Free (or Close Enough) Support
by AJ Riviezzo
Phlebology is an interesting niche as it is becoming one of the few types of practice where there is a solo physician owner. This creates some unique opportunities and challenges as most of the physicians that start a phlebology practice have worked for a larger group, a group within the hospital system, or the hospital system itself. Being a good physician is only half the battle. The other half of the battle then begs the question: How do you gain the necessary information to be a successful business?
Trial and error is one very painful way of course. And, sad to say, it will indeed be part of your experience. Reviewing other practices that have been successful is another way to gain a bit of information (using someone else's trial and error). This has limited results as your market, your patient base, your referral network and even your payers may be different.
I recommend a multi-faceted approach. The first facet is to use your vendors. You as the physician/owner will be spending a fair amount of money on equipment, supplies and services. Many of the vendors for these services have a plethora of information, marketing materials, and other support available. For example, CoolTouch has a hotline to answer any billing questions along with a lot of materials both on line and in print. VNUS has an extensive collection of marketing materials available on line along with some recommendations for marketing efforts. Juzo, who has an excellent line of compression stockings, has marketing materials that are great for Lunch and Learns. My own small company provides a variety of support efforts to our physicians as well. All of this is free for the asking. In short, talk with your vendors and see what they can bring to the table for you besides an invoice.
The second facet is to develop a Board of Directors. As a physician/owner you are not likely well versed in banking, marketing, public relations, human resources and a number of other areas that are important to developing and maintaining a strong business. One way to have these types of people support you is to have them on a Board. You likely have friends or friends of friends with some of the skill sets. A retired banker, a semi-retired CPA, a stay at home mom who used to be the Director of Marketing for a company would all make excellent Board members. They have the time to attend a quarterly meeting. They have the energy to think about your needs. You can usually have these folks be part of your team for not much more than a small meeting stipend and a catered meal. The key here is to actually use these folks as a sounding board and do your best to actually implement some of their ideas (if no real authority they will quickly fade away).
The third facet is to reach out to your local Chamber of Commerce. The CoC's usually have programs and support geared specifically for small businesses. They have a network of relationships already built. They can recommend tried and true services available in your community. The cost to join the Chamber is usually very minimal but the offerings they have to help enhance your success is usually vast.
There are likely a number of other low cost to no cost options as well. The key is to find a bit of time out of your normal operations and focus on the practice as a business. While this can be neither easy nor comfortable it is important to do every so often.
Monday, August 22, 2011
Documentation Compliance
Sclerotherapy
by Cheryl Nash
Sclerotherapy: It is just an injection! So why is so much documentation required for this simple service to be covered by the payers? In fact, Ultrasound Guided Sclerotherapy (also known as USG or Echosclerotherapy) is categorized as a surgical service and needs to be documented according to these standards. Typically USG is preceded by a duplex scan, either unilateral, or bilateral, to identify the veins that still need to be treated. This should be reported in the chart as a permanent record of the Ultrasound performed.
In addition to this report, there should also be documentation in an operative report format describing the Sclerotherapy service along with the ultrasonic guidance if performed. Remember, it is imperative to identify the veins treated in both reports and to note the rationale behind the decision for additional treatment. Even if an authorization has been obtained from the payer, they are still likely to request these records after the fact to ensure compliance prior to issuing payment.
Some payers also require the patient to continue to exhibit symptoms, and an additional progress note stating that this is the case, along with the examination results, duplex scan results, impression and plan ordering additional treatment may also be indicated. It seems like a lot of paper to generate, but with a consistent system in place, the reality is not as daunting as it sounds. The revenue and the patient outcome more than justify the means.
by Cheryl Nash
Sclerotherapy: It is just an injection! So why is so much documentation required for this simple service to be covered by the payers? In fact, Ultrasound Guided Sclerotherapy (also known as USG or Echosclerotherapy) is categorized as a surgical service and needs to be documented according to these standards. Typically USG is preceded by a duplex scan, either unilateral, or bilateral, to identify the veins that still need to be treated. This should be reported in the chart as a permanent record of the Ultrasound performed.
In addition to this report, there should also be documentation in an operative report format describing the Sclerotherapy service along with the ultrasonic guidance if performed. Remember, it is imperative to identify the veins treated in both reports and to note the rationale behind the decision for additional treatment. Even if an authorization has been obtained from the payer, they are still likely to request these records after the fact to ensure compliance prior to issuing payment.
Some payers also require the patient to continue to exhibit symptoms, and an additional progress note stating that this is the case, along with the examination results, duplex scan results, impression and plan ordering additional treatment may also be indicated. It seems like a lot of paper to generate, but with a consistent system in place, the reality is not as daunting as it sounds. The revenue and the patient outcome more than justify the means.
Medical Policy Alert
Humana Moves Towards AEtna's Policy
by Cheryl Nash
Some of you may have noticed the new changes to the language in Humana's coverage policy. Along the lines of last year's changes to Aetna's guidelines , Humana has also added a notation in their guidelines stating:
Initially, one treatment session of RFA, TIPP or, EVLT™, per leg is generally considered medically necessary, as endovenous ablation of the entire incompetent saphenous vein usually can be accomplished in a single treatment session.
Interestingly enough, we agree that 'staging' the GSV into more than one session is rarely if ever indicated. The above statement though is being used to state treatment of both the great and short saphenous vein should be treated in the same setting. They want the claim to be billed as a 36475/36478 for the GSV and 36476/36479 for the SSV. While this is of concern, they did allow a small amount of room for leeway in the statement:
Repeat sessions of RFA, TIPP, EVLT™ or stripping/division/ligation may be requested and are subject to medical necessity review. Repeat sessions may be medically necessary for persons with persistent or recurrent junctional reflux.
We have had some varying results on recent authorizations, and like Aetna, it appears to be subject to the medical director's discretion on how stringently this is being enforced. Also of interest is that Humana excluded the treatment of perforators, tributaries, and accessory veins with either RF or EVLT, stating that these services are considered experimental and investigational. We will be following up on this development as we receive more feedback from the insurance company and our clients.
by Cheryl Nash
Some of you may have noticed the new changes to the language in Humana's coverage policy. Along the lines of last year's changes to Aetna's guidelines , Humana has also added a notation in their guidelines stating:
Initially, one treatment session of RFA, TIPP or, EVLT™, per leg is generally considered medically necessary, as endovenous ablation of the entire incompetent saphenous vein usually can be accomplished in a single treatment session.
Interestingly enough, we agree that 'staging' the GSV into more than one session is rarely if ever indicated. The above statement though is being used to state treatment of both the great and short saphenous vein should be treated in the same setting. They want the claim to be billed as a 36475/36478 for the GSV and 36476/36479 for the SSV. While this is of concern, they did allow a small amount of room for leeway in the statement:
Repeat sessions of RFA, TIPP, EVLT™ or stripping/division/ligation may be requested and are subject to medical necessity review. Repeat sessions may be medically necessary for persons with persistent or recurrent junctional reflux.
We have had some varying results on recent authorizations, and like Aetna, it appears to be subject to the medical director's discretion on how stringently this is being enforced. Also of interest is that Humana excluded the treatment of perforators, tributaries, and accessory veins with either RF or EVLT, stating that these services are considered experimental and investigational. We will be following up on this development as we receive more feedback from the insurance company and our clients.
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