Email not displaying correctly? View it in your browser. Issue #11 — May 25, 2011
AAPC BillingInsider e-Newsletter

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F R O M   T H E   F I E L D

When Your Patients Leave, Are They Happy?
By Simone A Tessitore, CPC, COBGC

In an economy where everyone is cutting back on everything, how can we be sure our patients aren't cutting back on us? While going to the doctor certainly isn't a barrel of monkeys, it does not have to be a dreaded chore either. How do we balance the needs of the patient and the practice and keep everyone happy?

Are front desk staff and phone staff providing a friendly first impression? A patient can hear a smiling voice versus a rushed irritated employee a mile away. Why would patients want to come somewhere they feel isn't nice to them? Is the waiting area well maintained with adequate seating and magazines less than eight years old?

What about the clinical staff? Are they making good eye contact with your patients rather than just typing data into an EMR? Nobody likes to feel like just Mrs. 2:15, especially when already feeling sick, uncomfortable, or just plain vulnerable in that little paper gown.

And how is our back office follow up? Are we helping our patients through the web of deductibles and in-network referrals? Are patients being called back promptly?

You never know when you'll be the difference between a happy patient and a miserable experience. When your patient has many physicians to choose from, what impression would you rather leave?

G O O D   T I P S

Managing Patient Complaints

A patient or family member is unhappy. Maybe she is displeased by the wait to see a provider, or she felt ill-treated, or she doesn't like the way the business part of her visit went. Here are some tips practice managers recently shared with BillingInsider.

The key, they all agree, is taking time to listen and show compassion.

Listen – What they perceive is real. Let the patient or family member tell you what he or she thinks is wrong. Don't interrupt, try to mollify, or stop them.

Don't take it personally – The person is complaining about a problem, not you. Divorce yourself from any negativity he or she may have and listen for the real issue.

Respond positively – Be empathetic. Reflect back what you think the patient or family member is saying. This lets them know you're listening and helps clarify the issue.

Learn as much as you can – Ask questions so you understand as much as you can. Apologize for the negative experience.

Log the complaint – Keep a log telling who, what, and why. Leave space to document a resolution and a follow-up date. You can identify legitimate trends.

Be grateful – Thank the person. Explain what will happen from there, and ask if he or she would like to document it on a simple form.

Act – Investigate the issue with practice members involved and help develop a solution.

Follow-up – Contact the patient or family member. Let them know what the resolution taken is and how it will benefit them and other patients.

Practice managers also recommend posting a form on the practice's website and providing a special email address for issues. Others recommend reviewing Internet community forums like CitySearch for feedback on your practice.

F E A T U R E D   S T O R Y

Know Who Your BAs Are
By Ken Camilleis, CPC, CPC-I, CMRS

According HIPAA's Privacy Rule, covered entities (CEs) such as hospitals, physicians, clearing houses, and certain insurance payers are obligated to safeguard individually identifiable health data, or protected health information (PHI). The HIPAA Security Rule extends liability of CEs to PHI transmitted in an electronic format (ePHI). HIPAA also defined business associates (BAs) as entities that work as "trading partners" with CEs; and, medical billing services under this definition are classified as BAs.

Outsourcing of the medical billing function is a proven cost-effective method of allowing medical practitioners to focus on the clinical side of medicine while the billing company concentrates on effectively managing the practice's accounts receivable.

Unlike CEs, BAs were initially exempt from HIPAA statutes, but that has changed.

One provision of the American Recovery and Reinvestment Act (ARRA), the Health Information Technology for Economic and Clinical Health (HITECH), contains a stipulation about BAs such as billing companies now being liable for actions under HIPAA for such acts as breach of PHI/ePHI. This raised a stir among billing agencies as to the scope of responsibility under HITECH and also raised the question as to whether independent billing services can be cited under the False Claims Act if a client commits fraud.

The "missing link" in the life cycle of the administrative process is the coder. Independent billing companies do not always have coders on staff; neither do they have ready access to their clients' medical records. Coders are usually employed by a provider, and they abstract information from the providers' notes to determine the appropriate codes.

Billing companies serve as a pipeline to the payer, and are not especially vulnerable to false claim charges. However, if the billing company does provide coding services, such as documentation integrity review or code verification, its billers may be liable in the case of an OIG or payer audit should one uncover an act of fraud such as upcoding or unbundling.

Under HITECH, if an independent billing company receives PHI such as on paper registration forms, superbills, and referral forms, it must protect such information, including proper waste destruction with shredders and/or the use of a certified data destruction company. If the billing service handles ePHI, it must ensure that it has appropriate safeguards (such as firewalls and encryption/decryption) as required by the HIPAA Security Rule, and follows proper procedures for certain destruction or initialization of data-storing media.

FROM THE FIELD is thoughts and experiences from you the reader. If you have any tips, ideas, case studies, or just anecdotes please submit them to us for future editions.

In This Issue
Making Patients Happy
Managing Complaints
Know Who Your BAs Are

MEDICAL BILLING COURSE
Don't underestimate the importance of policies and procedures in the billing world.

HEALTH PLAN POLICY SEARCH TOOL
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