Having certain Medicare claims re-opened without the appeal process!

Medicare Claim Re-openings and How to Request a Reopening

In the case where a minor error or omission of your Medicare claim submission resulted in a claim denial, you can request Medicare to reopen the claim so the error or omission can be corrected, rather than having to go through the appeal process. There is no need to request an appeal/redetermination if you have made a minor error or omission in filing the claim, which, in turn, caused the claim to be denied. You can request a reopening for minor errors or omissions either by telephone, in writing or via NGSConnex. You have one year to request a reopening from the date on your RA.

The clerical error reopening process is not a part of the formal appeals process, but it allows providers to make a minor change to a previously filed claim, if the original claim has been denied or reduced. CMS provides the instructions for reopening activities conducted by MACs. Section 937 of the MMA required CMS to establish a process whereby providers, physicians, and suppliers could correct minor errors or omissions outside of the appeals process.

Clerical error reopenings can be done on the phone, in writing or via NGSConnex, for providers to correct minor errors, clerical errors, or omissions. The MAC reserves the right to refuse to adjust a claim as requested if it appears that such an adjustment would risk incorrect payment on any claims not identified for correction.

A provider, physician, or supplier may request a reopening up to one year from the receipt of the initial remittance notice. If the provider, physician, or supplier would like to request a reopening after the one-year time limit has expired, they may request the reopening in writing. Documentation supporting good cause to waive the timeliness requirement must be included.

CMS issued interim final regulations, which state clerical errors (which CMS likens to MMA’s minor errors or omissions), are defined as human or mechanical errors on the part of the party or the contractor, such as:

  • Mathematical or computational mistakes;
  • Transposed procedure or diagnostic codes;
  • Inaccurate data entry;
  • Misapplication of a fee schedule;
  • Computer error; or,
  • Denial of claims as duplicates which are denied as a result of a clerical error or minor omission and require a change on the face of the claim (i.e., adding or removing a modifier) in order for the claim to be reopened. (Exception: We will reopen claims that denied as a duplicate when multiple services have been billed and some are denied due to a separate claim submission; i.e., when three radiology services have been paid on one claim and a fourth one denied as a duplicate due to a separate claim submission and a request is made to allow a total of four services. A reopening can be performed even though the claim was submitted correctly and no change is being made.)
  • Incorrect data items, such as provider number, use of a modifier or date of service.

The basis of a clerical error or minor omission reopening is to correct the minor clerical or minor omission that resulted in an initial claim denial or reduction.

Types of Issues that can be performed as clerical error or minor omission reopenings:

  • Increase number of services or units (without an increase in the billed amount)
  • Add/change/delete modifiers such as 24, 25, 54, 57, 58, 59, 76, 77, 78, 79, 80, AS, or AQ (Note: Postoperative modifiers 24, 25, 57 and 58 can be added to a paid claim so the provider can submit a procedure code without having it reduced by the unrelated visit.)
  • Procedure codes
  • Place of service
  • Add or change a diagnosis on a denied service
  • Billed amounts
  • Incorrect provider number to deny
  • Incorrect HIC to deny
  • MSP unrelated – non-GHP records
  • Correcting rendering provider PTAN/NPI
  • Addition of referring provider PTAN/NPI
  • Add date last seen on the claim
  • Date of service – the date of service change must be within the same year
  • Services billed in error
  • Refunds (except 935 refunds)

Types of Issues that cannot be performed as clerical error or minor omission reopenings. For these issues providers must submit a redetermination request in writing:

  • Comprehensive Error Rate Testing (CERT)
  • Provider enrollment issues
  • Claim denial due to no response to a development request
  • Established Recovery Auditor (RA) overpayment (Telephone only)
  • Services with a high dollar amount ($7,500 or more)
  • Wrong payee
  • Complex claim situations (such as ambulance, anesthesia, Not Otherwise Classified codes, claims with modifiers 22, 23, 53, 62, 66, GA or GY or any other claim which requires analysis of documentation).
  • CMS input (e.g. services after date of death)
  • If there are multiple surgeries on multiple claims for the date of service in question

Some situations would not be appropriate for the reopening or redetermination process:

  • If the original denial is rejected as unprocessable, submit a new claim
  • If the claim in question is in process, you must wait until after the claim has processed before requesting a reopening
  • If there has been no claim submitted, submit a new claim
Level/Type Time Limit Amount in Controversy
Required (after deductible and coinsurance)
Telephone Reopening Within 1 year of receipt of the notice of initial determination. No minimum
Written Reopening Within 1 year of receipt of the notice of initial determination and within 4 years after the date of the initial determination, when the situation establishes good cause. No minimum

Telephone Reopenings

Providers may request a reopening of the original claims processing decision by contacting the Appeals Telephone Reopening Unit (TRU).

