7/22/2011
CONVENTIONAL FUNCTIONS
OF
MEDICAL PHYSICISTS
Farideh R. Bagne, PhD., J.D.
President and CEO

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MERCURY MEDICAL SYSTEMS
Clinical
Research
Administrative
Regulatory
Keego Harbor, Michigan
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CLINICAL DUTIES:
 Equipment Related
 Patient Related
 Computer Related
ADMINISTRATIVE ROLES
 Supervisory
 Budgetary
RESEARCH FUNCTIONS:
REGULATORY FUNCTIONS
 New Methods
 Improving Diagnosis and Treatment
 Basic
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 Federal and State Rules Enforcement
 Confidentiality
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IMPOSITION ON & CIRCUMVENTION OF
MEDICAL PHYSICISTS ROLE
IMPOSITION ON & CIRCUMVENTION OF
MEDICAL PHYSICISTS ROLE
Cont.
 CLINICAL AREA
- Dosimetrists
- Therapists
 ADMINISTRATIVE AREA
- Nurses
- Department Managers
- Hospital Administration
- Equipment Salesmen
 RESEARCH AREA
- Lack of Funding
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IMPOSITION ON & CIRCUMVENTION OF
MEDICAL PHYSICISTS ROLE
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SOLUTION
Cont.
MEDICAL PHYSICISTS NEED TO
EXPAND THEIR ROLE
BY GAINING
KNOWLEDGE IN OTHER
AREAS OF MEDICAL PRACTICE
 REGULATORY FUNCTIONS
- Nurses
- Physicians
- Therapists
- Dosimetrists
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3 GOLDEN RULES
ADDITIONAL ROLE FOR
MEDICAL PHYSICISTS
 RULE 1: Revenue Generation
- The Umbilical Cord of a Department is
its Revenue.
MediBusiness
 RULE 2: Interest
- Physicians are neither trained nor
have time to optimize the Department’s
Revenue.
 RULE 3: Ability
- Department Managers have little
expertise in increasing revenue.
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ADDITIONAL ROLE FOR MEDICAL
PHYSICISTS
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MediBusiness of a Department:
A- Generate Revenue
B- Deal with Medicare/Medicaid
& Insurance Companies Regulations
MEDIBUSINESS:
Taking Control of the
Revenue Generation
While Expanding the
Regulatory Functions
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MediBusiness:
A- AREAS INVOLVED IN REVENUE
GENERATION:
MediBusiness:
B- AREAS INVOLVED IN THE
REGULATION OF CODING BILLING &
COLLECTIONS:
 EHR
 CPT Coding
 Billing
 Collections
 Medicare/Medicaid Audits
 Insurance Companies Audits
 State Audits of Patient Funds
Collections
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WHY MediBusiness?
What can Medical Physicists Provide
With MediBusiness?
 No one in the Department has the full
understanding of the intricacies involved.
 Efficiency in Physicians' Time
 Reduction of Unnecessary Staff
 Reduction of Audits
 Optimization of Billing
 Elimination of Errors
 Faster Payment
 Little interest by Nurses, Dosimetrists,
Physicians, Managers, Therapists.
 Huge Financial Rewards.
 Medical Physicists already have the basic
background, education and expertise to
take on these functions.
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How Does MediBusiness Work?
MediBusiness
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MediBusiness:
- CPT Correct Coding

- Billing
- Collections
- EHR

Audit is done to Identify and Return Improper
Medicare Payments (Sec. 305 of MMA Act of
2003)
Compensation of Medicare to RAC is based on a
Contingency Fee.
RAC has Collected over $1.3 Billion from
Providers.
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KEY RAC ISSUES
 Correct CPT Coding
 Implementing Compliance Programs
 CMS has made RAC Audit Program
Permanent &Nationwide.
 Comprehensive Record Keeping
(Sec. 302, The Tax Relief and Health Care Act of 2006)
 Providing Full and Complete Response to
RAC Record Request
 RAC Audits Can Not Be Prevented, But
Their Consequences Can Be Minimized.
 Demonstrating Procedures Performed
MediBusiness:
UTILIZE A FULLY INTEGRATED
SOLUTION
- CPT Coding √
- Billing
- Collections
- EHR
Scheduling EMR Billing Collections Coding Credentialing
Single Database
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WHAT SHOULD BE OUR GOAL?
 Efficiency in Physician Time
 Elimination or Reduction in
Audits
 Optimization of Charges (legally)
 Elimination of Errors
 Faster Payments (Reduction of
Account Receivable)
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DO NOT RECOMMEND IN-HOUSE
BILLING /COLLECTION
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DO NOT RECOMMEND IN-HOUSE
BILLING /COLLECTION
Cont.
WHY?
OTHER REASONS:
 Billers have no interest.

Inefficient
 Managers have no or little expertise
to supervise the billing staff.

