeting: President John Watson presented the Nominating Committee's recommendations for officers and directors for the 2003 calendar year. The nominees were: President - Jim Keil, MBA; Past President - John Watson, CMPE; President-Elect - Pam Potter, MBA, CMPE; Secretary - C. Jane Hill; Treasurer - Rick Canady; At-Large Directors (2) - Andrea Anderson, MBA/MHA and Tomorrow Orsak, MBA/MHA; and Student Director - Terronica Wilson. The membership approved the slate by acclamation. The officers and directors will take their positions at the January meeting.
To download a copy of the presentation in PowerPoint format, click here
The November meeting was sponsored by Bronze Affiliate
To download the ACMPE credit hour form, click here
James
A. Reeder, Jr., partner in the
healthcare law section and co-chair of the litigation practice group of Houston-based Vinson
& Elkins, spoke on anti-trust and collective bargaining as it relates to
physician contracting with insurance companies.
He explained that
physicians can jointly negotiate prices only if they are 1) financially and
clinically integrated, or 2) accept risk contracts (capitation) which include an
incentive for cost containment.
Additionally, any discussion of prices with one�s competitors is considered price fixing by the FTC. Many �messenger model� PHOs have recently faced charges by the FTC for negotiating contracts and not following the messenger model which is primarily for the purpose of �communicating� on behalf of the individual participants.
To evaluate this meeting, click here
The October meeting was sponsored by Bronze Affiliate, the
To download the ACMPE credit hour form, click here
Susan Olis (formerly of University Care Plus), Vonda Hall (of Memorial Hermann Hospital) and Jim Hyland (of the UT Health Science Center - Houston) recounted their stories of recovery after the disaster of Tropical Storm Allison in June, 2001.
Their lessons learned were to a) have a disaster plan, b) have a good communication plan in order to stay in touch with staff, c) identify key vendors who provide essential services in an emergency and get them in immediately, and d) be prepared to hire consultants who are experienced in disaster recovery to minimize operational down time.
To download the presentation in PowerPoint, click here
To evaluate this meeting, click here
For a copy of the ACMPE credit hour form, click here
Diane Peterson, FACHE, President of D. Peterson & Associates, discussed the impact that appearance and presentation have on patients� perceptions of customer service. Her �secret shopper� experiences on behalf of healthcare organizations have revealed the many ways that gaps occur between what the entity intends to accomplish and the message that it actually sends to the patient.
The August meeting was
sponsored by Silver Affiliate:
To download the ACMPE credit hour form, click here
To download the presentation in PowerPoint, click here
To evaluate this meeting, click here
Mark Briggs, Compliance
Assistant Specialist for the Occupational
Safety and Health Administration (OSHA) spoke about the mandatory needle
stick safety and prevention law that was effective April 18, 2001. He also
spoke about the importance for employers to maintain an OSHA 300 log, which is
the employer�s record of injuries and illness of employees.
He emphasized the need for
employers to review/re-evaluate the processes and procedures in place that
reduce exposure to blood and other potential infectious material exposures.
OSHA advises employers to include employees in the exposure review and in the
selection of equipment used to reduce risks and exposure.
Mark�s phone number is: (281) 286-0583 and email address is: mark.briggs@osha.gov.
To download the presentation, click here
To download the ACMPE credit hour form, click here
To evaluate this meeting, click here
Audrey Selden, Provider Ombudsman and Senior Associate Commissioner of the Texas Department of Insurance, provided an overview of the Texas Department of Insurance's role in monitoring the reimbursement process between managed care plans and physician practices. She explained about common filing errors, clean claims, restitution and fines. She discussed upcoming amendments on clean claims and provider contracts providing for physician protection, which are now open for public comment.
Links to the information provided by Ms. Selden can be found:
https://www.tdi.state.tx.us/commish/doctors.htmlhttps://www.tdi.state.tx.us/consumer/drnews.html
To download the ACMPE credit hour form, click here
To evaluate this meeting, click here
Daniel
Stech, MBA, Survey
Operations Director for the Medical
Group Management Association in
The May meeting was sponsored by Silver Affiliate:
For a copy of the presentation, click here
To download the ACMPE credit hour form, click here
Mark T. Phelps, attorney-at-law and affiliate member of Gulf Coast MGMA, spoke to one of the largest groups of attendees regarding the impact of HIPAA on physician practices. According to Mr. Phelps:
Healthcare
providers have until April 14, 2003 to be fully compliant with HIPAA privacy
standards. The plan�s �Covered Entities� are: health plans,
healthcare providers (direct and indirect) and clearing houses.
The
information to be covered is �Protected Health Information� which is
individually identifiable health information in any form (written, verbal or
electronic). Confidentiality contracts will be required of �Business
Associates� who perform a function on behalf of the �covered entity�
and who are not a part of a practice�s workforce.