The TRU can be used when you wish to revise the initial determination or redetermination of a specific service or claim for minor clerical errors. If you have a general question or need to talk to someone about an issue that cannot be reopened, please contact our Provider Contact Center.

TRU representatives will reopen claims to correct minor, uncomplicated, provider or contractor clerical errors or omissions. However, TRU representatives cannot add items or services that were not previously billed. Please Note: Reopenings are granted at the contractor’s discretion; a claim may not be appealed if contractor decides not reopen the claim.

With the availability of the electronic remittance advice you can know the outcome prior to the complete finalization of a claim. Please ensure the claim has finalized prior to calling the TRU line to request changes to the claim.

Note: Unsolicited faxes will be returned to the sender unprocessed.

Using NGSConnex to Submit a Redetermination or Reopening Request

NGSConnex, a free and secure web-based application, has a convenient option available that providers can use to submit an appeal request for a claim redetermination or reopening online instead of submitting a paper appeal. Providers can also check the status of redeterminations/reopening requests.

For complete instructions on using NGSConnex for submitting a reopening request, visit our Reopenings for Minor Errors and Omissions section of our website.

Written Reopening Requests

Jurisdiction 6 providers in Illinois, Minnesota and Wisconsin should mail written reopening requests to:

National Government Services, Inc.
P.O. Box 6475
Indianapolis, IN 46206-6475

Jurisdiction K providers in Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont should mail written reopening requests to:

National Government Services, Inc.
P.O. Box 7111
Indianapolis, IN 46207-7111

Be sure to include the following information with your reopening request:

  • The beneficiary’s name
  • The Medicare HICN of the beneficiary
  • The specific services(s) and/or item(s) for which the reopening is being requested and the specific date(s) of service, and
  • The name and signature of the person filing the request

Reopening requests for issues requiring documentation such as adding modifier 22 and redetermination of overpayments are not permitted. These must be submitted as a written redetermination request.
Info from: https://www.ngsmedicare.com/ngs/portal/ngsmedicare/newngs/home-lob/pages/job-aids-manuals/

Will the FTC Slow Down the Current Medical Merger Mania????

Many of us remember the merger mania in healthcare that occurred in the 1990’s, and how the push toward consolidation that started with hospitals trickled down to the private practice  therapy sector. If we fast forward to 2014, it is readily apparent that the “urge to merge” is back.  We see local hospitals in a merger frenzy, and local MDs leaving private practice to become hospital employees. I have more and more therapists contacting me about practice sales. Yet, a strong but dominant voice, namely the Federal Trade Commission, is beginning to weigh in on the topic. Citing antitrust laws, particularly the Clayton Antitrust Act of 2014, they have successfully blocked some deals using antitrust enforcement as a powerful tool to dampen  conglomeration fever.

Hospitals say they are acquiring other hospitals and physician groups to comply with provisions
of the Affordable Care Act and take advantage of incentives that encourage hospitals and doctors to integrate their operations and collaborate to control costs and improve care.
 The concern is that hospitals that face less competition can charge substantially higher prices, which according to Martin Gaynor, Director of the FTC’s Bureau of Economics could be as high as 40-50%.  In the last two years the FTC intervened and blocked hospital mergers in Albany Georgia, Toledo Ohio and Rockford Illinois. Although the decisions are currently being appealed, the message is strong. “Vague promises and aspirations that an acquisition will reduce costs and improve care are not sufficient” said Julie Brill, a member of the FTC.

