Why has the business of medical practice consulting grown? There are a few reasons:

Running a medical practice has become more complicated. There are many reasons, including:  the increasing complication of filing insurance claims, the need to manage accounts receivable, the need to comply with OSHA and other regulations, and the necessity of keeping liability insurance coverage in place.

It has become more difficult to focus on the quality of patient care. Medical practice consultants can help busy medical offices preserve the quality of the relationship between caregiver and patient.

Physicians have learned that they can earn more money when their practices deliver care to more patients. This can involve: hiring additional front-desk staff, adding additional care rooms, and hiring support specialists to take blood pressure, do cardiograms, and perform other functions that may not require direct physician care. Medical practice consultants can analyze a medical practice and recommend which of these changes to apply.

And medical practice consultants can review office operations in other ways too. Here’s a list of services offered today by Healthcare Management Consultants Inc. (partial listing):

-  Billing Systems

-  Front Office Training

-  Interim Management

-  Managed Care Systems

-  Management Reorganization

-  Medical Practice Development and Management

-  Operational and Quality Improvement

-  Organization, Administration, Management, and Governance

-  Patient Care Delivery Systems Development

-  Patient Safety Training

-  Regulatory Compliance

-  Revenue Cycle Management

-  Strategic Planning and Marketing

So, where do medical billers and coders fit in the delivery of those services?  The answer is, just about everywhere. As medical offices become more efficient, the demand for billers and coders seems sure to rise. It’s another reason why the outlook for the profession looks so strong today.

Fisher, who founded the Harvard Negotiation Project, was right. When you stop and think about it, you realize that you are probably negotiating for something every day . . .

-     Can you work on a flextime basis, instead of logging in and logging out at regular hours?

-     Would your company consider setting up an in-house daycare center for employees’ children?

-     Will your husband or wife cook dinner for your family tonight, so you can go to the gym on the way home?

-     Can you take on a bigger job – the one that a departing colleague just vacated?

When you are about to discuss questions like those, it is tempting to think that you are about to enter into conflict, not into conversation. According to Fisher, that is a mistake. He writes that it is better to practice something that he calls Principled Negotiation – an approach in which both parties look for areas of mutual gain.

Here are the four principles of Fisher’s approach . . .

-     Separate the people from the problem. For example, set aside the fact that you don’t like your office manager and that you want to score a win against her. Remember that when you negotiate, you will come to a better agreement if you focus on issues, not personalities.

-     Focus on interests, not positions. Instead of saying, “I need flextime, period,” discuss your underlying reasons for needing it and invite the other side to express its interests too. When you strive to make a situation better for both sides, you are more likely to make progress toward your goals.

-     Generate a variety of options before coming to an agreement. Yes, it is tempting to seize upon the first agreement that you and the other party find. But is it really the best solution? According to Fisher, you need to do the hard work to develop several solutions to any negotiating problem – and then pick the best of them. After all, it is possible that the third solution you hit upon will be the best.

-     Make sure that your agreement is based on objective criteria. You will stick with your flextime schedule after a month of evaluation to make sure your productivity remains strong, for example. Or your promotion will become permanent if you improve your department’s output by 10 percent. When you develop objective ways to evaluate the results of your agreement, you make it more attractive for the other side to agree to what you want – and you keep the door open for later negotiations of the agreement does now work out as well as you hoped it would.

Medical Billing and Coding Blog is sponsored by Ultimate Medical Academy (UMA), a leading healthcare career school. UMA has campus locations in Tampa and Clearwater, Florida, as well as a national online program.  For more information about UMA please visit our website at www.ultimatemedical.edu

We all do it, because procrastination is one of life’s guilty little pleasures. But if procrastination becomes a habitual pattern, it can add a lot of stress to our lives.

So, do you procrastinate? According to the book Good Stress, Bad Stress, these could be the underlying reasons:

Cumulative procrastination – If you’ve let your work pile up, it becomes harder and harder to attack it.

Perfectionism – If you’re worried that you cannot handle certain tasks well, you tend to avoid them.

Conflict avoidance – If you fear that tacking a certain project will trigger disagreement with your boss or a colleague, you tend to avoid it.

