Wednesday, December 30, 2009

Working in Working Out



Everybody is either busy, or worn out from being busy. When, oh when, do we have time to exercise? But we must. Exercise is good for your heart, your muscles, your flexibility, and for maintaining a healthy weight. It's also great for your mood, especially important during these gray, cold days. Try exercising to music; the beat can't help but make you feel better.

Make a commitment to exercise, and then find time to do it. Signing up for a class, or joining a gym may make it easier to commit; once you've paid for a class, it's more of a motivation to stick to it. And exercising with friends makes it fun!
Even in our small community of Berkeley Springs, you should be able to find a class to suit your exercise level. Here are some that I've taken and can personally recommend; and by the way, music is used in all three classes to help you move and groove and improve your mood!

  • Zumba, taught by Rene Garcia Kesecker, is a high-to-medium impact aerobics class with a Latin beat. You'll need a good pair of training shoes, some loose clothing, and an attitude! Zumba is fun and will bring out your sassy streak. Rene teaches Zumba at the Ice House on Monday nights at 5:30 and Wednesday nights at 6:00. Call her at 304.258.6747 for more information. 
  • Bellysima, taught by Angela Petry, uses the technique of bellydancing isolations to strengthen your core, improve flexibility, and burn calories. Shimmying is good for the soul! Since beginning Bellysima this summer, my back feels stronger and I feel more balanced. You'll need some comfortable clothing to start out, and a yoga mat for the warm-up and cool-down; you'll probably also want to buy a jingly hip scarf and a veil to dance with. Beginners are welcome, especially to her new Tuesday class at 6:30 at the Ice House. Call (304)995-5832 for more information.

The Ice House hosts several other exercise classes (I haven't taken these myself):
Gentle Yoga with Joyce Morningstar, Saturdays at 9:00. Call 304.258.6247 for more information
Tai Chi with Michael Pushkin, Thursdays 11am & 5:30pm. Call 304.258.4653


  • Marcy Fleeharty, through Morgan County Adult and Community Education, is once again offering her awesome Yoga classes. Both classes are at Widmyer Elementary School in Berkeley Springs. You'll need comfortable clothing and a yoga mat. Yoga Basic begins on January 4 for 10 weeks at 4:30. Yoga Fusion, an intense workout that combines Pilates and Yoga, begins on the 4th at 6:00.  I can personally attest that the Yoga Fusion class will kick your butt! Call 304-258-2430, ext 19 or 20, to register.


Do you have a favorite exercise class in the area? Please let me know. We're happy to put flyers advertising exercise or wellness classes on our office bulletin board. Post your favorite exercise class on our Facebook page. If you're reading this on Blogger and you don't belong to Facebook, feel free to comment here.

Coming up next: Favorite workout videos. What's yours?

Tuesday, November 24, 2009

Just in Time for Open Enrollment: Navigating the Medicare Website

Open enrollment for Medicare recipients began November 31 and ends on December 31. During this time, people with Medicare can add, drop or change their prescription drug coverage. They can also select a health plan for their 2010 coverage.

Whether you are new to Medicare, and feeling bewildered by the choices you have, or if you’ve had the same plan for years but are curious about what else is out there, the Medicare.gov website is a great tool. Using customized searches, Medicare recipients can search for a health and drug plan that’s right for them.

Pam Mann of the Morgan County Library and Bibi Hahn of Hahn and Nelson Family Medicine will conduct a workshop at the Library on December 9 from 1-3 pm on using the Medicare website. This workshop is meant to raise the comfort level of using the website so that participants can make an informed decision on their own. In order to use the personalized searches, participants will need to bring a list of their prescriptions, their Medicare number, and the name of their preferred pharmacy.

Please call the Library at (304)258-3350 to register for the workshop. The workshop is free of charge and will be limited to 10 participants.

Monday, November 23, 2009

A Bitter Pill or a Better Choice? Is a Concierge Practice Right for You?

There has been a lot of news about a new type of primary care practice, sometimes called a "concierge" practice. In this type of practice, a patient pays somewhere in the neighborhood of $1000 a year for access to a primary care provider. The patient in turn, is guaranteed coverage of all primary care routine visits, with no co-pay. I have to disagree with the link's headline that it has to be a "bitter" choice. For a relatively healthy person, paying $1200 a year for personalized basic healthcare dictated by that patient and his/her doctor vs paying thousands of dollars to an insurance company that really, only cares about the bottom line, might make sense. For $1200 a year, I can go to my primary care doctor for routine blood pressure checks, occassional colds or allergy shots, and not have to face an office co-pay. Nor will there be any unpleasant surprises in the mail if my insurance company decides it shouldn't have to pay for something like a a flu vaccine.

