Content-Transfer-Encoding: quoted-printable ************************************************************ PRACTICE GUARDIAN NEWS... The Internet & Practice Management. ******************************************************************** This newsletter is freely circulated to the health care community. Subscribe today =46orward a copy to a friend or associate... Submit your www.association site Information today! Issue 1 - January 1, 2000 Main Page http://www.practiceguardian.com To unscribe to this newsletter please forward to unscribe@practiceguardian.com and include "unscribe" in the text you will be removed from the list as soon as possible. **************************************************** INDEX **************************************************** PRACTICE MANAGEMENT SITES =2E....The Journal of the Southeasten Society of Pediatric Dentistry =2E.......NewbyNews -Physician Coding/Practice Issues Newsletter PRACTICE TIPS =2E....HCFA CLARIFIES APPROPRIATE USE OF CONSULTATION CODES By Joy Newby, President Joy Newby & Associates, Inc. ASSOCIATION UPDATE AMERICAN THORACIC SOCIETY NEWS BRIEF =2E.....Sleep-related Breathing Disorder Is Risk Factor for Hypertension RECOMMENDED NEWSLETTERS & PUBLICATIONS NATIONAL HEALTH CARE ASSOCIATIONS (A TO Z) EDITORIAL INFORMATION ******************************************************************* Practice Guardian.Com - In 90 Days - "In House Collection System" Practice collections are an art form. Asking a patient for payment can be one of most difficult tasks accomplished by the practice=20 manager. Time, patient response and resources are important elements=20 to success. Using the right tool for the right job can pay dividends=20 and reduce future delinquency headaches. Nationwide, one third of all patient accounts aging into the 75 to 90=20 day time frame without partial or full payment will become=20 delinquent. As accounts age, the practice becomes overwhelmed by volume delinquencies forcing the manager to spend time on older=20 accounts while newer accounts reach delinquency. A vicious cycle is created under minding productivity and the collector's initiative. Practice Guardian.Com - In 90 Days - "Practice Collection System" is=20 the newest edition to Practice Guardian.Com. Now you can initiate an=20 in-house collection management process to collect patient accounts 90=20 days up to your state law statute of limitations. All within 90 days=20 from your subscription. The system is designed as an interactive and consulting resource.=20 Routine consultations are conducted by the web site to subscribers=20 who first sign up for the service then receive a user name and=20 password to enter the secure area. Telephone support and email=20 contacts are included without additional costs up to ten contacts. An=20 additional fee may be required for excessive use. Subscribers to the service first enter a secure area then choose from=20 a range of collection management letters to begin the 90 day clean up=20 process. All collection letters are designed and developed by Michael J. Berry, Consultant (Best selling author of=20 Collections Made Easy! 2), to open the communication lines between=20 the practice and patient, increase patient response, improve cash flow and create positive results without injuring your=20 patient's pride. Additional management letters are included in the system to create management follow up and secure payment including a motivational=20 thank you letter for payment and failed arrangement procedure. In all=20 subscribers are entitled up to five collection management letters all copyrighted and proven to yield outstanding=20 results. The main goal is to reach a 40% patient response and return. All letters and system processes are scheduled on a 30 day time frame to coincide with your billing process. Each month the subscribe=20 chooses a letter to begin the initial, secondary and final patient=20 contacts. In all, In 90 Days - Practice Collection System can be a=20 valuable resource tool to the practitioner or practice manager=20 interested in collecting plus 90 day accounts. A one time subscriber fee of $275.00 begins the process to turn loss=20 into cash flow without a third party. Designed to improve patient relations this is a consulting service. =46or more information visit Practice Guardian.Com at=20 http://www.practiceguardian.com or call Mr.Michael J. Berry,=20 Consultant at 219-583-4234. ******************************************************************** Practice Management Sites ******************************************************************** The Journal of the Southeasten Society of Pediatric Dentistry Attn: Dr. Edward S. Nacht, DDS. Editor J.S.S. P.D. 7400 NW 5th St. Plantation, FL 33317 Informative and practical clinical and practice management magazine. =46eatures articles, tips and up to date dental procedures and discussions. =46or more information on subscribing contact Dr. Edward S. Nacht, D.D.S. **********************************************************************=20 *********** NewbyNews Physician Coding/Practice Issues Newsletter Newbyassoc@aol.com After several years and numerous requests, Joy Newby & Associates,=20 Inc., one of Indiana's most sought after physician=20 coding/reimbursement consulting firms has finally decided to publish a newsletter! Joy Newby & Associates, Inc., is proud to present NewbyNews, a=20 bimonthly fax newsletter designed to meet the coding and general=20 practice issues of physician practices. The charter issue of NewbyNews was distributed in August 1999. This issue is available at no cost as a trial. We believe physicians will find this newsletter to be a must have, full of valuable, up-to-date information. Each issue is approximately 5-10 pages in length and will contain a variety of pertinent timely information. The newsletter is faxed at night so it will not tie up your fax machine and interrupt your daily business. You will see articles related to procedural/diagnostic coding, documentation= , medical policy clarifications received from Medicare/Medicaid and other insurance companies, practice management tips, and other hot topics. Periodically we will feature a guest author to share with you his/her area o= f expertise. The October issue featured an article regarding the Supreme Court ruling on the statue of limitations written