When hospitals and doctors join forces, their goal is not just to control costs or improve care, but to “get increased leverage” in negotiations with health insurance companies and employers, according to
  Ms. Feinstein, Director of the Bureau of Competition at the FTC. “They say they need better rates so they will have more money to invest in their facilities.When you strip that down, it’s basically just saying, ‘We want a price increase.’ Even if the price increase is motivated by a desire to invest more in the business, that’s problematic. That incentive to invest may not be there if you don’t have competition as a spur to innovation — if you’re not worried about losing business to the hospital down the street.”

Look back to the first merger mania in the 1990’s particularly the state of Massachusetts, which let its two most prominent hospitals — Massachusetts General Hospital and Brigham and Women’s Hospital, merge into   as Partners HealthCare. Investigations by the state attorney general’s office of that state have documented that the merger gave the hospitals enormous market leverage to drive up health care costs in the Boston area by demanding high reimbursements from insurers that were unrelated to the quality or complexity of care delivered. Twenty years later, the current Massachusetts Attorney General,  Martha Coakley is trying to rein in the hospitals with a negotiated agreement that would at least slow the increases in Partners’ prices and limit the number of physician practices it can acquire.

What’s the take away for therapy practices?? Carefully examine your “urge to merge” or be acquired, probably the second most important decision of your professional career. Make sure your motivation is not based on panic, and that you are not being re-active rather than pro-active. As hard as it is to bring a merger to fruition, it is harder still to undo!

 

Thoughts on the Ice Bucket Challenge

There is no denying that the ice bucket challenge continues to be an unqualified success, despite the naysayers who have negated and criticized it from many angles – waste of water, and more of an exercise in raising awareness of one’s own craziness, altruism, “slacktivism” and/or attractiveness in a wet T-shirt.

Here’s why I am so happy it has taken off.  Back in the day (30 plus years ago), I was one of the first OTs to consult with  the MDA ( Muscular Dystrophy Association), and provided services to children and adults  with  many neuromuscular diseases. I was always hardest hit by the people with  ALS. The decline in function, and decrease in strength was steady, apparent and ongoing. The impact on families was huge. Living rooms became makeshift bedrooms to accommodate hospital beds, hoyer lifts and the like. Spouses became caretakers, while secretly mourning the loss of their spouse as they knew them. Looking back, the challenges as an OT were paramount. With the  physical and functional decline so swift and non forgiving, I was constantly challenged to think on the spot, make immediate accommodations, re-purposing and intuitive adaptations to the environment.  All in the hope of making the moment, or the day more tolerable for the family and patient.  What worked one day didn’t the next as the disease ran its course.  My feelings of inadequacy and frustration matched the family’s feelings of desperation and isolation, yet in a way it was OT at its finest.

The Ice Bucket Challenge is raising public awareness of ALS  in addition to raising money for research on the disease. Like most fundraising, the efforts will focus more on the cure while families and therapists focus on making day to day living as tolerable as possible. ALS is classified as an “orphan disease”, since fewer than 200,000 people get the diagnosis annually. Generally that means there is less research and clinical trials for treatment.  ALS has never been and never will be  as profitable a target for pharmaceutical companies to invest millions of dollars in as they do with  more prevalent diseases ( ie cancer, arthritis etc.).

The New York Times reports that in the last few weeks, ALSA has received $13.3 million and welcomed 260,000 new donors.  While the President of the Association Barbara Newhouse says she appreciates the monetary aspect of the Ice Bucket Challenge, she says, “the visibility that this disease is getting as a result of the challenge is truly invaluable.” Monetary donations coupled with social-media-friendly stunts build awareness and encourage others to give in a way that quietly donating cash does not. That’s what that silly tub of cold water does; audiences get a little entertainment, which helps the viralness of the cause and encourages donations. It also strives to make people want to learn more about the disease, and what organizations like the ALS Association are doing to fight it and provide assistance to those living with it.”

Practice owners who work with neuromuscular conditions may want to jump on this bandwagon- a twin win situation, and what I call “cause –related” marketing. It can be  great publicity for your practice and a great way to help raise money and awareness.  ALS is not only an incurable disease, it is an underfunded one as well.

