Zachary is the Financial Controller at Family Allergy and Asthma. An experienced Controller, Zachary has held financial positions at many well-known companies including Castle & Key Distillery and GE Appliances. He has a MS focused in Accounting from The University of Akron.

, was founded in 1979 and is a group of board-certified allergy and asthma specialists with offices in Kentucky, Indiana, Ohio, and Tennessee. We currently operate more than 50 clinics with over 30 Board-certified allergists and physicians.

Like many businesses, we are continually looking for ways to streamline our operations, maximize cash flow and create better processes. One thing we have recently tackled is our accounts payable (AP) process.

We regularly work with hundreds of vendors from immunotherapy drug manufacturers for things like wasp serum, to medical suppliers to Staples for office supplies. But, none of our transactions are PO-based, as departments place orders as needed directly with vendors.

7 Financial Reports Your Practice Needs to Run

As such, our finance team has had little insight into the AP pipeline. Until recently, we didn’t have any visibility into invoices until the order arrived. With the majority of our 400 monthly invoices coming in via postal mail, processing was manual and slow. Our accountant hand-coded each invoice and managed approvals among fifteen people.

We knew there must be a better way, so a few months ago we began looking for new technologies to help. It was especially important that any new solution would integrate with our enterprise resource planning (ERP) system.

The work-from-home order due to the COVID-19 pandemic came in just as we were implementing our new automated solution, Stampli. Fortunately, we were able to get set up in about one day and our 15 invoice approvers trained quickly.

Automating our AP function has fundamentally changed the way we do business for the better.

. We can easily and quickly identify who has what invoice and its status in the approval process. It’s easy for our approvers to ask and answer questions in real time, track approvals, and establish an audit trail—all without anyone having to be onsite.

We have reduced our invoice lifecycle from 10 to 3 days

. Our invoice lifecycle used to take up to 10 days, and with that came the risk of late payments and potential fees. Now it's been shortened to about one day per approver, so three days total—that’s a 70 percent reduction in the invoice lifecycle.

We are 90 percent faster getting invoices into Intacct.

 We’ve gone from 10 days to just one day to get all invoices into our existing ERP system, and that's a 

 value add because it gives my team insight into all invoices so we can better plan. Additionally, with the COVID-19 crisis, cash flow management has become more critical, and our solution’s search capabilities allowed our team to quickly manage it by identifying outstanding invoices for payment.

Marketing and promotion strategies for medical practices

Big changes—like pivoting to telemedicine—are less painful

. Right after our invoices were automated, our IT director was tasked with rolling out telemedicine to enable providers to treat patients who were sheltering in place. Suddenly he had a huge project to implement, and at the same time a growing number of invoices to approve. With full visibility into all invoices, we were able to identify which ones needed his approval, reduce his load, and enable him to focus on other projects.

The combination of the pandemic and how much our AP process has improved has shown our company the need for digital automation. From an accounting systems’ perspective, we’re at the beginning of what we will do with automation and new we have the foundation to establish future growth.

A few tips for practices and physician offices looking to automate some of their financial processes:

Find solutions that integrate with your Accounting system. Avoid implementing multiple systems that do not communicate.

Secure buy-in from the accounts payable team that is performing the day-day work.

Make the case to the powers that be in dollars and cents (i.e. how much automation will save)

Zachary Kulow is the Financial Controller at Family Allergy and Asthma. An experienced Controller, Zachary has held financial positions at many well-known companies including Castle & Key Distillery and GE Appliances. He has a MS focused in Accounting from The University of Akron.

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How new technology is curing ailments and streamlining processes in one practice’s AP department.

Automating accounts payable

Weight loss programs are hard to initiate and hard to sustain. Such a program would need to maintain sustained visits over time—a prime opportunity for telehealth offerings. Julia Wright, MD discusses how telehealth offerings can benefit both physicians and patients working together to take back control of obesity.

Videos

Weight loss programs are a prime opportunity for telehealth offerings.

Telemedicine benefits patients struggling with their weight

is CEO of Fund-Ex Solutions Group, a non-bank SBA lender and wholly-owned subsidiary of Bankers Healthcare Group. For more information, visit

For most physicians, the last few months have been some of the most trying of their careers. For practice owners specifically, prioritizing staff and patient safety while also balancing the financial health of their business has been a day-to-day endeavor.

