Posts tagged with pediatric practice management

Save the date: April 17.

It's not official yet - we're confirming a location - but we hope and expect to produce a pediatric coding and practice management seminar in the greater Washington DC area on or around April 17.  It will be nearly identical to the one we produced in NYC in August.  We hope to get AAP endorsement again and, if everything works out, we may even be able to acquire an educational grant from a generous source that might lower or eliminate the cost for AAP members!

That last item is a bit of a dream still, but it's not off the table.

Anyway, I thought I'd let everyone here be the first to know.  As soon as it's official - speakers, location, date, and content - I'll post it all here.

Last week, Igor and I were looking at the usage of -25 Modified E&M codes as the information about them is a bit of an unspoken subject in our business. I can't find any good, definitive sources so, as usual, we have to create our own.

Two days ago, I posited that the distribution of -25 modified E&M codes should be different from non-modified codes for a simple reason: acute medical issues typically generate their own sick visits and the most common type of modified E&M would be an "Oh, by the way..." Those OBTWs don't often rise to the level of a 99214 or 99215, at least as often as a walk-in would.

That was the thought, anyway. Here are the results, complete with my original estimate of what it would be:

What do we learn? That -25 modified E&M codes actually mimic "normal" E&M codes quite closely. Fewer 99213s, certainly...but more 99214s and 99215s! The opposite of what I predicted. Figures.

So, why were we wrong (I'm trying to spread the blame)? First, we learned that our clients have as many modified E&M codes as non-modified! In other words, even with 22% of our clients not using the codes at all, boatloads of -25 modified codes go out the door of our practices. Why? A faithful reader - who will go unnamed until she asks for credit - offered the following insight:

They are not only when there is an associated well visit
Asthma Checks
When we do spirometry at these visits, we don't get paid unless we put a -25 on the E/M.
Imms visits
When there is a recheck of illness, Imms won't pay unless there is a -25.
Infant Bili-Weight Check Visits
When We do a transcutaneous bili, we need the -25 on E/M.
Sick visits with opth complaints, migraines, injuries
Visual testing won't pay without the modifier.
Sick visits with hearing, tinnitus
Hearing testing requires us to add the -25 on the E/M.
If the modifier -25 is not used , we would get "bundled" payments from quite a few inscos.

Well, that explains that. Perhaps Igor and I will explore looking only at E&Ms at well visits after all! Harumph.

Over the last month, I have had three practices ask me about multi-year contracts.  What do I think of them?

Multi-year contracts can be great.  Why not?  It's one less contract to worry about for 2-3 years.  Presuming you do it properly, of course.  Sometimes, the payors are willing to give price increases over time that you could never get going year-to-year.  In addition to all of the normal contracting issues to consider, here is my general advice when a multi-year contract is on the table:

• Whatever rate you are paid for your multi-year contract should increase each year.  100% -> 110% -> 120% of Medicare, etc.  Obviously, it's more money.  And, obviously, it reflects an expected cost-of-living increase.  But it also means that the starting point in your negotiations 3y from now is higher.  And it's a matter of principle.
• Lock in your RVU year.  In the past quarter I have seen more contracts that talk about the "prevailing CMS rates" than in the previous two years.  Why?  Because all the payors know that Medicare rates are going to get cut.  In fact, as I've pointed out here, depending on your "gypsy," you may already be getting a sizable cut.  So, the smart payors tie you the most recent year because they expect that it will cut their reimbursement 10-20% in the years to come.  So, lock your contract to, say, 2006 or 2007.
• Finally, take this chance to make sure the payor refers to RVUs, etc., and not the "Medicare rates" - the latter language gives them freedom to use the Budget Neutrality adjusters, which are an additional ~5% cut.

It's official. PCC's Spring 2008 Pediatric Coding Conference will be held on April 17 at the Capital Hilton in Washington DC.

You can get all of the details here, some of which are repeated below. To sign up, race here. We sold out in NYC last time and this venue is a lot nicer and holds fewer people.

And - yes - the seating will be a huge improvement over NYC. Tables, guaranteed viewing, etc., etc., etc.

Thanks again to our amazing speakers, Dr. Lander for helping make this all happen, and the AAP for endorsing the event. Remember: AAP members get a big discount!

Spring 2008 Pediatric Coding Conference

Developed by PCC and Endorsed by the American Academy of Pediatrics

Thursday, April 17, 2008 — Washington, DC

Put your practice ahead of the curve with PCC's 2008 Pediatric Coding Conference, endorsed by the AAP. Pediatric coding experts address key issues during a full day of courses with question and answer sessions designed to improve your coding practices and reimbursement.