 

 

A Shift in the Healthcare Dollar Pie

By my second lecture, I have taught my students about the healthcare dollar pie and its 3 pieces:

Piece 1 for the patient or consumer
Piece 2 for the service/medical provider
Piece 3 for the insurer/payor

I always tell them how the size of the pieces shift over time reflecting the cycles within healthcare delivery. Most of my students were not even born when patients got a big piece of the pie – that is, when patients received the services they needed for the amount of time that they needed them, all without pre-authorization! Many students can barely remember when the piece for the medical provider was big- when doctors were “rich” and therapists could become financially successful. My students do learn about the big piece of the pie that the insurers are eating, how well their stocks are doing, how much their CEOs are making, and how big their pended/denied departments are. And just in time for this fall’s lecture, the pie is shifting again, and in the wrong direction.

Yesterday, I received a letter from my insurance company (BCBS), informing me, as is required by law, that they are seeking a 17% increase in the premium for the new policy I got in January 2015. This both shocked and bothered me on many levels. Year one and the insurers are already taking “affordable” out of the Affordable Health Care Act. More disturbing is that this insurance company has systematically been lowering the fees paid to private practitioners –lowering the fee, eliminating CPT codes and time/ modality based payment in favor for flat fee methodology and bundling. While they systematic deny therapists a rate increase, even one based on cost of living and instead are lowering fees or canceling contracts, they claim they need a 17% increase in part because of the rising costs of medical care, a new pool of customers, and new providers.

I am beginning to no longer see the 3 pieces of the healthcare dollar pie. Instead, slowly it is becoming one pie solely for the insurers and payors, with 2 crumbs, one for providers and the other for patients.

Table of Contents- Starting a Professional Private Practice

TABLE OF CONTENTS

1. STEP ONE – IDENTIFY A NEED THAT YOUR PRACTICE CAN MEET …pg.8
TRENDS TO CONSIDER  …pg9
2. STEP TWO – WHO, WHAT AND WHERE …pg.10

3. STEP THREE – DETERMINING THE LEGAL STRUCTURE OF YOUR …pg.11-13
PRACTICE
4. STEP FOUR – CHOOSING A NAME …pg.14-16

5. STEP FIVE – MINIMUM START-UP REQUIREMENTS
Business Plan …pg.17-18
Insurance Information …pg.19-20
The Place of Business …pg.21-23
Contracting With Insurance Carriers – Medicare Enrollment, Plan- Lock out
The Perfect Storm: Cash based versus Insurance …pg.24-25
Financial Considerations – Budgeting, Securing a Loan …pg.26-33
HIPAA/ FERPA Compliance …pg.34-37

6. STEP SIX – MARKETING …pg.38-41
7. STEP SEVEN – GROWING YOUR PRACTICE …pg. 42-45
8. HEALTH CARE REFORM AND THE PRIVATE PRACTITIONER …pg.46

APPENDIX …pg.47-67

RESOURCES AND WEBSITES … pg. 68-72

Why Are There So Few Adult OT Private Practices?

Re-printed from the Advance POV blog

Published January 29, 2014 8:41 AM by Iris Kimberg

Thanks to everyone following my blog  I have already received many fantastic questions to answer for several weeks to come. This one really struck a chord:

Question:  Why do you think there are so few OT practices that treat adults, and so many that treat children??? Is there not a market for adult services in OT private practices???

Answer: 

I have often asked this myself – well over 60% of the OTs I consult with are pediatric private practitioners, and only a few work with adults. I think the answers lies in the cyclical nature  of therapy services. Like  everything else, there is a life cycle of therapy services – back in the 80’s healthcare, especially in rehabilitation  was adult driven. Private practices (mostly PT because very few OTs dabbled in private practice then outside of hand therapists) treated adults, there was no managed care, and very little was done in pediatrics.

Fast forward to the 90’s when 2 things happened:

1) Managed care rolled out across the country from West to East in part due to billing/therapy treatment abuses of the system by those providing  rehabilitation services
2) Parents of children with special needs woke up and began demanding the services their children were entitled to under Federal law PL 94-142, its expanded version, PL 99-457, and PL 105-17 (in 2004)

These two scenarios lead the cycle shift in therapy services from adult driven care to pediatric care. There was a significant increase in OTs developing private practices to serve the demands of the pediatric community nationwide starting in the 90’s and continuing fr the next 20 years. Guess what cycle watchers – it should come as not new news to pediatric practices, that the cycle is shifting again. Funding for pediatrics is declining and at the same time, baby boomers are living longer, and demanding to live better. This points to a very ripe opportunity for OTs to offer adult driven services. Right now, certified hand therapists who have always offered adult services will continue to do so, and there are some OT private practices who specialize in niche offering like low vision rehabilitation, drivers rehab, home modification services, vestibular rehab etc.