by Kevin Speer, Attorney-at-Law, with the firm of Hall, Render, Killian, Health & Lyman, P.S.C. Because we serve such a diverse base of physicians, this newsletter will not be geared toward any one practice type or specialty. However, it will be state specific, containing information written specifically for physicians practicing in Indiana. A one-year subscription is available for only $195. Individual issues are available for $40 per issue. To receive your free issue or if you have any questions/comments, please fee= l free to contact our newsletter coordinator, Maureen Hoffmeyer, at (317) 577-3066. Questions, comments, and subscription requests may also be=20 mailed, faxed, or e-mailed to us at the following address: Joy Newby & Associates, Inc. 6828 Hawthorn Park Drive Indianapolis, IN 46220 =46ax: 317-577-3061 Newbyassoc@aol.com Be sure to include your name, practice name, telephone number, and fax number. *Joy Newby & Associates, Inc., is a private third party reimbursement consulting firm specializing in Medicare and Medicaid reimbursement issues. We are not employed, endorsed, or affiliated with the Health Care Financing Administration, the American Medical Association, any Medicare or Medicaid Carrier, or insurance company. ******************************************************************** PRACTICE TIPS ******************************************************************** HCFA CLARIFIES APPROPRIATE USE OF CONSULTATION CODES By Joy Newby, President Joy Newby & Associates, Inc. Since many Medicare Carriers, physicians, and consultants had been=20 confused about what type of service could be billed as a=20 consultation, the Health Care Financing Administration (HCFA) issued additional clarification on the use of consultation codes. The=20 clarification included almost a total revision of Section 15506 of=20 the Medicare Carriers Manual, Part 3, Claims Process (MCM). With the publication of this information, there is no doubt=20 what type of services HCFA considers consultations. The clarification supports what has been our impression all along;=20 however, some Medicare Carriers had taken a different position which=20 caused us to contact the Health Care Financing Administration for=20 assistance in resolving this issue. We appreciate the assistance we=20 received from Senator Richard Lugar, representatives of HCFA Region V=20 and the HCFA Central Office. For those of you providing consultation services, we believe you will be=20 as excited as we were with the clarification of Section 15506. We are=20 pleased to provide you with excerpts from the Medicare Carriers=20 Manual - Transmittal No. 1644 - August 1999. Consultation Versus Visit-Pay for a consultation when all of the criteria fo= r the use of a consultation code are met: (1) Specifically, a consultation is distinguished from a visit=20 because it is provided by a physician whose opinion or advice=20 regarding evaluation and/or management of a specific problem is=20 requested by another physician or other appropriate source (unless it=20 is a patient-generated confirmatory consultation). (2) A request for a consultation from an appropriate source and the=20 need for consultation must be documented in the patient's medical=20 record. (3) After the consultation is provided, the consultant prepares a written report of his/her findings which is provided to the referring physician. Consultation Followed By Treatment-Pay for an initial consultation if=20 all the criteria for a consultation are satisfied. Payment may be=20 made regardless of treatment initiation unless a transfer of care=20 occurs. A transfer of care occurs when the referring physician=20 transfers the responsibility for the patient's complete care to the=20 receiving physician at the time of referral, and the receiving physician documents approval of care in advance.=20 The receiving physician would report a new or established patient=20 visit depending on the situation (a new patient is one who has not=20 received any professional services from the physician or another=20 physician of the same specialty who belongs to the same group=20 practice, within the past three years) and setting (e.g., office or inpatient). A physician consultant may initiate diagnostic and/or therapeutic=20 services at an initial or subsequent visit. Subsequent visits (not=20 performed to complete the initial consultation) to manage a portion=20 or all of the patient's condition should be reported as established=20 patient office visit or subsequent hospital care, depending on the setting. Consultations Requested by Members of the Same Group-Pay for a=20 consultation if one physician in a group practice requests a=20 consultation from another physician in the same group practice as long as all of the requirements for use of the CPT consultation codes=20 are met (See =A715506A.) Documentation for Consultations-A request for a consultation from an=20 appropriate source and the need for consultation must be documented=20 in the patient's medical record. A written report must be furnished=20 to the requesting physician. In an emergency department or an inpatient or outpatient setting in=20 which the medical record is shared between the referring physician=20 and the consultant, the request may be documented as part of a plan=20 written in the requesting physician's progress note, an order in the=20 medical record, or a specific written request for the consultation.=20 In these settings, the report may consist of an appropriate entry in=20 the common medical record. In an office setting, the documentation=20 requirement may be met by a specific written request for the=20 consultation from the requesting physician or if the consultant's=20 record shows a specific reference to the request. In this setting, the consultation report is a separate document communicated=20 to the requesting physician. Examples of Consultations: 1. An internist sees a patient that he has followed for 20 years for=20 mild hypertension and diabetes mellitus. The patient exhibits a new=20 skin lesion and the internist sends the patient to a dermatologist=20 for further evaluation. The dermatologist examines the patient and=20 removes the lesion which is determined to be an early melanoma. The=20 dermatologist dictates and forwards a report to the internist regarding his evaluation and treatment of the patient. 