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Archive for July, 2009

This Sounds Familiar; Red Flags Rules Delayed

Posted by Paul Spencer, CPC, CPC-H in Fi-Med Services, Hot Topics, Paul Spencer CPC CPC-H

It was announced on July 28th that the twice-delayed implementation of the Red Flags Rules for identity theft (wait for it…..) have been delayed for a third time.

This third delay sets aside the rules’ implementation from August 1, 2009 to November 1, 2009, which would be exactly one year from the original proposed implementation date of 11/1/08.

From what I’m hearing throughout the industry, the entities both most affected and least prepared for implementation of the Federal Trade Commission guidelines are medical providers. This is somewhat ironic, as it was discovered within a year of the HIPAA Privacy Rule becoming the industry standard that the greatest threat to patient privacy was identity theft from the “inside”.

Medical providers and their ancillary agents now have an additional three months to get procedures in place for the prevention of identity theft. My primary suggestion to anyone who would ask would be to run credit and background checks on all employees who interact with protected health information on a daily basis.  Given the stringent nature of the Red Flags Rules, this should be standard operating procedure for all new and/or prospective employees in this capacity going forward.

Additionally, all patients should be asked for picture ID and an actual insurance card upon presentation to a clinic setting for treatment. This is a good practice to get into from a business perspective as well, as it insures that the most up-to-date information is on file and that claims are submitted to the correct entity from the get-go. 

This standard is a little harder to follow in an emergency room setting, as EMTALA laws force patient treatment upon arrival regardless of ability to pay. It is suggested that hospitals design a red flag model that allows for real-time determination of the identity of the patient above and beyond what is presented by him/her and/or their representatives upon arrival to an ER for treatment.

Building a Profitable and Defensible Fee Schedule

Posted by Lisa Velasquez in Fi-Med Services, Hot Topics, Industry Updates, Webinars

Do you know where your fee schedule came from? Is your office manager working off of a fax of a fax of a fax of a fee schedule created by a billing company you used years ago? Stark laws prevent physicians from comparing fee schedules–so how do you come up with your fee schedule?

Whether you are just starting your own medical practice or a seasoned veteran, I think you will find the information in this webinar very informative. The topic is “Building a Profitable ad Defensible Fee Schedule”. And as usual, if you can’t attend, the information is available to you (free) if you visit the webinar section of Frank’s website. 

Here is a brief description of what you can expect:

The fee schedule is the medical practice’s most important, yet least analyzed financial tool. Learn the benchmarks, metrics and resources needed to analyze and fine-tune your practice’s fee schedule code by code. In this workshop, Frank Cohen, data analyst and statistician, will show you how to identify over and under-priced services and how to solve low-paying fixed-fee contracts. Methodologies will include RBRVS, time, global charge models and benchmarking against  national and state charges. When complete, attendees will have acquired the skill set necessary to immediately begin their own in-depth fee schedule analysis.

For a nominal charge, attendees will have access to a complete tool box, which includes recorded versionsof the workshop handouts along with worksheets, templates, benchmark data and other resources necessary  to assist with the fee analysis and development process.

Title: Building a Defensible and Profitable Fee Schedule

Date: Tuesday, July 7, 2009

Time:1:00 PM-2:00PM EDT

If you can’t make it for the live webinar Frank will make all information available on his website.

Did you find this information helpful? If you have information that you think would be valuable to the medical community and would like me to post the information on our blog, please submit your request for review to my attention at (or via DM on Twitter@fimed).