Internal controls have always played a strong role in preventing fraud.  Now more than ever it’s important to establish procedures in your practice that will mitigate your risk of loss. 

ELLS CPAs has been engaged on numerous occasions to investigate the circumstances and damages resulting from employee fraud or embezzlement.  These cases have cost the medical practices anywhere from several thousand to over a million dollars.   Many of these frauds were perpetrated by the physician’s most trusted employee.

Don’t wait until you are a victim to take action.  We have developed a two page “Risk Assessment Checklist” that will enable us to determine many of the weaknesses you have in your practice. Once these risks are assessed we can recommend and help you incorporate procedures and/or safeguards into your practice to lessen your risk of fraud and embezzlement.  

Please contact ELLS CPAs  for the checklist, call 714.569.1000.

By Gregory N. Lewis

The credits can be reduced when a state has an outstanding advance or loan for two consecutive years, thereby allowing the Federal government to recover their monies directly from employers.

As a result of outstanding loans, tax reduction of .3% will be applied to wages paid in 2011 for 21 states, inculding California.

For more information please call Brett Adolph, 714.467.3434 x 231

For more information call Brett Adolph, Payday Payroll at 714.467.3434

Physicians and their staff have long expressed frustration with the time they spend interacting with health plans. Until recently, however, little information existed about the magnitude of these interactions. In What Does It Cost Physician Practices To Interact With Health Insurance Plans? (2009) L.P. Casalino et al conducted a national survey with physicians and practice administrators. The findings are shocking.

Revenue Deterioration

When time is converted to dollars, the authors estimate that the national cost to practices just from interactions with health plans is at least $23 billion to $31 billion each year. Furthermore, physicians reported spending three hours weekly interacting with plans while nursing and clerical staff spent materially more time.

Casalino et al estimate that medical practices spent an average of $68,274 per physician per year interacting with health plans.  The median value was $51,043. Shockingly, primary care practices spent $64,859 annually per physician. This is roughly one third of the income plus benefits of the average primary care physician!

Today, health plans proclaim that they have reduced the administrative burden they place on physicians. However, Casilino’s paper strongly suggests the contrary. Physicians continue to be dissatisfied with this burden. For example, (1) the average physician reports spending nearly three weeks per year on these interactions; (2) the nursing staff spends twenty three weeks per physician per year; and (3) clerical staff spends forty four weeks. Ironically with the emergence of electronic health records which were designed to improve administrative obstacles in the spirit of increased efficiency, the average physician is dedicating only two hours per week to providing quality data to health plans or to reviewing quality data for the practice.

Billing and administrative costs are no less onerous than time spent with insurance companies on the phone. California spends $167 billion on health care each year. Administrative costs account for approximately twenty-five percent of this sum or slightly over $42 billion per annum. While little was known about billing and insurance-related (“BIR”) costs until recently, James G. Kahn, et al. estimate in their paper, The Cost of Health Insurance Administration in California: Estimates for Insurers, Physicians, and Hospitals (2005), that physician offices spend a staggering 27 percent and 14 percent of revenue on administrative and BIR functions, respectively. Simply, this is grossly inefficient.

Billing and Insurance Functions Graph

As practices attempt to improve reporting coupled with an emphasis on measuring outcomes, the administrative costs, unfortunately, will only increase. While the thirst for more statistics will increase providers’ knowledge and ostensibly improve the ability to measure a wide variety of data points, the reality is that administrative burdens are increasing – not decreasing.

These findings are a grave concern for our health care system. The estimated $31 billion cost to physician practices for time spent with health plans is more than twice the GDP of Jamaica while the $23 billion that California spends on billing and insurance-related costs is roughly twice the GDP of Iceland. As legislative change – such as the migration of ICD-10 – continues to add complexity to our system, it is imperative that physicians take a more proactive approach to their revenue and cost structures.

For more information call Ken Alston at 949.250.0011 ext 233 or visit our website www.medvisioninc.com

ELLS CPAs & Business Advisors can help you safegaurd your practice by placing financial controls in your practice. For more information call ELLS at 714.569.1000.

If your site provides a digest of “industry news” to your clientele then you could definitely benefit here.

This update is based on a concept known as “query deserves freshness” which means that Google is assuming that you are looking for the very latest web postings on a given topic. The example used at Tech Crunch was a search for “Apple earnings”. Without a date modifier, like “Q4 2011″ Google would just assume that this is what you were looking for.

If your site is set up to allow you to publish on the fly using your own staff or your web services provider then you by publishing timely developments about your industry you can increase the likelihood that those posts or pages will rank for their given keyword terms.

If you have any additional questions about your own site and its ability to benefit from this new Google algorithm update or in fact anything regarding online marketing feel free to contact Open Interactive at 949-722-6119.

Link to complete article on Tech Crunch.

