Online Reputation Management for Doctors
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Online Reputation Management for Doctors
Curated and Written Articles to help Physicians and Other Healthcare Providers manage reputation online. Tips on Social media, SEO, Online Review Managements and Medical Websites
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Physician Beware: Delayed Annuities with Guarantees

Physician Beware: Delayed Annuities with Guarantees | Online Reputation Management for Doctors |

Forgive me for the somewhat arcane topic, but I see a constant stream of delayed annuities with guaranteed withdrawal benefits sold and advertised, and I think this needs to be addressed.

Here are some of the key things physicians should know about annuities, and why they may want to proceed cautiously when considering delayed annuities with guaranteed withdrawal benefits:

The two types of annuities:

Annuities are instruments that involve giving an insurance company your money and then hopefully getting some or more of it back in the future.  The two broad types of annuities are immediate annuities and delayed annuities. 

Immediate annuities occur when you give the insurance company money and it immediately begins giving you regular (usually monthly) income for a period time or for your lifetime (or even for a joint lifetime with your spouse).  You receive a return of your principal, some interest on the principal, and a small "mortality benefit" of money that comes from people who buy such an annuity and then die earlier than expected.

A delayed annuity occurs when the insurance company keeps your money for a while before you are allowed to take your investment back. 

Delayed annuities with guaranteed withdrawal benefits:

Currently popular are delayed annuities with guaranteed withdrawal benefits.  You will hear them advertised as a product in which you cannot lose money no matter what the stock market does. You may even hear that such an annuity allows you to make gains in a good market.

Those selling these products may promise that you can take withdrawals after 10 years on twice the amount of money you initially deposited, guaranteed.

So, you give the insurance company $100,000, and are guaranteed a given withdrawal rate (usually 4 percent to 5 percent at age 65) on $200,000 after 10 years. 

If you are considering one of these products, just assume this is the absolute best you will do.  Realize that you may not withdraw the $200,000, but only get the guaranteed withdrawal amount. 

Although it appears that you are receiving up to a 10 percent return on your initial investment as an annual withdrawal, the financial math actually reveals a low single-digit return (remember the insurance company has the use of your money in full for 10 full years, then is paying you back completely with your own funds over the next 10 years of withdrawals while still having the majority of your funds to invest for itself).

These products have such high internal costs (especially including very fat commissions up front for the salesmen that push them) that any promise to participate in stock market gains is a very iffy promise indeed.

If you are contemplating buying such a product, I'd recommend you get some fiduciary and impartial advice. 

Ignore the selling points and assume that you are giving an insurance company money that will be paid back many years later with a very small return (assuming the insurance company remains solvent).

There remains no "free lunch."


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'Mix and Match' Documentation for Higher Reimbursement

'Mix and Match' Documentation for Higher Reimbursement | Online Reputation Management for Doctors |

Recent changes in how CMS permits you to select evaluation and management (E/M) service levels are a benefit to providers who manage patients with multiple chronic conditions.

E/M services may be provided at various levels of intensity, with more intensive services garnering higher reimbursement. E/M service levels (and the codes that describe them) are assigned according the elements of patient history, exam, and medical decision-making (MDM) documented in the provider’s encounter notes.

CMS allows you to choose between two sets of guidelines when translating provider documentation into E/M codes: The 1995 Documentation Guidelines for Evaluation and Management Services and the 1997 Documentation Guidelines for Evaluation and Management Services. The guidelines differ in how they define the history and exam portions of an E/M service (the guidelines are identical regarding MDM).

The ‘95 guidelines define the exam component such that specialist providers found it difficult to report higher-level E/M codes, even when services warranted doing so. The ‘97 guidelines addressed this issue by providing bullet points for single organ system examinations, thereby allowing specialists to report higher level services for intensive, problem-specific exams. The ‘97 exam requirements tend not to work as well for general practitioners, however.

The ‘97 guidelines also differ in the history component, and allow “the status of three or more chronic conditions” to qualify as an “extended” history of present illness (HPI). Under the ‘95 guidelines, providers must document four or more HPI “elements” (location, quality, severity, duration, timing, context, modifying factors, and associated signs and symptoms) to attain an extended HPI.

