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.