Tools

Looking for a way to get a handle on Relative Value Units (RVUs) tied to Medicare payments or even use of RVUs in your own practice? Here's the formula Medicare uses to calculate payments for the services you provide.

With the beginning of meaningful use attestation on April 18, practices will have to prove to CMS that they have followed guidelines to receive incentive checks for their hard work. Here's some simple guidance on how to comply with the Stage One meaningful use core initiatives.

The Affordable Care Act, signed into law in 2010, is the roadmap for healthcare reform for the next decade. The legislation includes several initiatives that will impact the way physicians operate and change their everyday business practices. Here is a year-by-year outline of the biggest benchmarks that will affect physician practices.

Posting a general disclaimer on your practice's social media platforms protects both you and your patients.

Are you ready to make social media platforms part of your practice? Make sure you put reasonable constraints in place.

Is your practice ready to begin the EHR transition? Take this simple quiz to find out.

Made your choice? That’s only part of the battle. Now you have to get it running. Our preparation checklist should help.

Not sure how you’re going to pay for all this? Check out our EHR pricing worksheet.

See what Medicare owes you in 2011.

In order to access federal incentive dollars through your EHR, you must prove "meaningful use," the goal of which is to improve care and outcomes for your patients.

The deadline for conversion from the present electronic claims transaction standard to Version 5010 is fast approaching. Make sure both your practice and systems vendor are ready for the change.

How good are your key accounts receivable processes? Do you even know what to measure? Find out how you are doing by entering key data from your practice and comparing your key measurements to industry benchmarks.

This is similar to the general notice above, but is specifically for laboratory work. Again, this form comes directly from the Center for Medicare and Medicaid Services. Access its Web site for more information.

Medicare denies claims for 26 percent of all services submitted. More distressing -- 40 percent of those services are never resubmitted for payment by providers. Talk about missed opportunities! Customize this form letter -- and the ones below -- to appeal claims denied, no matter who the payer is. Use this letter to show payers that the claims you are sending are not dups, but corrections.

Use this letter is a claim is denied becasue a patient saw a physician in your group who is not his or her designated primary care physician.

This simple work sheet will let you compare your payers' reimbursement for specific procedure with your costs for each procedure. If you're spending more to provide a service than you're making for it, then it's time to address the problem.

Consider this template for annual or quarterly reviews of the performance of business managers in your practice. Of course, make sure your review reflects goals set at the beginning of the year or in a job description.

Thinking about buying an EMR, but not sure how it will pay off? Try this ROI calculator, supplied by A4 Health Systems. It will show you where you can expect to cut costs, regardless of what system you buy.

If you are closing your practice, you need to let patients know and advise them to find another physician. Here is a letter you can use to get the job done.

This is the first in a series of letters to use for patient collections.

Ask staff to sign this agreement, showing that they understand the need to protect patient confidentiality.

Tell 'em what you want and how you'd like to hear about what happened.

Is your practice in the market for a new EMR or other new technology you’re not all that familiar with? Or do you want to upgrade some outdated software or IT tool, and you’re not sure how to start looking? Physicians Practice’s new Product Assessment Worksheet, adapted from a checklist created by New Jersey’s Regional Women’s Health Group, can help you compare products and ensure they are appropriate for your office’s specific needs.

Compare your denial rate from Medicare to national averages for your specialty by total amount denied, number of services denied, or percent of services denied. Data from the Centers for Medicare and Medicaid Services.

Manage your denials from insurance companies by tracking them in this worksheet. Track the denials according to the functional area to identify opportunities for improvement. By tracking and monitoring denials, you can fix the problem and prevent denials in the first place.

Use this sample template for guidelines on documenting established patient visits. Provided by Hill & Associates.

Use this sample template for guidelines on documenting patient visits in general. Provided by Hill & Associates.

Use this sample template for guidelines on documenting inpatient visits. Provided by Hill & Associates.

Use this sample template for guidelines on documenting outpatient visits. Provided by Hill & Associates.

Compare your E&M coding patterns with national norms from Medicare (2005). It's a fast way to see if you are out of whack. Translate Medicare's data for your specialty into percentiles for easier comparison.

Use this easy calculator to find out which of your payers are worth your efforts. By comparing the percentage of revenue to the percentage of patient encounters for each of your payers, you can tell at a glance which plans are the poor performers.

Abstracted with permission from Chapter 4 of The Toyota Way by Jeffrey Liker. This chapter summarizes the principles of lean manufacturing, now being used in medical practices. Order the book at www.amazon.com.

Base your fee schedule on the Relative Value Unit (RVU) scale. We'll show you how -- and help you with the math.

Let new patients know about your policies from the get go. Follow these guidelines.

The Health Insurance Portability and Accountability Act requires authorization from patients for the release of protected health information for uses other than treatment, payment or health care operations. Here's a sample form for this purpose. Provided by Rachel Glitz, Paul Smith, and Becky Williams of Davis Wright Tremaine, LLP.

Straight from the HIPAA regulation, here is an outline to follow as you create your Notice of Privacy Practices.

CMS has released its proposed changes. Not sure how it will impact you? Have a gander at this. It'll give you what you need to prepare. We took it straight from the horse's mouth, straight from the proposed regulations.

If you can't verify a patient's insurance, their signature on this form shows they know they are responsible for payment.

Use this form to document internal review of and response to complaints concerning compliance with human resource, HIPAA, Medicare billing or other ethical and legal guidelines.

A quick overview of the Initial Preventive Physical Examination (IPPE), a new Medicare benefit effective 1-1-05. Understand the components and how to bill for the exam.