The time is  now for additional OTs to enter the world of private practice and succeed. The cycle is in your favor, the ACA is already addressing habilitative services in addition to rehabilitation services as an essential health benefit, more and more elderly want to stay and live in their homes, every day 10,000 people in the USA become baby boomers. Opportunity is definitely knocking – it is up to you to answer the call!

For the next few weeks, I will be opening this blog up for questions which may be answered in subsequent blogs.  My goal is to help therapists understand the business end of therapy provision through many lenses and achieve the success that they want for the mutual benefit of themselves and their patients.

Questions relating to the following topics can be submitted to me at infonytherapy@aol.com

  • Finances/ Billing
  • Legal  and Risk Management Considerations
  • Strategic Marketing and Business Communication
  • Day to Day Operational Issues
  • Ethical Considerations
  • Long Term Growth and Development

I look forward to hearing from many of you in the weeks to come!

Using Inbound Marketing For Your Practice

Chances are if you are reading this column, that you and I have developed a relationship, though we may not have met in person. That is because over the years, I have been developing relationships with therapists and creating trust through content via inbound marketing techniques. These same techniques that I have used to gain your trust, you can use to gain the trust of consumers in the hope they will become your clients when the need arises. The internet affords all of us the vehicle to meet new prospects and build trust without having to resort to cold calling, which has a notoriously low success rate in bringing in new clients. Inbound marketing focuses on creating quality content that pulls people toward your practice and services you offer. By aligning the content you publish with your niche areas of expertise, you automatically attract inbound traffic that you can then convert, close, and work with over time.

Creating trust through content means that a great way to start a conversation is by continually publishing some type of educational/meaningful content to your website. Your article choices, blog posts and opinions will begin to engage website visitors, FB fans and LinkedIn connections well before they may actually contact you for services or make referrals to you. What this means is that instead of spending time talking on the phone trying to make contacts, you are instead allowing consumers to get to know you and learn from your experiences. Professional services will always be relationship based, and consumers look to educate themselves before selecting a service provider. Sharing knowledge is an effective way to gain trust quickly – if you are still reading this, this is a live example of what I am talking about!

Become a magnet, attracting those who need your services by owning your space and your niche, and becoming the “go to” person for a particular skill and bolstering this by your targeted content. This is when you are educating “early stage” prospects who may contact you at some point down the road. No doubt there will be consumers who may look to you for content and information, and never take the relationship to the second stage, but others will, and you will be ready when they do. Using words that are “calls to action”, such as ready to get started? helps to move the relationship along to the point where you are contacted. Consumers that have been reading your material and learning to trust you will contact you when they are ready to start or need your services. You want to make sure they have an easy way to move into this stage of the relationship so keep your “contact us” form easy to fill out, and your telephone number/ personal email address readily visible to use. ( Case in point – are you still reading? Have I moved you to action to contact me so we can work on the targeted content for your practice’s website??)

There are no true substitutes for a personal meeting, and gaining the trust of your clients and referral sources in the traditional sense, so I would not be concerned that it is becoming obsolete. But in this age of the internet as a primary source of information in healthcare, content marketing and online nurturing is becoming more and more important as a tool to utilize in forming solid long term relationships.

Iris Kimberg, MS PT, OTR, has worked in the non-clinical aspect of therapy for the past 30 years. She is the founder of New York Therapy Guide (https://www.nytherapyguide.com), a site dedicated to the growth, viability and success of therapists in the private sector. Iris now enjoys sharing her expertise with others in the field through workshops, webinars and private consultations. She can be reached at infonytherapy@aol.com.