Expensive

Time Consuming

Inadequate

Prone to errors

Lack of Supervision
 Frictions between Clinical and
Billing Staff.
 Physicians are only interested in how
much is generated & not how.
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WHAT TO CONSIDER IN SELECTING
A BILLING /COLLECTION COMPANY?
Scheduling EMR Billing Collections Coding Credentialing
A.Must have a Single Data Base
Single Data Base
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WHAT TO CONSIDER IN SELECTING
A BILLING /COLLECTION COMPANY?
WHAT TO CONSIDER IN SELECTING
A BILLING /COLLECTION COMPANY?
C. Criteria
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B.Comprehensive Full Service
Providing Both
Billing & Collections Services
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Experienced staff
Not Publically-Traded
Specialty - Specific
Legal Expertise
Certified Billers
Licensed Collection Agents
No Out-sourcing to Other Countries
Advanced and Routinely Updated Software
Certified Coders
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MediBusiness:
- CPT Coding √
- Billing √
- Collections √
- EHR
EHR SYSTEM
(Electronic Health Recording)
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A.
Choice of Input Devices
EHR REQUIREMENTS
A. HARDWARE
B. CAPABILITIES
System Must Allow Physicians To Select The
Method Of Their Preference
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12 CRITERIA FOR
A COMPLETE EHR SYSTEM
B. CAPABILITIES:
Must Meet Medicare Requirements
(Per Medicare/Medicaid Requirement)
1.
Full and Accurate Documentation
2.
Access to Clinical Data
3.
e-prescription
4.
Expandability
5.
Correct CPT Coding Capabilities
6.
Patient Education Materials
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FACTORS TO CONSIDER
WHEN
SEARCHING FOR
AN EHR SYSTEM
12 CRITERIA FOR
A COMPLETE EHR SYSTEM:
(Continued)
7.
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Specialty-Specific Templates
8. Image Management, e-Lab & Hospital Reports
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9. e-Generation (H&P, Follow-ups, Other Reports)
10. Interoptability (EMR, Billing, Scheduling,
Coding)
11. Treatment Outcome Analysis & Reports
12. Physician & Office Friendliness
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Medicare Requirements √
Meet CCHIT Criteria
Meaningful Use
Federal Incentives
Vendor Market Longevity
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 CCHIT
is a Private Not-For-Profit
Organization that serves as a Recognized
U.S. Certification Authority for EHR
Systems.
WHAT IS CCHIT?
 The
U.S. Department of Health &Human
Services has Contracted with CCHIT to
Develop & Evaluate the Certification
Criteria & Inspection Process for EMR
Systems & the Networks (Vendors) through
which they incorporate.
Certified Commission For Health
Information Technology
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PROPOSED FEDERAL
INCENTIVES
FACTORS TO CONSIDER WHEN
SEARCHING FOR AN EMR SYSTEM
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Medicare Requirements √
Meet CCHIT Criteria √
FEDERAL INCENTIVES
Meaningful Use
Vendor Market Longevity
Purchase
Agreement
Signed
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EHR
Installed
with
Required
Data
Collected
2011
2012
2013
2014
2015 2016 TOTAL
$18K
$12K
$8K
$4K
$2K
$18K
$12K $8K
$4K
$2K
$44K
$15K $12K
$8K
$4K
$39K
$12K
$8K
$4K
$24K
$44K
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CURRENT CRITERIA TO OBTAIN
FEDERAL FINANCIAL ASSISTANCE
FOR PHYSICIANS USING
AN EHR SYSTEM:
FACTORS TO CONSIDER WHEN
SEARCHING FOR AN EMR SYSTEM
 Medicare Requirements
 CCHIT
 Meaningful Use
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Medicare Requirements √
Meet CCHIT Criteria √
Federal Incentive √
Meaningful Use
Vendor Market Longevity
22A
MEANINGFUL USE
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FACTORS TO CONSIDER WHEN
SEARCHING FOR AN EMR SYSTEM
(Meaningful Use Parameters)
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REQUIREMENTS
 (ARRA) American Recovery and Reinvestment Act
 (CMS) Centers for Medicare and Medicaid Services
 CCHIT Certification
 (HIE) Health Information Exchange
 (ONC) Office of National Commission
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Medicare Requirements √
Meet CCHIT Criteria √
Federal Incentive √
Meaningful Use √
Vendor Market Longevity
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ANALYSIS
BY
There Are Over 300
EHR Vendors
GARTNER GROUP
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Gartner Group
GARTNER GROUP:
Gartner Group (Gartner, Inc.) is an
Independent Information Technology
Firm Headquartered in Stanford,
Connecticut & Employees 4,000
Professionals.
PROVIDES RESEARCH, MARKET
ANALYSIS
& CONSULTING SERVICES TO
GOVERNMENT AGENCIES
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GARTNER ANALYSIS
GARTNER ANALYSIS
Criteria Used:
 COMPLETENESS OF VISION
(Completeness With Regard To
Medicare/Medicaid Requirements)
 ABILITY TO EXECUTE
(Ease of Installation, Use & Upgrade)
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CONCLUSION
REMINDER!
Medical Physicists have many
opportunities in any Medical
Practice to broaden their role and
expand their influence by utilizing
the concept of MediBusiness
In 2013, EHR Will Become
Mandatory For
Medicare/ Medicaid Providers
Without Any Incentives.
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Thank you.
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