The Pulse is the bi-weekly e-newsletter from The Physician Alliance, one of Michigan's largest physician organizations serving more than 2,200 primary care and specialty physicians.
The Pulse of The Physician Alliance
Friday, February 2, 2018
Seminar shares new and updated coding tips
 
The Physician Alliance is hosting a complimentary education seminar for member practices to gain a better understanding of new and updated billing codes.  
 
Coding for the care and evaluation of patients
Wednesday, March 7, 2018; 8-9:30am
 
Key objectives include:
  • Cognitive assessment and new billing opportunities
  • Advanced care planning
  • Update on telehealth 
  • Coding co-morbidities/risk stratification
Who should attend: primary care physicians, billing staff, care managers, office managers
Seminar presenter: Jill Young, CPC, CEDC, CIMC, principal, Young Medical Consulting 
Where: St. John Macomb Oakland Hospital - Oakland Education Building, 27321 Dequindre, Madison Heights
 
Space is limited so register today!
 
Click here for more information. Still have questions? Contact Teresa at teresa.pontello@thephysicianalliance.org
Incentive program updates available now on website

The latest updates to Blue Cross Blue Shield of Michigan's Provider Delivered Care Management program are available for review on The Physician Alliance website (under the Care Management tab), including information on both the primary care and specialist focused programs.

TPA also provided an updated provider tip sheet for adult condition specific HEDIS measures. To view that tip sheet and other helpful materials, click here or visit the Learning Center tab.
Fraud, fines and prison time: Update on healthcare in Michigan
 
Did you know every physician practice is required to have a compliance plan? Healthcare fraud is rampant in Michigan and the federal government is cracking down on healthcare practices.  
 
An Oakland County physician practice biller was recently ordered to pay $3,252,107 in restitution and sentenced to 50 months in prison. The biller was convicted of mail fraud and of conspiracy to commit health care fraud, wire fraud, and mail fraud. These convictions were passed down as the biller knowingly submitted fraudulent bills on behalf of a physician, for services she knew were not rendered. The physician paid her 6% of the total billings from Medicare. The case was investigated by the FBI and the U.S. Department of Health and Human Service Office of Inspector General. 
 
How can you protect your practice from fraud and fines? There are many things you can do to make sure that you don't share this fate.
  1. Perform an external audit to catch potential billing errors. Audits serve many functions and can help to catch mistakes before it's too late.
  2. Train your staff on both HIPAA and compliance regulations, as well as on the potential sanctions that come with violations of regulations.
  3. Your staff and all physicians must also be trained on billing and coding, to make sure that physicians in your practice are not upcoding or billing for services not rendered. Physician billing and coding is under constant scrutiny from the government and insurance companies.
  4. Ensure that your practice has open lines of communication so that physicians, staff, and billers feel free to communicate their compliance concerns and questions. Make sure to have a way for all staff to anonymously report their concerns.
  5. Follow through. Make sure to take all potential compliance concerns seriously. Investigate allegations and make the necessary changes to prevent further issues from arising. Let your staff know that you take their compliance concerns seriously.
Always remember that compliance is an ongoing process and compliance education should be ongoing at your practice.
 
Contributed by: Lori-Ann Rickard of Rickard & Associates, P.C., a multi-specialty law firm serving corporate and individual clients. Rickard & Associates is a member of TPA's Affiliate Partners program. Contact Rickard & Associates, P.C. at (586) 498-0600. TPA members get discounts on rates! 
Patient education materials available

If you submitted an online order for patient education posters, and have not yet received your materials, please contact Kathryn at kathryn.bartz@thephysicianalliance.org.

Haven't seen TPA's patient education posters yet? Check out the variety of materials available to your practice (complimentary to TPA members). From breast cancer screening to managing diabetes to decreasing antibiotic use, these materials focus on key quality metrics and help initiate conversations with patients. They're perfect for posting in exam rooms and waiting areas, and giving to patients as 'non-prescriptions.' Flyers and forms can be downloaded and printed by practices, or ordered online.
Newsletter offers coding tips, healthcare updates and more

The latest issue of The Pulse, TPA's quarterly newsletter, is headed to the mail to arrive soon at practices. Anxious to check out what's new? Download the new edition from TPA's website. This issue includes a review of 2017 accomplishments, tips on improved coding to help with quality metrics and revenue, an update on the opioid crisis and more. Read this issue and past newsletters by visiting TPA's website
News you can use

newspaper
 Intense flu season has required some of medicine's most difficult choices, CBS News
After Months In Limbo For Children's Health Insurance, Huge Relief Over Deal, Kaiser Health News
Drug companies fight state opioid lawsuits, CBS News
Detroit Medical Center to eliminate up to 300 jobs, Beckers Healthcare Review
Lino Realty offers TPA members special pricing on commercial real estate services, including a discount on brokerage commission. Lino Realty can provide expertise in leasing, purchasing, real estate investments and property management.

Learn about this Affiliate Partner.
The Physician Alliance | 20952 Twelve Mile, Suite 130, St. Clair Shores MI 48081 | 586-498-3555
thephysicianalliance@thephysicianalliance.org | www.thephysicianalliance.org