The physician, with the assurance of a steady income rather than being bogged down by the fits the insurance claim process can cause, can take the time that a primary care provider should devote to every visit. Most patients don't understand how long it actually takes to bill for that $88 office visit. To them, they may be with the doctor for 20 minutes. But behind the scenes, the work starts even before the patient arrives in the office. Does the patient still have insurance eligibility? Once the patient gets into the office, the provider then has to spend time trying to decide how to "code" the visit so the claim gets paid. Should that wart removal be a surgery, or something else? Will we get paid for the EKG by this insurance company, or should we just bill for a more comprehensive visit? If the claim is rejected, someone has to figure out what went wrong. This often means countless time on the phone with a claim representative. The claim is resubmitted, hopefully, to get paid this time. Patients often don't realize that it's not just their insurance company the provider is dealing with; it's often 20 or 30, many of them with different rules and nuances.

Time and other resources should be spent on the treating the patient, not worrying about how to get paid. Time spent with a patient is especially important in the Family Practice, where the emphasis is on treating the whole patient rather than specific body systems as in a specialized practice.

So, would a concierge practice, perhaps backed by a lower-cost catastrophic insurance policy, be right for you? One of our friends, Dr. Shawn Moyer, offers his Pinchot Plan to his patients. It's also a great idea for small businesses. What do you think? Would this be right for you and  your family? In this age of rising premiums, and minimal healthcare reform in the future, maybe it's time to think of alternatives.

Friday, November 20, 2009

Coming Soon: Navigating the Medicare Website Workshop

Just in time for Open Season! The Morgan County Library and Hahn and Nelson Family Medicine will conduct workshops for seniors interested in learning how to navigate the Medicare website, especially during Open Enrollment season. Stay tuned to this blog for times and places. Call (301)678-7007 or email if you're interested in attending.

Thursday, November 19, 2009

Medicare Open Enrollment Begins

Beginning November 15, our patients eligible for Medicare coverage can review their plan and update it according to their needs. For many, this can be bewildering. However, if you're able to read this blog, you're already on your way to some helpful information.

I went straight to the Medicare website and found some helpful links. First of all, if you want a primer on using the page itself, the Help link on the upper right hand side of the page will get you started. On the right side of the page, you can find general topics such as "Original Medicare" and "Medigap Policies." This is great information especially to those new to Medicare. Be aware that if you choose to "Learn More," your browser will want to open a pop-up window so be sure you have your pop-up blocker off. Note that the pop-up window is divided into tabs, so you can look at a Glossary, learn how a plan works, or even learn more about how to choose a plan.

One very useful tool is found on the left side of the page. Find the section headed Learn More about Health Plans and Medigap Policies in Your Area. You can open the listbox within, choose your state and click View Plans. A chart displays showing you all the plans available in your state, and you can easily see how much the premiums are, and what is covered. You can also see how it's rated. There are links to plan websites, and phone numbers for further contact.

Take your time, ask questions, and talk to friends before choosing your plan. Consider cost, convenience (can you use your local pharmacy and physician?), quality and performance, and benefits. You have until December 31st.

earn More About Health Plans and Medigap Policies in Your Area

Wednesday, November 11, 2009

United, more.

Yep. I am seriously going to consider shopping around for insurance... I currently carry United, and now I'm wondering: why am I paying these people $600 a month?
  • They are living proof of why we need a public plan. Why can the government afford to pay us more than they do?
  • They denied a claim of Willa's because her problem occurred within 6 months of buying the policy. Too bad for her. She should've waited to get sick!
  • They refuse to realize that we do not participate in their capitated plan: which means I have a small pile of rejected claims. Each of these takes approximately 20 minutes on the phone. I've spoken to the provider representative at least twice, and called about each mis-calculated claim to the claims department.
  • See my previous insurance rant.
  • Now I've been on the phone for 20 minutes for an $88 claim that was rejected because, supposedly, the member's plan "does not cover this visit, consultation, evaluation and management." I was able to find the member online on United's website (which is actually, surprisingly, quite good.) and find that her coverage is 100%. But, I couldn't find her claim status anywhere. So I reluctantly picked up the phone. The phone number on the top of the EOB was, I find out after sifting through the voice response system, only for customers. I was connected to the provider number and got a very nice young man who could, after awhile, finally pull up my patient. But he couldn't find any claims matching the one that we have that was rejected. He looked and looked -- we used every number on the EOB that could conceivably be used to retrieve a patient's records. Nothing. He put me on hold. He looked some more. Finally he decided to transfer me to a "claims specialist" who he was sure would be able to resolve the problem. I sat on hold for about 2 minutes, and then -- I was disconnected.
Ooooof. So now what do I do? Is it worth $88 to start all over again? Do they want me to just forget it, and maybe bill the patient?

