One can hardly turn on the news today with hearing something about some natural disaster. In recent weeks it’s been about earthquakes, tornados, floods and wild fire. And of course, the Northern Hemisphere Hurricane Season is upon us.

Clinicians need to be prepared for disasters…not only at home, but in your business as well. Even if you think it will never happen to you, you need to be prepared for the “never gonna happen” event.

Making a disaster plan is really just a business plan for disasters. Here are a few things to address:

1. Take a look at everything in your office. Think about what would happen if it was not available. What would you do? How would you continue?
2. How will you communicate and take care of your employees?
3. Payroll…it’s gotta happen. Are you using a payroll service that is off site that will be able to generate that paycheck?
4. Is there an alternative site you can operate if your building is unsuitable? Perhaps you can work something out with another provider with the idea you can each use the others space in order to keep you business going.
5. Where will you be able to get equipment and supplies? Have all sorts of alternatives listed…everyone in your neighborhood may be headed for the local supply house for computers, etc.
6. Data:  Back up your charts and practice management system regularly and store it off site. Consider storing it several miles away…say 50-100 miles. If you entire town floods, having a copy in your house may not help you.
7. Video tape your office – include all equipment, furnishings and supplies. Consider giving a copy of the tape to your insurance agent, as well as storing a copy off site (see #5 above) as well as a copy for your files.  (This is a great idea for your home as well).

You can get more free information, including templates to make your plans at www.Ready.gov .

Photo Credit:  1985 — Typhoon Pat — Image by © Royalty-Free/Corbis

Are you a Nurse Practitioner or Physician Assistant? Do you see Medicare patients? If so, you’ll want to make sure you are listed in PECOS – Provider Enrollment, Chain and Ownership System.

CMS continues to urge physicians and non-physician practitioners who are enrolled in Medicare but who have not updated their Medicare enrollment record since November 2003 to update their enrollment record now. If these physicians and non-physician practitioners have no changes to their enrollment data, they need to submit an initial enrollment application which will establish a current enrollment record in PECOS.

Visit this CMS  page to learn more.

Early in the process of starting up your Nurse Practitioner practice, or even after you have been open for a while, you will be faced with what to do about billing. Your options are limited: you hire someone to come in, you do it yourself, or you outsource the billing. My choice, when I first opened was to outsource and while I thought that I was making good choices, my experience was less than poor. Let me share with you what I’ve learned since then so you can avoid my mistakes.

When you are looking for a billing company to outsource to the first thing you want to do is ask around. Who are your colleagues using? Why do they like/dislike them? Check the forums and social media where they are likely to talk about billing, like the EMR support forums or the coding forums. And of course, you can check the NPBO™ forum. And don’t forget to network with colleagues at conferences and gatherings.

When you find companies that you are interested in, Google them. Look for complaints as well as praises. If it’s an individual, are they certified? And if they say they are, can you get proof? You’ll also want to check references, but not just those listed (few people will give you the name of someone who will give them a bad reference). Again, ask around about this company or person and try and find references that are not listed.

So what are some of the questions you should ask?

1. What are their qualifications?
2. How long have they been in business?
3. How many people are handling the claims?
4. How are follow ups handled?
5. What happens when there is a denial?
6. Who is managing the accounts receivable (AR)? How often is it evaluated and worked? Who is responsible?
7. Communication Issues: What forms of communication are available? Is there a time difference? Is there a language difference?
8. Do they specialize in a particular area of billing such as primary care or surgery?
9. What kind of reports will you receive? Can you read them? Can you get help with them?
10. Is the company familiar with your regional issues?
11. Does this company know about NPs and are they familiar with some of the issues in billing for us? Are they familiar with your state regulations?
12. What other services do they provide?

This is not by any means an all inclusive list, but it will get you started when thinking about hiring a biller.

Nurse Practitioners that accept Medicare in their practices need to be aware of how this will impact their practices. With the exception of Midwives, NPs are allowed only 85% of the physician allowable. Here is the update:

The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010. At this time, Congress is debating the elimination of the negative update that took effect June 1, 2010. The Centers for Medicare & Medicaid Services (CMS) is hopeful that Congressional action will be taken within the next several days to avert the negative update.

