Medical Billing Companies Columbus Ohio

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Medical Billing Companies Columbus Ohio Powered By Docstoc
					                   For Independent Medical Practices
                                    In Central Ohio

                                               Sponsored by:

                                   Central Ohio Trauma System

Columbus Medical                     Ohio Department of Health
CME & Disclosures
                 Ohio State Medical Association
                      1.5 AMA PRA Category 1 Credits ™
 As a provider accredited by the Accreditation Council for Continuing Medical
 Education, the Ohio State Medical Association, who is certifying this activity for
 CME credit, requires planning members and faculty to disclose if they have any
 financial relationships with commercial interests that would be considered in
 conflict with this presentation. The content of this presentation does not relate
 to any product of a commercial interest. Neither the speakers nor any planning
 committee member has any financial relationships with commercial interests to
                            MGMA / ACMPE
                       2.0 Continuing Education Units
It’s Coming
 “One of the most important public health
 issues our Nation and the world faces is the
 threat of a global disease outbreak called a

 No one in the world today is fully prepared
 for a pandemic – but we are better prepared
 today than we were yesterday - and we will
 be better prepared tomorrow than we are
       Mike Leavitt, Health & Human Services Secretary
Experience Shows
Number of Episodes of Illness, Healthcare Utilization, and Death
Associated with Moderate and Sever Pandemic Influenza Scenarios*

                                           Source: 2006 HHS Pandemic Influenza Plan
Impact in Central Ohio
     2000 Census for Franklin County                  1,068,978*

       30% infection rate                  320,693
       50% seeking outpatient medical care 160,347

       Potential death rate
        Moderate impact (0.23%)                               2,459
        Severe impact (2.1%)                                 22,449
                       *2000 Ohio County Profiles: Franklin County
From Outbreak to Pandemic
 Outbreak                         Pandemic
  Sudden onset of a virus that    An outbreak that spreads
   spreads rapidly                    worldwide
  Localized to a community or       Near-simultaneous outbreaks
   region                             in communities across the US
  High mortality rate               Enormous demand on
  Those infected are                 healthcare system
   asymptomatic during initial       Delays & shortage of vaccines
   onset (show no evidence of        Disruption of community and
   the disease)                       national infrastructures
Medical Practice Preparedness

                   MGMA Connexion, January 2009, Pg 13
Focus for Medical Practices
Pandemic Response Plan Includes:

   Clinical Care Plan

   Business Continuity Plan

   Personal and Family Response Plan
For Medical Offices
Necessary Components
 Create an internal flu monitoring system
 Diagnosing Influenza-Like-Illness (ILI)
 Responding to suspected cases
 Infection control
 Antiviral medications and vaccines
 Other considerations
Flu Monitoring System
Use various methods for diagnosing influenza cases
   Rapid testing
   Culturing by an appropriate lab
   Watch for signs and symptoms of
    seasonal influenza
Track possible cases
   Consider monitoring all seasonal flu cases for experience
   Necessary information to track for the CDC form
      Demographics, Onset & duration, Related past medical history,
      Treatment regimen, Travel, Contacts potentially exposed, etc.
Flu Monitoring System (continued)
           Signs & Symptoms of Seasonal Flu
                 Acute infection of respiratory tract
                 Fever (101oF – 102oF), usually with an
                  abrupt onset
                 GI symptoms (nausea, vomiting,
                 Generally subside in 3-7 days
                 Watch for complications
                   Febrile convulsions

                   Viral pneumonia

                   Bacterial pneumonia

                   Otitis media
Diagnosing ILI
                      CLINICAL CRITERIA
                          Current Signs
                      I     of Illness

           History of
   II   Recent Exposure
                          either/both     Occupational   III

Diagnosing ILI
I. Clinical Criteria
 Temperature > 101oF – 102oF

 Cough, sore throat, or dyspnea (labored

 Requires hospitalization, or has a strong
  epidemiologic link

Diagnosing ILI
II. History of Recent Exposure

     Recent travel to an affected area

     Close contact with a person with suspected or
      confirmed novel influenza

     Close contact with a person who died or was
      hospitalized due to a severe respiratory illness
Diagnosing ILI
III. Employment in an Occupation at Risk

     Healthcare worker in direct contact with
      suspected or confirmed novel influenza case

