Many changes either taking effect in 2013 or requiring preparation in 2013 for implementation in 2014 can have a huge financial impact on the health of your practice. Are you ready? This is the time to take stock of the resources you already have and those which you will need to consider.

Medicaid Reimbursement

With a new influx of lives being added to the Medicaid pool of patients, many PCP and Internists are going to see a large increase of new patients. So in order to compensate physicians for the new workload, fees for evaluation and management services as well as immunization services will be increased to 100% of Medicare allowables for 2013 and 2014.

Supply and Demand

With more patients being added to our system, due to the individual mandate and the increase of Medicaid qualified individuals, some physicians will see a heavier load of patients in their practice. Adding the fact that many of these patients are new to the system and therefore will require more work, practices need to have a plan in place as to how they will be adapting.

OIG 2013 Work Plan

The OIG will be taking a close look at claims from 2002 to 2011 billed with G modifiers (GA, GY, GX and GZ) to determine erroneous payments issued to physicians. These modifiers are used by practice when submitting claims to Medicare, indicating that a denial is expected for these services. However, in a review performed by the OIG, they found that a significant amount of claims submitted with these modifiers were paid in error. There is potentially $4 million of erroneous payments.

ICD-10

What was to be an effective date of October 1, 2013 has now been extended to October 1, 2014. However, practices will need start preparing for the changes soon or at least have an implementation plan in place. Many practices will wait until the last minute to start the planning and preparation because the deadline may once again be extended. However, with the complexity of the new coding system, there are certain areas that your practice may want to consider preparing, to aid in a smoother transition.

So what do these four issues have in common? They all have a potential to impact your practice financially. Too often medical practices choose to ignore changes to the until it is too late. The time to prepare your practice is now.

Are your employees venting about having too much work and not enough time? Are they expressing that they never having enough time to finish all of their work? Is the office paying too much overtime because your employees are having to stay late or come in early?

Many medical practice employees find themselves playing catch up on a daily basis. We as managers have tried several times to help. We have scheduled training sessions, thinking that maybe the employee is simply just not adequately trained to do the job. We have reorganized their desks, created daily tasks lists and taught them how to manage their day, only to find that they are still not able to complete their work. This is where the hard part comes in. Is it time to consider terminating the employee? Can you honestly say that the employee has been given all the resources to perform his/her job and is still not able to do so?

Here is an exercise that I have done in my office that has been an eye opener several times: I will observe my employee all day long. There, that simple. Now, what do I look for? Is the employee being interrupted numerous times? Is he/she properly supplied with the correct resources (computer, office supplies, information) Is he/she taking unnecessary steps or doing another employee's work? You'd be surprised how much information you didn't have before by performing this simple task.

It is imperative that all office roles are identified, but you have to be realistic about it, simply saying these are the responsibilities for this position isn't going to do it. Understanding what that person does already and what areas are suffering due to he/she not having enough time do it is very important in reorganizing your office roles. It not only is unfair to the employee since you are really just setting them up for failure but it could potentially create revenue leakage in your practice. I know you are probably cringing at the thought of hiring more people, but have you looked at the overtime you're already paying. If one employee is working 10-20 hours of overtime every 2 weeks (lets say she gets paid $14.00/hour) thats equivalent to $210-$420 at $21.00/hour, again for for only 10-20 hours. How about you hire a part timer to work those 10-20 hours at $12/hour? That's only $120-$240 for the same amount of hours of work. This person can come in to work on the small tasks that are taking time away from that full time employee. For example, maybe your front desk is spending a lot of time calling patients to remind them of their appointments or answering phones. If your office has a high volume of patients on a daily basis, having someone performing these two simple tasks can really help your front desk provide better service, be more thorough about checking benefits, and so on.

Do these simple tasks to determine what if any roles in your office need to be revised: Observe the employee; analysize your office's overtime and how this can translate into a part timer being hired. You'll find that you can run a more efficient office when you do this. Many times overworked employees are unhappy employees. This results in low office morale, bad customer service and a bad experience for your patients.