The 2008 Pediatric Coding Conference will be held at the Capital Hilton in Washington, DC.
This is an intensive, one-day session focused on important pediatric issues that effect your practice every day. You'll master the coding basics, get answers to your specific questions during Q&A sessions with our pediatric panel, and gain valuable insight on timely topics about immunizations, pay-for-performance programs, physician compensation, and more. Our expert panel of instructors include AAP Fellows Richard Lander, MD; and Richard Tuck, MD.

Register now. Admission to this conference is only $325 for AAP members ($379 for non-members)!
Thursday, April 17, 2008

Schedule
7:30-Registration and Continental Breakfast
8:00-Welcome and PCC's Free Online Practice Management Tools
8:15-Coding 101
9:00-Give Me the Money: How to Decrease your A/R
9:45-Q&A
10:00-Break
10:30-Procedure Power Coding
11:15-Pediatric Physicians' Compensation Models
12:00-Q&A
12:15-Lunch (provided)
1:30-Vaccine Coding: Preventive Medicine for a Healthy Bottom Line
2:15-Who Wants to Be a Coding Millionaire?
3:00-Q&A
3:15-Break3:45-Thirty Tips in Thirty Minutes
4:15-Q&A

Course Descriptions
PCC's Free Online Practice Management Tools
Your host, PCC, will provide information about free online pediatric practice management resources. These free resources can help you update your pricing, review your coding curve, select an EHR and more.

Coding 101
Super coding expert Richard Tuck, M.D., covers the essentials of pediatric coding with updates for 2008. Whether you are new to coding or feel like you already know it all, there is something here for everyone.

Give Me the Money--How to Decrease Your A/R
The AAP's SOAPM Chairperson, Richard Lander, M.D., will cover the policies and procedures you need to have in place to collect the money that is due to you. Topics will include everything from preparing for HSAs to how your staff can ask for money at the Time of Service and still keep your patients happy.

Procedure Power Coding
Most pediatric offices leave thousands - tens of thousands! - of dollars on the table every year for work that they have done but failed to code properly. National CPT expert, Richard Tuck, MD, will walk you through providing and coding for procedures to increase your bottom line.

Pediatric Physicians' Compensation Models
Developing a fair compensation model is an ongoing struggle for many pediatric practices. PCC's Chip Hart will walk you through the challenges of many real offices to determine what might work for you. The varied skills, personalities, productivity levels, experience, lifestyle demands, and non-financial contributions of those involved are just some of the factors that contribute to the challenge of physician compensation. Hart will provide an overview of existing models and data from pediatric office across the country and identify patterns of success.

Vaccine Coding: Preventive Medicine for a Healthy Bottom Line
Each passing year makes the process of billing for vaccines more difficult. With the introduction of new vaccines, changes in the coding rules, and many insurance companies adding their own interpretations, Dr. Lander will help you navigate the muddy waters to get properly reimbursed. Stop losing money on one of the most expensive, risky - and necessary! - aspects of running your practice.

Who Wants to Be a Coding Millionaire?
Dr. Tuck provides an entertaining and challenging review of coding highlights to maximize your practice income. Whether you work for a practice that is afraid to use 99214s or have already mastered the subtle details of the -25 modifier, this game show format course is a must attend.

Thirty Tips in Thirty Minutes
Join Dr. Tuck and Dr. Lander in a fast-paced barrage of all the little, but important, tips and tricks that didn't make it into the other topics!

About the Instructors
Richard Lander, MD, FAAP
Dr. Richard Lander is a managing partner in a pediatric private practice in New Jersey and is president and co-founder of Resources in Physician Management Services. He is currently a Clinical Assistant Professor of Pediatrics at UMDNJ. Along with his dedication to the care and well being of children and adolescents, Richard has made it a priority to help to ensure that pediatricians are properly remunerated for their hard work on children's behalf. As the president of the NJ-AAP Chapter, he initiated and remains as co-chair of the Pediatric Council. Richard serves on the national Committee on Child Health Financing and chairs the AAP Section On Administration and Practice Management (SOAPM). He has been a consultant to the AAP Task Forces on Reimbursement, the Task Force on Obesity, and the Task Force on Mental Health. Since 1989, he has been an AAP Regional CPT Trainer and has lectured on coding and practice management for the AAP, private enterprises, and pediatric residency programs. He serves on and contributes to several coding newsletter editorial boards.