Here are some procrastination-fighting techniques for medical billers and coders recommended by Barry Lenson, author of Good Stress, Bad Stress:

Tackle unpleasant tasks first thing in the morning. If you’ve been delaying a touchy conversation with your boss or a colleague, have it as soon as you arrive at work. Tackling dreaded tasks first gives you energy that can boost your productivity through the day.

Say, “I’ll work on it for just five minutes.” This tactic works especially well if you have let work pile up. When you make just a small commitment to start on a backlog of work, you break the logjam and get going.

Work with a partner. Take a batch of coding work, divide it up with a colleague, and get started. (And offer to share his or her work in the same way.) When you cooperate on a body of work, you stand a better chance of whittling a pile of work down to size. Cooperation is fun and energizing.

Have you found strategies for fighting procrastination? If so, why not take a moment and share them here with other readers of Medical Billing and Coding Blog?

“Little things mean a lot when it comes to making important impressions,” Benton tells Medical Billing and Coding Blog. “A traditionally professional bearing shows respect to people in the company and the organization as a whole.”

Debra Benton’s advice for interviewing women . . .

-     Dress in a dress, slacks or a jacketed skirt.

-     Don’t wear jeans, even designer ones.

-     Wear close-toed, low-heeled shoes or flats, not today’s sexy, popular platforms.

-     Pull your hair off your face and out of your eyes, and don’t play with it during the interview.

-     Show no cleavage or upper thighs, because your clothes shouldn’t be more interesting than you are.

-     Don’t wear noisy bracelets or distractingly dangly earrings, despite today’s fashions.

-     Cross your legs at the ankle rather than at your knee to avoid a nervous or a flirty-looking swinging of the leg.

-     Laugh, but don’t girlishly giggle.

Debra Benton’s advice for interviewing men . . .

-     Wear a collared sport jacket, suit jacket, or suit.

-     Wear a collared shirt.

-     Don’t wear jeans, even designer ones.

-     Wear close-toed shoes, not sandals or sneakers.

-     Your shoes and belt color should match.

-     Have a reasonable hair cut.

-     Be well groomed, which means checking out your fingernails, nose and ear hair too.

Debra Benton’s advice for both men and women . . .

-     Arrive with an attitude that says, “I really want to be here!”

-     Sport no tattoos – unless you’re part of the Maori tribe.

-     Show no visible body piercing – your ear lobe is okay, but pass on nose, lip, and eyebrow.

-     Stand up straight and carry yourself with control.

-     Firmly shake hands.

-     Slow down your walk, talk, and gestures, so that you will look more confident.

-     Refrain from using sexual expressions like “we’re screwed” or, “turned on.”

-     Keep a game face, with a relaxed expression of lips apart and corner of the mouth turned up.

-     Never drink alcoholic beverages before interviews.

-     Be good-humored – it makes the interview pleasant for you and your interviewer.

-     Speak in complete sentences.

-     Turn off your cell phone – don’t text, talk or have it buzzing in your pocket.

-     Don’t smoke before the interview. You might think you can hide it with Altoids – but you can’t!

Medical Billing and Coding Blog interviewed Debra Benton, who has been called “America’s top executive coach.” Ms. Benton is author of the new book, CEO Material: How to Be a Leader in Any Organization (McGraw-Hill, 2009). Her client list reads like a “Who’s Who” of top executives from such companies as Campbell’s Soup, Dell Computer, McDonald’s and Time Warner. She has been featured in Business Week, Fortune, the New York Times and Time, and has appeared on Today, Good Morning America, and CNN. Her other bestselling books include Executive Charisma and How to Think Like a CEO. She is founder and CEO of Benton Management Resources in Livermore, Colorado.

Medical Billing and Coding Blog is sponsored by Ultimate Medical Academy (UMA), a healthcare career school. UMA has campus locations in Tampa and Clearwater, Florida, as well as a national online program.  For more information about UMA please visit our website at www.ultimatemedical.edu

If you’re looking for a book to get you moving, here’s a list of 10 of today’s self-help bestsellers on Amazon.com, with quick descriptions. (If you click on the books’ titles, you’ll be taken to their full listings on Amazon.com.)