The SBA’s Paycheck Protection Program provided much-needed support and stability for physicians who sought to maintain their employees during this time. If you received a PPP loan, you may now be juggling reopening your practice with preparing to apply for loan forgiveness.

First, borrowers should be aware of the provisions in the recently passed PPP Flexibility Act, which helps borrowers better qualify for forgiveness. The Act reflects several key changes relevant to forgiveness:

Borrowers now have 24 weeks to use their funds, as opposed to the original eight weeks. However, those who took out loans prior to June 5 have the option to use the original eight-week period, if they prefer, while loans originated after June 5 will be required to use a 24-week covered period.

Non-payroll expenses that can be forgiven has increased from 24 percent to 40 percent.

Any portion of the loan that is not granted forgiveness can now be repaid over five years, increased from the original two years, though the extension must be mutually agreed upon by the borrower and lender for all loans originated before June 5.

Borrowers do not have to make any payments on the unforgiven portion of the loan until SBA makes a final decision on the forgiveness application. If no such application has been filed, payments begin after 10 months.

Employers have until Dec. 31, 2020 to eliminate a reduction in full-time employees or salary that would otherwise reduce the forgivable amount.

When it comes to the loan forgiveness application, it may seem daunting to enter another unfamiliar process, it doesn’t have to be. Here are some facts that physicians need to know now:

5 questions to ask about wRVU compensation

1. The PPP was designed to cover payroll-related costs.

As indicated by the name, the PPP was created to cover costs related to your staff’s compensation. Most loan amounts were calculated at 2019 payroll expenses, which includes expenditures such as:

Employee salary or wages, commissions, cash tips, or similar compensation

Payment for vacation, parental, family, medical, or sick leave

Payment required for the provisions of group healthcare benefits, including insurance premiums 

Payment of state or local tax assessed on the compensation of employees

Compensation to or income of a sole proprietor or independent contractor 
up to $100,000/year

However, some non-payroll costs, such as interest paid on your mortgage, rent payments, or utility bills may be forgiven under the PPP, so long as they make up nor more than 40% of your total loan. Non-payroll expenses must be subject to mortgages, leases, or utility contracts that were in place prior to Feb. 15, 2020. PPE, a major cost for physicians reopening their practices, is not covered by the PPP, and therefore funds that are allocated to this purpose will not be forgiven.

2. 100% of your PPP loan can be forgiven.

It’s true—your PPP loan can be forgiven entirely if you follow certain criteria and you can prove the funds were spent accordingly. For instance, make sure that you’re using your funds for explicitly approved purposes only, and that you’re spending the entirety of your loan within the covered period. Any funds that are not used according to the guidelines will become part of the balance you have to repay.

3. You must provide proof of your expenditures in order to submit them for forgiveness.

First, make sure that you have the right forgiveness application. The SBA recently released a revised full version and a new short version (the Form 3508EZ).

The EZ application can be used by self-employed individuals, independent contractors, sole proprietors with no other employees, or any other borrower who did not reduce the number of full-time employees during the covered period or did not reduce pay for any employees by more than 25 percent (full-time employee and salary levels are compared to a pre-pandemic reference period to determine any reduction). Borrowers who don’t meet these criteria must complete the full application.

Keeping detailed documentation of your PPP-related spending is critical for ensuring maximum loan forgiveness. Some examples of acceptable documentation include forms such as paid checks, payroll documentation, receipts, billing statements, and more. The more diligent you are in maintaining and organizing your proof documents, the easier it will be for your lender to process your loan forgiveness application in a timely manner.

Will a waiver protect me from COVID-19 infection claims?

4. You apply for PPP loan forgiveness through your lender

Your financial institution has 60 days to review your application and return with a decision about your loan forgiveness. From there, the lender submits it to the SBA, which then has 90 days to finalize the decision and remit funds to the lender in the amount forgiven. The lender will notify the borrower of the decision.

The SBA has released a standard forgiveness application, as well as guidelines for applying and details about the documentation required to do so. Borrowers may submit forgiveness applications any time on or before the maturity date of the loan, and will have to start making payments on the full loan amount if a forgiveness application has not been filed within 10 months of receipt of PPP loan funds. You want to be sure that your application is complete and correct, so that you can be confident that you’ve done everything you can to maximize your forgiveness.

