August 2009

First RAC Has Posted CMS Approved Audit Issues
As we mentioned in our Business of Medicine blog on August 7, the first RAC posted their CMS approved audit issues. There seems to be a focus on the proper use of units. Remember, issues posted by any RAC open the door for all RACs to audit these specific areas across the board. This is not to say these are the only areas of focus for the RACs. They will continue to conduct reviews based in part on issues identified in the demonstration project, as well as those highlighted by the OIG. These issues just give them one more area to focus in on. Visit our blog for details.

The Somerset Health Care Team hosted a seminar about RACs on August 13. The speakers were Cathy Weaver of Somerset CPAs, Joy Newby of Newby Consulting and Linda Batten of Kroger, Gardis & Regas. If you were unable to attend and would like to receive the audio recording and handouts, please contact us.

Indiana Orthopaedics Roundtable
On August 20, Somerset and Krieg DeVault co-sponsored the Indiana Orthopaedics Roundtable. Topics discussed were organization of the Indiana Association of Orthopaedic Executives, risk purchasing groups and captive insurance companies, financial markets and current orthopaedic strategies and joint ventures after Stark 4. If you missed it and would like to be part of the Indiana chapter of the AAOE or would like to discuss any of these topics, please contact Kathy Rokita.

Somerset Orthopaedic Practice and ASC Benchmarking System
The Somerset Orthopaedic Practice Survey provides valuable interactive, online benchmarking tools for the practices, including data on the following: financial information for the core physician medical practice, financial information for in-office ancillary services (MRI, PT/OT, DME, etc.), accounts receivable and payer mix information, physician compensation (including RVUw data), NP/PA compensation, head and FTE counts for employees and recruitment data. The Somerset Orthopaedic ASC Survey provides valuable interactive, online benchmarking tools for the ASCs, including data on the following: financial information for surgical cases, financial information for pain procedures, accounts receivable and payer mix information, head and FTE counts for employees and square footage data. Survey responses are compiled and analyzed by the accountants in Somerset's Health Care Team and represent reliable and valuable information. Please contact us for a free demonstration and more information about participating.

Be Diligent About Denied Claims
Having reliable procedures in place for submitting claims to payers in a timely manner is critical to a medical practice’s cash flow. Given that up to 20% of all claims submitted are denied (according to industry experts), it is equally important to have effective procedures for managing denied and underpaid claims. It’s understandable that some physicians feel they’re between a proverbial rock and a hard place on this issue. Not making an effort to collect on denials means they’re missing out on what could be significant revenue. Read more...

Recent Developments

Changes to Stock and Bill DME - On August 7, 2009, CMS released Change Request 6528 regarding Compliance Standards for Consignment Closets and Stock and Bill Arrangements. The "Summary of Changes" reads: The purpose of this change request is to define and prohibit certain arrangements where an enrolled supplier of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) maintains inventory at a practice location which is not owned by the enrolled DMEPOS supplier, but rather, owned by a physician, non-physician practitioner or other health care professional for the purpose of distribution, commonly referred to as a consignment closet and/or stock and bill arrangement. In addition, this change request will instruct physicians, non-physician practitioners or other health care professional’s practices that use of consignment closets and/or stock and bill arrangements (as defined above) must be in compliance with current standards. The effective date/implementation date is September 8, 2009.

Recovery Act to Fund 12 State Efforts to Improve Care in Ambulatory Surgical Centers - On July 30, 2009, HHS Secretary Kathleen Sebelius provided the down payment for a nationwide effort to reduce health care associated infections in stand-alone or same-day surgical centers. The first effort will begin in 12 states under provisions of the American Recovery and Reinvestment Act of 2009, administered by the Centers for Medicare & Medicaid Services (CMS). The 12 states--Maine, New Jersey, Maryland, Florida, North Carolina, Indiana, Michigan, Arkansas, Oregon, Utah, Wyoming and Kansas--will survey more than 125 ambulatory surgical centers (ASCs) before September 30, 2009, at an estimated cost of up to $1 million. The onsite reviews, paid for out of Recovery Act funds, are designed to ensure that the facilities are following Medicare’s health and safety standards. As part of the new initiative, state surveyors will employ a new CMS survey process that uses a tool developed in conjunction with CDC. In addition, Recovery Act funds will increase the number of ASCs surveyed. Full release...

Somerset and Squire Sanders & Dempsey Host Hospital/Physician Acquisition & Employment Strategies Conference in Cincinnati Today
Economic and health policy issues are driving hospitals and physicians toward a more integrative system of care delivery, including employment. Today, Thursday, August 27, 2009, Nicole Webb of Squire Sanders and Jim Hamilton of the Somerset Health Care Team will present a conference to address hospital/physician acquisition and employment strategies. They will discuss the facts that both hospital executives and physicians need to know about these types of transactions--from governance, autonomy and compensation to the legal implications of hospitals and doctors coming together. Please contact us for more information on this topic.

Taking Control of Your Inventory
How long has it been since your medical practice reviewed its supply costs and inventory management procedures? If it’s been a while, you may be overlooking opportunities to save money and become more efficient. Here are some ideas you may find helpful. Read more...

Somerset Health Care Team News

IMGMA Tech-Knowledgy 2009 Conference - On September 1, 2009, Jim Hamilton of Somerset's Health Care Team will present "HITECH—What Every Physician Practice Needs to Know." Please visit Kathy Rokita, Mandi Clossey and Mary Knerr at our vendor booth at the conference as well. For details about the conference, visit IMGMA's web site.

Same-Day Surgery Newsletter - Cathy Weaver and Mandi Clossey were quoted in the September 2009 issue of Same-Day Surgery in the article, "Have checks and balances in place, or open the door for embezzlement." Some warning signs of embezzlement listed in the article include a change in an employee’s work habits, a change in an employee’s spending habits, patterns of cash draw shortages, unusual bad debt write-offs, a decline in cash or credit encounters, bounced business checks and inventory shortages. An article that ran in our May issue of Health Care Commentaries provides additional information on this topic. Contact us to discuss an internal control review today.

American Academy of Orthopedic Surgeons (AAOS) - From October 2 to 4, 2009, Mike McCaslin will be at the AAOS 4th Annual Practice Management Course in Albuquerque, New Mexico speaking on the topics of Ancillary Revenue Streams and Mergers & Acquisitions.

Somerset Client Satisfaction Survey - If you are a Somerset client, please take our survey concerning the services we have provided to you. Our goal is to improve our overall relationship and better serve you. Go to survey.

Health Care Commentaries is provided by Somerset’s Health Care Team for our clients and other interested persons upon request. Since technical information is presented in generalized fashion, no final conclusion on these topics should be made without further review. For additional information on the issues discussed, please contact a member of our Health Care Team. This document is not intended or written to be used, and cannot be used, for the purpose of avoiding tax penalties that may be imposed on the taxpayer.