Each set of guidelines has its advantages and disadvantages. For many providers, the ideal guideline would combine the ‘95 exam requirements (which are more subjective, as compared to the ‘97 exam requirements) with the ‘97 history element (which are more flexible than the ‘95 guidelines when defining the history of present illness). For many years, such “mixing and matching” of the guidelines has not been allowed.

Effective since Sept. 10, 2013, CMS has revised its E/M Documentation Guidelines to allow an extended HPI, as defined by the ‘97 guidelines, with the other elements of the ‘95 guidelines. As a result, “the status of three or more chronic conditions” qualifies as an extended HPI for either the ‘97 or ‘95 guidelines. 

CMS announced the change as a “Question and Answer” on its website.

Q. Can a provider use both the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services to document their choice of evaluation and management HCPCS code?
A. For billing Medicare, a provider may choose either version of the documentation guidelines, not a combination of the two, to document a patient encounter. However, beginning for services performed on or after September 10, 2013 physicians may use the 1997 documentation guidelines for an extended history of present illness along with other elements from the 1995 guidelines to document an evaluation and management service.

CMS has also updated its Evaluation and Management Services Guide to reflect the new policy.

Ask your coding staff if they are aware of this change, and if they are measuring E/M services against the revised guidelines. Those physicians who manage patients with multiple chronic conditions, especially, may find that the new rules allow their coding and billing to better reflect the documented level of service provided, thereby legitimately boosting E/M levels and reimbursement levels. If providers are already documenting their services well, they won’t have to change their process to realize an advantage from these revised E/M guidelines.

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Is Top-Down Management Right for Your Medical Practice?

Is Top-Down Management Right for Your Medical Practice? | Online Reputation Management for Doctors |

In order for your practice to run smoothly you need more than excellent medical skills. Because as much as your priority is to provide exceptional care for your patients, there are other vital components you must master to ensure the successful operation of the corporate elements of your practice. These include effectively managing your staff and efficiently monetizing your business. After all, if your business can't thrive, neither can your patients.

Most doctors don't have the training or the time to double as human resource and financial experts. That's why some medical practices can benefit from establishing a unique co-management structure rather than relying on a traditional top-down management style.

Unless you intend to earn an MBA, you may want to consider instituting one of these three simple geometric-themed alternatives for enhancing the functionality of your day-to-day business operations:

1. Round Management

Imagine a bicycle wheel. In this management model, which works well for a sizeable practice with a multidisciplinary team, your patients are at the center of the wheel, the hub. They are the reason you have a business at all. Every member of your team symbolizes one of the spokes, and each of them has a unique duty to perform that will add to the health of either your patients or your business. Because you are both the doctor and the business owner, your role is twofold. First, as the business owner, you act as the rim of the wheel; the person responsible for holding everything together by overseeing the professionalism of your staff and the economic success of your practice. Second, as the doctor, you are in the position of being the axle, which supports the hub (your patients), the spokes (your team), and the rim (your business). If you are out of alignment, your business will be out of alignment as well.

2. Triangle Management

Ideal for midsized practices, this three-pronged management approach includes a people manager, a financial manager, and a medical manager. In addition to handling conflicts and complaints, the people manager directs human resources — including hiring, firing, training, and scheduling. This person is also responsible for developing and maintaining patient relationships, and for the implementation and execution of office policies and principles. The financial manager is in charge of fiscal accountability, supplies, and payroll. The medical manager, who is usually the physician who owns the practice, is the in-house authority on medical practices, procedures, and records. The managing physician also has the final say on conflict resolutions, financial decisions, and corporate operations. The system usually works well because it provides clearly defined roles and responsibilities, multiple perspectives, and a variety of advisers who have specific areas of expertise.

3. Spiral Management

This is the most fluid and flexible mode of management because it offers minimal pecking order and maximal independence. Spiral management is perfectly suited for practices with one or two physicians and a small number of auxiliary staff. The success of this model relies heavily on mutual trust, teamwork, and open communication. Naturally, patients are the center point of the spiral, with physicians, support personnel, and administrative staff surrounding them in varying rings of care. No matter what their role is, people working in these practices generally have a vested interest in the success of the business because they enjoy the autonomy that the spiral management system provides. It is not uncommon for business owners who believe in this style of management to offer financial, educational, and scheduling assistance to their staff because they value the return they see on such investments.

Top-down management has certainly been proven to work well in many circumstances. But if you're looking for a more unconventional style, you may want to try a new angle.

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