Applying for PPP loan forgiveness is a critical final step for physicians who took the financial initiative to safeguard their staff and their practice during this uncertain time. Making sure to use funds correctly, document your expenditures, and apply with confidence will set physicians up to receive the maximum forgiveness on their loan, and get back to doing what they do best–caring for their patients.

Applying for PPP loan forgiveness is a critical final step for physicians who took the financial initiative to safeguard their staff and their practice during this uncertain time. 

PPP loan forgiveness: What physicians need to know

Physicians in these five states reported the highest incomes compared to their peers in other states.

Setting up a practice, or just generally working for a health system, in these states might fare better; however, you must also consider the 

 and other competition that might already be residing there.

5 states with the highest physician salaries in 2019

Slideshows

Find out in which states you can make the most for your services. Will the rankings surprise you?

Best states for physicians in 2020: 5 states with the highest physician salaries

M.D. is Chief Strategy Officer and Chief Privacy Officer for

. He is a board-certified cardiologist and internal medicine specialist with over 40 years of clinical practice and is a past president of the Massachusetts Medical Society.

When considering the importance of medication adherence, former 

 said it best: “Drugs don’t work in patients who don’t take them.” That was 35 years ago, and the issue remains a major area of concern for clinicians today.

of new prescriptions are never filled—and even when filled, 

 with chronic conditions fail to take their medications as prescribed. These statistics reflect the situation before COVID-19 led to social distancing and stay-at-home orders that may be making the situation worse.

Medication non-adherence can lead to serious health consequences and higher medical costs. Each year, 

 results in approximately 125,000 deaths and up to 25 percent of hospitalizations, which is estimated to cost the American healthcare system nearly $300 billion.

As the number of coronavirus cases continues to grow across the U.S., medication adherence has never been more critical, especially for the elderly and those with chronic conditions who are the 

 to complications, including death, from COVID-19, according to the Centers for Disease Control and Prevention (CDC). To protect our most vulnerable patients, physicians and pharmacists must work together to identify the underlying reasons why patients aren’t taking their medications as prescribed and to provide solutions that improve adherence.

There are three primary reasons why patients don’t fill new prescriptions or take their medications as directed: high cost, lack of symptoms, and forgetfulness.

A major contributor to medication non-adherence is high out-of-pocket costs for prescription drugs, as evidenced by the 

 of a recent consumer survey. In the study, 48 percent of respondents reported not filling a prescription within the past few years because of cost. The research also found that even a $10 rise in copay increases the likelihood of prescription abandonment by as much as 19%.

 a direct correlation between the amount of a patient’s copay and the likelihood of prescription abandonment. Patients with $50 copays were nearly four times more likely to abandon a prescription at a pharmacy than patients paying $10.

Today, millions of Americans have lost their jobs, their health insurance, and the incomes they used to pay for out-of-pocket healthcare costs. One in seven report they would avoid seeking care for potential COVID-19 symptoms because of cost concerns, according to a 

. Unless patients find some financial relief, medication non-adherence rates will surely rise.

Lack of symptoms and misunderstanding of disease impact

Patients often do not understand why they need certain medications. It’s not uncommon for a person to say they don’t feel their blood pressure is high or that they don’t have any symptoms from high cholesterol. Because they don’t 

sick, people may stop taking their medications, which can have serious consequences that add up over time. This situation often leads to unnecessary visits to the ER and, occasionally, hospital admissions that could have been avoided.

During the current health crisis, we have all been encouraged to stay at home, limit trips to the grocery store and pharmacy, and postpone non-essential medical care. This means patients may have less interaction with physicians and pharmacists who can educate them about prescribed therapies. Now is the time for care team members to adopt proactive measures to make sure patients understand what their medications are for, how to take them, and why doing so as prescribed is important.

 9 ways to improve your patient communications

Delaying or forgetting prescription pickup

Even in our former everyday busy lives, it was easy enough to put off a trip to the pharmacy for a prescription. Now, as many of us still remain sheltered at home, it’s a challenge to recall what day it is, much less remember to pick up a prescription.

Using reminder tools that notify patients when medications are prescribed and when they are ready for pickup, pharmacists and physicians can help reduce prescription abandonment. Many independent pharmacies and national chains are offering free delivery services for prescriptions, which is particularly beneficial for patients who feel leaving home could compromise their health. Additionally, health plans have eased restrictions on filling prescriptions in larger quantities, reducing trips to the pharmacy.