The Under Utilized Buy in- Buy Out Option

When the older  TV doctor Marcus Welby MD, took on the younger, dashing Steve Kiley MD as a partner, beside being a rating coup, he probably orchestrated  the first televised  buy in to a medical  practice  ( sorry readers born after 1970, you may have to Google them). Many physician medical groups are set up to potentially allow other physicians  to become partners  (or buy in) to  the medical group if both sides are amenable, over a period of time. This affords the older physician to ability have a balanced  lifestyle, a  contributor to the generation of revenue for the practice, a built in colleague, someone to share overhead expenses, and the right person who can pay them to own a portion, and then buy them out upon retirement.

There are  many established, well seasoned  therapists in private practice that  do not  have an exit strategy, built in or otherwise in their practice model, and an outright sale to a third party may be difficult to bring to fruition. Likewise, many younger therapists are on the fence about taking the plunge into private practice because of economic concerns, the competitive market place and the lack of access to start up funds to build or buy an existing practice outright.  The buy in may be a viable, workable option for both parties. It is never too late for any private practice to do some restructuring and offer a buy in option ( either for existing staff or a therapist new to the practice).  It is never too early for any therapist seeking employment in a private practice to inquire whether a buy in option does, or potentially could, exist.

Structuring the Buy In – There are many ways the buy in can be structured. The basics typically include multifaceted mutual decisions, including  what the buy in price is, which requires a practice valuation by the primary owner. Ownership  price should include, at a minimum, the value of the practices’ furniture, fixtures and equipment ( FFE) allocable to the equity interest being purchased by the new owner – for example, 30% of the FFE if the new owner is purchasing a 30% interest in the practice.   The buy in price will be a percentage of the total value, usually divided equally among all of the partners. Thus, if there are already two partners, you would be the third partner, and the total practice value would be divided by 3 to determine your buy-in amount.  Group practices have different cultures that influence how the ownership is divided. The price should also account for the new owner’s pro-rata interest in the practice’s accounts receivable (AR). The practice can either require the new equity owner to purchase the value of the AR allocable to the equity interest it is purchasing or allocate the existing collectible accounts receivable directly to the existing owners, payable to them over a pre determined period of  time ( ie.12-24 months).

Realistically it almost always  make the most sense for the  buy-in  to occur over several years. If  the buy-in is structured over 3 years, every year a  third of the total buy-in price is paid until. you become an equal partner with the others in the group. Additionally, buy-ins spanning several years are often structured as deductions from your annual salary. So if the buy-in payment is $50,000 for each year, instead of paying cash, your salary would be reduced by $50,000 each year.

If you are paying the amount of the buy-in during a period of time, the agreement should specify the interest rate, frequency, and duration of your payments.

As an equity shareholder you will also be responsible for buying out the share of any partner leaving the group. The buy-out structure is equally important, and often times what is called a  force buy-sell. If someone leaves for any reason (retirement, death, moving ) the remaining shareholder(s) is obligated to buy that party out. The buy-out is typically paid over time and, for tax purposes, usually part of it is structured as a combination  of stock  and deferred compensation.

In addition to consulting with the right attorney and accountant, it is equally important that the therapist on both side of the equation are a good fit. A brilliantly crafted contract will be meaningless if there is not first a sound compatibility on practice standards,and  ideas for growth and development between the parties.

We now offer a user friendly formularized excel spread sheet to help determine how to structure the buy in schedule so that it is doable for both parties

Excel Spread Sheet Formula for Practice Buy in Option

 

Table of Contents – When a column becomes a body of work

TABLE OF CONTENTS- 76 columns. 76 actionable ideas. Purchase the book now!

