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Posts in the ‘In the Press’ Category

The Many Ways of Being Newsworthy

Posted by Paul Spencer, CPC, CPC-H in Coding and Compliance, Electronic Health Records, In the Press, Paul Spencer CPC CPC-H

As I begin this post, it’s been a typical Friday. My 4-year-old son took an interminably long time getting dressed this morning, I showered, shaved, ate breakfast and my picture ended up on the front page of the Milwaukee Journal Sentinel….

OK, so one of those things is atypical. I’ll give you a hint: I usually eat breakfast.

For more information on my 14th minute and 58th second of fame in my lifetime, click here (I’m the guy with the orange guitar). The story accompanying my grainy image is self-explanatory. So as not to worry readers who may not click through about the reasons for appearing in the newspaper, it doesn’t involve an indictment, a drunken man running onto a baseball field or (surprisingly, to those who know me) a vicious automobile accident. In these troubled and trying times, it’s nice to be part of a good story for a change, and I’m looking forward to tomorrow’s events as described in the article.

So now that we all know what a happy story looks like, let’s explore the flip side as it applies to health care compliance. I came across a story out of Florida that is a good case in point. A couple from a town called Land O’ Lakes (like you, I immediately thought of butter) were making their Sunday run to their local recycling center. When they got there, they found that there was no room for their paper items in the designated dumpster at the center. This was because someone had filled the paper bin to capacity with discarded medical records. In some cases, the records included Social Security, credit card and driver’s license numbers in addition to medical information.  

The first thing I thought of with this story was regarding EHR, and how stories like this may become obsolete within five years. Then I begin to think the opposite, with the personal theory that as practices transition from a paper record to an electronic record, we may see instances like this more often thanks to record destruction companies attempting to cut corners.

Then I begin to daydream, first about dancing in rain made of Newcastle Brown Ale to the music of the Who, then shaking my head and quickly transitioning to the government’s recent re-dedication to recovering money lost from Medicare and Medicaid due to fraud.

Having been involved with coding and compliance for several years, I’ve learned that there really is no end to to the devious machinations of the ethically-challenged in our business. From podiatrists who bill foot care on patients who have had previous foot amputations to DME suppliers forcing unneeded power mobility devices on the local population of elderly residents, extending to the virus of identity theft currently infecting  some medical practices, you need a chain saw to cut through the levels of immoral behavior in this industry.

The damage that these assorted criminals inflict is not restricted to the CMS trust funds. Medical providers who spend their waking hours operating by the rules inadvertently find themselves in the outer remnants of the spotlight that shines on the crooks. The doctors acting above board and rendering legitimate services ultimately pay a high price for the actions of the bad seeds in increased regulation, investigation and bad public relations for the health care industry as a whole.

The current administration has doubled down on recovery of overpayments through fraud and abuse investigations. For the future of Medicare and Medicaid, I see this as overdue. There are many ways to make the news, but perhaps the best approach for the honest medical provider is to implement and follow policies that insure that you end up in the non-”perp walk” portions of the local news.

No News Is, In Fact, No News

Posted by Paul Spencer, CPC, CPC-H in In the Press, Medicare Fee Schedule, Paul Spencer CPC CPC-H

When last we left the legislative world as it relates to the 21.3% cut in the Medicare Physician Fee Schedule on Friday the 18th, the passage of a 2.2% pay increase was sent to the House of Representatives as a stand-alone bill ticketed for what was hoped to be immediate passage. Unable to hold claims any further due to statutory limitations, CMS ordered contractors to begin processing claims with dates of service of June 1st, 2010 and after with the 21.3% cut applied. It was also recognized that the earliest the House would vote on the Senate bill was Tuesday (yesterday).

This past Saturday, House Speaker Nancy Pelosi (D-CA) made it very clear that she was not inclined to pass the Senate bill unless it is part of a larger measure similar to what the House passed in late May. It appears from a cursory look at the House calendar for yesterday and today that Pelosi was not bluffing. Yesterday’s legislative session in the House was dedicated to such weighty issues as a recognition of National Caribbean-American Heritage Month and a discussion of a resolution supporting National Men’s Health Week. Today’s calendar continues the focus on just the sort of topics that should shoot straight up to the top of the legislative calendar when there is near-10% unemployment, two wars and the looming threat of Medicare patients not receiving medical treatment: a discussion of the Formaldehyde Standards for Composite Wood Products Act and the Congressional Award Program Reauthorization Act (who would want an award from these people?). Sixteen other bills and resolutions are on the House calendar for today, and the Senate pay fix bill is not one of them.

Here’s a tip for the House of Representatives: the best way to insure that National Men’s Health Week comes off as a success is to make sure that men, and indeed all people, of Medicare age do not have their relationship with their physician threatened by a 21.3% percent cut in the doctor’s reimbursement.