Let me state here that every single person I've talked to at United Healthcare has been very nice. I have nothing against them personally. But they need to do something about this mess they call "healthcare."

Thursday, November 5, 2009

1000 strong! AND H1N1 vaccine is HERE!

11/5/2009 5:05 pm: Hahn and Nelson Family Medicine, after being open for barely four months, registered our 1000th patient! We can't reveal the name of the patient because of HIPAA regulations, but let's just say she was happy to receive the bouquet of beautiful flowers that were presented to her.

We'd like to say right now that every single one of our patients is special to us, no matter when we registered you. We love and care for you all.

Actually, we care about everyone regardless of patient status. In fact, we're getting a shipment of H1N1 vaccine that we are happy to administer to anyone in the community. We prefer that you meet the criteria specified by the CDC and preference will be given to those who meet it. Just call us at 301-678-7007 or email us at hnfm @ verizon.net (you'll have to type this into your email software -- we're not linking to it because of spammers) to make sure we have some left and to find out the best time to stop by. We will be charging a small $10 fee to administer the vaccine -  the vaccine itself is free. You will need to fill out a form.

OK, that's enough good news for now! Stay healthy.

Tuesday, November 3, 2009

Ode to the Front Desk Staff


Next time you go to your doctor's office, take a really close look at the people sitting behind the desk. They probably appear fairly calm, although they may be surrounded by paperwork, ringing phones, and a computer demanding that they click something.  I never really thought much about what goes on there until this week. Robin is this minute somewhere on a cruise ship, probably enjoying one of those round-the-clock buffets and endless fancy drinks, while I've been attempting to fill in for her and help Lindy run the front office.
Monday could best be compared to sitting in a room with 5 tiny babies. As soon as one of them goes to sleep, another starts to cry. As you pick up the crying baby, another one needs its diaper changed, and another one rolls off of the changing table. It goes like this: The phone is ringing, sometimes 2 or 3 lines at once. Someone is waiting to check in and pay a co-pay, someone else is waiting after their appointment to schedule another appointment. Then, just as you think it's quieting down, someone walks in and wants to register as a new patient.  Or one of the doctors needs to be shown how to do something on the computer, or asks you to make a phone call.
I'm used to working in the back office, calling insurance companies about claim denials, posting payments (when we're lucky enough to get a check!), calling patients with appointment reminders, creating billing statements, and lots of other little tasks. I enjoy working on one thing at a time, with occasional breaks to stretch my achy neck. Working up front was a shock to this extremely introverted soul!
I tried to recall any time when either Lindy or Robin had seemed overwhelmed, cross, or even mildly upset. I wasn't able to summon up one negative peep out of either one of them! As I cruised through my mental image library, all I could see were two calm, usually smiling faces, talking gently to patients, answering the phone professionally and politely. How do they do it?
I think it's because they genuinely care about doing a great job, and because they really love our patients.  I hope it's also because they've found a place where they feel valued and like they're making a difference. Because they are.

Tuesday, October 20, 2009

I blog so I do not scream.

It might frighten the patients.

United Healthcare is right now on the top of my sh*t list. This is terrible, because they are currently my insurance company (but if I can help it, not for long). First of all: they pay doctors terribly. There is at least one Medical Assistance payer that pays better than they do. Then, they can't seem to get anything right. I keep getting back EOBs (Explanation of Benefits, to those of you fortunate enough to  not know) that claim we have a capitation agreement, meaning the insurer is supposedly paying us a monthly fee to care for their patients instead of paying a fee for service. We do not. So I have to call them, spend at least 10 minutes on the phone waiting for the insane Muzack to just STOP already and have someone pick up the phone.

This morning I got back an EOB with the capitation problem. I called United, punched in the numbers for the patient and our providers, got put on hold for about 10 minutes and finally got "helped" by a representative that claimed he couldn't help me because my patient's policy was held by a different group. I protested, saying that the patient's card had this phone number to call, as well a the EOB. He didn't cave, and gave me another number to call.

I called the number.... on hold for 5 minutes this time. Really bad Muzack, couldn't even tell what genre it was supposed to be ruining. Now I'm told that my patient must have an outdated card; the representative can't even look up my patient. I decide to call back the original United number I have, since I was able to get claim information using the automated system.  So, after being on hold for 15 minutes, someone answers, takes all my patient's information and our provider's information and told that I don't have the claims department and get transferred. After being on hold for another 10 minutes, the call is answered by someone with a very strong accent who sounds like she's talking underwater..... but I finally gathered that she was also the wrong department... this after she took all my patient's information as well as our provider's. I have now been on the phone for 30 minutes with no results. This for a charge of $118, which United, if we're lucky, will end up paying $60. Seriously.