2. A general ophthalmologist diagnoses a patient with a retinal=20 detachment. He sends the patient to a retinal subspecialist to=20 evaluate the patient because the general ophthalmologist does not=20 treat this specific problem. The retinal subspecialist evaluates the=20 patient and subsequently schedules surgery. He sends a report to the referring physician explaining his=20 findings and the treatment option selected. (JNA Example) 3. A family physician diagnoses a patient with diabetes mellitus. The=20 family physician asks the ophthalmologist for a baseline evaluation=20 to rule out diabetic retinopathy. The ophthalmologist examines the=20 patient and sends a report to the family physician on his findings.=20 The ophthalmologist tells the patient at the time of service to=20 return in one year for a follow-up visit. This subsequent follow-up=20 visit should be billed as an established patient visit in the office=20 or other outpatient setting, as appropriate. (JNA Example) 4. A rural family practice physician examines a patient who has been=20 under his care for 20 years and diagnoses a new onset of atrial=20 fibrillation. The family practitioner sends the patient to a=20 cardiologist at an urban cardiology center for advice on his care and=20 management. The cardiologist examines the patient, suggests a cardiac catheterization and other diagnosti= c tests which he schedules and then sends a written report to the=20 requesting physician. The cardiologist subsequently routinely sees the patient once a year as=20 follow-up. Subsequent visits provided by the cardiologist should be=20 billed as an established patient visit in the office or other=20 outpatient setting, as appropriate. Other routine care continues to=20 be followed by the family practice physician. 5. A family practice physician examines a female patient who has been=20 under his care for some time and diagnoses a breast mass. The family=20 practitioner sends the patient to a general surgeon for advice and=20 management of the mass and related patient care. The general surgeon=20 examines the patient and recommends a breast biopsy, which he=20 schedules, and then sends a written report to the requesting physician. The general surgeon subsequently=20 performs a biopsy and then routinely sees the patient once a year as=20 follow-up. Subsequent visits provided by the surgeon should be billed as an established patient visit in the office or=20 other outpatient setting, as appropriate. Other routine care=20 continues to be followed by the family practice physician. 6. An internist examines a patient who has been under his care for=20 some time, and diagnoses a thyroid mass. The internist sends the=20 patient to a general surgeon for advice on management of the mass and=20 related patient care. The general surgeon examines the patient,=20 orders diagnostic tests, and suggests a needle biopsy of the mass.=20 The surgeon then schedules the procedure and sends a written report=20 to the requesting physician. The general surgeon subsequently=20 performs a thin needle biopsy and then routinely sees the patient=20 twice as follow-up for the mass. Subsequent visits provided by the=20 surgeon should be billed as an established patient visit in the=20 office or other outpatient setting, as appropriate. Other routine care=20 continues to be followed by the internist. 7. A patient with underling diabetes mellitus and renal insufficiency=20 is seen in the emergency room for the evaluation of fever, cough, and=20 purulent sputum. Since it is not clear whether the patient needs to=20 be admitted, the emergency room physician requests an opinion by the=20 on-call internist. The internist may bill a consultation regardless=20 if the patient is discharged from the emergency room or whether the patient is admitted to the=20 hospital as long as the criteria for consultation have been met. If=20 the internist admits the patient to the hospital, he/she may bill=20 either an initial inpatient consultation or initial hospital care=20 code but not both for the same date of service. Examples That Do Not Satisfy the Criteria: 1. Standing orders in the medical record for consultations. 2. No order for a consultation. 3. No written report of a consultation. 4. After hours, an internist receives a call from her patient about a complaint of abdominal pain. The internist believes this requires immediate evaluation and advises the patient to go to the emergency room where she meets the patient and evaluates him. The emergency room physician does not see the patient. The internist should bill for the appropriate level of emergency department service, or if the patient is admitted to the hospital she would bill this visit as an inpatient admission. ******************************************************************** ASSOCIATION UPDATE ******************************************************************** AMERICAN THORACIC SOCIETY NEWS BRIEF Sleep-related Breathing Disorder Is Risk Factor for Hypertension Individuals with sleep-related breathing disorder (SRBD) are at=20 greater risk for high blood pressure and increased resting heart rate=20 independent of such factors as body mass index, age, and cholesterol level, according to a study published in the December=20 American Journal of Respiratory and Critical Care Medicine. Ludger=20 Grote, M.D., of the Department of Clinical Pharmacology and Sleep Disorders Clinic, Sahlgrenska University Hospital,=20 Gothenburg, Sweden, along with five associates, studied 1,087 men and 103 women referred=20 for clinical symptoms of SRBD. The investigators=3D results showed a=20 relationship between SRBD severity and systolic/diastolic blood pressure, as well as heart rate. During the study, the researchers recorded patient age, sex, race,=20 and body mass index. Each participant completed a questionnaire and=20 had a standard medical interview, including questions about=20 SRBD-related symptoms such assnoring, witnessed apneas, excessive=20 daytime sleepiness, insomnia, and falling asleep while driving a car.