This trend underscores the importance of patient retention. For most companies, customer retention and loyalty are paramount to increasing revenue and generating a higher return-on-investment. THe general consensus is that retention and loyalty programs are cheaper than other intiatives to acquire new customers. Fredierick F Reinchheld, a fellow of management consultancy Bain & Company  and +consultant whom The Economist magazine describes as the “the high preist of the loyalty cult,” states the following:

The best predictor of top-line growth can usually be captured in a single survey question: Would you recommend this company to a friend? Surprisingly, the most effective question wasn’t about customer satisfaction or even loyalty per se. In most of the industries studied, the percentage of customers enthusiastic enough about a company to refer it to a frined or colleague directly correlated with growth rate among cempetitors.

So should medical practices employ successful strategies from other industies? Absolutely! And the reality is that they will have to in order to compete in the future. Our nation’s pateint  population is shifting while stablility and permanence of recent legislative changes are tenous. As a result, the need for a steady influx of new patients is critical to a practice’s survival.

Studies show that approximately sevently percent of patients leave thier physicians becuase of a perceived attitude of indifference. This does not mean that explicit rudemess was involved but rather the fdeeling of being ignored or rushed. Astute providers know that they cannot take their patient population for granted. The following are just a few examples of ways in which physicians can retain patients and hopefully, attract referrals.

1. The Office as a First Impression. Is the office clean? Is it cluttered? is the staff dressed appropriately?
2. Stay on Schedule. People dislike having to wait to see thier doctor.
3. Treat Patients and Family Mebers with Respect. While ths seems pbvious, recent data suggest that the mentality of “Physician as GOd” alientates patients.
4. Listen to Patients and Answer their Questions. Take the extra time to really focus on what your patients are saying. Many just want thier fears assuaged.
5. Use Patient Satisfaction Surveys to Identify not only Flaws but Successes as well.

Behavioral science applied with empathy and sound bsuiness fundamentals can improve your servie delivery. Simply, it can change the impressionals that your patients remember, refer back to, and pass on to future customers.

For more information call Ken Alston at MedVision, (714) 258-0011 ext 233

Changes Implemented:

1.  No lifetime limit on covered services
2. Children of covered employees may be on the parents coverage up to age 26
3. All medically covered persons regardless of the medical unsurance plan can access a zero cost annual wellness exam when using an in network provider which includes screening for various conditions and lab work
4. Women have access to an OB/GYN as their primary care physician
5. Pre-existing condition exclusion is eliminated for children under age 19

Items to be implemented

 Clinical Trails

The new coverage requirements for approved clinical trials are listed below and are going to be effective January 1, 2014.  Group health plans and health insurance issuers offering group or individual health insurance coverage may not:

1. Deny “qualified individuals” participation in certain “approved clinical trials”
2. Deny the coverage of  ”routine patient costs” furnished in connection with the clinical trials or discriminate against the individual on the basis of the individuals’ participation in such trials

Employers Penalties

The August 2011 debt limit agreement averted a U.S. default. It did little, however, to address the intermediate to long-term outlook for Medicare. While the debt compromise does not impose any immediate cuts in Medicare spending, Congress must devise a plan by the end of 2011 to reduce the deficit by $1.5 trillion over the next ten years. If they are unable to come to a resolution, the debt reduction plan will require the federal government to impose a two-percent reduction in payments to Medicare providers starting in 2013.

Doctors are already facing a bigger issue. On January 1, 2012, there is anexpected 29.5 percent pay cut unless Congress acts decisively. Simply, lawmakers passed the buck this August. Medicare will now be front and center later this year when the 2012 election campaign gets under full swing. This is not good news. Already a polarizing issue, Medicare will now be even more politicized.

Cuts of any size or an increase in age eligibility (65 to 67; a three percent change) will undoubtedly harm patients by affecting their access to quality of care. Providers are already increasingly opting out or limiting their number of Medicare patients. According to a recent AMA study, 17 percent of doctors already say they restrict the number of Medicare patients largely because of low reimbursement. This same study found that further pay cuts perhaps will force many doctors out of Medicare entirely. This is ominous for patients, doctors, and our health system in general. And it appears that these Medicare reductions do not work in concert with the Affordable Care Act of last year, which was intended to lower costs but produce better medical outcomes.

David Cutler of Harvard alarmingly discovered that cuts to Medicare have traditionally correlated with cost-shifting to the private sector. In short, providers attempt to transfer these costs to other payers, which translate to

 For more information call MedVision at 714.258.0011 x 233

higher expenses for insurance companies. As a result, these cost increases result in higher premiums for employers who are then forced to reduce the level of benefits to their employees. This leads to inferior care and medical outcomes thus driving up healthcare costs. As it stands today, it is uncertain how these proposed cuts would affect correlative legislative changes (electronic health records and e-prescribing for example) and their respective incentives.