Notice must be given to patients on �uses and disclosures� of protected health information. The patient�s consent will be needed for 1) treatment, 2) payment, and 3) healthcare operations, i.e. accreditation. This would include a consent needed in order to verify benefits.
Mr. Phelps concluded by saying that he was available to meet with practice administrators to discuss their HIPAA concerns, and that he was offering a discounted professional rate to members of Gulf Coast MGMA. He can be contacted at his office number: (281) 540-6662.
To download the ACMPE credit hour form, click here
The April meeting was
sponsored by Bronze Affiliate
Joe B. Herrera, Director of Healthcare
Services for Dickey, Rush,
Duncan, Ansell & Co. spoke to those in attendance on �Strategic
Management.� Mr. Herrera discussed the importance of physician practices
having a strategic plan in place that includes near term goals to as far as five
years in the future. Strategic planning should be followed by strategic
management and should involve the entire staff in the �buy-in.� The
mission statement should also support the strategic plan or may need to be
updated.
He also recommended that when developing
a strategic plan to consider where the leaders of the practice want the
organization to be in the future; what�s occurring in health care, with
competitors, patients; and will the plan meet the financial goals of the owners?
Several �strategy traps� were discussed, a key one being that a practice
should not assume that bigger is better unless a competitive advantage or
increased profits can be gained.
For a copy of his PowerPoint presentation, click here
To download the ACMPE credit hour form, click here
Greg Barnes, CHE, Managing Director in Houston for Korn/Ferry International, the world's leading executive search and leadership capital consulting firm, addressed the GCMGMA membership on career management strategies. Mr. Barnes presented a fresh approach to consider in our strategy for achieving career success.
Barnes recommended that we would benefit by developing ideas about how we can apply our experience and accomplishments to broader areas than previously considered. He gave many examples of healthcare-related services not reimbursable by Medicare, but which have a strong consumer demand. Using the marketplace as a guide could reveal new possibilities and challenges over traditional practice management positions.To download the ACMPE credit hour form, click here
For a copy of the presentation, click here
Pat Harris of
the Harris County Medical Society
spoke to our group on the latest state and federal legislative developments,
i.e. Medicare reimbursement fee decreases and an upcoming Prompt Pay Hearing to
be held on January 24, 2002 at Rice University. She also discussed the
need to address skyrocketing mal-practice premiums through lawsuit reform and
advised our members of the need to voice our concerns over slow payors to our
legislators.
Members had a round-table discussion of current topics affecting physician practices, mainly the frustration over the large reduction in Medicare rates, which trickles down to all plans � resulting in lower revenue for all specialties, especially surgery.
To download the ACMPE credit hour form, click here
The December meeting was convened as the Annual Meeting of Gulf Coast MGMA. President Brenda Lelay introduced the slate of officers nominated for the 2002 calendar year: President - John Watson; President-Elect - Anne Eads; Secretary - C. Jane Hill; Treasurer - Jim Keil; At-Large Directors - Pam Potter and Rick Canady; and Student Director - Suzette Barber. She moved that the slate be accepted and the motion passed unanimously. The new officers will be effective January 1, 2002.
Misha Lambeth from TMA Physician Services addressed the meeting attendees and discussed the current state of evaluation and management (E & M) coding requirements, using either 1995 or 1997 CMS/HCFA guidelines. She provided several useful tools that will help practices monitor their own compliance.
To download the ACMPE credit hour form, click here
For a copy of the presentation, click here
The December meeting
was sponsored by:
Jan Kennedy, Practice Administrator for the Waterbury Medical Group, Waterbury, Connecticut, addressed the GCMGMA membership on the financial decision making that impacted her group's decision to purchase and implement an electronic medical records system. Financial constraints placed on them by their local hospital sponsor forced the group to rapidly diminish their losses, and they have found over the last two years that the revenue enhancements and expense reductions have had a positive impact on their bottom line. For more information, refer to her presentation.
For a copy of Jan Kennedy's presentation, click here
To download the ACMPE credit hour form, click here
The November meeting
was sponsored by:
Dennis McDowell, Market Plan President for Humana Healthplans of Houston, spoke to the Gulf Coast MGMA meeting attendees on Humana's strategy for the Houston marketplace. He was joined by Tina Yost, EC Coordinator for EDI Development, who discussed Humana's web portal, which offers physician practices the opportunity to verify member enrollment and benefits and to check claim status.
For a copy of the ACMPE credit hour form, click here.
For a copy of the presentation, click here.