=20 Smoking habits and current alcohol consumption were recorded. Blood samples were analyzed to determine total=20 cholesterol, and blood gas samples were studied. Blood pressure=20 readings were performed, along with heart rate determinations. Also, all patients underwent unattended home monitoring of nocturnal=20 breathing on two consecutive nights, using a device that they wore=20 from 6 p.m. to 8 a.m. The device measured oxygen saturation, snoring, beat-to-beat heart rate, and body position. Experienced sleep technicians evaluated all events recorded during=20 sleep and devised a respiratory disturbance index (RDI) based on=20 estimated sleep duration. An RDI of less than five, which indicated no SRBD, was found in 400 patients. They assigned an=20 elevated RDI (more than five) to 790 individuals. After the allocation of patients into different RDI classes, we saw an obvious stepwise increase in blood pressure and heart rate,@ the=20 authors wrote. "In particular, SRBD, had a highly significant=20 influence on daytime resting heart rate.@ The authors emphasized that they found the risk of hypertension=20 associated with SRBD greater for younger patients. Secondly, RDI=20 showed an independent influence on resting heart rate, which was larger than that found for blood pressure. In fact, during future=20 studies, the researchers believe that resting heart rate will be=20 considered an important predictor for cardiovascular illness and=20 mortality in SRBD patients.Finally, the investigators found that daytime blood gas levels independently influence blood pressure and resting heart rate. Contact for Media: Ludger Grote, M.D., Department of Clinical=20 Pharmacology and Sleep Disorders Clinic, Sahlgrenska University=20 Hospital, Gothenburg,Sweden. Phone: 46-31-342-2964, or 46-31-342-2974; Fax: 46-31-826723; E-mail: ludger.grote@pharm.gu.se. ******************************************************************** RECOMMENDED NEWSLETTERS & PUBLICATIONS ******************************************************************** "Managed Care Insider eNews" Published MonthlyFor more information contact: Ms. Nancy Belle, Editor, at nkbelle@erols.com Subscription: Free at insider@scheur.com =46ocus Point: Managed Care Issues Website: http://www.scheur.com/smghome.nsf/webcontent/ezine.html Healthcare Management Advisors, Strategy Advisor =46ree Newsletter http://www.HMA.com/sa11/ =46ocus Point: HMA's team of MD, JD, RN, RRA, CPC, CFE and CPA consultants perform=20 corporate-wide risk assessments, DRG and CPT benchmark analyses, and=20 focused compliance audits for hospitals, physicians and attorneys nationwide. To Subscribe: webmaster@HMA.com. Gerontological Nurse Ventures, P.A. http://www.jwger-nurseventures.com Monthly Ezine =46ocus Point: Nursing Issues. To Subscribe: http://www.jwger-nurseventures.com/scripts/subscribe.cfm or afgnv@erols.com with subscribe in subject The Health Care Collector Published Monthly by: Aspen Publishers Questions contact: JoAnn Petaschnick , Editor 414-462-0278 =46AX 414-462-7547 200 Orchard Ridge Dr. Gaithersburg, MD 20878 Yearly Subscription: $197 Focus Point: Collections The Credit Connection Published Quarterly by: Wisconsin Clinic Credit Managers Association (WCCMA) Questions Contact: Support Services - Deen Clinic Ms. Teresa Addison, Editor 608-250-1121 1808 W. Beltline Highway Madison, Wisconsin 53725 Yearly Subscription: $35 =46ocus Point: Medical Collections, Accounts Receivables, Federal & State Regulations. =20 American Medical News Published weekly by: American Medical Association (A.M.A.) Questions contact: A.M.News Staff 312-464-4429 515 North State Street Chicago, Illinois 60610 Yearly Subscription: (Free with AMA Membership) =46ocus Point: All Medical/Socioecomonic Issues. Web site: http://www.ama-assn.org/public/journals/AmNews/AmNews.htm Physican1s Marketing & Management Published monthly by: American Health Consultants Inc. Questions contact: Managing Editor, 404-282-7436 3525 Piedmont Road N.E. Atlanta, Georgia 30305 Yearly Subscription =46ocus Point: Medical Management In Confidence Published Bimonthly by: American Health Information Management Association (AHIMA) Questions contact: Ms. Jennifer Carpenter. RRA Professional Practice 312-787-2672 919 N. Michigan Avenue, Suite 1400 Chicago, Illinois 60611-1683 Yearly Subscription: $90 ($75 with membership) =46ocus Point: Health Information, Patient Privacy & Information System Security Web Site: http://www.ahima.org ****************************************************************************= ** NATIONAL HEALTHCARE ASSOCIATIONS (A TO Z) ************************************************************************* Academy of Operative Dentistry Contact: Dr. John Reinhardt at john-reinhardt@uiowa.edu Website : http://www.uiowa.edu/~aodweb. American Academy of Family Physicians Contact: (816) 333-9700 Web Site: http://www.aafp.org American Academy of Pediatrics Contact (847) 228-5005 Web Site: http://www.aap.org American College of Cardiology Contact: 800-253-4636 ext.697, or 301-897-5400, ext.697) http://www.acc.org American Dental Association Contact: (312) 440-2500 Web Site: http://www.ada.org American Medical Association (A.M.A.) Contact: (312) 464-5000 Web Site: http://www.ama-assn.org Association of Managed Care Dentists Contact: Call: 310-4553-3439 http://www.dentalgroup.com/amcd. Association of Military Surgeons of the United States (AMSUS) Contact: (301) 897-8800 ext. 20. marisab@amsus.org http://www.amsus.org Healthcare Financial Management Association (HCFMA) Contact: (800)252-HFMA (4362), ext. 362 tarya@hfma.org http://www.hfma.org Integrated Healthcare Association (IHA)(Managed Care) Contact: (925) 746-5100 bcarter@iha.org. Web Site: http://www.iha.org Medical Group Management Association Contact: (303) 799-1111 Web Site: http://www.mgma.com National Institute of Dental and Craniofacial Research Contact: Phone: 301-496-4263 E-mail: Sally.Wilberding@nih.gov The American College of Physician Executives Contact: wcurry@acpe.org 813-287-2000, http://www.acpe.org The American College of Chest Physicians Contact: 1-800-343-2227 or 847-498-1400 registration@chestnet.org http://www.chestnet.org The American Gastroenterlogical Association Contact: http://www.gastro.org The American Thoracic Society Contact: 212/315-6442 ladkins@thoracic.org http://www.thoracic.org **************************************************** PRACTICE GUARDIAN NEWS Practice Guardian News is published monthly. Send all inquiries to=20 attention editor at (219) 583-4234. E-Mail info@practiceguardian.com=20 The subjects and written examples in this newsletter are for general=20 use only. The publisher and author do not accept any responsibility=20 or liability in regards to misuse or misinterpretation. A qualified=20 attorney should be consulted in all matters concerning practice=20 management. Visit Practice Guardian.Com web site today at http://www.practiceguardian.com Copyright 1999, MJB Consultant. May your new year be welcomed and rewarding. ****************************************************************************= ** --============_-1263712178==_ma============ Content-Type: text/enriched; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Geneva***********************************= ************************* PRACTICE GUARDIAN NEWS...