OK. I've got someone on here who speaks English and I can actually hear her. I've given her my patient information. She can resolve the issue of the capitation but not why we're not getting paid for the office visit and just the procedure we did. So an initial charge of $118 will probably end up getting paid $30 if we're lucky. People with United HealthCare, your insurance company stinks!

If we had a single-payer system, I would be able to always call the same phone number, enter the same kind of information each time, and get help. I would be able to type the same kinds of numbers on my telephone's keypad. My providers would have one set of ID numbers instead of 15. We would only need to credential with one entity instead of 13 or 14. I would only have to access one website to get claims and benefit information. Robyn and Lindy would only need one access point to make referrals and get benefit information....Medical students could graduate and open their own little offices like ours without having to have an entire team of billing specialists to worry about all this stuff.... Dream on.

Wednesday, October 14, 2009

Flu/Pnemonia clinic

Hahn and Nelson Family Medicine and Pharmacare/Optioncare administered approximately 100 seasonal flu vaccines on Saturday October 10. A number of pneumonia vaccines were administered as well. If you were unable to attend our flu vaccine clinic and you still want a vaccine, Pharmacare has several additional clinics coming up. You should call to make sure the clinic is still scheduled, as the seasonal flu vaccine is in short supply.

Monday, October 12, 2009

Laughter is the best medicine

...and we can serve that up, too, apparently! It's good to know that your doctor has a good sense of humor, right!?

Saturday, October 3, 2009

Dr. Nelson to be Guest Speaker at Breast Cancer Awareness Day

Make some time for yourselves this Monday, ladies. Come to War Memorial Hospital in Berkeley Springs at Noon on Monday, October 5 for a light lunch and find out the latest on breast cancer screening guidelines from Dr. Marilyn Nelson. The lunch and talk are sponsored by the Morgan County Community Educational Outreach Service, the Morgan County Health Department, and the Morgan County War Memorial Hospital. Everyone is welcome!

Wednesday, September 30, 2009

Insurance Rant #99887789999

I'd just like to preface this little rant with a disclaimer: I love most of my work at Hahn and Nelson Family Medicine. However, it seems to be the work of our insurers to suck every little piece of joy out of life that they can. Once in awhile, though, I'll talk to someone who seems to really care. That happened today, after almost an hour speaking to other not-so-caring sheeple.
So one of our patients was told that she had to pay an out-of-network deductible because Aetna told her that the physician she saw was not an Aetna participant. Well, we are, and have been since at least July 15. Of course, this is after months and months of filling out forms and sending in duplicates of duplicates of licenses, etc. for the 12 or so insurance companies we wanted to cover. Don't even get me started on the incredible inefficiencies of the credentialing process (like, why isn't there ONE form, ONE set of standards, to credential physicians?)
So I called Aetna this morning... first thing on my to do list.
8:30 Called Provider Services and made my way through the maze of what number to press, inserted my Tax ID, etc. etc. and got someone on the line who said they couldn't help me because my providers were not linked correctly. We are credentialed, yes, considered participating, yes, but we're not linked correctly to our "service area." What does that mean? My head is just starting to spin. The trip to insurance world has begun. OK, so what number do I call? Got it.
8:45 Called the number I was given, which turns out to be claims, typed in the correct numbers for our tax ID (is there any way to put that on speed dial?) and my patient's ID number, blah blah blah. Got "Jen" on the line who looked up the claim and said that the claim had been processed under an incorrect Tax ID. I replied that that's strange, because the correct tax ID is on my Explanation of Benefits that came back from the claim. She replied that it must be a problem with my biller (yeah, right, let's pass the buck! quickly!). I sighed (deeply) and agreed to call Office Ally to get them to check things out.
8:55 Called Office Ally. They are so  nice to work with... someone picked up the phone immediately -- I only had to press one number on my phone's keypad. Nobody even asked me for an ID number. The representative assured me that the claim contained the correct Tax ID. I asked him if there was anything else that might've caused this to happen, but he was mystified. But he did ask me to call back if there were any other issues. OK, I called them, now back to Aetna.
9:00 Called Aetna back. After having to type in the patient's ID, Date of Service, etc. again, I had to listen to the claim details before pressing "0" to get a representative. It's now 9:10 because I accidentally asked for a fax of the claim to be sent.... duh. But that kind of stuff happens when you're in the altered universe that is the Insurance phone call.
9:10 OK now I have a very competent person on the phone, Sonya. She has the claim information already that I've typed in, but asks a few identifying questions. She tells me that the Tax ID number is fine. It's ours and she doesn't know why both the patient and myself have been told that it was incorrect. But she also verifies that the patient was billed for an out-of-network provider when she shouldn't have been, and gives me a resubmittal tracking number. I'm still concerned about why both the patient and myself were told about the incorrect Tax ID number, and ask to speak to the representative that told me about it. She tries to get my friend Jen on the phone but she's busy. I leave Sonya with my phone number and email address because I'd really like to know why it is that Jen was seeing something completely different from Sonya. Sonya is now my new best friend. Sonya gets busy trying to investigate the mystery herself. She's very thorough, and finds the provider that Jen said the claim was mixed up with but cannot figure out why someone thought it was linked to this claim. Now it's 9:33 and I've been on the phone for an hour. I have a stack of payables and checks on my desk along with some other more fun projects...
9:42 So I called the patient to just kind of wrap things up. She had originally gotten an email about the claim so she's sending that to me. I don't want to become obsessed with this. Blogging about it really helps. Not only will it help me journal my way through this learning process, it also helps me blow off steam!

