Swindler of the Week—Covid 19 test Scam
Swindler of the week--focused on two Jacksonville women who have been accused of scamming Medicare out of nearly $4 million in Covid-19 reimbursements for tests. Their scam involved creating a company, using a billing company to submit the claims for reimbursement, and obtaining a list of Medicare beneficiaries and submitting false Covid-19 tests under those names. Sometimes they submitted as many as eight tests per person. To read more about their scam and their upcoming court hearing, click the link.
Navigating Conflicts in the workplace
Conflicts--disagreements or a variance of interests, goals, or understanding of direction (dictionary.com). Conflict resolution--the process of ending or resolving the disagreement or dispute in a way that satisfies all involved to some degree. Conflicts happen all the time in our lives, both daily and in the workplace. Addressing those conflicts in the workplace can be harder than those handled in our daily life.
Conflicts in the workplace can occur between employees, managers and employees, and employees and customers/patients. How it gets addressed and resolved can both define the practice and determine the retention of employees and patients. So, how should conflicts in the workplace be resolved? In a healthcare setting, conflicts can affect patient care and resolving these conflicts immediately is of utmost importance. There are seven key points that can help guide you as a manager or employee on navigating conflicts in your workplace.
Open Communication
Communication is the key and open communication is of utmost importance. Open communication involves establishing a culture that engages your employees to speak openly, respectively, and comfortably. Having open communication from day one of each hire where they feel comfortable coming to others with their questions, challenges, concerns, or ideas helps foster open communication during conflicts and discussions surrounding those conflicts.
Active Listening
Active listening is a way of defusing conflicts through actively listening and waiting to respond until the complete statement or statements of the others are done. Active listening means you have eye to eye contact with those involved in the conversation, do not interrupt, do not jump to conclusions, listen without judging, and do not start planning what you are going to say as you will miss what the person talking is trying to convey. This gives you, the manager, the ability to identify what the real problem is and helps you create the proper response at the right moment.
Ask Questions
Resolving a conflict is almost impossible when it feels like you are being attacked or like you, as the manager, are attacking your employees. When you hear a conflict happening or you become part of a conflict, it is important that you approach those involved in the right way. This means choosing your words carefully and avoid starting the conversation with negative feedback. If you start by asking questions such as, "I heard there was a disagreement about job descriptions/role and wanted to check in. Can you share with me what happened or how you are feeling?" This approach opens the door for you and is less triggering and more receptive by the employee(s) involved in the conflict.
Pause
Before you, the manager, begins to jump right into the conflict with your thoughts and opinions that may be biased, it is important to take some time to pause. It is important to avoid having an opinion or bias until you have heard all the information and have a complete picture. This does not mean that you can validate their feelings or concerns right away, but rather do not give your opinions or thoughts on the conflict. Take a moment to digest the information you have received by saying, "I hear what you are saying and I am going to just go and think about this and we will meet in a few minutes to discuss this further." This approach not only gives you time to digest all the information, compile your thoughts, but also to set aside personal feelings for the employees involved and focus only on how the conflict affects production or the environment of the workplace.
Stay Objective
It is vital that you do not take sides or involve your personal feelings or experiences in the situation. Your role as the manager is to help your employees, patients, or team members resolve the conflict and not simply determine who is at fault or to blame. To stay objective, it is imperative that you as the manager guide the conversation to stay focused on the facts of what occured, what the specific scenario was, and do not let employees become focused on whose fault it is or their personal feelings and opinions of others. Do not use the words always or never as these words tend to feel aggressive to those involved. Keep the focus on what you as the manager are hearing and continue clarifying the situation.
Encourage Ownership
It is important, as the manager, to not find the solution for your employees or those involved in the conflict, but rather help your team to find solutions on their own as this helps them learn and grow. It is important, though, that as the manager you listen, guide, ask questions to help clarify the situation for yourself and those involved, and encourage each person involved to take responsibility for their part in the conflict and the importance of resolving the conflict.
One way to encourage ownership is to ask questions that help those involved recognize their power and ability to improve the conflict or situation moving forward. This can be done by asking questions that involve asking what will make them feel better going forward, what would they do differently if this happens again, or how do you want to talk to the others involved and find a solution. Asking these types of questions helps to guide your employees or patients to feel satisfied and empowered to fix the problem and find solutions on their own. It also helps guide them into taking ownership of their role in the conflict.