=20 The Internet & Practice Management. ******************************************************************** This newsletter is freely circulated to the health care community. Subscribe today =46orward a copy to a friend or associate... Submit your www.association site Information today! Issue 1 - January 1, 2000 Main Page http://www.practiceguardian.com To unscribe to this newsletter please forward to unscribe@practiceguardian.com and include "unscribe" in the text you will be removed from the list as soon as possible. **************************************************** INDEX **************************************************** PRACTICE MANAGEMENT SITES =2E.....The Journal of the Southeasten Society of Pediatric Dentistry =2E........NewbyNews -Physician Coding/Practice Issues Newsletter PRACTICE TIPS =2E.....HCFA CLARIFIES APPROPRIATE USE OF CONSULTATION CODES By Joy Newby, President Joy Newby & Associates, Inc. ASSOCIATION UPDATE AMERICAN THORACIC SOCIETY NEWS BRIEF =2E......Sleep-related Breathing Disorder Is Risk Factor for Hypertension RECOMMENDED NEWSLETTERS & PUBLICATIONS NATIONAL HEALTH CARE ASSOCIATIONS (A TO Z) EDITORIAL INFORMATION ******************************************************************* Practice Guardian.Com - In 90 Days - "In House Collection System" Practice collections are an art form. Asking a patient for payment can be one of most difficult tasks accomplished by the practice manager. Time, patient response and resources are important elements to success. Using the right tool for the right job can pay dividends and reduce future delinquency headaches. Nationwide, one third of all patient accounts aging into the 75 to 90 day time frame without partial or full payment will become delinquent.=20 As accounts age, the practice becomes overwhelmed by volume delinquencies forcing the manager to spend time on older accounts while newer accounts reach delinquency. A vicious cycle is created under minding=20 productivity and the collector's initiative. =20 Practice Guardian.Com - In 90 Days - "Practice Collection System" is the newest edition to Practice Guardian.Com. Now you can initiate an in-house collection management process to collect patient accounts 90 days up to your state law statute of limitations. All within 90 days from your subscription. The system is designed as an interactive and consulting resource. Routine consultations are conducted by the web site to subscribers who first sign up for the service then receive a user name and password to enter the secure area. Telephone support and email contacts are included without additional costs up to ten contacts. An additional fee may be required for excessive use. Subscribers to the service first enter a secure area then choose from a range of collection management letters to begin the 90 day clean up process. All collection letters are designed and developed by Michael J. Berry, Consultant (Best selling author of Collections Made Easy! 2), to open the communication lines between the practice and patient, increase patient response, improve cash flow and create positive results without injuring your patient's pride. =20 Additional management letters are included in the system to create management follow up and secure payment including a motivational thank you letter for payment and failed arrangement procedure. In all subscribers are entitled up to five collection management letters all copyrighted and proven to yield outstanding results. The main goal is to reach a 40% patient response and return.=20 All letters and system processes are scheduled on a 30 day time frame to coincide with your billing process. Each month the subscribe chooses a letter to begin the initial, secondary and final patient contacts. In all, In 90 Days - Practice Collection System can be a valuable resource tool to the practitioner or practice manager interested in collecting plus 90 day accounts.=20 A one time subscriber fee of $275.00 begins the process to turn loss into cash flow without a third party. =20 Designed to improve patient relations this is a consulting service. =46or more information visit Practice Guardian.Com at http://www.practiceguardian.com or call Mr.Michael J. Berry, Consultant at 219-583-4234. ******************************************************************** Practice Management Sites ******************************************************************** The Journal of the Southeasten Society of Pediatric Dentistry Attn: Dr. Edward S. Nacht, DDS. Editor J.S.S. P.D. 7400 NW 5th St. Plantation, FL 33317 Informative and practical clinical and practice management magazine. =46eatures articles, tips and up to date dental procedures and discussions.=20 =46or more information on subscribing contact Dr. Edward S. Nacht, D.D.S. ****************************************************************************= ***** NewbyNews Physician Coding/Practice Issues Newsletter Newbyassoc@aol.com After several years and numerous requests, Joy Newby & Associates, Inc., one of Indiana's most sought after physician coding/reimbursement consulting=20 firms has finally decided to publish a newsletter!=20 Joy Newby & Associates, Inc., is proud to present NewbyNews, a bimonthly fax newsletter designed to meet the coding and general practice issues of=20 physician practices.=20 The charter issue of NewbyNews was distributed in August 1999. This issue is=20 available at no cost as a trial. We believe physicians will find this=20 newsletter to be a must have, full of valuable, up-to-date information. Each issue is approximately 5-10 pages in length and will contain a variety=20 of pertinent timely information. The newsletter is faxed at night so it will=20 not tie up your fax machine and interrupt your daily business.