Need a better way to track the status of lab work you've ordered -- but not ready for an EMR? This Excel document provides semi-automation. Be sure to turn on your macros and review the instructiosn on the last worksheet. Provided by www.docsboard.com.

Here are the fourteen key measurements you need to make -- about once a quarter -- to measure your practice's financial health. We've made it easy for you. Just enter some information; we'll do the math.

Instead of having patients carry all their medications to every visit, ask them to bring in this simple chart. It's a more efficient way to check for counterindications. You can even give patients a digital copy by saving it to a disk or e-mailing a copy. That makes it easy for patients to update it.

Plain language advice on using common modifiers.

Opening a new practice? Here are some of the things you will need to get done before the doors open.

We'll help you accurately measure your overhead costs -- and compare them to national benchmarks.

An easy way to find out what patients think of your practice -- and where you need to improve.

Take a page from your mortgage company. Instead of sending self-pay patients on a payment plan statements every month, give them coupons. The coupons remind them what they owe. They simply need to mail one in, with a check, each month.

You give annual reviews to staff, why not to physicians? This form gives physicians feedback about their clinical quality, bedside manner, and ability to work with others.

See who the RACs are in your region.

Crazy busy but not sure if you can afford to hire another physician? Just fill in the blanks on this site. It'll do the analysis for you.

This document includes other necessary forms related to the Red Flags Rule, including an identity theft affidavit. Don’t forget to replace “Our Medical Group” with your practice name.

Is your practice “Red Flags” ready? Here are several forms to help you develop a policy to comply with the Federal Trade Commission’s Red Flags Rule, which requires creditors to implement programs to prevent and detect identity theft. Here you’ll find a document with a policy, board resolution, and contract addendum. Just replace “Our Medical Group” with the name of your practice, and you’re on your way.

Physicians often want to review an overdue patient account before it is sent to a collection agency. Staff can use this form to summarize the status of the account, making review easier.

Smooth patient referrals -- and your relationship with specialists -- with this easy form.

Specialists, use this waiver if a patient forgot his referral. It says that the patient agrees to pay for services rendered that are not covered by his managed care company.

If you are shopping for sharps or syringes, make your selection easier using this template. Provided courtesy of Quality America, Inc. For more information about OSHA compliance, please visit www.quality-america.com.

Placing a sign-in sheet on the reception desk makes the reception process less friendly. Instead, try asking patients to fill out this slip -- and do the necessary paperwork immediately.

A sample review form for staff performance.

The best performing practices in the country tend to have more staff than practices doing less well. Why? More support staff means physicians can focus on seeing patients -- and bringing in money. Find out how your staff per physician ratio compares to national benchmarks.

Make sure you know everything you need to know.

Get the message right the first time. Use this form to make sure all the information is covered.

Make sure the tests you ordered get done, that you get the results and that the patients knows if anything is wrong. Print this form on carbon paper to create two copies: Send one copy to the lab. Keep the other in the office, but don't file it until the results come back and the patient is notified. If the form is still sitting out a month after the test was ordered, you'll know to follow-up.

A white paper provided by Roche

Follow our flowchart to find ways to improve your collections. A great companion to our Accounts Receivable Key Indicators calculator. If your results there are lower than you like, this flowchart will help you improve.

Detailed elements to consider when reviewing workflow in your office. Use this checklist to help define staff responsibilities and best methods to make workflow seamless.

This document includes other necessary forms related to the Red Flags Rule, including an identity theft affidavit. Don’t forget to replace “Our Medical Group” with your practice name.

Is your practice “Red Flags” ready? Here are several forms to help you develop a policy to comply with the Federal Trade Commission’s Red Flags Rule.

Use this form if you think Medicare will not cover a service you are about to perform on a patient covered by Medicare. If the patient still wants the treatment, their signature shows they know they may be responsible for payment. Please note that a separate form must be signed for each service for each date of service, and that the patient has the option to refuse the service. Because of the specificity required, this process (and form) is best managed by the clinical team, instead of the front office. This form was created by the Center for Medicare and Medicaid Services (formerly the Health Care Financing Administration) for your use. For more information, visit http://www.hcfa.gov/medlearn/refabn.htm.

Appeal Letter for Claims Denied for Improper Bundling

Appeal Letter for Prompt Payment

Appeal Letter Justifying Emergency Treatment

Appeal Letter Justifying Fee Schedule as Fair and Reasonable

Appeal Letter Justifying Medical Neccessity

Assignment of Benefits

Assignment of Benefits -- Spanish

Collections Letter 1 -- Spanish

Collections Letter 2

Collections Letter 2 -- Spanish

Collections Letter 3

Collections Letter 3 -- Spanish

Consent to Treat

Consent to Treat -- Spanish

If you can't verify a patient's insurance, their signature on this form shows they know they are responsible for payment.

Medical Practice Management Technology Resources

Patient Information Form

Patient Information Form -- Spanish

Patient Satisfaction Survey -- Spanish

Records Release Form

Records Release Form -- Spanish

Referral Waiver -- Spanish

The Health Insurance Portability and Accountability Act requires physicians to have their business associates -- claims processors or third-party billers, for example -- agree to protect private patient data. Here's a sample form to use for this purpose. Forms provided by Reece Hirsch, attorney with Davis Wright Tremaine, LLP.

Use this letter if a patient consistently refuses to pay for services rendered, and you are forced to dismiss the patient from your practice.

Measure physician productivity by relative value units (RVUs) -- one of the most reliable ways to do it. This spreadsheet does the necessary calculations for you.