Update: Sonya called back to tell me that Jen was, for some inexplicable reason, looking at two claims from JUNE. JUNE. We weren't even open yet. Hmmmmm. Hey, I don't know want to hear anything from people who claim the *government* can't run healthcare when this kind of stuff is happening in the private healthcare industry where people are paying dearly for their coverage. Of course, let's see what happens next week when we start filing our Medicare claims! Stay tuned....

Saturday, September 19, 2009

Walk Across Maryland is a Huge Success!



Thanks to all who came out to walk today. Leading up to the event, people frequently asked me "What is the walk for?" The answer was, YOU! The Walk Across Maryland is a way to make people aware that exercise is easy to access. Most people just have to walk out their door and there it is: a sidewalk. Others (like me) jump in their cars and drive a short distance. My favorite destination is Cacapon State Park. I go out there every couple of weeks and follow my favorite hiking trail. It's a bit wild, and the trail is far from perfectly flat, but it's a great workout. Part of the attraction is watching the environment change through the seasons. Some of us stop along the path and leave stacked stone sculptures. It's a jewel of a place.
Other days, it's just as easy to drive to the C&O Canal in Hancock. There, the trail is paved and flat. I can go a bit faster here and I don't have to be on the constant alert for branches, snakes, and bears. I love sneaking peeks of the river; sometimes I'm startled to hear one of the small airplanes that use the airstrip that runs alongside the railroad tracks on the West Virginia side of the river.
There are a couple of other walking alternatives here in Berkeley Springs: a cross country trail runs around the Intermediate and Middle Schools, and there is a new trail on the north end of town but I don't know a lot about that yet. I know there are still a lot of fans of the track, but this just isn't my thing. I suppose if I put on my iPod I could make it around a few times without falling asleep. But that's ok -- everyone needs to find their own thing and "just do it!"

Saturday, September 12, 2009

Oxbow to the rescue

I was just eavesdropping on my husband's phone conversation with his Oxbow colleagues. They're deep in discussion about how to bring their Electronic Medical Record (EMR) software to market. He was reading them a Journal of the American Medical Association (JAMA) article
(sorry, unless you have a membership you'll just be able to see the extract here) about how the current EMRs on the market don't provide good querying capabilities since most of the record is in "free text" format. This gives OK information on an individual patient, while you're looking at the patient record. But what happens, if in the case of our practice yesterday, your practice receives a limited number of flu vaccines? Shouldn't your EMR allow you to run a query and find those patients who should receive the vaccine because of existing health reasons such as COPD? Apparently most EMRs on the market wouldn't allow a physician to do that. Ours does. So that's what Dr. Hahn did yesterday. He ran a query to find those patients in the practice with certain health conditions that should prioritize them to receive the flu vaccine and called them up. It took a few minutes.

Compare that to the practice with paper charts. Have you ever seen a medical records room? It's a room with nothing but shelves and shelves, or cabinets and cabinets, of folders containing patient records. Can you imagine going through all those hundreds of records to find 50 patients to receive a vaccine? Would you bother? Probably not. Our EMR allows us to care. And that's what it's all about: a new way to practice old fashioned care.

Friday, September 4, 2009

Announcing Flu Clinic October 10

Hahn and Nelson Family Medicine and Pharmacare would like to announce a community flu clinic at the Hahn and Nelson office on October 10, 2009 from 10 a.m. to 2:00 pm. You do not need to be a patient to participate. Medicare will be billed directly for all Medicare patients; all other insured patients will need to file for reimbursement on their own (Pharmacare will provide you with the necessary paperwork). Please call Hahn and Nelson for other details: (301)678-7007. The cost of the vaccine will be available in early October.

Who should get the flu vaccine? The Centers for Disease Control (CDC) website has some excellent information on how to protect yourself from the flu.

Please note, this is NOT the H1N1 (Swine) flu vaccine. For information on H1N1 vaccine, please consult the CDC website.