=20 You will see articles related to procedural/diagnostic coding, documentation,=20 medical policy clarifications received from Medicare/Medicaid and other insurance companies, practice management tips, and other hot topics.=20 Periodically we will feature a guest author to share with you his/her area of=20 expertise. The October issue featured an article regarding the Supreme Court=20 ruling on the statue of limitations written by Kevin Speer, Attorney-at-Law,=20 with the firm of Hall, Render, Killian, Health & Lyman, P.S.C. Because we serve such a diverse base of physicians, this newsletter will not=20 be geared toward any one practice type or specialty. However, it will be=20 state specific, containing information written specifically for physicians=20 practicing in Indiana.=20 A one-year subscription is available for only $195. Individual issues are=20 available for $40 per issue.=20 To receive your free issue or if you have any questions/comments, please feel=20 free to contact our newsletter coordinator, Maureen Hoffmeyer, at (317) 577-3066. Questions, comments, and subscription requests may also be mailed, faxed, or e-mailed to us at the following address:=20 Joy Newby & Associates, Inc. 6828 Hawthorn Park Drive Indianapolis, IN 46220 =46ax: 317-577-3061 Newbyassoc@aol.com Be sure to include your name, practice name, telephone number, and fax number.=20 *Joy Newby & Associates, Inc., is a private third party reimbursement=20 consulting firm specializing in Medicare and Medicaid reimbursement issues.=20 We are not employed, endorsed, or affiliated with the Health Care =46inancing=20 Administration, the American Medical Association, any Medicare or Medicaid=20 Carrier, or insurance company.=20 ******************************************************************** PRACTICE TIPS ******************************************************************** HCFA CLARIFIES APPROPRIATE USE OF CONSULTATION CODES By Joy Newby, President Joy Newby & Associates, Inc. Since many Medicare Carriers, physicians, and consultants had been confused about what type of service could be billed as a consultation, the Health Care Financing Administration (HCFA) issued additional clarification on the use of consultation codes. The clarification included almost a total revision of Section 15506 of the Medicare Carriers Manual, Part 3, Claims Process (MCM). With the publication of this information, there is no doubt what type of services HCFA considers consultations.=20 The clarification supports what has been our impression all along; however, some Medicare Carriers had taken a different position which caused us to contact the Health Care Financing Administration for assistance in resolving this issue. We appreciate the assistance we received from Senator Richard Lugar, representatives of HCFA Region V and the HCFA Central Office. For=20 those of you providing consultation services, we believe you will be as excited as we were with the clarification of Section 15506. We are pleased to provide you with excerpts from the Medicare Carriers Manual - Transmittal No. 1644 - August 1999. Consultation Versus Visit-Pay for a consultation when all of the criteria for=20 the use of a consultation code are met: (1) Specifically, a consultation is distinguished from a visit because it is provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source (unless it is a patient-generated confirmatory consultation). (2) A request for a consultation from an appropriate source and the need for consultation must be documented in the patient's medical record. (3) After the consultation is provided, the consultant prepares a written=20 report of his/her findings which is provided to the referring physician. Consultation Followed By Treatment-Pay for an initial consultation if all the criteria for a consultation are satisfied. Payment may be made regardless of treatment initiation unless a transfer of care occurs. A transfer of care occurs when the referring physician transfers the responsibility for the patient's complete care to the receiving physician at the time of referral,=20 and the receiving physician documents approval of care in advance. The receiving physician would report a new or established patient visit depending on the situation (a new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years) and setting=20 (e.g., office or inpatient). A physician consultant may initiate diagnostic and/or therapeutic services at an initial or subsequent visit. Subsequent visits (not performed to complete the initial consultation) to manage a portion or all of the patient's condition should be reported as established patient office visit or=20 subsequent hospital care, depending on the setting. Consultations Requested by Members of the Same Group-Pay for a consultation if one physician in a group practice requests a consultation from another physician in the same group practice as long as all of the requirements for use of the CPT consultation codes are met (See =A715506A.) Documentation for Consultations-A request for a consultation from an appropriate source and the need for consultation must be documented in the patient's medical record. A written report must be furnished to the requesting physician. In an emergency department or an inpatient or outpatient setting in which the medical record is shared between the referring physician and the consultant, the request may be documented as part of a plan written in the requesting physician's progress note, an order in the medical record, or a specific written request for the consultation. In these settings, the report may consist of an appropriate entry in the common medical record. In an office setting, the documentation requirement may be met by a specific written request for the consultation from the requesting physician or if the consultant's record shows a specific reference to the request. In this=20 setting, the consultation report is a separate document communicated to the requesting physician. Examples of Consultations: 1. An internist sees a patient that he has followed for 20 years for mild hypertension and diabetes mellitus. The patient exhibits a new skin lesion and the internist sends the patient to a dermatologist for further evaluation. The dermatologist examines the patient and removes the lesion which is determined to be an early melanoma. The dermatologist dictates and=20 forwards a report to the internist regarding his evaluation and treatment of=20 the patient. 