Richard Tuck, MD, FAAP
Dr. Richard Tuck is a general pediatrician in a private group practice in Zanesville, Ohio. He is also medical director of Quality Care Partners, a southeastern Ohio PHO. Dr. Tuck is a nationally known expert with extensive knowledge of CPT and ICD coding, as well as payer and reimbursement issues, gained through his personal practice and state/national committee involvement. He serves as the American Academy of Pediatrics’ representative to the AMA RBRVS Review Update Committee (RUC). Dr. Tuck received the Buzzy VanChiere award for his efforts to educate pediatricians on appropriate coding. This education assists physicians in obtaining adequate payment for the work they do and maintains access to care for their patients.

Chip Hart
Chip Hart is the Director of PCC's Pediatric Solutions consulting group. Chip's pediatric practice management expertise has helped hundreds of pediatricians increase their financial health. He has conducted many successful negotiations with insurance companies, and worked as a consultant for the American Academy of Pediatrics (AAP) and the AAP Section on Administration and Practice Manangement (SOAPM). As a dynamic and motivating speaker, Chip leads educational seminars and consults for pediatric professionals nationwide. He established the popular "PedTalk" mailing list and moderates this lively forum for pediatric healthcare professionals. Using his varied experiences with pediatric practices for inspiration, he writes regularly about the "Confessions of Pediatric Practice Consultant" (which you can read online at www.chipsblog.pcc.com). Chip has also authored articles on practice management and health care information technology for Pediatric Coding Alert, Beansprout, and Medical Group Management Association.
Location and Accommodations

The conference is held at the Capital Hilton , 1001 16th Street, NW, Washington, DC.

Register now. Admission to this conference is only $325 for AAP members ($379 for non-members)!

I get a lot of little messages every day that I feel like I should save and/or share, but they don't add up to an entire blog entry (I don't like to do more than one a day, if that, as it feels like spamming). So, here's my house cleaning:

• The AAP has released the 2008 Immunization Schedule. You can read the details from Pediatrics here or get the PDF/chart here.
• Speaking of the Pediatrics journal, here's an interesting reprint about "Incorporating Quality Improvement Into Pediatric Practice." It's a few years old, but still rings true. I keep getting ideas about how to measure the value of preventive care, but I never follow through. For years, I just presumed the data was there, the connection being so obvious. What a surprise when I learned it hasn't been done! Someday.
• Here is an interesting site (thank you Dr. Stoller) that will give you a side-by-side summary of the health care positions and proposals for each of the presidential candidates who is still in race (I am disappointed that they drop those who have dropped out, as I'd still like to see their positions). Courtesy of the Kaiser Family Foundation.
• Thanks to SOAPM, I have this piece to share:
  

  In response to concerns raised by the AAP and several pediatricians across the country, UHC revised its clinical policy on palivizumab. Effective January 1, 2008, benefits coverage for palivizumab will now be aligned with the AAP recommendations published in the Red Book. UHC is in the process of sending notification letters to its physician provider network. A copy of the AAP letter to UHC can be accessed on the AAP Member Center, private payer advocacy page. Many thanks to SOAPM members for sharing information about the change.

  Thanks to The Verden Group for that text.

• Finally, Lynn@Eden sent out a heads-up to PedTalk about Merck pricing changes:
  

  Pricing up 4%, effective Mar 1, on Gardisil, MMR, Rotashield, Varivax
  Gardisil promo (if you purchase >70 doses) extended until Feb 29
  Time to negotiate with your inscos for an increase in reimbursement
  before you have to buy in at the higher price

Our coding/PM event is filling up. I have to update the talk about Pediatric Compensation Models with more recent data, but otherwise we're in good shape. This will be great.

It's not too late to sign up, I'd love to see you there.

* April 17 Pediatric Coding Conference: Earn 5.0 CEUs!

This April 17, put your practice ahead of the curve with PCC's 2008 Spring Pediatric Coding and Practice Management Conference, endorsed by the American Academy of Pediatrics. Pediatric coding experts will address key issues in a full day of courses and question and answer sessions designed to improve your coding practices and reimbursement. PCC's 2008 Spring Pediatric Coding and Practice Management Conference will be held at the Capital Hilton in Washington, DC. This is an intensive, one-day session focused on important pediatric issues that effect your practice everyday. You'll master the coding basics, tackle additional coding topics, get answers to your specific questions during Q&A sessions with our pediatric panel, and gain valuable insight on timely pediatric issues!Our expert panel of instructors includes Richard Lander, MD, FAAP, Richard Tuck, MD, FAAP, and PCC's Chip Hart.