I’ll continue to monitor the ongoing and oh-so-important work of Congress as the payment apocalypse continues. For now, as the headline says, there is indeed no news on this front.

CMS Claims Hold To Continue

Posted by Paul Spencer, CPC, CPC-H in Hot Topics, In the Press, Paul Spencer CPC CPC-H

Due to what is considered the pending passage of legislation that will once again set aside the scheduled 21.3% pay cut to the Medicare Physician Fee Schedule, CMS has taken the unprecedented step of extending the current hold on processing of claims, which was set to expire today, through this Thursday, June 17th.

This current hold affects services from June 1st, 2010 and after. If for some reason legislation is not passed by Thursday, the claims hold will be lifted on Friday and claims will be processed with the cut.

Better News For The Physician Fee Schedule

Posted by Paul Spencer, CPC, CPC-H in Fi-Med Services, In the Press, Industry Updates, Paul Spencer CPC CPC-H

It’s been an interesting few weeks with regard to the Medicare Physician Fee schedule.

In my post on February 26th, I detailed the last-minute objections by lame-duck Kentucky Senator Jim Bunning to the passage of the bill which contained a 30-day hold on the 21.3% decrease in the physician fee schedule. Due to Bunning’s hold, CMS was left no alternative but to instruct carriers to hold all claims with dates of service March 1st and beyond for 10 business days in the hopes that the bill would be passed in the Senate. On March 2nd, after several hours on the Senate floor shaking his fists and yelling at clouds as only an elderly man can for the viewing pleasure of the C-SPAN audience, Bunning relented, the bill passed, President Obama signed the legislation into law and the claims hold was lifted almost immediately.

Due to the new deadline of April 1st, the issue was taken up again this week by Congress. The Senate actually acted first this past Wednesday, passing a bill that would extend the hold on the fee schedule decrease until October 1st. This legislation now returns to the House of Representatives for consideration next week.

What is still needed, and apparently not being talked about on the legislative side, is a permanent fix to the sustainable growth rate formula. The October 1st deadline now represents the 4th moving of the goalposts in a period of 3 months. While no one wants to see the 21% cut, the chorus from those wanting a permanent fix continues to grow louder.

With better news, we now enter a world more plagued by uncertainty than even the payment fix, this being the continuing saga of the broad healthcare legislation currently coursing its way through Congress at the rate of a sloth in an opium den.

From what I can gather from news reports, it would appear that a final vote on healthcare legislation is going to occur by the end of the month. President Obama has delayed a planned trip to Guam, Australia and Indonesia that was scheduled to take place from March 18-24 by three days in order to concentrate on getting healthcare legislation passed and enacted into law. So many variables remain on the table as the bill enters final negotiations that it would be premature of me to predict the shape of the final legislation. Judging by what I’m hearing, my optimism isn’t high.

As is often the case in Washington, the inflated sense of self-importance so prevalent in American politics tends to rear its head in the most ugly fashion possible when one side perceives that they aren’t getting everything they want right this minute. The cacophony of nonsense that has poisoned the well of civilized political discourse for the last 20+ years insures two outcomes, the first being ever expanding concentric circles of bad legislative decisions and the second being a chronic loss of interest in the issues that count from the rational people who most need to be part of the debate.

Rather than ending on a pessimistic note, I’ll end with a happier tone. St. Patrick’s Day is now five days away. I’ll be “out of the office” on Wednesday, March 17th. If you happen to be out in the great beyond of Milwaukee this coming Wednesday and you come across someone with brown hair wearing a Guinness hockey jersey, do the right thing and prop me up.

Until then, have a great weekend!

Christine Krause, Vice President

Posted by Lisa Velasquez in Business Awards, Business Owners, Fi-Med News, Fi-Med's Executive Team, In the Press, Mergers and Acquisitions

As Fi-Med’s certified compliance consultant and operations leader, Christine has brought to independent medical practice’s a re-engineered “billing” office, expanding it into the efficient and compliant business management of accounts receivable. Christine worked alongside Adrian Velasquez to form and build Fi-Med Management, Inc. in 1993 with the common vision: aiding independent physicians in increasing profits, reducing compliance risk and creating, and maintaining, a healthy practice.

Christine brings to Fi-Med a unique and powerful blend of healthcare and business experience, along with a double major in accounting and business management at Lakeland College where she graduated magna cum laude. She is a certified compliance consultant and member of the Medical Group Management Association, American College of Healthcare Executives, Healthcare Compliance Resources, and Comprehensive Medical Practice Analysts.

Her contributions to the community include serving on the board of NewCastle Place, Inc., EastCastle Place, Inc. and Milwaukee Protestant Home, Inc. She also volunteers her time as an election official in Elm Grove, WI.