Tuesday, September 1, 2009

Nice story....


I'm not going to moan about insurance companies today, even though it's been months since we started credentialing with Medicare and United and are still not able to bill all of our patient visits with those companies! No, today, I'm going to share with you the story of Jim McCoy and Dr. Hahn. Matt and Jim wrote the story for the American Academy of Family Physician's "Closeup" section in its August publication. I can't link to the story, so I'm going to post it here as a Jpg -- just click on it to make it big enough to read.

We love Jim and Bertha McCoy. I'll never forget the year Matt planned my surprise 50th birthday out at the Troubadour, Jim's famous roadhouse out on Highland Ridge. I didn't suspect a thing, not even when we pulled into the parking lot on a weeknight, to find it full of cars. I was so shocked when I walked in and saw all my friends, and even my mom! that I ran into Bertha's arms and gave her a big hug. I just wanted to hide at first! Since then we've had many wonderful nights of music and friends out there. In fact, we've had so much fun out there that we've decided to have our 20th wedding anniversary party out there later this month. Ya'all come by: it's gonna be fun!


Wednesday, August 26, 2009

Walk Across Maryland article

click on the article to make it big enough to read!

No EMR can fix this

2 hours on the phone today. 45 minutes on the phone to various phone numbers for help with a claim to Maryland Medical Assistance. Same annoying MIDI muzak for every single wrongly connected call. Talked to one human who told me that my patient was a "Priority Partners" patient and transferred me to another number where I was on hold for 15 minutes. Finally talked to another human who told me someone would have to call me back. So I went onto the next rejected claim, this one from Mountain State Blue Cross Blue Shield. I decided to go online and try to find some answers using their website.... but they just had a phone number (their fancy name for it is Interactive Voice Response System). And they had listed a special number for providers. So I called it, and realized as the robot listed all the choices I could make using my telephone's numeric keypad that this was a number for patients, not providers. So I started hitting random keys on my phone while muttering invectices under my breath, which sometimes leads me to an operator, but that didn't work (and, in this case, it relieved some stress!). Back online to find another number.... under the contact link, there it is, a number for providers! After 10 minutes on hold, I'm told that everyone is too busy to talk to me; do I want to call back in half an hour, or have someone call me back after 4:00? Well, neither of those choices is exactly a dry martini, so I get off the phone and so now it's 10:50 a.m. and once again, I feel like I've gotten very little done. How do people manage this job every day and not pull all their hair out?! I know, I'll move on to something positive, something good.

I want to blog about our next big event, The Walk Across Maryland, which will kick off the 2009 Health Olympics! The Hancock News has an article about it this morning, but I don't believe they make their paper available online, so once again as I did with the Journal article, I will post it seperately as a jpg. Basically, the Walk Across Maryland is just that -- we found a stretch of Maryland that is just one mile across here in Hancock. Many of our local businesses get involved, and post themselves along the route with water stations, apples, and other healthy offerings. Washington County Hospital is making up our t-shirts this year. The Walk will take place on September 19 as part of Hancock's Canal-Apple Days Festival. It only takes about 30 minutes to complete and it's a lot of fun! We'll probably have a table at the Festival where people can sign up for the Health Olympics. The Health Olympics is a very simple program to help people get started, or maintain, a healthier lifestyle. For 2 months, they'll track their exercise and eating habits each day, and attempt to give up one unhealthy habit. We give you a calendar where you can mark your progress, we weigh you in and note your goals. At the end of the 2 months, you come back, we re-weigh you. In years past, we've done some type of drawing to reward those who have met their goals. Rankin's Fitness is one of our partners -- they always donate some awesome prizes such as free memberships at their wonderful gym. We're still in the process of getting everything wrapped up, so stay tuned for more details!

Wednesday, August 19, 2009

Insurance woes

So I came into the office the other day at 1:00, full of energy and good intentions. I had a lot to do -- scads of files to be scanned and saved onto our network drive, billing statements that haven't been done since we started up, some promoting of our Health Olympics, and little things like getting new signs made... instead, I have been on the phone now for almost an hour now trying to figure out why one $132 claim hasn't been paid. A combination of waiting on hold just to find out I was waiting for the wrong person, and then finally getting only a voice message box to leave my patient's information and what I'm calling about has made this ordeal quite frustrating. Having left the information, I can only hope I'll get a call back -- and that I'll get the answer to my question.