Lift by Kelly Corrigan

From the publisher’s description of this book: “In Lift, Corrigan weaves together three true and unforgettable stories of adults willing to experience emotional hazards in exchange for the gratifications of raising children.” (Voice Publications; $16.99)

Women Food and God: An Unexpected Path to Almost Everything by Geneen Roth

From the publisher’s description of this book: “If you suffer about your relationship with food – you eat too much or too little, think about what you will eat constantly or try not to think about it at all – you can be free.” (Scribner Books; $24.00)

Life! By Design: 6 Steps to an Extraordinary You by Tom Ferry

From the author’s statement: “Writing this book is the culmination of 20,000 hours of coaching clients on choosing to have a life – By Design . . . I’ve been given unprecedented insight about what kills performance or what stops people from truly living a life that they really, and I mean really, love.” (Ballantine Books; $16.50)

The Secret by Rhonda Byrne

From the publisher’s description of this book: “In this book, you’ll . . . begin to understand the hidden, untapped power that’s within you, and this revelation can bring joy to every aspect of your life.” (Atria Books; $24.95)

Drive: The Surprising Truth About What Motivates Us by Daniel H. Pink

From Publishers Weekly’s review of this book: “According to Pink . . . everything we think we know about what motivates us is wrong. He pits the latest scientific discoveries about the mind against the outmoded wisdom that claims people can only be motivated by the hope of gain and the fear of loss.”  (Riverhead; $26.95)

The 7 Habits of Highly Effective People by Stephen R. Covey

From amazon.com’s review of this book: “The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change was a groundbreaker when it was first published in 1990, and it continues to be a business bestseller with more than 10 million copies sold.” (Free Press; $15.95)

Getting Things Done: The Art of Stress-Free Productivity by David Allen

From Booklist’s review of this book: “Allen, a management consultant and executive coach, provides insights into attaining maximum efficiency and at the same time relaxing whenever one needs or wants to.”  (Penguin Books; $16.00)

The Book of Awesome: Snow Days, Bakery Air, Finding Money in Your Pocket, and Other Simple, Brilliant Things by Neil Pasricha

From Publishers Weekly’s review of this book: “Though tongue-in-cheek, Pasricha emerges a committed but inviting optimist, combating life’s unending stream of bad news by identifying opportunities to `share a universal high five with humanity.’ Readers looking for simple, unsentimental pick-me-ups should find this happy browsing.” (Putnam Books; $22.95)

Blink: The Power of Thinking Without Thinking by Malcolm Gladwell.

From Amazon.com’s review of this book: “The key is to rely on our `adaptive unconscious’ – a 24/7 mental valet – that provides us with instant and sophisticated information to warn of danger, read a stranger, or react to a new idea.” (Back Bay Books; $15.99)

If You Have to Cry, Go Outside: And Other Things Your Mother Never Told You by Kelly Cutrone and Meredith Bryan.

From the publisher’s description of this book: “With chapters on how to find your tribe (those like-minded souls who make your heart sing), how sometimes a breakdown is really a breakthrough, and how there is no such thing as perfection, Kelly also shares practical advice, such as how to create a personal brand and how sometimes you have to fake it to make it.” (HarperOne Books; $22.99)

Medical Billing and Coding Blog is sponsored by Ultimate Medical Academy (UMA), a leading healthcare career school. UMA has campus locations in Tampa and Clearwater, Florida, as well as a national online program.  For more information about UMA please visit our website at www.ultimatemedical.edu

- Maya Angelou, in an interview with Oprah Winfrey.

Is it possible to manage workflow that comes to you from two, three or more bosses?

It can be done, but it can also be a challenge. Consider these words from a medical biller and coder who works for a small group of physicians:

“Each doctor thinks that his or her work is priority one,” she states. “And since I am not really in a position to say no to any of them, I feel like I am being pulled in all directions while my in-basket piles higher and higher.”

So, how can you manage workflow from multiple bosses? Here are some suggestions from a variety of experts.

Suggestion One: Let Your Bosses Decide what Comes First

Get conflicting bosses into one room and let them help set your priorities. But don’t use this tactic if both bosses are already fighting aggressively for your time – you could end up with an even bigger pile of work and no resolution.

Source: Adapted from the book Managing Multiple Bosses: How to Juggle Priorities, Personalities & Projects – and Make It Look Easy by Pat Nickerson (AMACOM books, 1998).

