Priorities, Priorities, Priorities! Priorities = Productive Staff!

No matter what type of medical setting you are working in, you have experienced the joys of proper priotization and the frustration of innapropriate prioritizing.  Staff who appropriately prioritize, without direction, are far and few between and should be cherised.  But, what if you have (or are) a great staff member who just doesn't prioritize appropriately?  Don't throw in the towel!  Having the ability to prioritize effectively is a gift and doesn't come naturally to everyone, however with all of the demands on our medical system we all know that prioritizing isn't optional - prioritizing in the medical field means 'swimming' while lack of prioritizing means 'sinking', and unfortunately sometimes sinking the entire office.  Sinking is something we have all experienced and it brings a constant feeling of chaos and sometimes brings frustrated and angry patients, physicians, nurses and/or staff members who experience the brunt of the preventible- the chaos can be organized! 

An invaluable office management tool is a daily / weekly checklist.  Not only do they help you to remember those silly vital steps but they direct the work flow and account for everything so as long as the list is being followed - your office will be on track come the end of every week - as long as the list is followed.

Sometimes communication and work distribution issues within the office exist purely because the expectations of each staff member have not been clearly outlined.  When staff understand exactly what their responsibilities are, and what is expected of them it removes a lot of "issues" that were not really "issues" at all.  We've all experienced the employee/colleague who was never trained properly, even though we thought/told they were; or the colleague who was never told they were responsible for certain tasks.

While the pratical benefits of this type of hardcopy resource for employers and employees are obvious, there are also hidden legal benefits in situations where staff are not living up to their job requirements.  Due to the nature of these checklists (to be followed and completed each day) it will become obvious very quickly if you have a staff member who is non-compliant.  Unfortunately when dealing with a "problem" staff member a lot of the time the situation is muddied by responsibility not being clearly assigned, responsibility doesn't get much more clearly assigned than with checklists; and in fact this responsibility distribution protects colleagues of "problem" staff.  These checklists can be used when disciplining or dismissing an employee in a few ways, the first is if a task isn't completed, however, the tasklist is signed off and the issue becomes that either the employee inadvertently or purposefully signed off to something that wasn't done - time will quickly highlight which is the case.  Secondly, these sheets should be saved and can provide support when dismissing an employee either for habitually failing to meet job expectations or fraudulantly stating job expectations were met, when they weren't. 

When incorporating this system into your practice/office, this shouldn't be done without sitting down with the person/people who complete the applicable jobs and asking them what needs to be put on the list.  This level of communication will serve two purposes, the first is that the staff won't feel as though it is being done without their input - no better way to start out on the wrong foot than to assume that you know the tasks of another position, they will feel resentful and it won't be relevant - it needs to be relevant to work!  Also, by having discussion as to what will be on the list and how work should be distributed surrounding clinic or office hours, you have now had an involved conversation with your staff and cooperatively set clear job expectations - this will make them feel valued and they won't feel as though the only purpose is to "spy" on what they are doing.  You should explain the intention of the checklist is to organize the chaos and to help support them in their position.
We have created a customizable template with WORD, just send us an email if you would like us to forward you a copy.  Our template comes with common office tasks that will also give you an idea of the type of tasks to be noted - you don't want to get too general and you don't want to get ridiculously specific to a point that you are detailing every job task.  The types of tasks that should be on the list are tasks that will affect office work flow and tasks that would be beneficial to remind the staff. 

Contact us at feedback@ombis.ca

Colon Cancer Check Kits

Colon Cancer Check Kits have a shelf life of 3 years.  The last batch of FOBT kits were in 2008 and have an expiry of May 2011.  Check the kits that you haven't given out yet and also make sure that if patients haven't completed their FOBT testing yet that they are given one of the new kits.  It's a good idea to point out the expiry date to the patient when you are giving them the kit and explaining the process.  To find more information and to learn how to check expiry dates go to:  http://www.health.gov.on.ca/en/pro/programs/coloncancercheck/fobt_kit_expiry.aspx

Also, with respect to colon cancer exclusion codes see the following link on clarification that was issued regarding Q142 (colorectal exclusion code) http://www.health.gov.on.ca/english/providers/program/ohip/bulletins/11000/bul11012.pdf

Members, see Q142 in "Billing Modules" for further information regarding Q142 including eligibility.

Spotlight On Resources

MDcme.ca offers online access to accredited CME courses.  The courses are available on-demand whenever it suits your schedule.  Courses are delivered in a self-directed learning environment with access to many features including discussion boards and "email a specialist".  Did we mention it's free?

Another time saving resource is http://www.vex.net/~lawrence/LU.html .  Limited Use (LU) Codes are a constant annoyance that can quickly be referenced at the noted site.  LU codes are broken down by medication, descriptions of LUs give a complete breakdown.

You're a physician, you don't work for free!

And WSIB doesn't expect you to work for free either!  The most common misconception that I have dealt with from a physician perspective is believing that they don't get paid for seeing WSIB patients. 

WSIB has just released a new Form 8 that pays slightly more than the last version (and another increase if you submit electronically), the redesign was completed with physician efficiency in mind so the final product should also result in a cleaner work-flow.  Form 8 payment is automatically initiated when the Form 8 is faxed (or submitted electronically) to WSIB - just make sure that you have your WSIB number and information clearly legible in the provider information section.  For more information on Form 8's, see our WSIB section on our site. 