MEETING CANCELLED
Mark Netoskie, M.D., network medical director for United Healthcare, Houston, addressed the membership on the collaboration that UHC sees as the future of the patient/physician/payor relationship. A copy of his presentation can be downloaded by clicking here.
Provider relations representatives then introduced UHC's new web presence, UnitedHealthcare Online (www.unitedhealthcareonline.com), designed to facilitate verification of benefits, eligibility and the checking of claims status. The presentation can be downloaded by clicking here.
For those wishing ACMPE credit, click here to print the credit hour form.
The August meeting was
sponsored by
Joe Craigen, President of Visualutions, Inc., spoke to the GCMGMA attendees on the subject of technology options for physician practices. Mr. Craigen's presentation focused on the pros and cons of a variety of hardware, software and connectivity strategies, each different combination requiring a cost vs. benefit analysis to ensure that it fits the particular practice's needs.
For example, many practices are faced with a choice between networked personal computers with a common server providing the backbone of data handling in the office, versus using "thin client" technology that places longer-lived "dumb PCs" at each workstation. One of the advantages of networked PCs is that each PC can stand alone in running independent software installed upon it, compared to thin clients which runs only enough programming to access applications loaded on the server. This advantage is mitigated somewhat, however, by the security, convenience and flexibility of the thin client structure. Some practices even take the thin client structure a step further by renting a server and software off campus, usually under an ASP (applications services provider) arrangement. Such an arrangement removes the physician practice from routine, but important, functions such as backing up data, installing upgrades, and performing maintenance on the server. In an ASP relationship, these functions are all handled by the provider of application services.
If a practice does decide to keep its data and processes in house, it is essential that the practice make the investment to keep its data safe, through hard disk redundancy, regular and verified backups, and off-site storage of backup media.
To view the presentation on the Visualutions website, click here, or click here to download the Adobe .pdf file.
For those wishing ACMPE credit, click here to print the credit hour form.
The June meeting was sponsored by
Susan Chmieleski and Fred Bautista of the Chubb Group spoke on the topic of risk management in the physician office. System problems are at the root of the vast majority of all professional liability claims filed against Chubb clients, but the speakers offered several tips that practices can use to greatly reduce their exposure to such claims:
Track appointments made and kept. Follow up on patients who cancel or no-show a scheduled appointment.
Archive appointment books and records, just like you do for medical records.
Establish a written reminder system for patients, so that those with conditions requiring follow-up are reminded by mail or a documented telephone call to return as requested by the physician.
Include a follow-up plan for the patient when documenting the visit.
Ensure that nothing is filed in the chart without review by the physician.
Follow up on all tests ordered to make sure they are performed and results are received.
If charts are dictated, be sure that all dictation is returned. Check off transcribed notes received against daily appointment schedule.
Never tell a patient: "If you don't hear from us, everything was normal."
By improving systems, closing the cracks that can lead to problems in patient care, physician practices can have a positive impact on their liability risk.
For a copy of the presentation, click here
For those wishing ACMPE credit, click here to print the credit hour form.
The June meeting was sponsored by
Prior to the start of the
meeting, speakers representing sponsor PSS spoke about the new OSHA regulations
requiring the use of safety devices in the office reducing the risk of the
occurrence of needle-stick accidents. There are now retractable-needle syringes,
among other devices, that greatly reduce or even eliminate these risks, albeit
at a significantly higher cost than traditional syringes. Samples of
retractable-needle syringes were distributed to those in attendance.
For the main event, Robert
Corrigan, JD, partner at the Houston-based law firm of Fulbright
& Jaworski addressed the group on patient confidentiality in the
physician office, and the implications of HIPAA and recent state of Texas
legislation. Mr. Corrigan urged practices to begin to develop their plans for
compliance with HIPAA regulations as soon as possible, but to be wary of those
consultants who could currently assure compliance without having an
understanding of a practice's internal systems.
For a copy of Mr. Corrigan's presentation, click here.
For those wishing ACMPE credit, click here to print the credit hour form.
The May meeting was sponsored by
David Mathis, Vice President of Business Development for Payors with Medical Present Value, Inc., spoke to the GCMGMA membership on the topic of "Improving the Physician/Payor Relationship." Mr. Mathis has led payor organizations covering half a million lives and gave his perspective on issues facing payors as they interface with medical practices. One myth that he debunked was the feeling by medical practices that payors enjoy the "float" they earn by delaying payment of claims. It was his experience that the cost of adjudicating the second and possibly third submission of the same claim far outweighed any financial advantage to the payor of deliberately delaying payment. Most of the delays, Mathis felt, were the result of out-of-date computer systems, complex contract administration problems and the confusion resulting from mergers in the insurance industry.
To view Mathis' presentation slides, click here.
For those wishing ACMPE credit, click here to print the credit hour form.
