Prac%ce Management. Peter Bidey, D.O. February 20, 2016 Instructor, Family Medicine Medical Director, Family PCOM PCOM

Transcription

1 Prac%ce Management Peter Bidey, D.O. February 20, 2016 Instructor, Family Medicine Medical Director, Family PCOM PCOM

2 Outline The Man The Measures The Money The Madness hdp://maddantodd.com/2013/01/18/introverts-extroverts-and-being-fake-online/

3 Occupa%onal Safety & Health Administra%on (OSHA) Blood borne pathogens Everyone must comply Must use Safer Devices Must have training and documenta%on Aware of proper disinfectants HIV and HBV specific

4 Occupa%onal Safety & Health Airborne hazards Administra%on (OSHA) Employer s role Employee s role Mask myths Masks and respirators provide the same protec%on They can be reused You can write on your respirator Everyone can wear a respirator You can t have facial hair and wear a respirator

5 Laboratory Repor%ng Know your state hdp:// portal/server.pt? open=514&objid= &mode=2 CDC reportable diseases hdp://wwwn.cdc.gov/ nndss/condi%ons/ no%fiable/2015/ infec%ous-diseases/ hdps://seriouslyyouboughdhat.wordpress.com/2011/04/01/stuffed-stds-alimentaries/

6 Human Resources Hiring Things you can ask: Ask open-ended and scenario driven ques%ons General knowledge, conflict management, mo%va%on, work ethic, problem solving strategies, response to office poli%cs, gossip, & computer confidence Things you can t ask: Age, religion, na%onal origin, mar%al status, children, and medical issues. Ask if you can contact previous employers

7 Human Resources Firing Communicate Expecta%ons WriDen, orientated, and regularly checked Termina%on Who? Where? When? How? Address the Details Pimalls hdp://thezom.com/tag/donald-trump/

8 Family Medical Leave Act (FMLA) Who is covered? Works for a covered employer Has worked for the employer for at least 12 months At least 1,250 hours of service for the employer during a 12 months period preceding leave Works at a loca%on where the employer has at lease 50 employees within 75 miles

9 Family Medical Leave Act (FMLA) What it allows? Eligible employees may take up to 12 work weeks of leave in a 12- month period for: Birth, or placement for adop%on, or foster care Care for spouse, son, daughter, or parent who is seriously ill If the employee has a health condi%on that makes the employee unable to preform essen%al func%ons For any qualifying exigency arising out of the fact that a spouse, son, daughter, or parent is a military member on covered ac%ve duty or call to covered ac%ve duty status 26 work weeks of leave for care of a covered service member with a serious injury or illness when the employee is the spouse, son, daughter, parent, or next of kin of the service member IntermiDent leave allowed This is unpaid, job-protected leave for specified family and medical reasons

10 Quality Improvement Basics Establish a culture of quality in your prac%ce Determine and priori%ze poten%al areas of improvement Collect and analyze data Communicate your results Commit to ongoing evalua%on

11 QI Lingo/Pa%ent Safety Adverse Event- results in unintended harm to the pa%ent by an act of commission, or omission rather than by the underlying disease or condi%on of the pa%ent. Composite Measure- a combina%on of two or more individual measures in a single measure that results in a single score Incident- A pa%ent safety event that reached the pa%ent, whether or not the pa%ent was harmed

12 QI Lingo/Pa%ent Safety Mandatory Repor%ng- legal requirement for physicians and other professional providing health services to report suspected incidents or abuse or neglect Near miss- an event or a situa%on that did not produce pa%ent harm, but only because intervening factors, such as pa%ent health or %mely interven%on Preventable (event)- Described an event that could have been an%cipated and prepared for, but that occurs because of an error or other system failure Sen%nel event- an unexpected occurrence involving death or serious physical or psychological injury or the risk thereof

13 QI Math Specificity-SpIN Specificity=true nega5ves/(true nega5ve + false posi5ves) Sensi%vity-SnOUT Sensi5vity= true posi5ves/(true posi5ve + false nega5ve) Posi%ve Predic%ve Value PV+= true posi5ve/(true posi5ve + false posi5ve) Nega%ve Predic%ve Value PV-= true nega5ves/(true nega5ves +false nega5ves)

14 Billing and Coding CPT Codes for NEW pa%ents for established pa%ents for NEW preven%ve pa%ents visit for established preven%ve pa%ent visit G Medicare Annual Wellness Ini%al G0439 Medicare Annual Wellness Subsequent hdp://memegenerator.net/instance/

15 Billing and Coding Basics History Physical hdps:// hdp://

16 Billing and Coding Basics Medical Decision Making hdp://

17 Billing and Coding MC Chronic Care Management (CCM) Requires an agreement There is a co-pay Requires 2 or more chronic condi%ons expected to last 12 months and place pa%ent at significant risk of func%onal decline Require at last 20 minutes of clinical staff %me directed by physician or qualified health care professional per month Comprehensive care plan established, implemented, revised, or monitored

18 Billing and Coding Transi%onal Care Management (TCM) Communica%on with pa%ent or caretaker within 2 business days from discharge Medical decision making of at least moderate complexity during the service period Face-to-face encounter within 14 calendar days of discharge

19 Billing and Coding OMT 1. Bill regular office visit with -25 modifier 2. Place allopathic diagnosis 3. Place osteopathic-soma%c dysfunc%on diagnosis 4. Level of OMT performed body regions body regions body regions body regions body regions

20 Billing ICD Head region Cervical region Thoracic region Lumbar region Sacral region Pelvic region Lower extremiges Upper extremiges Rib cage Abdomen and other ICD-10 M99.00 Segmental and soma%c dysfunc%on of head region M99.01 Segmental and soma%c dysfunc%on of cervical region M99.02 Segmental and soma%c dysfunc%on of thoracic region M99.03 Segmental and soma%c dysfunc%on of lumbar region M99.04 Segmental and soma%c dysfunc%on of sacral region M99.05 Segmental and soma%c dysfunc%on of pelvic region M99.06 Segmental and soma%c dysfunc%on of lower extremity M99.07 Segmental and soma%c dysfunc%on of upper extremity M99.08 Segmental and soma%c dysfunc%on of rib cage M99.09 Segmental and soma%c dysfunc%on of abdomen and other regions

21 Documenta%on/EHR You should do it. You should do it well. It will protect you.

22 hdp:// HIPPA

23 HIPPA Business Associates (BA) Who is a BA.more complex then you think En%%es that access, use, or disclose pa%ent Personal Health Informa%on (PHI) on your behalf Anyone you have direct control over is not a BA, but rather considered workforce Examples: electronic prescribing gateways, health informa%n organiza%ons, document storage agencies, EHR vendors (if they provide personal health records to pa%ents on your behalf), adoneys, call services If they are BAs you need an agreement

24 HIPPA HIPPA Office Compliance-Checklist Have your No%ce of Privacy Prac%ces posted in a visible loca%on. Make sure new pa%ents sign that they ve received it Inventory all mobile devices and make sure they are both password protected, secure, and encrypted for texts and s Use a virtual private network (VPN) to access our HER remotely Make sure you fax cover sheet has a HIPAA disclaimer and never fax without a cover page Ensure that passwords are changed at least every 6 months

25 Ques%ons? hdp://newsroom.carleton.ca/2014/02/14/got-ques%ons-need-answering/