To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers paid under the MPFS, CMS had instructed its contractors on May 27th to hold claims for services paid under the MPFS for the first 10 business days of June (i.e., through June 14, 2010). This hold only affects MPFS claims with dates of service of June 1, 2010, and later.

Given the possibility of Congressional action in the very near future, CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18.

This action will facilitate accurate claims processing at the outset and minimize the need for claims reprocessing if Congressional action changes the negative update. It also should minimize the provider and beneficiary burdens and costs associated with reprocessing claims.

We understand that the delayed processing of Medicare claims may present cash flow problems for some Medicare providers. However, we expect that the delay, if any, beyond the normal processing period will be only a few days. Be on the alert for more information regarding the 2010 Medicare Physician Fee Schedule Update.

Source: LEARNRESOURCE-L Email Update, National Institutes of Health, U.S. Department of Health and Human Services dated June 14, 2010

Posted: 6/14/2010

As you think of your Nurse Practitioner owned business and practice, consider these thoughts.

One of the challenges for any practice is collecting payments from payers, including our patients. However, most practices do not utilize all the options available to them.

On Sunday June 13th, we will be talking with Nurse Practitioner Carolyn Zaumeyer. She has combined her expertise in Independent Practice and Patient Payment Options – which will be the topic of our discussion.  Carolyn’s goal is to help you along the way to success in your practice which means, showing you ways to keep more of your hard earned money.

She has authored two books on Independent Practice for Nurse Practitioners. She has also written over 27 publications and has given over 73 presentations at national and international conferences.  Zaumeyer is a pioneer in the field, establishing and operating her own Women’s Health Watch, in Ft. Lauderdale in the early 90′s.

You are invited to join us on Sunday June 13, 2010 @ 5pm Pacific, to evesdrop on our conversation, ask your own questions, and expand your knowledge about the business of practice.

If you have not been receiving our notices for these interviews, sign up at www.NPInterviews.com to receive your special link to this interview.

Answering Nurse Practitioner questions about business…

Teresa has asked me what do I think about having a niched practice such as with men’s health, since women have GYNs; and I’ll tell you, I think it’s a great idea.

First of all it does a couple of different things.  It allows you to practice in an area that you have passion for, and I think that is so important.  I mean, let’s face it.  We all work really hard, and we’re working harder every day.  So, why not practice in an area that brings you a lot of pleasure, it brings you a lot of joy, and it allows you to use your expertise in that particular area.

So, one of the things that I would recommend if you are just getting started in your practice is go ahead and have a general practice, build it up, just let everybody know that you have a growing interest, and a growing expertise in men’s health, pain management, bladder health, dermatology, whatever it is.  And then as you get more patients in that particular area, and once you have enough that you can start backing off on the primary care, you’ll be able to just move right into that particular specialty and move forward and enjoy your practice a great deal.

Now this is something that I talked about not too long ago in Progress Notes, which are business tips for nurse practitioner entrepreneurs.  You can access archive by going to www.NursePractitionerBusinessOwner.com and clicking on Progress Note Archives.  If you would like to sign up for the newsletter there you can go ahead and do that there.  And I’ll see you next time for the next NPBO Minute.

Nurse Practitioners who accept Medicare, will want to be aware of this:

May 27, 2010 — The dreaded 21.3% reduction in Medicare reimbursement for physicians will likely take effect June 1 as scheduled following the failure of House and Senate Democrats tonight to pass the necessary legislation to stop it.

The Memorial Day recess for Congress officially begins Monday, but lawmakers will start to leave the nation’s capital tomorrow. Democratic leaders who have tried to avert the massive Medicare pay cut say they simply have run out of time to cut a deal. They might have beat their deadline if it had not been for staunch opposition from both Republican and Democratic lawmakers who argued against the deficit spending involved in the legislation.

Anticipating that Congress might not act in time to avert the June 1 pay cut, the Centers for Medicare and Medicaid Services has instructed its carriers this week to hold payment on claims with June service dates for the first 10 business days of the month. That way, if Congress retroactively postpones the pay cut early next month, carriers would process the suspended claims at either the current reimbursement rate or any higher — and temporary — rate that lawmakers might approve.

The Centers for Medicare and Medicaid Services has taken this route before when a rate decrease took effect, only for Congress to avert it after the fact.