2. A general ophthalmologist diagnoses a patient with a retinal detachment. He sends the patient to a retinal subspecialist to evaluate the patient because the general ophthalmologist does not treat this specific problem. The retinal subspecialist evaluates the patient and subsequently schedules=20 surgery. He sends a report to the referring physician explaining his findings and the treatment option selected. (JNA Example) 3. A family physician diagnoses a patient with diabetes mellitus. The family physician asks the ophthalmologist for a baseline evaluation to rule out diabetic retinopathy. The ophthalmologist examines the patient and sends a report to the family physician on his findings. The ophthalmologist tells the patient at the time of service to return in one year for a follow-up visit. This subsequent follow-up visit should be billed as an established patient visit in the office or other outpatient setting, as appropriate. (JNA Example) 4. A rural family practice physician examines a patient who has been under his care for 20 years and diagnoses a new onset of atrial fibrillation. The family practitioner sends the patient to a cardiologist at an urban cardiology center for advice on his care and management. The cardiologist=20 examines the patient, suggests a cardiac catheterization and other diagnostic=20 tests which he schedules and then sends a written report to the requesting physician. The=20 cardiologist subsequently routinely sees the patient once a year as follow-up. Subsequent visits provided by the cardiologist should be billed as an established patient visit in the office or other outpatient setting, as appropriate. Other routine care continues to be followed by the=20 family practice physician. 5. A family practice physician examines a female patient who has been under his care for some time and diagnoses a breast mass. The family practitioner sends the patient to a general surgeon for advice and management of the mass and related patient care. The general surgeon examines the patient and recommends a breast biopsy, which he schedules, and then sends a written=20 report to the requesting physician. The general surgeon subsequently performs a biopsy and then routinely sees the patient once a year as follow-up. Subsequent visits provided by the surgeon should be billed as an established patient visit in the office or other outpatient setting, as appropriate. Other routine care continues to be followed by the family practice physician. 6. An internist examines a patient who has been under his care for some time, and diagnoses a thyroid mass. The internist sends the patient to a general surgeon for advice on management of the mass and related patient care. The general surgeon examines the patient, orders diagnostic tests, and suggests a needle biopsy of the mass. The surgeon then schedules the procedure and sends a written report to the requesting physician. The general surgeon subsequently performs a thin needle biopsy and then routinely sees the patient twice as follow-up for the mass. Subsequent visits provided by the surgeon should be billed as an established patient visit in the office or=20 other outpatient setting, as appropriate. Other routine care continues to be followed by the internist. 7. A patient with underling diabetes mellitus and renal insufficiency is seen in the emergency room for the evaluation of fever, cough, and purulent sputum. Since it is not clear whether the patient needs to be admitted, the emergency room physician requests an opinion by the on-call internist. The internist may bill a consultation regardless if the patient is discharged=20 from the emergency room or whether the patient is admitted to the hospital as long as the criteria for consultation have been met. If the internist admits the patient to the hospital, he/she may bill either an initial inpatient consultation or initial hospital care code but not both for the same date of service. Examples That Do Not Satisfy the Criteria: 1. Standing orders in the medical record for consultations. 2. No order for a consultation. 3. No written report of a consultation. 4. After hours, an internist receives a call from her patient about a=20 complaint of abdominal pain. The internist believes this requires immediate=20 evaluation and advises the patient to go to the emergency room where she=20 meets the patient and evaluates him. The emergency room physician does not=20 see the patient. The internist should bill for the appropriate level of emergency department service, or if the patient is admitted to the hospital=20 she would bill this visit as an inpatient admission. ******************************************************************** ASSOCIATION UPDATE ******************************************************************** AMERICAN THORACIC SOCIETY NEWS BRIEF Sleep-related Breathing Disorder Is Risk Factor for Hypertension Individuals with sleep-related breathing disorder (SRBD) are at greater risk for high blood pressure and increased resting heart rate independent of such factors as body mass index, age, and cholesterol level, according to a study published in the December American Journal of Respiratory and Critical Care Medicine. Ludger Grote, M.D., of the Department of Clinical Pharmacology and Sleep Disorders Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden, along with five associates, studied 1,087 men and 103 women referred for clinical symptoms of SRBD. The investigators=3D results showed a relationship between SRBD severity and systolic/diastolic blood pressure, as well as heart rate. During the study, the researchers recorded patient age, sex, race, and body mass index. Each participant completed a questionnaire and had a standard medical interview, including questions about SRBD-related symptoms such assnoring, witnessed apneas, excessive daytime sleepiness, insomnia, and falling asleep while driving a car. Smoking habits and current alcohol consumption were recorded. Blood samples were analyzed to determine total cholesterol, and blood gas samples were studied. Blood pressure readings were performed, along with heart rate determinations. Also, all patients underwent unattended home monitoring of nocturnal breathing on two consecutive nights, using a device that they wore from 6 p.m. to 8 a.m. The device measured oxygen saturation, snoring, beat-to-beat heart rate, and body position.