Improving medication adherence with technology

Care team members can improve medication adherence—and health outcomes—by leveraging technologies that provide price transparency, offer access to educational materials, and send reminders directly to patients’ mobile devices. Technology also can facilitate secure communication between prescribers and pharmacists.

For example, when prescribers see patient-specific drug pricing detail

 at the point of encounter within prescribing workflows, it empowers them to discuss formulary options and out-of-pocket costs with patients, and potentially review financial assistance options if cost is a barrier. Real-time price transparency tools improve medication adherence and clinical outcomes because patients know exactly how much their medication will cost before going to the pharmacy. These tools eliminate the all too common “sticker shock” experienced by the patient when the pharmacist accesses the patient’s specific health plan benefit to discover that the medication is unaffordable for the patient.

Care providers can also reduce financial barriers with new technology that gives patients direct access to copay assistance options. Emerging solutions also may link patients to educational content about prescribed medications, giving them a better understanding of the prescribed therapy.

Patient-centered care in an interoperable environment

Better communication between pharmacists and doctors can improve adherence

Physicians and pharmacists can further drive adherence by sending automatic reminders to patients’ smartphones, for example, to notify them when a prescription is sent to the pharmacy or when a prescription is ready. Such tools also may allow patients to set reminder notices to pick up their medication. By committing to a specific time, patients are more likely to pick up their prescriptions and are more likely to take them.

Sometimes, prescriptions are not filled in a timely manner because the pharmacist needs additional clarification from the physician or the payer. For example, a pharmacist may place a call to the physician and leave a message, which starts a time-delaying game of phone tag. To increase efficiencies, improve coordination, and ultimately fill prescriptions more quickly, a patient’s care team can alternatively communicate directly using secure texting, email, and videoconferencing technology.

The novel coronavirus has impacted every aspect of our lives and created tremendous financial and emotional strain for many of our most vulnerable patients. Now more than ever, healthcare professionals must help patients overcome any hurdles standing in the way of medication adherence, including financial and safety concerns. With the right communication and educational tools, providers can help ensure patients take the medicines they need, especially those managing chronic conditions or at the highest risk of complications.

Medication non-adherence results in approximately 125,000 deaths and up to 25 percent of hospitalizations annually. 

Improve medication adherence with technology

The designation of the COVID-19 pandemic as a national emergency led to both changes in and an increase in the use of telehealth services. Telehealth encompasses a broader away of remote healthcare services than telemedicine because it includes both clinical and non-clinical services. For purposes of this article, we’ll focus on telehealth during the COVID-19 pandemic, with the caveat that providers need to stay abreast of the following:

permanent changes to existing state and federal laws after the end of the pandemic; and

reimbursement codes and settings for providing telehealth services.

In 2018, the Department of Health and Human Services Office of the Inspector General (“OIG”) published a report, 

CMS Paid Practitioners for Telehealth Services that Did Not Meet Medicare Standards

. This related to the telehealth before the COVID-19 waivers. Notably, there were no concerns with physicians reassigning billing rights to hospitals. But the OIG did find that “[f]or seven claims, institutional providers billed outpatient claims for telehealth services performed at distant sites for beneficiaries located at rural originating sites, but the distant sites were not CAHs, and the services provided were not MNT services.” Therefore, underscoring that billing under Medicare Part A or Medicare Part B is material. This should not change under the COVID-19 pandemic.

Periodically, the Centers for Medicare and Medicaid (“CMS”) releases updates related to different waivers and telehealth coverage. A good example is the 

 that was posted on May 11, 2020, which included a video update the types of services and correct billing for telehealth services.

A related issue which physician practices and hospitals should be aware of is the reassignment of Medicare benefits through utilizing a 

 First and foremost, providers should refresh themselves that telemedicine services are meant to prohibit kickbacks for referrals. Medicare Audit Contractors (“MACs”) have confirmed that a hospital can submit claims for a physician’s distant site telehealth services when the physician has reassigned his or her benefits to the hospital. The restrictions found in the regulation and Medicare Manual, simply state that the hospital cannot be the distant site provider. 66 Fed. Reg. 55332, 55282 (Nov. 1, 2001). In order to obtain reassurances that the hospital and the physician’s office are acting in accordance with the relevant laws and regulations providers should contact their MAC.

Overall, providers on both sides of the agreement should ensure that all actions associated with telehealth are above-board. The best way to mitigate risk is to call a MAC, read the laws, and the telehealth waivers over COVID-19.