Celebrate
Recognize that solving the conflicts help build relationships within the organization and foster a positive work culture. The most effective teams are those that recognize a conflict, find solutions, and celebrate in the conflict resolution. This allows individuals, teams, and patients to feel more comfortable with conflict and understand that conflict helps grow the organization through resolution and relationship building. This is done by giving credit where credit is due!
Report
This step is often overlooked by many managers. When a conflict occurs, it is important that the manager creates a brief report of the conflict that documents those involved, the discussion that was had, the circumstances surrounding the conflict, the solution decided on, what could have been done differently and why as well as how it was celebrated. This is important so that when other conflicts happen you can review what was done and if it was successful then taking cues from that report can help resolve the new conflict quicker.
Conflicts happen every day to some degree in the workplace. In a healthcare setting though, conflicts--even minor ones--can create lasting effects for the patients and the practice. It is important to have a conflict strategy or plan in place before conflicts happen. Have someone you as the manager can go to for advice and can remain neutral and be able to offer you good advice and direction when needed.
Sources:
https://www.armyandnavyacademy.org/blog/effective-communication-is-key-to-resolving-conflicts/
a perfect storm for audiology in 2024
As we move to the end of the first quarter in 2024, I have noticed a few trends that have created a perfect storm for the audiology industry. First, the economical situation for most Americans is one of uncertainty. Second, the boomers are now becoming the older generation and with that means almost 430 million people world-wide with disabling hearing loss according to the World Health Organization's statistics. Third, the ever changing, progressing, and fast moving advancements of technology. These three aspects combined have created a significant need for audiologists and yet the industry lacks the number of audiologists needed to meet the demand. To better navigate this storm and help those facing hearing loss, the audiology industry must confront these three issues head on.
The economical situation for Americans, and world-wide, has created a situation where patients must decide between a house payment, food on the table, basic bills paid or hearing aids. Hearing aids, while a necessity for a qualitative life, are often not covered by insurance companies and if they are they are limited to the quality of aid they can choose from. This creates a problem for audiologists who are trying to make sure their patients have the best to live their best life.
The big generation of boomers, has now reached an age where they are facing significant hearing loss. It is this group that is most affected by disabling hearing loss, according to WHO, and yet this group is the median on the economic scale. Making sure your practice targets this group and yet has different economical packages available is a challenge for many audiologists today.
The rapid development of technology has taken every industry by storm and especially the industries that deal with devices such as hearing aids, mobile phones, computers, and more. This is both a blessing and curse for the audiological industry. Advancements in cochlear implants have helped so many hear and have better outcomes in their health plans. Advancements in hearing aids have helped varying generations have better outcomes with conversations, hearing, understanding, and even using their bluetooth devices such as phones. Today's hearing aids can often connect to the phone so that the user does not even need to have their phone next to them or holding it in their hand. They can just talk like normal while doing other things. Hearing aids can block out the background noise so often heard on mobile phones thus creating a better outcome and more enjoyable experience for the patient. Again, leading to a higher quality of care being given to the patient.
These three challenges combined with the challenges of CPT coding and the ever changing guidelines from CMS on how and what audiologists can bill, a perfect storm has been created that leaves audiologists and patients in the middle of the storm. There is a need for new codes to be created as old codes are outdated and not encompassing of all the new technology. There is a great need for providing more expansive codes that are more comprehensive and draws the complete picture of the patient's hearing health, not just a snapshot.
With this perfect storm brewing, Audiologists need to make sure that there practice is prepared to weather this storm and come together to help create new codes and code definitions. Those of us in the consulting business, coders, and medical insurance billers know that if we can all come together and find new ways of helping our patients navigate the storm, your office can also be successful and increase your patient base and your revenue.
Article source: https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss#:~:text=Overview,will%20have%20disabling%20hearing%20loss.