* Earn Continuing Education Units (CEU)

This program has prior approval of the American Academy of Professional Coders for 5.0 Continuing Education Units. Granting for prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

* Learn More and Register Now

View the complete course schedule and register online now at: www.pcc.com/practmgmt/codeconf0408.php Admission to this conference is only $325 for AAP members ($379 for non-members)! Space is limited, so register now.

I have a vision of being one of those fancy bloggers who somehow writes a "live" blog from some important event. I don't know why, but it seems cool.
So, as I type, Dr. Tuck is giving the first full lecture of the day, his CPT 101 course. Dr. Lander goes next with his "Give Me the Money" bit. My quick assessment of the crowd today:

• A lot of PCC clients! Good to see them.
• This crowd is famished for this information.

I want to get these people to our UC in Vermont this summer.
In NYC, we were (somehow) really good at staying on schedule. Today, we started 10m late and we're going to have to squish Dr. Tuck more than we'd like, I suspect. This is the cornerstone talk, so we're cutting him some slack :-)
Of course, he did his course on time and we're almost back on track. It is always a pleasure working with the pros.
Dr. Lander is on now. I like putting these practice management talks back-to-back with the CPT content. Talking CPTs for 2 hours (or more) will fry any brain. So, talking codes then talking money then talking codes, etc., breaks it up well.
Dr. Lander just name-dropped the Verden Alerts, which is cool!
In theory, we had to cut the break in 1/2, but then we went over on the break by almost 15m again. Ay yi yi! Too many people, too many questions (I'm not complaining). Some of the index card questions we got were awesome.
Dr. Tuck is up for Power CPT Coding now and I'm up next for Pediatric Compensation Models (which I like doing). I'll have to go quickly...and note to self: use the facilities now, not just before I need to talk. OK, back after my talk.

Igor and I have been working tirelessly on the various pediatric benchmarks we track for our customers (and the rest of the world). In fact, we've been focusing on developing a single PCC financial benchmark figure, with a clinical one to follow.

As a result of building this page, we have had to do a lot of thinking about normalization of scores, benchmark "ranges" and more. I thought I'd share a quick review of a tiny part of what we've seen so far. Here are three interesting changes in the values of key measurements from 2006 to 2007:

First, I like seeing that 7% drop in the median A/R days! It's particularly notable when we realize that even more PCC customers dropped capitation this year (bye bye, BCBS HMO of NJ).

Also interesting is the "Revenue Per Visit" data. For the first time ever, PCC clients have passed the magic $100/visit line - an increase of over 10% - good news. Great news, actually. Until you pull the immunizations out of it...and realize that nearly 80% of the increase our customers saw in their revenue last year got plowed straight back into the pharms. No wonder they have such bad reputations.

Still, no need to sneeze at a 3% increase in per-visit revenue when report after report shows things moving in the opposite direction.

Meanwhile, some of you may want to check out this blog/podcast, the Pediatric Pearls Show. In an ideal situation, I envision a practice getting a call from a mom about, say, wanting care for her kid with a cold, but not having the time to bring him on - perhaps the nurse could direct the mom to the episode about The Common Cold? Of course, you have to vet these for yourself, but it's an overdue idea.

It's been tough getting to the blog the last week or so. I've been busy getting ready for our Pediatric Practice Management Conference in August (why aren't you signed up?!) and will announce later this week a new AAP-endorsed event in Columbus, OH on September 17 (save the date!) and a teleconference series sponsored by Physicians' Alliance to begin in August.Worse, I had a very vivid dream this morning that I'd already written this entry, so it was tough to motivate out of bed.Here is some good content for you, though. First, a while back, I put together an "Immunization Chart" or "Vaccine Chart" (I don't know what else to call it). Then, I found out - thanks Siouxsie - that the AAP puts out something very, very similar. We include the disease associated with each vaccine, theirs might be better laid out. Click on the image below for a PDF version.Originally, I had planned to update ours with the CDC pricing info, but I want to get some sense about whether I should use my original chart, the AAP's, or somehow combine them all together. Eyeball this and tell me what you think. In the meantime, you can get the latest CDC pricing info here.

More, perhaps even later today, about our new conferences!.

Whew, we have finally gotten our ducks in a row and announce our Fall Pediatric Coding and PM conference in Columbus, OH on September 17. It's the usual deal: AAP endorsed and AAP members get in cheaper. The individual class titles include:

• Free Online Practice Management Tools
• Coding Primer
• Give Me the Money: How to Decrease your A/R
• The Codes You Leave on the Table
• Pediatric Physicians' Compensation Models
• Vaccine Coding: Preventive Medicine for a Healthy Bottom Line
• The No Surprises Chart Audit

Please check out the promotional site or register ASAP!