Healthcare technology shouldn’t disappear with COVID19

, JD, MBA, advises clients on compliance and transactions in healthcare, cybersecurity, corporate and securities law, while representing plaintiffs in False Claims Act and Dodd-Frank whistleblower cases. She also teaches bioethics at

in Houston. Rachel can be reached through her website,

The best way to mitigate risk is to call a MAC, read the laws, and the telehealth waivers over COVID-19.

Reassigning Claims? Make sure to complete the CMS 855-R Form

Since I have the honor of having my post featured on Independence Day, I thought it would be fun to talk about some of the good points of remaining an independent physician or independent physician group.

Giving Google a quick spin on “reasons to remain an independent physician” really yields only reasons to sell your practice and become employed. One source indicated that the number of independent physicians had decreased from 57 percent down to 33 percent. Another source polled 5,012 doctors on whether or not they would consider selling their practice, and more than 40 percent of the doctors said they would sell if offered.

But, as I mentioned I would like to remind you of five of the big-picture reasons to remain independent.

Hope you and your family have a happy and safe Independence Day!

Top five best things about being an independent physician 

In honor of Independence Day, here are five of the top good things about remaining an independent physician.

The complex, highly manual prior authorization (PA) system continues to frustrate clinicians, negatively impact patients, and cost practices huge sums of money. The PA process causes frequent delays in care, often at the expense of patient health.

Technology is a significant part of the problem, despite years of efforts to streamline systems and speed up processes. A lack of coherent electronic systems has some practices resorting to paper faxing while others struggle to submit documents to multiple health plans’ proprietary web portals. As health plans add more drugs, procedures, and medical equipment to the long list of items requiring prior authorization, 

have been forced to hire staff dedicated entirely to submitting and tracking requests.

One of the first attempts at fixing the PA system was based on the HIPAA Healthcare Service Review X12-278 transaction standard. Unfortunately, the protocol wasn’t 

 enough to support all of the detailed clinical data necessary for PA.

5 things physician practices need to do when hiring during a pandemic

More recent streamlining efforts involve the Fast Healthcare Interoperability Resources (FHIR) standard, which is based on HL7 v2. FHIR combines the best features of HL7 v2, HL7 v3, and Clinical Document Architecture (CDA), while leveraging the latest web service technologies. The design of FHIR is based on RESTful web services–a contrast to the majority of IHE profiles which are based on SOAP web services. FHIR supports information exchange via mobile phone apps, cloud communications, EHR-based data sharing, and server communications. The Office of the National Coordinator for Health Information’s (ONC) 

calls for open APIs (application program interfaces) to be certified.

The industry seems to be coalescing around FHIR-based APIs, but how widespread the adoption will be is hard to predict. And although the major EHRs will likely adopt these standards quickly, smaller practices not using a certified EHR may have to wait months or years.

There are four best practices physician groups can implement as they wait for improved integration. All aim to lower PA-associated costs and shorten the time patients must wait for approvals.

 It’s not possible to have updated information on the PA-related policies for every health plan you work with. But it 

 possible to create clinician guides for the insurers you work with most frequently. If you limit the guide to the prescriptions, medical devices, and procedures your practice routinely recommends, the task is achievable. The guide should:

Inform clinicians about care recommendations that necessitate a PA

List the clinical documentation required by the health plan for approval of each care item.

Follow evidence-based guidelines to reduce denials

Standardizing on widely agreed upon clinical guidelines for all/most procedures and care recommendations speeds up the PA process and decreases denials. This is a three-pronged effort. First, decide if you’ll develop your own set of guidelines using a resource such as the National Guideline Clearinghouse or purchase them. Second, create a program to inform all clinicians about the guidelines to be used and the benefits of using them. Third, outline the steps needed when deviating from the standards (i.e., if the standard of care for knee surgery is X rehab days and your patient’s condition necessitates X+10 rehab days, what additional documentation will be required).

Discuss options for reducing PA volume with your main payers

Some payers are allowing PA exceptions for certain patients, such as those with multiple co-morbidities or who need a repeat procedure. Other payers are allowing physicians with proven patient-care track records or who are participating in risk-based payment contracts to bypass the PA process. Another option is bundled authorization for certain procedures, medications, or medical equipment for practices participating in alternative payment models.