Christine’s Awards & Nominations

Selected to receive “Wisconsin’s 2007 Small Business Person of the Year Award”
Received Certificate of Special Congressional Recognition in recognition of outstanding and invaluable service to the community.
Nominated for Women of Distinction Award
Nominated for Women of Influence Award

Adrian Velasquez, President

Posted by Lisa Velasquez in Business Awards, Business Owners, Fi-Med News, Fi-Med's Executive Team, In the Press, Mergers and Acquisitions

Armed with an extraordinarily successful career in the business of health care, Adrian E. Velasquez has successfully blazed new trails, taken risks, defied the odds, and in 1993 partnered with Christine Krause and formed Fi-Med Management, Inc. Their mission: to bring business acumen and compliance expertise to independent health care providers throughout the United States.

Prior to his work at Fi-Med, Adrian worked with health care providers across the country, mastering all areas of business function and management for medical organizations of all sizes. His previous experience as a system administrator, executive director of a 54-provider medical group, and health care consulting from New York to California formed the foundation that he harnesses today for Fi-Med clients.

Adrian is a member of the Medical Group Management Association and Comprehensive Medical Practice Analysts, and is currently working on enhancements to the paperless accounts receivable environment, further reducing operational costs to independent physicians and clinics.

Adrian’s Awards & Nominations

Selected to receive “Wisconsin’s 2007 Small Business Person of the Year Award”
Received Certificate of Special Congressional Recognition in recognition of outstanding and invaluable service to the community.
Selected to receive Small Business Times Bravo Entrepreneur Award

Skip Shaw, VP New Business Development

Posted by Lisa Velasquez in Fi-Med's Executive Team, In the Press, Industry Updates

With wide-ranging, hands-on experience in business operations, strategy, finance, legal, mergers and acquisitions, human resources, IT, marketing, and research, William “Skip” Shaw may be the most well-rounded business development executive to walk through the doors of a burgeoning company. 

Shaw’s career in healthcare management began in 1983 at surgical products supplier Aesculap, where he was instrumental in growing the company’s annual revenue from $2 million to $57 million in just 12 years, attributable in large part to his high-touch influence on everything from technology to marketing to operations. 

In 1996 Shaw joined Velocity.com, and in his eight years there served as President, CEO and CFO. A software company who saw its heyday in the dot com boom of the mid 1990s, Velocity.com provided Shaw with no shortage of opportunities to further sharpen his skills in multi-disciplinary management. 

When it came time to restructure and sell Velocity.com assets, including PSImed, a billing solution for the healthcare industry, Shaw crossed paths with medical billing veteran Charles Morf. The two hit it off, and PSImed became one of three companies that merged to form ArborMed Corporation. Shaw stayed on to help with the transition, but by late 2004 he had become ArborMed’s full-time CFO. 

Over the next five years, Shaw would help ArborMed navigate growth through both market expansion and acquisition. In 2009, Shaw, Morf and the executive team at ArborMed recognized the opportunity for future growth and market share by partnering with Fi-Med Management, Inc., where they could leverage Fi-Med’s aggressive investments in technology and its culture of innovation to become a major player in the fast-changing medical billing landscape. Fi-Med’s acquisition of ArborMed was completed in October 2009. 

As vice president of business development at Fi-Med, Skip will oversee the due process for mergers and acquisitions, and will continue to apply his breadth of expertise to help Fi-Med navigate its rapid growth in the marketplace. 

Shaw lives in Orinda, California, with his wife, Michele, and son. An emphatic music fan, Shaw’s collection of records, tapes and CDs numbers in the thousands.

Richard Usry, CHBME, Senior VP Healthcare Management Systems

Posted by Lisa Velasquez in Fi-Med News, Fi-Med's Executive Team, In the Press, Industry Updates

In 1970, when the rest of his college classmates were taking the stage in cap and gown at Virginia Commonwealth University’s graduation ceremony, Richard Usry was hard at work debugging software in Detroit. Just days before, medical supply industry giant General Medical Corporation had offered Usry a job as Data Processing Manager – an impressive offer for a new graduate and one he says he couldn’t refuse. 

The offer followed others from companies like IBM and ITT in New York, but Usry, newly married at the time, didn’t want to relocate. The opportunity to work with General Medical Corporation’s 11 divisions in Maryland and Virginia came at the right time, on the heels of a fresh degree – a B.S. in business management with an emphasis in computer science– and the preparatory experience of his work during school as a computer operator and programmer assistant for the Federal Reserve Bank in Richmond.

Over the course of his 40-year career, lucrative job offers and opportunities followed, and Usry became sought after in the industry by companies like Medical Data Services, who were implementing similar health care processing systems and needed expertise that at the time was in short supply. Usry built a reputation for speed and precision, developing highly saleable systems in a fraction of the time typically required – once developing a complex prototype from scratch in less than a week. The first system sold within hours of final post-production testing, and Usry went on to close more than $1 million in system sales to hospitals around the country. Later, Usry would be instrumental in the development of one of the first medical billing solutions for physicians using the mini-computer.