     Worker in a Lab that contains live novel influenza

     Worker in a poultry farm, live poultry market,
      or poultry processing operation with a known
      or suspected avian flu infection
Diagnosing ILI
Collecting Lab Specimen
 Collect ALL of the         Storing specimen:
 following:                     Place into viral
   Nasopharyngeal swab          transport media
   Nasal swab                  Refrigerate at 4oC
   Throat swab
   Tracheal aspirate (if
Responding to Suspected Cases
   If “YES” to either Recent or Occupational exposure:
      Initiate standard and droplet precautions
      Treat as clinically indicated
      Notify Communicable Disease Response System
          CDRS (614) 719-8888 ext 1                  (24 hours)
      Initiate general work-up as clinically indicated
      Collect and submit specimen for Novel Influenza virus
       testing to the practice’s preferred laboratory
      Begin empiric antiviral treatment
      Help identify all contacts, including healthcare workers
Infection Control
 “The period when an infected person is contagious depends on the age
 of the person. Adults may be contagious from one day before becoming
 sick and for three to seven days after symptoms develop. Some children
 may be contagious for longer than a week”
                                            Source: “Influenza Fact Sheet”, Ohio Dept of Health, 2005

     Pre-Symptom           Onset of Symptoms
           0    1        2      3      4     5          6        7     8     9      10

                    Potential Contagious Duration for an Adult

                           Potential Contagious Duration for a Child
Infection Control (Continued)
Goal: Care for the sick and do not expose the healthy

Practices need an alternate plan
for patient flow during a Pandemic:
   Reschedule non-urgent office visits
   Triage appointments by phone
      before visit and redirect ILI cases
   Require appropriate infection control measures for all
    patients, family, transport, vendors, personnel, etc:
       Hand Hygiene/Cough Etiquette & Appropriate use of PPE
       Separation of ILI-patients from others
Infection Control (Continued)
Personal Protective Equipment (PPE)
  OSHA has outlined the following PPE to be used:
   Contact Precautions
       Gloves and Gowns - New gloves and gown for each patient
       Use disposal equipment if possible (Thermometers, BP Cuffs)
       Disinfect other equipment between each patient (stethoscope)
   Droplet Precautions
       Goggles when within 3 feet of the patient
   Airborne Precautions
       Face Masks for patients and visitors
       N95 Respirators for personnel
        (requires fit testing)
Antiviral Medications and
         Antiviral medications for a novel influenza
          strain require 6 months to prepare

         HHS will distribute vaccines from the
          national stockpile, coordinated by local
          health authorities

         Healthcare workers are among the first to
          receive the vaccine, followed by high-risk
Other Considerations
1. Dual Medical Responsibility 5. Security considerations

2. Additional space needs      6. Patient transport

3. Increased hours of          7. Handling patient deaths
   operation                      in the office

4. Staff communications        8. Monitoring stress
   outside the office             indicators of personnel
For Medical Offices
Necessary Components
 Budgeting and stockpiling of medical supplies
 Purchasing and storage of medical supplies
 Antivirals and Vaccines
 Education and training of personnel
 Budgeting for temporary reduction in cash flow
 Anticipate significant loss of available personnel
 Potential changes to sick-leave policy
 Temporary closure of the practice
Budgeting and Stockpiling
Access to Supplies         Disposable Supplies
   Stockpile necessary       Hand hygiene supplies
    medical supplies          Face masks and
   Determine need &             respirators
    purchase over time          Face shields, gowns,
   Employ FIFO rule             gloves
   Consider warehousing        Blood pressure cuffs
    and security needs          Thermometers
                                Facial tissue paper
Purchasing and Storage of
Disposable Medical Supplies
 CMA will maintain an emergency stockpile of limited
 supplies for 20 days for the region
       N95 Respirators, Gloves, Gowns, & Face Masks
 Practices should accumulate a 10 day stockpile
       Above items plus hand cleaners, BP cuffs, thermometers, tissue
       Store in a safe and secure space to protect from:
         Unintended Use

         Accidental Damage or Theft

         Consider impact from natural environment (temperature, light,
          moisture, etc)
       Rotate supplies to reduce waste from expiring
Antivirals & Vaccines
 HHS recommends against offices stockpiling antivirals
       Individual purchases require prescription
       Expensive with Rx (Per dose: Tamiflu® $7-$8/ Relenza® $90-$105)*
           3-5 times more expensive without Rx, authorized purchasers only
       Shelf Life   (Tamiflu® – 36 mo / Relenza® – 60 mo)