Organized medicine has lobbied Congress hard to block the pay cut. It warns that many physicians would respond to the reduction by turning away seniors, as well as military families covered by TRICARE, which bases its fee schedule on Medicare rates. Physicians on average depend on Medicare for 31% of their revenue, according to the Center for Studying Health System Change.

Unease Over Deficit Spending Stymied a Legislative Solution

House Democrats were hoping to postpone the pay cut until January 1, 2012, and increase Medicare rates 2.2% for the rest of the year and 1% in 2011. To become law, the measure also would have needed Senate approval. Senate Democrats had said earlier that they would legislate through the weekend to finish what the House started.

The solution to the Medicare reimbursement crisis — dubbed the “doc fix” by lawmakers — was part of the Democrat-sponsored American Jobs and Closing Tax Loopholes Act that also would have extended unemployment compensation benefits and a slew of tax breaks as well as ended other tax breaks. House Democrats, however, could not muster enough votes to pass the bill due to the red ink it represented, even after they had whittled down the doc fix to satisfy Congressional budget hawks, which included Blue Dog Democrats. The original version of the bill would have extended the effective date of the pay cut to January 1, 2014.

As the legislation stood earlier today, it would have cost $127 billion in total spending, raised $43 billion in new revenue, and increased the federal deficit by $84 billion. The doc fix accounted for $23 billion of the cost — down $40 billion from before.

Late Thursday night, House Democrats announced that they would split the American Jobs and Closing Tax Loopholes Act into 2 bills — one for the doc fix, and the other for everything else — and vote on them separately Friday. However, Senate Democrats said Thursday night that even though they would meet again on Friday, they would not vote on any House bill until they reconvened on June 7 after the Memorial Day recess. Part of the problem for Senate Democrats is that they anticipate the same kind of stonewall opposition to deficit spending that their House counterparts encountered.

A spokesperson for Senate Majority Leader Harry Reid (D-NV) told Medscape Medical News that Senate Democrats will seek unanimous consent for a 14-day extension of the Medicare pay cut as well as the unemployment benefits and tax breaks, but that Republicans are likely to block it. Democrats expect that Republicans will propose their own short-term extension, drawing on unspent funds from last year’s economic stimulus legislation. In turn, Democrats plan to block the Republican measure because it diverts money from job creation, the spokesperson added.

Source:  http://www.medscape.com/viewarticle/722634?sssdmh=dm1.619218&src=nl_newsalert&uac=14312EX

Nurse Practitioner Business Owner, hosted “Getting Started in your OWN Practice” teleseminar on Sunday April 25, 2010. There were RECORD numbers of Nurse Practitioners and Physician Assistants in attendance.  The questions sent in before and during the event were fantastic. I did not get a chance to answer all the questions, but watch this blog for updates and answers to questions.

If you missed it, you can listen to it here:  www.nursepractitionerbusinessowner.com/startupsystem-replay.html

On this teleseminar, we introduced the NPBO™ Practice Startup System Program which starts Wednesday May 5th. I’m so excited to be actually teaching this course – I’ve had so many requests for something like this, and I believe it will make a huge difference for the NPs that are already participating! You’re invited to check it out, but you’ll want to do so before May 1st at 12 midnight Pacific (hint: the special pricing ends then).

Hope you’ll join us on May 5, 2010!

A Nurse Practitioner recently asked how location could be important when looking at creating a clinic for people with low income. I think it makes a huge difference.

When you are creating services for people, regardless of their socio-economic, culture, language status or ability, you will want to make sure you were addressing their particular needs. Thus location can be vital. You’ll want to ask yourself the following questions.

1. Will your intended clients have access to the clinic? If they are likely to use public transportation, is it located near a bus or light rail stop?
2. Is the clinic located in their neighborhood? Does it feel familiar and safe?
3. Is this in a location where your intended clients hang out?
4. If they are driving to the clinic, does it have adequate parking for able bodied as well as disabled people? Is it well lit and safe?
5. While not location dependent, consider as well cultural and language differences. Most often this will come into consideration when looking at neighborhoods, but may extend beyond those bounds as well.

A clinic that is in an area that is hard to reach, and unfamiliar neighborhood, or is inconvenient will less likely draw in the intended population. When you wish to be in service to a particular population of people, you must be considerate of their needs and desires.

Thus, location and can, and does make all the difference in the world. Regardless of the population you are serving.