Today Usry heads up Healthcare Management Systems (HMS), a software division of medical revenue cycle management firm Fi-Med Management, Inc. HMS software, built to be scalable to medical billing operations of any size, was first put into practice by the University of Virginia Hospital System’s new health services foundation in 1980. Under the direction of the university and Price Waterhouse, Usry and his team customized an HMS software installation to bring the foundation’s members – 270 independent physicians at that time – all under one billing umbrella.

Usry continued to develop and evolve HMS through changing technologies and healthcare regulatory landscapes in the 30 years following, its success attracting the attention of ArborMed Corporation, a medical billing firm led by well-know medical billing veteran Charles Morf. ArborMed purchased Health Management Systems in 2005, and both entities were later acquired by Fi-Med Management, Inc. in 2009.

At Fi-Med, Usry continues to expand HMS nationally, and will be instrumental in developing the company’s growing presence in the radiology market. As part of the executive management team, he’ll help to shape Fi-Med’s future as a leader in the fast-changing healthcare billing and revenue management industry.

Richard Usry is a long-time member of the Healthcare Billing and Management Association (HBMA), involved in numerous committees, including vendor and education. He and his wife, Betty, live in Richmond, Virginia, and have three daughters with successful careers of their own.

Haiti Earthquake Relief

Posted by Karla Brown in Community Involvement, In the Press

I am sure by now you have all heard and seen the devastation that occurred in Haiti this week. A country of people who already have so little, now have even less. The loss of life is expected to be in the thousands and even more are injured or unaccounted for. Even though some relief has reached Haiti by planes, helicopters and Navy ships, efforts to get supplies to the people are being hampered by trees and other debris blocking roads. I have been to this place a few times, located in the beautiful Caribbean. Some cruise lines stop there so we can relax on the beaches, listen to the music and see what the locals have to offer. They are always happy to see visitors and eager to show us their goods they have made to sell in order to make a living. I must say I have left there a few times with a bag of goodies and a hope I have helped someone with the few dollars I gave.

Now, we all have a chance to help in some way, big or small. They truly need or prayers, but monetary donations are also urgently needed. They need this funding for food, water, shelter and medicine. The doctors there are saying they cannot even provide simple things such as aspirin because all was lost in the quake. You can find information on how and where you can donate on internet sites such as CNN or your local and world news networks. The Red Cross has information on their website and former President Bill Clinton has a relief site at www.clintonfoundation.org/haitiearthquake. I got a text number last night while I was watching ABC World News that I used to make a donation. You text the word HAITI to 20222 and $10.00 will be added to your cell phone bill. It may seem minimal, but honestly they are pleading for whatever people can give.

So pass the word on to your family and friends and give whatever you can. And please don’t stop praying for the people of Haiti.

Denial Management Made Easier With Version 5010 Billing Standard

Posted by Paul Spencer, CPC, CPC-H in Fi-Med Services, Hot Topics, In the Press, Industry Updates, Paul Spencer CPC CPC-H

We are often told that life has no instruction book. Personally, I have seen this blatantly come true in the form of my daily dealings with my 3-year-old son. I also longed for a better set of rules back in 1990, when I found myself briefly dating a woman who thought she was telekinetic, but was actually a hypochondriac. No worries, though. I came out unscathed and not once was she able to throw me across the room using only the power of her mind.

In the realm of Medicare denials, currently, under Version 4010 of the X12 electronic billing standards, Medicare offers very little in the way of pointing the EOMB recipient to a solution for a denial. With time, an experienced follow-up specialist can train themselves to understand in what direction each claim adjustment reason code (CARC) and remittance advice remark code (RARC) is pointing, leading to faster resolution.

Version 5010, set to be implemented by CMS beginning on January 1st, 2012, is slated to make this process much easier. As part of Version 5010, if a claim is denied due to a conflict with a Local Coverage Determination (LCD) or a National Coverage Determination (NCD), the Explanation of Medicare Benefits will indicate what LCD or NCD is being applied in the denial of this claim.

Given that local carriers now have their LCD’s categorized on the CMS website, first by carrier, then in alphabetical order (which is helpful roughly 30 % of the time),  referring the follow-up specialist to the exact coverage determination will cut down on the amount of time needed to research these denial issues.  As someone with daily involvement in Fi-Med’s denial management process, I cannot begin to tell you how I welcome this change.

While there are many other benefits to Version 5010, such as compatibility with ICD-10 and the removal of some redundancies found in the current version, finding a clearer path to a denial solution may turn out to be its most substantive change.

I look forward to the day when my lack of psychic powers ceases to be an impediment to the timely correction of Medicare denials. This whittles down my list of  ”50-10″ challenges in my life down to what happens in 7 years when I’m 50 and my son is 10. I really need to get in shape….