But on the whole, the problems haven't been that bad. Now that we're credentialed with most of our insurance companies, as long as I have our patient information, and the EOB (Explanation of Benefits) handy, I can usually get problems resolved. One of the big frustrations, however, is trying to figure out who to talk to. Because payers are usually managed by great big companies, just because a patient has, say, a CareFirst card, doesn't mean a simple phone call to the phone number on the back of the insurance card. Oh no. When you get the automated voice, you're asked to choose between 4 options -- none of which sound like what you're looking at on the card. So what I usually do is just punch a number on the phone at random. This usually works after awhile. I used to be careful about this, and listened with rapt attention to the robotic voice on the other end of the line. But as my eyes started to cross and my brain twisted into irretrievable little rivers of sweat, I figured out what plan I wanted to reference and pressed the correct key on the phone. After waiting for 15 minutes to talk to a live human being, I recited the patient's ID number, only to be told that I was speaking to a customer service representative of Carefirst's National Plan -- not the plan that my patient had. So I figured it doesn't really make any difference.

Today we got our first sizeable insurance check. That almost made all of this seem worthwhile. Real pay day will come the day we can bill for Medicare, and we actually get a check. I think we'll all go out for a big happy hour that day!

Matt and Marilyn had a nice article in the Martinsburg Journal about how they're using Oxbow. Unfortunately, it's not linked for some reason. So I'm going to upload a JPG of the article -- not the best, but until I can get it on the hahnandnelson.com website, that's what I've got....

Our friend Russell Mokhiber appeared on the Greta Van Susteren's show on Fox Cable News last night to talk about his rally today against the Whole Foods CEO who has come out against Obama's healthcare reform plan. Russell, of course, is the organizer of Single Payer Action. Things got pretty heated... this woman is a barracude and I don't think Russell realized what he was in for. At any rate, they disagreed to put it mildly. We talked to Russell today, and he told us that not only had he received 500 hate emails, his family received threatening phone calls. Classy, right? I don't care if you disagree with someone, but you don't call up a guy's kids and act like a caveman. It reminds me of those Neanderthals that are showing up at healthcare town halls with their shotguns. What's that about? I get that you're against healthcare, but acting like you're going to kill someone is a bit out there!

I had my own little moment of fame last Friday when myself and 4 friends decided to make a show of support for Healthcare Reform. Our US Representative, Shelley Moore Capito, was in town for a celebration of our town's Streetscape project.

Alright that's enough rabble rousing for one day. More later!

Friday, August 14, 2009

No communication breakdowns here!

I got my laptop the other day and am now happily connected to our practice's network and the internet. I have Quickbooks loaded along with the practice's data. The only thing I need now to be a one-woman show is Oxbow. By the way, be sure to look at the new website! It's got video screen captures showing the software at work. 

At home I don't even really need the laptop unless I want to do accounting chores. For example, this afternoon I will log on to Office Ally, and make reminder calls to our Monday patients. I'll be able to file claims to the insurance companies, and if I wanted to, I could even print billing statements right from home.

I've been looking at ways to keep our small staff in touch with one another. Throughout the day we're all so busy doing our various jobs, but there is a lot of information that we really need to share. Our good old-fashioned whiteboard is in the back with lists of things to remember there; we have a bulletin board to post those many insurance company updates, our HIPPAA policy, workers comp, and other employee-type notices. But I'd like something electronic to use that we'll all see as soon as we turn on our computers. I've pretty much decided on going the Google route. I've designed a home page for each of us that displays our shared Google calendar, the user's  inbox, and some good health news sites such as WebMD and Google's health news. For fun I included a weather gadget and something called "the world's healthiest foods (this week's focus is grapes!) I like the shared calendar so far; Lindy and Robyn have been using it too. It even syncs with my Sprint Palm Pre along with my personal calendar at home, so I can see my entire day in a glance!. One gadget that shows promise is the "Things to Remember" gadget. I created it using the Make your Gadget page. This gadget can be shared, and it allows me to post things like "Always collect co-pays upon checkin!" and "Dr. Nelson is now par with Mountain State." The only drawback I can see is that only one person can update it, but that's not horrible. 

So once we play with this setup for awhile, I'll configure Google home pages for the providers, and configure gmail to import all their email from their previous email addresses. Between this and the good old-fashioned whiteboard, we can keep better touch with one another. Just another example of a New Way to Practice Old Fashioned Care!

Saturday, August 8, 2009

It's been a month...



We've been open for a whole month now... and it's been mostly good. Many many of our old patients have followed us to our new home, and we've gotten a few brand new ones as well. Our motto is "a new way to practice old fashioned care." Because we are a micropractice -- keeping low overhead with a tiny staff and a no-frills office -- we can afford to spend 30 minutes with the average patient. We don't need to see 25 patients a day, nor do we want to. Oxbow, our amazing EMR (electronic medical record) system, keeps our charting time down, reminds us of important health maintenance for our patients, sends out prescriptions and lab orders. We use an online scheduling and billing system that's free and easy to use so we don't have to pay a full-time billing or front office staff.  Lindy and Robyn, our nurses, do an incredible job of taking the stacks of new patient records and digitizing them so we can use them in the EMR. Their high-tech expertise is a wonderful complement to the caring attitude they always have towards our patients.  

