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