 National Stockpile Activities
       Ohio is ahead of its accumulation target:
           25% of population by 2010, enough to cover Tier 1 individuals
           In 2010, set new stockpile target
       Distribution will be conducted by HHS and carried out by
        Ohio DOH
                                                    *Current pricing as of December 2008
Education and Training
“to ensure that all personnel understand
the implications of, and control measures
for pandemic flu”          –CDC, 2006

    Identify a person with appropriate authority to
     coordinate training
    Identify medical training programs (web-based & local)
    Educate on infection control measures to prevent
    Conduct an annual disaster drill which includes
     response to pandemic flu
Budgeting for Temporary
Reduction in Cash Flow
 Anticipate a disruption in the billing & revenue cycle

 Establish a Rainy Day Fund
    Discuss specific options with your accountant
    How much the practice spends on average each day
    How many days the disruption will last (6-8 wks)
    How much disruption to expect (25%-35%)
Anticipate Significant Loss
of Available Personnel
 In the worst scenarios, as much as 25% of the
  population could be impacted
 Practices should prepare for a temporary reduction in
  their workforce
       Cross-train personnel to perform critical tasks
       Focus on episodic care, avoiding unnecessary clinical steps
       Change workflow to accommodate critical needs
       Cancel unrelated or non-critical patient appointments
       Eliminate unnecessary business office tasks
Sick-Leave Policy
       Consider modifications to address:
          Onset of ILI symptoms in the workplace
          Care for family members
          Access to, or leave for counseling services

       Healthcare facilities must prepare to:
          Protect healthy personnel from exposure
          Evaluate and manage symptomatic and ill
Temporary Office Closure
    Practice size matters
    Who will decide to close the office
    What triggers will be included
        Space limitations
        Overwhelming reduction in staff
        Lack of necessary medical supplies
    What resources may be reassigned
        Healthy personnel, medical supplies, available office space
    Who will reassign available resources
        Potential support from a local Incident Command Center
For Medical Offices
Necessary Components
Practice personnel should consider how to address:
   School and daycare center closings
   Medical care for chronically ill
   Essential services may be disrupted
       Banks, restaurants, post offices, telephone companies, etc

   Preparing a written family response plan
   Family food storage
   Rainy day fund for each family member
Questions and Answers
For Medical Offices
Reporting Form for ILI Cases
         Consumable and Durable Supply Needs
Supplies                                                        U/M           Qty*              Cost/Unit            Total Cost
Antimicrobial Soap                                             12/case            4                $40.80               $163.20
Anti-bacterial lotion (waterless)                              12/case            4                $181.32              $725.28
Disposable Face Masks                                          50/box            160               $12.95              $2,072.00
Disposable (N95 Compliant) Respirators                         30/box            60                 $10.93              $655.80
Face Shields, Disposable                                       24/box            75                 $35.49             $2,661.75
Gowns                                                          50/case           29                 $34.99             $1,007.71
Gloves                                                        1000/case          13                 $68.90              $909.48
Disposable BP Cuffs                                             5/box            320                $36.19            $11,580.80
Disposable thermometers                                        100/box           16                 $15.75              $252.00
Facial Tissues                                                 30/case            4                 $21.65               $86.60

      Subtotal Costs                                                                                                  $20,114.62
      Taxes and shipping not included

      Staffing assumes 2 physicians, 4 clinical assistants and 3 administrative staff. Patient volume assumes 40 ILI patients per day, 5
      days per week, 8 weeks
        Education and Training Programs
            for Pandemic Influenza



 Ohio Dept of Health
Necessary Cash On-Hand Required to Stay Open Per FTE Physician

25% Impact                     Projection 1             Projection 2             Projection 3

Day's Cash On-Hand             45                       60                       90
Anticipated Impact             25%                      25%                      25%

Avg Daily Operating Cost*      $1,625                   $1,625                   $1,625

Required Cash On-Hand          $18,276                  $24,368                  $36,552

35% Impact                     Projection 4             Projection 5             Projection 6

Day's Cash On-Hand             45                       60                       90
Anticipated Impact             35%                      35%                      35%

Avg Daily Operating Cost*      $1,625                   $1,625                   $1,625

Required Cash On-Hand          $25,586                  $34,115                  $51,173

*Median Total Operating Cost from 2007 MGMA Cost Survey; Table 1.4c Operating Cost per FTE Physician All
Multispecialty; TC/NPP excluded; Adjusted to 1/250 of total median figure (50 weeks x 5 days per week).

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