PAGE
Introduction 4
Make it Your Business 5-6
The Shape of Things to Come 6-7
What’s Your Marketing Plan Going to Be 8-9
Independent Contractors vs. Employees 9-10
Can You Replicate Success in Another Location 9-11
Choosing the Legal Structure for Your Practice 12-13
Evaluating Your Position in Managed Care Contracts 14-15
The Fiscally Fit Practice Part I and II 15-18
Protecting Your “Ship” from Mutiny 18-19
Everything You Need to Know about Coding Part I and II 20-23
Preparing to Sell Your Practice 24-25
Applying Stark Law in Your Practice 25-26
Practicing as a Partnership 27-28
Location, Location, Location 29-30
Your Moral Compass 31-32
Opening Your Own Contract Agency.32-33
Medicare Part B Exceptions 33-34
Understanding the Medicare Cap 35-36
Handling No Shows and Cancellation 37-38
Intellectual Property and Copyrights 38-40
Trademarks 101 40-41
Beyond Your Website, Succeed Online 42-43
Global Fees/Flat Fee Methodology, We Must Say No 43-44
Participating IN CMS’s QM Reporting 45-46
Practice Management Software Options Available 46-47
Practice Vital Signs to Be Aware Of 48
Risk Management When Offering Related Services in Your Practice 49-50
NPI Numbers – What You Need to Know 50-51
Understanding Your Malpractice and General Liabilities Insurance Policies 52-53
Value Purchasing Part I and II 53-56
Planning For a Crisis – The Need for a Continuity of Operations Plan 56-57
Private Practice Questions and Answers 58-59
Business Communications Strategies Part I and II 60-63
Managing In Hard Economic Times 63-64
Health Insurance for the Self Employed 65-66
Private Practice – a Family Matter 66-67
Retirement Plans for the Self Employed 67-68
Keeping Employee Records – What You Need to Know Part I and II 69-72
Maintaining Financial Health in Your Practice 73-74
The Need for a Policy and Procedure Manual 74-75
How We Are Shaping OT’s Personna 75-76
Compliance with Marketing and Advertising Plans 76-77
If Disney Ran Your Practice 77-78
Are OT’s Ready to Embrace Direct Access 79-80
Healthcare Reform and Private Practice 80-81
What the New ICD-10 Means to You 82-83
Pursuing a More Perfect Practice 84-85
Plan for Summer 2013 Now 85-86
Whys OTs Need a National Directory to Reach Consumers 86-87
Strategic Alliances in Healthcare – Lessons Learned from the Wizard of Oz 88-89
Patient Satisfaction Takes Center Stage in the Healthcare Arena 89-90
The New Look of Competition.91-92

Table of Contents – Practice Analysis and Strategies for Success

TABLE OF CONTENTS

 

INTRODUCTION 4
SUMMARY OF CURRENT CHALLENGES AND CONSIDERATIONS/TRENDS
TO KEEP IN MIND……………………………………………..5

STUDY SNAPSHOT OF YOUR PRACTICE – ASSESSING STRENGTHS AND WEAKNESSES/ PROFIT MAKERS VS.PROFIT TAKERS……………………………. 6-8

YOUR CURRENT POSITION IN MANAGED CARE / INSURANCE CONTRACTS
CONSIDERATIONS BEFORE DROPPING A PLAN………………………………………..9-10

BEST PRACTICE MANAGEMENT of CANCELLATIONS AND NO SHOWS…………..10-11
EVALUATING YOUR CURRENT ROLE IN THE PRACTICE AND THOSE OF YOUR STAFF 11-12

A WORD ABOUT INDEPENDENT CONTRACTORS VS. EMPLOYEES 13-14
KEY EMPLOYEES: CAN YOU LOSE THE EMPLOYEES and KEEP THE BUSINESS?

TIPS FOR RETAINING STAFF……………………………………………………………..14-15

TRENDS FOR THE FUTURE TO CONSIDER BEFORE ANY EXPANSION…………….16-17

THE EXPANSION PROCESS/HOW TO KEEP GROWING……………………………,,,, 18-25
EXPANDING AN EXISTING LOCATION
STARTING A SECOND OFFICE OR MULTIPLE LOCATIONS
VENTURING INTO COMPLEMENTARY AREAS
CONSIDERATIONS FOR PEDIATRICS AND ADULTS

BECOMING AN AGENCY/ COMPETITIVE BIDDING FOR CONTRACTS ..26-27

APPLICATION OF THE STARK LAWS FOR PRIVATE PRACTITIONER………………28-29

FINANCIAL MANAGEMENT, NEEDS AND ISSUES ……………………………………30-32

NECESSARY LEGWORK PRIOR TO THE SALE, MERGER, ACQUISITION OF A PRACTICE …………………………………………………………………………………………………33-35
CONCLUSION……………………………………………………………………………… 36

TO PURCHASE