Suggestion Two: Keep a Time Log

Simply keep a calendar for three or four days where you log exactly what you worked on, in 15-minute increments. If certain bosses are claiming an unbalanced share of your time, your time log should provide documentation that things are not being handled fairly.

Source: Adapted from the book How to Get Control of Your Time and Your Life by Alan Lakein (Signet, 1989).

Suggestion Three: Schedule Individual Meetings with Your Bosses

Schedule time with each one. Explain that you want to handle everyone’s work more effectively, explain the workload you are dealing with, and ask them to make suggestions. Asking for help in this way is more effective than saying no to new work.

Source: Management consultant Jennifer B. Kahnweiler writing on AMANET.com.

Suggestion Four: Ask Your Bosses to Assign a Number Priority to Each Piece of Work

If you get your bosses to assign a priority rank to each piece of work they give you, you then have a system in place that helps you first tackle the work they say is most important.

Source: Advice on Monster.com’s AdminSecret blog.

Suggestion Five: Make It All Visible

Set up a different inbox where each of your supervisors should place work that is being delegated to you. Make sure to set up this area so that all delegators can see how their demands compare to those of other delegators.

Source: Barry Lenson, contributing editor to this blog. Barry was senior editor at the National Institute of Business Management for more than 10 years.

And another tactic . . .

Saying “can you help me set priorities for the work you are giving me?” can be a subtle, yet effective, way to get your bosses to accept the fact that not every piece of work they give you is your #1 priority. As Maya Angelou implies in the quote that opens this post, you sometimes have to set up boundaries on the work that others give to you.

Medical Billing and Coding Blog is sponsored by Ultimate Medical Academy (UMA), a leading healthcare career school. UMA has campus locations in Tampa and Clearwater, Florida, as well as a national online program.  For more information about UMA please visit our website at www.ultimatemedical.edu

1.  Unbundling of codes

a. Unbundling is breaking apart codes that are inclusive of other codes.  This not only affects reimbursement but it is illegal to do and will trigger an audit.

2.  Not coding the diagnosis code to the highest level

a. This is due to the fact that some ICD-9-CM codes need a 4th or 5th digit to be accurate and correct, something that many beginning coders will miss.

3.  Not understanding how to interpret the operative reports

a. For instance, if a laminectomy is performed, but the word laminectomy is not mentioned in the body of the operative report, the coder thinks that it has not been performed.  The physician has described the procedure in the report but not mentioned the term laminectomy; fully understanding how to interpret the operative reports will limit this error

4.  The physician not marking on the encounter form or superbill that they performed an x-ray gave an injection…etc

a. The coder has no idea that these were done unless it is mentioned in the documentation on the chart.  Usually by this time, the coder or biller has already sent the claim out. They then have to submit an amended claim which could result in lost time and money.

5.  Not having access to the provider, surgical tech or the documentation to be able to audit the claim.

a. In the situation where a coder is working off site from the provider’s office, they may not be able to contact the provider or see the documentation from the patient’s chart.  If they have a question about something, they have no way of getting that information unless they have a good relationship with the physician’s office.  Therefore, it takes a team of the physician, surgical tech, medical assistant, front desk staff and the medical records to sometimes get the information they need to code the claim correctly.

6.  Coders and Billers not having access to the Explanation of Benefits.

a. The coders and billers have no idea of any mistakes that have been made when the claim has been denied.  The bigger the practice the harder it is to track and correct these mistakes right away.  Usually, whoever is putting in the payments work the denials.  However, if the coder does not know what is wrong with the claim, they have no way of fixing the problem in the future.

7.  Collecting the patient’s co-pay up front.

a. The co-pay should be collected before the patient sees the physician.  The front desk coders should know in advance what the patient’s co-pay is and if they have met their deductible for the year so they can be ready to ask for it when the patient arrives.  This is an agreement between the patient and the insurance company.  If they continue to not pay their co-pay, the insurance company has a right to drop them.

8.  Undercoding.

a. This happens when the physician actually performs more than he charges for because he is afraid of an audit.  This is just as bad as upcoding; charging for services that were not performed.  This is also illegal and can trigger an audit as well by the OIG (Office of Inspector General).