Coding and billing for advanced practice clinicians

Practices waiting for EHR-based PA technology may want to consider a cloud fax solution. A 

 of physicians use phone or fax as the primary method of requesting PAs, so cloud faxing is a natural next step. More secure than traditional fax, cloud fax technology lets users quickly send email messages with attachments (e.g., clinical documentation) to other digital and physical faxes.

The pain caused by the current PA system is very real for both physicians and patients. The AMA’s Prior Authorization Physician Survey 

 that 44 percent said the PA process “sometimes” leads to care delays, and another 36% said it “often” does so. Almost 30 percent reported that the PA process has led to a serious adverse event for a patient.

A whopping 86 percent of physicians said they’d describe the burden associated with PA as “high or extremely high.” Slightly more than 35 percent said they have staff who work exclusively on PA, and the average number of PAs completed per physician per week in 2018 was 31.

For many physicians in small practices or rural areas, the discussions about HL7 and FHIR standards are nothing more than noise in their daily efforts to get patients the care they need in a timely manner. Indeed, the long battle between physicians and payers over the best way to get patients the care they need is raging hotter than ever, despite decades of effort to come together to create a solution.

Unfortunately for physicians, payers continue to demand prior authorization for more care items: 50 percent of physicians said their PA burden has increased significantly in the last five years.

The best practices described above are strong steps in easing that burden, allowing clinicians to spend less time on paperwork and more time with patients, as well as freeing up resources currently dedicated to the PA process to allow your business to grow.

is the Chief Health Information Officer for J2 Cloud Services. She specializes in the area of healthcare interoperability where she is focused on open data exchange of healthcare information inside and outside of the EHR and using open platforms and tools such as APIs as a means of sharing.

Unfortunately for physicians, payers continue to demand prior authorization for more care items.

Grow your practice by optimizing your prior authorization process

 As physicians across the country get their practices reopened and back to the new normal, we examine COVID-19 infection liability waivers and their effectiveness in managing patient infection lawsuits.

Coronavirus infection liability creates significant professional and personal legal risk for doctors. From family practices to cosmetic surgery, practices are struggling to 

 with a combination of reduced patient volume to due fear of infections and lockdowns; labor shortages; and now, a massive number of unemployed, hence uninsured, patients. We’ve followed a variety of risks since the crisis emerged, including a look at the ways a global pandemic 

 risks including shifting standards of care as more states are now operating at or near their crisis contingency plans.

Shockingly, practices across the country are taking very different approaches to protect their patients and staff. One Scottsdale medical professional told me about her own recent medical visit to her physician; no pre-screening, no temp check, no signage about not entering if sick, no social distancing, and no masks. She asked her doctor why they weren’t taking those basic precautions and he responded, “Well, we haven’t had any cases in here yet”. My response was that 

a doctor’s office should be at least as hard to get into as an Apple store

, which recently required every single item on the list above of me, before I could enter.

Will A Covid-19 Infection Liability Waiver Protect Me?

A well drafted waiver can be one part of a risk management plan but like most asset protection strategies, should not be relied upon as complete protection 

. Waivers cannot provide a shield against 

 conduct and are typically only effective against mere “negligence”. Waivers may be frowned upon by courts, are construed in favor of the plaintiff and may also specifically be void for public policy in certain settings. As such, waivers should narrowly comply with state law and should be professionally drafted. Other layers of protection should 

 include insurance and fact specific legal tools.

Enforceability of Waivers —Four Important Factors the Courts Will Examine

Was it clear and obvious that they were signing a “Covid19 Infection Liability Waiver” and that it “may affect important rights and future legal remedies”? (make it dummy-proof, don’t minimize its importance at check in or pre-screening, etc.)

Was the too broad or inclusive or was it narrowly drafted with language specific to the risk of COVID-19 infection in a public setting? Avoid ‘kitchen-sink’ waivers that throw in too many items.

Did the patient have meaningful opportunity to review, question and reject the waiver before treatment was rendered? Did the patient have a choice (i.e. emergency services were required) and did they provide informed consent? Consider providing the waiver in advance as part of your pre-screening process.

Evidence of sterilization and safety standard compliance is another vital line of defense. Is your organization able to provide affirmative defenses like the following about the proactive steps you took and the expenses you incurred specifically to prevent infection? 

Are you compliant with standards and safety protocols established by local, state and federal law?

 including any guidelines provided by your specialty medical associations?

 infection compliance and office safety program in place for sterilization and staff and patient screening that all staff and patients are aware of? 