=20 Experienced sleep technicians evaluated all events recorded during sleep and devised a respiratory disturbance index (RDI) based on estimated sleep duration. An RDI of less than five, which indicated no SRBD, was found in 400 patients. They assigned an elevated RDI (more than five) to 790 individuals. After the allocation of patients into different RDI classes, we saw an obvious stepwise increase in blood pressure and heart rate,@ the authors wrote. "In particular, SRBD, had a highly significant influence on daytime resting heart rate.@ The authors emphasized that they found the risk of hypertension associated with SRBD greater for younger patients. Secondly, RDI showed an independent influence on resting heart rate, which was larger than that found for blood pressure. In fact, during future studies, the researchers believe that resting heart rate will be considered an important predictor for cardiovascular illness and mortality in SRBD patients.Finally, the investigators found that daytime blood gas levels independently influence blood pressure and resting heart rate. Contact for Media: Ludger Grote, M.D., Department of Clinical Pharmacology and Sleep Disorders Clinic, Sahlgrenska University Hospital, Gothenburg,Sweden. Phone: 46-31-342-2964, or 46-31-342-2974; Fax: 46-31-826723; E-mail: ludger.grote@pharm.gu.se. ******************************************************************** RECOMMENDED NEWSLETTERS & PUBLICATIONS ******************************************************************** "Managed Care Insider eNews" Published MonthlyFor more information contact: Ms. Nancy Belle, Editor, at nkbelle@erols.com Subscription: Free at insider@scheur.com =46ocus Point: Managed Care Issues Website: http://www.scheur.com/smghome.nsf/webcontent/ezine.html Healthcare Management Advisors, Strategy Advisor=20 =46ree Newsletter http://www.HMA.com/sa11/ =46ocus Point: =20 HMA's team of MD, JD, RN, RRA, CPC, CFE and CPA consultants perform corporate-wide risk assessments, DRG and CPT benchmark analyses, and focused compliance audits for hospitals, physicians and attorneys nationwide. =20 To Subscribe: webmaster@HMA.com. 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Beltline Highway Madison, Wisconsin 53725 Yearly Subscription: $35 =46ocus Point: Medical Collections, Accounts=20 Receivables, Federal & State Regulations. =20 =20 American Medical News Published weekly by: American Medical Association (A.M.A.) Questions contact: A.M.News Staff 312-464-4429 515 North State Street Chicago, Illinois 60610 Yearly Subscription:=20 (Free with AMA Membership) =46ocus Point: All Medical/Socioecomonic Issues. Web site: =20 http://www.ama-assn.org/public/journals/AmNews/AmNews.htm Physican1s Marketing & Management Published monthly by: American Health Consultants Inc. Questions contact: Managing Editor, 404-282-7436 3525 Piedmont Road N.E. Atlanta, Georgia 30305 Yearly Subscription =46ocus Point: Medical Management In Confidence Published Bimonthly by: American Health Information=20 Management Association (AHIMA) Questions contact: Ms. Jennifer Carpenter. RRA Professional Practice 312-787-2672 919 N. Michigan Avenue, Suite 1400 Chicago, Illinois 60611-1683 Yearly Subscription: $90 ($75 with membership) =46ocus Point: Health Information,=20 Patient Privacy & Information System Security Web Site: http://www.ahima.org ****************************************************************************= ** NATIONAL HEALTHCARE ASSOCIATIONS (A TO Z) ************************************************************************* Academy of Operative Dentistry=20 Contact: Dr. John Reinhardt at john-reinhardt@uiowa.edu Website : http://www.uiowa.edu/~aodweb.=20 American Academy of Family Physicians Contact: (816) 333-9700 Web Site: http://www.aafp.org American Academy of Pediatrics Contact (847) 228-5005 Web Site: http://www.aap.org American College of Cardiology Contact: 800-253-4636 ext.697, or 301-897-5400, ext.697) http://www.acc.org American Dental Association Contact: (312) 440-2500 Web Site: http://www.ada.org American Medical Association (A.M.A.) Contact: (312) 464-5000 Web Site: http://www.ama-assn.org Association of Managed Care Dentists Contact: Call: 310-4553-3439 http://www.dentalgroup.com/amcd. Association of Military Surgeons of the United States (AMSUS) Contact: (301) 897-8800 ext. 20. marisab@amsus.org http://www.amsus.org Healthcare Financial Management Association (HCFMA) Contact: (800)252-HFMA (4362), ext. 362=20 tarya@hfma.org http://www.hfma.org Integrated Healthcare Association (IHA)(Managed Care) Contact: (925) 746-5100 bcarter@iha.org. Web Site: http://www.iha.org Medical Group Management Association Contact: (303) 799-1111 Web Site: http://www.mgma.com National Institute of Dental and Craniofacial Research Contact: Phone: 301-496-4263 E-mail: Sally.Wilberding@nih.gov The American College of Physician Executives Contact: wcurry@acpe.org 813-287-2000,=20 http://www.acpe.org The American College of Chest Physicians Contact: 1-800-343-2227 or 847-498-1400 registration@chestnet.org http://www.chestnet.org The American Gastroenterlogical Association Contact: http://www.gastro.org The American Thoracic Society Contact: 212/315-6442 ladkins@thoracic.org=20 http://www.thoracic.org **************************************************** PRACTICE GUARDIAN NEWS Practice Guardian News is published monthly. Send all inquiries to attention editor at (219) 583-4234. E-Mail info@practiceguardian.com=20 The subjects and written examples in this newsletter are for general use only. The publisher and author do not accept any responsibility or liability in regards to misuse or misinterpretation. A qualified attorney should be consulted in all matters concerning practice management. Visit Practice Guardian.Com web site today at http://www.practiceguardian.com Copyright 1999, MJB Consultant. May your new year be welcomed and rewarding. ********************************************************************= ********** --============_-1263712178==_ma============--