9.  Physicians not documenting everything they did in the chart even though they may have done it.

a. A physician’s note should be able to stand alone – what the patient is being seen for, the physical examination, the doctor’s assessment and his treatment plan.  If it is not documented, it was never done and is not billable. Sometimes, this is where the coder needs to educate the physician on how to document.

10.  Coder’s not keeping up with their education of what has changed from the previous year or even daily with some insurance companies.

a. Physicians need to realize that a coder’s job has to include continuing education.  If the coders do not have the opportunity for continuing education, they will fall behind in their knowledge of the industry and therefore make mistakes.

It might be tempting to say “not much,” especially if you are setting up a computer in a home office and working part time. But then you start to think. What would happen if your computer was lost or stolen and you were not able to keep working for a period of time? What would happen if a client who stopped by to see you slipped on your front steps and got injured?

According to the U.S. government’s Small Business Matters resource for small businesses, here are some kinds of coverage that you would be wise to consider before starting a small business of your own:

-     Home-Based Business Insurance – According to Small Business Matters, homeowners’ insurance policies generally do not cover home-based business losses. While you may be able to add property damage riders to your policy, you may need to purchase additional policies to cover other risks, such as general and professional liability.

-     Commercial Property - This covers losses and damage of company property due to fire, smoke, severe weather, vandalism, and other events. It can cover lost income, business interruption, buildings, computers, company papers and even money that you have on hand.

-     General Liability - This insurance can provide protection against accidents, injuries and claims of negligence.

-     Professional Liability - If you provide a service, this insurance protects against malpractice, errors, and negligence in the services you provide to your customers. (Let’s say, for example, that a client incurs a loss because of errors you made.) Some state governments require certain professions to carry such a policy. To check your state’s requirements, click here.

Where can you find out more about the coverage you need? Speaking with an insurance agent in your area can be a good place to start, since local agents are likely to be aware of state and local laws and legal precedents. The Independent Insurance Agents & Brokers of America, a not-for-profit professional organization, offers a “find an agent” service that you can search online.

That’s a question you should discuss in depth with an attorney and tax advisor, because each structure can present different liability protection, tax liabilities, and reporting requirements. But according to “The Basics of Business Structure,” an article on Entrepeneur.com, here are some basic concepts you need to know:

• A sole proprietorship simply means that you are an individual doing business as yourself. (You can use your own name as the company’s name, or operate under a different company name you create.) Setting up a sole proprietorship is simple, though you might need to register your business with your municipality. The disadvantage is that there is no distinction between you and your company, and you could be personally liable for business debts.

• A partnership means that you and one other person are doing business together – it is essentially a sole proprietorship operated by two people. It’s easy to set up too, but both partners can be liable for debts. This is one reason that Entrepreneur.com advises potential partners to retain an attorney to draft a partnership agreement ahead of time.

• A Limited Liability Company (LLC) is a relatively new kind of business structure that offers the simplicity of a partnership with the liability protection of a corporation. To set one up, you may need to file legal forms with state agencies and pay registration fees.

• A corporation functions as a legal person in the eyes of the law. It can protect its owners from liabilities, and it can sell stock to raise funds. However, corporations are generally required to pay annual fees, hold stockholder and board meetings, and file reports.

So, what is the best structure for you? That’s a rather complex question. So if you’re going out on your own, meet with your attorney and tax advisor to weigh your options.

Job-seekers with common sense would never make mistakes like those. But the problem is, even smart people can make small blunders that tarnish their images.  The most common mistakes seem to be scuffed shoes, stained ties and excessive jewelry.  But other problems can be overlooked by smart job-seekers too. Here are some basic points to cover, adapted from “Dressing for Success”, an article by Alison Doyle on About.com.

Women’s Interview Attire . . .

-     Moderate shoes

-     Limited jewelry

-     Neat, professional hairstyle

-     Tan or light hosiery

-     Sparse make-up and perfume

-     Manicured nails

-     Portfolio or briefcase

Men’s Interview Attire . . .

-     Dark socks, professional shoes

-     Very limited jewelry

-     Neat, professional hairstyle

-     Go easy on the aftershave

-     Neatly trimmed nails

-     Portfolio or briefcase

Have you made mistakes in interview that you would like to help other job-seekers avoid? If so, please take a moment to tell us about them on this blog.