The April meeting was sponsored by:
Brian Bosien, partner with the law firm of Cokinos, Bosien and Young, addressed the GCMGMA membership on the subject of hiring and firing practices. Employment law is one of the areas in which he specializes and in his own practice, Bosien has served as the managing partner in numerous situations involving staff members.
Some pearls from his presentation:
For those wishing ACMPE credit, click here to print the credit hour form.
The March meeting was sponsored by
Mr. Harold Freeman, Assistant Director of Legislative Affairs with the Texas
Medical Association (TMA), spoke on several bills relating to healthcare
currently being presented before the Texas State Legislature. After giving
attendees a brief history of his professional background and tenure with the TMA,
Mr. Freeman indicated that the two most prominent bills the legislature has to
pass currently are the Budget Bill and the Re-districting Bill.
Re-districting will assign all new districts to the current legislators and,
therefore, has legislators somewhat noncommittal about the issues thus far.
Freeman also mentioned that there is continued focus for physician offices on
clean claims enforcement and more specific penalties for non-compliance.
At the same time, the legislature is working on proposals for managed care
contract verbiage with penalties and clear restrictions from �gaming� the
contracts to comply from the standpoint of the insurance carriers. Patient
privacy is also expected to be a very big issue for Texas lawmakers in 2001.
Upon opening up the floor for questions, Mr. Freeman discussed the Physician
Negotiation Bill, which would allow physicians to be exempt (only at the state
level) from antitrust action in negotiating contracts together or
�collectively�, as this issue has been so publicly addressed through the
courts in other states in the past. Freeman said he also expects a
decision on �All or Nothing� rules for managed care companies to discontinue
forcing physicians to accept all their products (HMO, PPO, etc.) when the
physicians sign one contract. It was mentioned that this practice should
already have died down in the Houston market.
For those wishing ACMPE credit, click here to print the credit hour form.
The February meeting
was sponsored by
In the first GCMGMA meeting of the new millennium, Reed Tinsley, CPA, principal in the Houston office of Horne CPA Group, spoke on the state of managed care in the Houston marketplace. After giving attendees an insider's view of the rise and fall of North American Medical Management (NAMM) and its impact on physician practices, Tinsley gave those present several practical tips on negotiating their managed care contracts. Negotiation, he said, was essential, since the physician practice has nothing to lose and everything to gain. But a practice needs to know itself, Tinsley added, by having a thorough understanding of its own costs of care and outcomes, among other statistical measurements. Without this base of information, a practice won't know whether the reimbursement proposed under the contract is reasonable or not.
Tinsley offered a few other tips on revenue optimization for the group, stressing the need for coding education in medical practices. How is the practice choosing its level of service? Are all services and supplies being captured on the superbill? Is the practice correctly using modifiers? Practices should be constantly reviewing all of these areas to ensure that they are being paid for everything they do. Finally, EOBs are a valuable source of data about payment patterns, showing the practice whether reimbursement is correct and claims are paid timely, payor by payor. Tinsley recommended that practices keep their EOBs organized for easy access.
For a copy of Tinsley's handouts in MS Word format, click here; for Adobe format, click here.
For those wishing ACMPE credit, click here to print the credit hour form.
The January meeting
was sponsored by
The GCMGMA meeting was held at the Museum of Health and Medical Science. After dinner, member registration and networking, attendees convened in the McGovern Theater for a brief business meeting conducted by President Tim Thomas. Vice-President Brenda LeLay reviewed proposed changes to the Bylaws and after defining members eligible to vote Tim entertained a motion to approve the changes. The motion passed unanimously. Tim then presented the slate of officers and directors for the coming year: President - Brenda LeLay, President-Elect - John Watson, Secretary - Anne Eads, Treasurer - Jim Keil, Past President - Tim Thomas, At-Large Directors - Jane Hill and Charelle Grant, and Student Director - Divya Matai. Tim entertained a motion to accept the slate of officers as nominated and the motion passed unanimously. Brenda LeLay then presented Tim with a gift to recognize his outstanding efforts in getting GCMGMA off the ground over the last three years. John Watson was introduced and gave a brief talk on the benefits of credentialing through the American College of Medical Practice Executives (ACMPE), including a waived application fee (a $95 value) if the specially-marked application was submitted to ACMPE by November 18. Tim then introduced Rachel Westheimer who introduced the guest speaker, Trudy Millard Krause, DrPH, CHCA of Dynamic Health Strategies (an affiliate of Healthcare Research Associates). Dr. Krause spoke on HIPAA (also known as the Kennedy-Kassebaum bill, or the Health Insurance Portability and Accountability Act of 1996). For more information on HIPAA, click here to link to the official HCFA HIPAA web site.