Dr. Nelson is new to the area. She had been practicing in Cumberland in a family practice center, but was eager to try something new. She especially loves seeing children, and is looking for ways to expand our pediatric base. 

Dr. Hahn is happy to be back with his former patients. His forte seems to be the older patient. He loves hearing their stories, especially those involving secret fishing spots! 

The only problem we've been having is with insurance companies. We decided to embark on this adventure over the holidays last year. We found some support, especially through a local health system, who, among other extremely helpful things, offered us a credentialing specialist to get our insurance participation going. This can be an especially daunting experience, since every insurance is different, and they all need endless documentation; if just one "i" is not dotted, or "t" crossed on an application, it can send a provider's credentialing back to square one. So the credentialing started probably in February. I started sending Dr. Hahn's documents to our angel Amanda, who in turn, would send me reams of documents to read and sign. We started receiving contracts in May. 

The average patient doesn't realize that every insurance company pays its participating providers something different. Some insurance companies are notoriously bad at payment fees as well as service, others are better. It was very interesting to us that none of the contracts we received included fee schedules! We were being asked, in essence, to sign a contract with no specific agreement on what we'd be paid for each type of office visit. We would call the company, which could often mean 2 or 3 hours on the phone just trying to figure out who was the right person to talk to about this. So we would get the fee schedule finally, and either sign the contract, or try to negotiate some of the more pitiful fee schedules.

Now that we have been open for a month, and it's been almost 7 months since we started the credentialing process, we are still not totally "on par" with several companies. We have signed the contracts, received information in the mail, etc., but still when our patients call and request the change of provider, it's like we don't even exist. This, I suppose, will just take time, to "load" our record into their Byzantine system.

I had some real fun yesterday. The day before, a representative of the West Virginia Medicaid system came into our office to try to explain how they worked. I have only so much patience for the absurdity of unneccesarily complex systems, so I started tuning her out until I heard her mention that there were 3 entities, not just 1, involved in WV Medicaid. It seems that if a patient has "UNICARE" following the date of birth on their card, we bill something called Unicare, rather than UNISYS, which is one of the other entities. And then there is something called PAAS. Now, I knew that Amanda had credentialed us with Unicare and UNISYS, but I didn't know anything about PAAS. I also didn't realize that Unicare administered WV Medicaid; I thought it was a totally private insurance company, and I figured that we probably had already seen some patients that participated in that program. So yesterday I got to work. I had to figure out if Unicare that we were participating with already was the one that ran WV Medicaid, or if we had just been par with some other private company that also had the same name. It took me 2 hours. I had a credentialing letter from a company named "Unicare" and when I went to their website mentioned in the letter, I saw that they had state-sponsored programs, one of which was West Virginia. But, when I called the number on the letter, the representative I talked to declared that she had never heard of the West Virginia program and that it must be some other Unicare. And, furthermore, she said that she couldn't find either of our doctors in her system! So, I called one of the phone numbers on a patient's Unicare card (from WV Medicaid), and was told that they, too, thought that this Unicare had absolutely nothing to do with the "commercial" Unicare, but that both providers were, yes, credentialed. I still thought they were wrong based on what I'd seen linked to their website. To make a long story short, I finally called another phone number from the patient's ID card, and finally finally finally found some happy-sounding woman who declared that, yes, you should file all Unicare claims under the Unicare billing number, including WV Medicaid, and Yes, allelujah! she has both doctors as credentialed providers in her system.

Sorry if that is so rambling. But this is the sort of thing I've been doing since we opened. I had pictured myself going in to the office for a few hours each day to follow up on claims, happily depositing checks, calling patients to remind them of their next-day appointments, helping Lindy and Robyn up front, and then going on about my day. But instead, I've been doing stuff like my previous paragraph. I'll have a letter from an insurance company acknowledging that our doctors are credentialed, but then when I call with a question, it's like the letter was mailed from Mars or, maybe I'm in some weird altered universe. I cannot imagine that this is the best way to run healthcare! Why does each insurance company have such different credentialing requirements? Why does it seem like they don't know what's going on within their own companies? Why are they so mysterious about what they're going to pay us? Why does it take 7 months to push some paper around? 

If there were one payer, it might take awhile to get credentialed. But then it would be done. As it is now, we will have to stay on top of what -- 11? insurance payers and their constantly changing policies. It's our responsibility to read each of their bulletins on changes in how they're paying, and initiate changes in our procedures to keep up with it.  What other industry has this burden? We are responsible for people's lives. That should be our focus, not having to constantly read fine print, or risk not getting paid.