Published by
Julie Barth, DM, MBA Julie Barth, DM, MBA
Leadership and Management Consultant--specializing in processes and procedures for best practices of leadership and management Leadership and Management Consultant--specializing in processes and procedures for best practices of leadership and management
Published • 1d
The Perfect Storm Facing the Audiology Industry
Friday’s Swindler of the week
Mathew James of East Northport used his medical billing companies to scam insurance companies into paying millions in fraudulent claims. From impersonating patients and family to requesting appeals and reviews of services that were never done to advising his physicians to schedule elective surgeries through the ER so that reimbursement was higher. He was found guilty on February 2, 2024 and ordered to pay more than $336 million in restitution. To find out more, click the link.
What are your three main problems with billing in your healthcare office?
Wednesday's Question of the Week--What are the three main top challenges with billing in a healthcare office? Understanding what these are and how to combat them and help your practice solve these problems before they affect your revenue. Click here to find out easy solutions.
Spotting Health Insurance Scams
In today’s world, there are many scammers out there trying to make a quick buck off vulnerable people. Today’s Swindler of the Week is focusing on 5 signs of health insurance scams. Click here to find out what those five signs are and how to protect yourself and your loved ones—especially those of the older generation—from being scammed.
Wednesday Question of the Week
Can NP's bill the same as Physicians in Wisconsin? Billing for NPs is a complex set of rules that need to be followed and can often be confusing for the medical biller. Click here to read the article that helps simplify some of the confusion surrounding the policies, laws, and exceptions.
Swindler of the Week
It's time for Swindler of the Week. This week's case comes to us from Columbia, South Carolina where St. Francis Physician Services, Inc and their entities agreed to pay $36.5 million to resolve allegations that it violated the False Claims Act, Stark Law, and the Federal Anti-kickback Law. The violations were founded in the fact that this group made payments to orthopedic surgeons based on volume of referrals. Click here to read all the details and the outcome to the group after this settlement.
Click our services page and see what we can do for you and how we can help you avoid this same situation for your facility.
Value-based care vs. fee-for-service
As we navigate toward payments for value-based care versus fee-for-service, what are your thoughts? Understanding the difference can help clarify why value-based care is going to improve patient outcomes and reduce overall healthcare costs. Click here to find out how value-based care is supposed to work and the benefits when it does.
2024 CY Final Medicare Physician Fee Schedule Ruling
Every year providers wait anxiously to find out what the changes will be with the Medicare Physician Fee Schedule. These changes effect the bottom line and revenue that a provider brings in each year. This year, there is a 1.25% reduction in the payment rates. Click here to read what codes, specialties, and services are affected.
ICD-10 April 2024 Updates out now
Any biller and coder knows that ICD-10 codes tell the story to the insurance companies on what was done and why. Click here to find out all the updates that will go into affect April 1, 2024.
2024 Medicare final rules for Specialty—Audiology
Every year specialty providers are faced with changes in how they can bill, what they can bill, and what they will be reimbursed. This link takes you to the specialty, audiology, and brings you updates for 2024 on new physician fees for 2024, coding updates, and two new timed codes that can be billed and potentially allow for greater services for your patients.
CPT Coding updates 2024—What you need to know
As anyone healthcare facility and employee knows, coding updates are crucial in the industry. Coding updates reflect the evolving environment of medical services, procedures, and equipment. Click this link to find out the changes, revised codes, and deleted codes for 2024.
Eight Trends All Healthcare Billing Specialists Need to Know for 2024
With the new year here and the ever changing world of healthcare billing, here are eight trends in healthcare billing that continue to evolve as technology changes. It is important for all billers to know these trends and help their providers engage in these to ensure they do not risk loss of revenue and patients.
Eight Trends All Healthcare Billing Specialists Need to Know for 2024
OIG Released Opinions Relating to Healthcare Providers
The OIG just released the first four advisory opinions of 2024. The opinions are regarding the use of gift cards for referrals, preferred hospital networks, and retiring physician buy-out policies. Check these out today as they affect your practice in one way or another. If not now, then in the future! Click this link to read the opinions now.
Insurance coverage changes
Insurance changes constantly. Are you ready for what the new year has in store?
Insurance is ever changing and in the field of medical billing, it is imperative that billers understand those changes when they occur. 2024 has many changes coming. Click this link to find out what changes are coming and how you can use those changes to your advantage.