Yes, this means denying service to those who won’t comply.

8 Ways to Play the Prior Authorization Game

Are You Obtaining Specific Informed Consent on Infection

Obtaining informed consent about COVID-19 infection risks and all its other potential effects on patient treatment is another vital affirmative defense and waivers are always more effective when backed by it. Effective informed consent forms and procedures DO NOT merely add a line about infection risk, seek professional guidance and document this additional communication carefully.

Think broadly and advise patients of possible treatment delays that may occur due to their illness, staff illness, local law (lockdowns, elective treatment restrictions), hospital bed availability, PPE availability and other issues beyond your control.

Discuss options for and risks of delayed treatment

Disclose your COVID-19 screening and testing requirements to be cleared for treatment including the risks of false negative tests

Discuss post treatment follow up protocols

, JD, has practiced law exclusively in the areas of asset protection, risk management and wealth preservation for the last 16 years. He helps protect a national client base with more than $5 billion in personal assets, including several thousand physicians. He is a contributing author to multiple books for physicians and a frequent medical conference speaker and CME presenter. Learn more at

As physicians across the country get their practices reopened and back to the new normal, we examine COVID-19 infection liability waivers and their effectiveness in managing patient infection lawsuits. 

Will a waiver protect me from COVID-19 infection claims? 

, a leading San Francisco based healthcare technology company.

The final rule on interoperability from the Office of National Coordinator of Health Information and Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS) were issued early in March of 2020 and were nothing less than a landmark; however, just weeks later, the interoperability rules were pushed back as US healthcare streamlined all of its resources to battle the COVID-19 pandemic.

The interoperability mandates that would have nudged healthcare into a truly digital era became an afterthought as the country dealt with a crippling pandemic. The paradox is that COVID-19 has highlighted the critical need for exactly what the rule would have encouraged: the advancement of interoperability for care coordination and greater data sharing across healthcare organizations.

Interoperability is critical to the fight against COVID-19

Although CMS has only announced a delay in enforcing the rule, the need for making healthcare data interoperability has only become more obvious. Had interoperability gone into effect earlier this year as planned, many healthcare organizations would have been able to securely share the data they have around their patients for seamless care coordination. Data flowing across geographical borders would have been extremely useful in detecting risk factors, identifying resource shortages, and pharmaceutical development.

So far, the current healthcare system is only slightly better than a patchwork of different data systems, and COVID-19 has exposed these gaps. While we have pivoted our efforts to combat the pandemic, the success of these containment measures will heavily depend on the timely exchange of critical information. Healthcare’s response to the pandemic will rely on the effective collaboration of healthcare providers, community health organizations, labs, and insurance companies to test patients, identify patterns of infection, and design ways to improve these activities over time.

Creating a foundation for impactful health innovation

 has continued to evolve, but the siloed nature of data systems and archaic practices of sharing data thwarts much of the potential positive impact. However, with the COVID-19 outbreak, the stress on frontline healthcare workers to assess a patient’s healthcare history and prioritize them based on their risk has increased dramatically. A patchwork of systems or makeshift data exchange infrastructure will not suffice.

Although electronic health records (EHRs) have been around for a long time now, data from other systems often doesn’t flow into the EHR. As a patient moves from facility to facility in the continuum, the information rarely moves with them, except for physical notes. Implementing interoperability among systems would allow real-time, patient-centered care.

Critical patient information can be delivered to providers to understand more about their patients, their risk profiles, their travel history, previous episodes and more. The quick access to data would be useful in reducing redundancy in tests and procedures and helping the patient receive more rapid care. Additionally, interoperability among providers can ensure that all physicians are accessing information that reflects real-time changes and can better coordinate care among themselves for the patient.

Interoperability can be significantly helpful in reducing patient-facing tasks such as filling out forms repeatedly or explaining their medical history to every new provider. Access to updated and real-time information can result in faster and more efficient treatment and better patient experience of care. In addition to that, the new ONC interoperability rule encourages healthcare organizations to let patients have ownership of their own health data. The patient is the common entity in all healthcare encounters, and it’s important that they have access to their information and that their providers have access as well, because they are ultimately the ones coordinating all of their care.

Keeping up with regulatory changes during COVID19

Interoperability will ignite significant and sustainable change in healthcare quality, delivery, and payment.