Health Care Reform is Law. Now What?

There is a big debate going on right now about the passing of health care reform. There is a lot of ranting and rhetoric floating around. But just like any other historical passage of a controversial bill, ie, Social Security, Medicare and Medicaid, things will settle down. The masses will settle down. In the meantime, there are patients to take care of. It is my hope that medical providers will take the time to really study how the law will affect them and their patients. Just watching CNN or Fox is not going to give them the real facts. That is a fact! I believe that if you take the politics and pessimism out of the picture and begin to see the law for what it is, a way for many patients to finally get care that they have not had for years. We will be a healthier society, a more productive society. Quoting John Lennon, "Some may say I'm a dreamer, but I'm not the only one."

Doctors have to find ways for their medical offices to be more cost efficient. They have to be better business persons. It's time to stop complaining and do what needs to be done to accomplish this. Sure there are going to be challenges and more red tape in some areas. But if you face it head on and be prepared for it, you can overcome it. You can see your practice grow and more patients can receive care. Isn't that what you got into medicine for? I hope so.

My website is currently down for repairs. Hope to be back up next week!

Health Care Reform and Effects on Prior Authorization

There will be some type of healthcare reform. At this time, no one is quite sure exactly how it will pan out. But there is one thing that will not change. That is prior authorization for advanced imaging. No matter what, medical providers will still have to justify why the test is needed.

Health care is cost driven. In order to control the costs of advanced imaging, the need for the test must be documented. The prior authorization process itself may change. The American College of Radiology is pushing to cut out the middle man (radiology benefit managers). They are recommending Electronic Decision Support(EDS), an online software program that determines appropriateness. This program will allow medical providers to input the clinical information which will automatically rate the appropriateness of the test being requested. It may also suggest an alternative test. If the medical provider does not accept the recommended test, they will be required to have a peer-to-peer discussion or talk with an onsite radiologist.

What will not change in this process is the fact that medical staff must still input the correct information. Even one small error can send a case for further medical review or if using the EDS system, spit out an inappropriate rating, causing delay.That is where my training program can help. I can teach medical office staff how to provide accurate clinical, avoid the most common mistakes and make the most of their time doing prior authorizations. Contact me for a free consultation on how I can help you today!

Is your patient getting the test they need at the right time?

The doctor orders an MRI, CT, PET scan or nuclear medicine scan for their patient. The paperwork is given to medical office staff to get prior authorization, aka precertification from the health insurance company. You call in and give the medical insurance information, study requested, CPT code, diagnosis, demographics of the patient, site and medical office. Then you are transferred to a clinical reviewer, usually a nurse. Questions are asked about the patient's medical history, signs and symptoms and physical exam findings just to name a few. This is where most medical staff have problems. The answers to these questions will determine if the test is needed. If it is not immediately approved, the case is sent for review to a medical director, who is a physician for the health insurance company. This can take up to two business days if it is not medically urgent. If the medical director asks for additional information, add about another two days for the medical office to respond. Add about another two days for the medical director to make a final determination. In the meantime, you are waiting for an answer. The patient is waiting to have their test done. This is frustrating for everyone involved. It is my experience that 1 out of 3 medical office staff are unable to provide complete clinical. This results in an automatic medical review.
This is where I can help you. No matter what experience you have had with prior authorization, you can benefit from my educational program. I can teach you how to be a "pro" at providing clinical, understanding the study being requested and give many, many tips on how to avoid the red tape and help you to be more efficient in this process. Contact me today to talk about how I can help you right now.

Make Your Medical Office Staff More Efficient in 2010!

It is the end of the year, many medical offices are looking back at what went wrong and looking forward to what can be better for the new year. Healthcare is in reform. Everyone is waiting to see what changes will come about and when. That includes prior authorization/pre-certification for advanced imaging. For now, it is business as usual for the health insurance companies. In order for your patient to get that MRI, CT, PET scan or nuclear medicine study, your medical office staff will still have to obtain prior authorization/pre-certification. Is it going to be easier than last year? No. I suspect it will be more difficult in the future. And it will probably be one of the areas health insurance companies, Medicaid and Medicare will use to cut corners to contain cost. It is all about the bottom line you know! Well, what about your bottom line? Medical offices also need to be profitable. As you look at your bottom line for the past year, think about what you can do better this next year. If you could give your staff 25-50% more time to do other tasks, would that not be of benefit to you? The one-of-a-kind training program that I offer can reduce cost, staff frustration and improve patient outcomes by teaching your staff how to perform prior authorization more efficiently and confidently. By purchasing the training program before year end, you are also eligible for the tax write off.(IRS section 162, check with your tax advisor). Contact me today to get started! http://www.rosewoodconsulting.biz/

Happy New Year!

The Senate Has Passed the Health Care Bill....

The health care bill has passed the senate. Now we await the final revision of the bill and votes from the house and senate before the president can sign it into law. Then, the real questions will need to be answered. How are the health insurance companies going to react? President Obama has already placed additional wording into the bill that health insurance companies will not be allowed to raise premiums prior to the bill being enacted. We all know the health insurance companies are going to do whatever it takes to save their bottom line. We do not know what that will be yet but I am sure we will all know in due time.

In the meantime, are you confident your staff is prepared to handle precertifications (prior authorizations) for advanced radiology procedures? Are you experiencing delays or denials from health insurance companies for your prior authorizations of MRI, CT, PET scan and nuclear medicine scans? I can train your staff to be better prepared for what many are saying is going to be an increase in precertification/prior authorization for advanced imaging by health insurance companies. Visit my website for more details.

Healthcare Debate Continues!

What does this mean to you as a medical provider or medical office? It means that no one knows what the outcome will be for healthcare reform. In the meantime, it is business as usual for the health insurance companies. They are still requiring prior authorization (aka precertification) for radiological procedures(MRI, CT, PET scan, nuclear medicine studies). If you are still having problems with this process, contact us to start your training program today. Order by the end of the year and receive 45 days of follow-up consulting services instead of 30 days! Remember, this is also a great tax deduction for your medical office! (see IRS section 162 and your tax consultant for details)

Did you know?......

Did you know that a standard CT of the brain exposes the patient to an equivalent of 115 chest xrays? With radiation exposure errors in the recent headlines as noted in an article posted in the Wall Street Journal, More Patients Got Radiation Overdoses in CT Scans, it is the responsibility of the imaging facility to ensure the correct dose of radiation is being used. It is also the responsibility of the medical provider to weigh the risks of doing a CT vs an MRI or alternative study in the non-urgent setting.Check out the radiation equivalency chart link located on my website. It is a great tool to educate staff and medical providers as to the amount of radiation the patient is receiving.