But, what happens if I see a patient after the Form 8 has already been submitted - I don't get paid for the assessment, right?  Wrong, you definitely get paid for each time the patient presents with respect to the WSIB related ailment.  If you are in the ER and you see a patient for WSIB related billing, make sure to note it on your billing sheet along with the applicable code just as you would do for an OHIP patient (i.e. H codes or necessary services (stitches, etc.), the same goes for GP clinic or walk-in-clinic.  The only exception is if a patient presents for a WSIB related reason and a non-WSIB reason during the same visit - in this case you should consider billing A008 (WSIB Mini Assessment - see billing modules for further details and eligibility) to WSIB and the appropriate assessment to OHIP for the OHIP related portion of the assessment.  Keep in mind that if any service is billed on a WSIB claim, other than a partial or minor assessment, no other assessment can be submitted as an OHIP claim.  Even premium OHIP codes can be applied to WSIB (i.e. Q012 - see billing modules for further details and eligibility), the only catch is to ensure that both the assessment and premium codes are sent to WSIB. 

Uninsured Services = Free Services?

Did you know that most physicians are, on average, losing $20,000.00 to $30,000.00 per year because they aren't billing for uninsured services?  I think we can all agree that $30,000.00 per year is worth taking the time to develop a system.  Initially, creating systems takes time; and if you had spare time you can probably think of a multitude of things you would rather be doing - but isn't $30,000.00 tempting?

A popular solution for uninsured services is physicians have their front-desk staff work alongside an outsourced company and track uninsured services, as they are provided.  The outsourced company will collect payments from your patients based on what they receive from your staff - for a price.  The major problem that we have found with using outsourced companies is that the communication is extremely lacking between your staff and the patient, which leads to a whole new set of issues.  When your staff don't feel responsible for the collection aspect of finances, they don't worry about ensuring the patient is advised up front about fees associated with provision of uninsured services.  Quite frequently the issue that quickly ensues is your patients receive invoices for services they had no idea they would be billed for.  Another concern I have heard raised by patients is that it makes them uncomfortable to receive a phone call from a third party company- though not the case, they tend to feel as if their confidentiality has been broken. 

For the best attainment rates, and a well received program, uninsured services and block billing fees need to be coupled into one seamless program that includes detailed dialogue between your front desk staff and your patients.  An effective program will include pamphlets clearly explaining uninsured services and rates. 

No matter what type of program you opt for, whether physician directed or outsourced, you will need to ensure that your front-desk staff aren onboard with the program; if not, you won't enjoy the same rate of success financially.

Lastly, your staff should be provided with set office rates for all uninsured services so that they are never left in a position to decide on a price themselves - appearances are everything and if your staff are "winging it", patients will pick up on it quickly and overall it will reflect on the physician. 

We are currently developing block fee billing and uninsured service programs for our membership, we will have packages to choose from that will include customized pamphlets for patients as well as instructional material for your front desk staff - we'll keep you posted.  We are determined to support our members in actually earning money for the work they are doing, we think this will be a good step in that direction.

Recent Billing Changes

Effective April 1, 2011 changes were made to the Special Diet Allowance Application Process (K055).  A new code has been added to the Schedule of Benefits (K056) that is payable for completion of Breast-Feeding & Pregnancy Nutritional Allowance.  The changes have been made on our website and the new forms are linked to each description.

Sinus ultrasound codes have been removed from the Schedule of Benefits, effective April 1, 2011, due to a lack of evidence supporting the usefulness.  The affected codes J106 and J406 have been removed from the Schedule of Benefits.

The Out-Of-Country (OCC) Prior Approval Application process has been revised with a significant change.  Previously applications were able to be brought forward by family physicians, the change now requires that applications MUST be supported by a specialist in the field.  OCC Applications that submitted for genetic testing must also be submitted or supported by a geneticist.

Effective March 14, 2011, accredited pharmacists are able to authorize renewals of existing prescriptions (exclusing narcotics and controlled drugs) without further authorization from the prescriber.

The new regulation under the Drug & Pharmacies Act can only be enacted if;

• The physician cannot be contacted;
• The drug is for a chronic or long-term condition; and
• The patient has a stable history with the drug.

The pharmacist must notify the physician within 7 days from when the medication renewal was authorized; and the medication cannot be renewed for any more than 3 months.

Welcome To Our New Medical Forum!

This blogging forum will be open to members and non-members alike.  We have discontinued our monthly newsletter and will instead be updating this blog as the topics occur and changes happen - this change will give you access to the information you need on a daily basis. There is no catch, we will be providing relevant and up-to-date information/commentary relevant to the medical industry, based on our committment to our membership!  You can follow our blog via email, just type in your address to the provided space on this page. 

We will be discussing topics relevant to physicians, billing agents office managers/administrators and front end office staff so send your colleagues the link - is there a topic that you would like us to take a look at?  Just let us know feedback@ombis.ca and we will.  We're going to support you so that you can save time and become more efficient, enabling you to work smarter, not harder!