It Pays to Know the Latest Business Trends in Practice Management

March 4, 2008


This is one in a series of articles designed to help clinical neurologists and their staffs achieve success in today's—and tomorrow's—medical environment.

By William S. Henderson, FACMPE
Administrator, Upstate Neurology Consultants
Member, Practice and Technology Editorial Board
Member, Practice Management and Technology Subcommittee
Member, BRAINS
Author Disclosure

As part of the January 2008 AAN Winter Conference in Miami, the AAN Winter Practice Management sessions offered courses to inform members about recent innovations and changes in practice management, and tips to improve productivity and efficiency. The courses covered a wide range of topics, including the latest in coding procedures, modifier usage, claims and billing, and many other important business functions for running an effective neurological practice.

For members who missed any of the Winter Conference sessions, presentations and syllabi will be available at the Academy's Annual Meeting in April. Pre-order yours today ($39) or, for on-site purchases, pick up at the AAN Store in Chicago.

Patterned after the Fall Conference, the Practice Management Series covered basic and advanced subjects on the business side of neurology, with a third session devoted to special topics. The courses provided an extended, engaging presentation of virtually every business area that a practicing neurologist needs.

Subjects in the Basics Series (Practice Management 101) included:

  • Basic information for the proper diagnostic coding of neurological diagnoses (ICD-9-CM)
  • Overviews of the current 2008 CPT codes
  • Insights into CPT coding for neurological procedures, featuring the key CPT codes and modifiers for proper coding–presentations ranged from EMG, EEG, and Botox to infusion and correct modifier usage
  • Discussions on evaluation and management documentation (with E/M codes making up over 80 percent of all charges, it's essential for neurologists to know how to accurately code for these visits)
  • Tricks and techniques for reducing claims denials and avoiding coding pitfalls

The Basics Series offered a direct message: a practice that doesn't bill properly will find itself in serious jeopardy.

The Advanced Series (Practice Management 201) focused on more intense, but crucial, topics in practice management. Subjects included:

  • Working smarter in 2008—proper claim submission, dealing with payment denials by insurers, and use of benchmarking in practice
  • Surviving chart audits by an insurer—although neurology accounts for less than two percent of all health dollars spent in the United States each year, most neurologists don't realize how likely it is for them to be audited
  • Assessing and managing medical liability risks—how can neurologists most effectively identify and address aspects of their practice with the greatest potential for legal liability? Key areas identified in this session included:
    • Effective communication with patients: listening, questioning and giving positive support
    • Encouraging patients to participate in their health care decisions
    • Managing advance directives and end-of-life care
    • Understanding surrogate decision making

In addition to these topics, the Advanced Series showed how to incorporate evidence-based medicine in an explicit, transparent, and defensible manner into neurology practice by using guidelines developed by the AAN.

For the Special Topics (Practice Management 301) Series, subjects included:

  • General strategic planning issues for neurologists looking to the future with an eye on making their practices profitable
  • Billing do's and don'ts for advanced practice providers (APPs: nurse practitioners and physician assistants)
  • Incident-to billing and analysis of financial contribution margins for APPs
  • Infusion billing updates (including tips on how to get started with infusion)
  • Compliance issues with a special impact on neurology practices
  • Office of Inspector Generals' audits of consultation
  • PQRI performance measures for 2007 and 2008 (for which CMS will reimburse practices if they document their compliance)

A number of crucial areas were discussed in the Special Topics Series, all of which can be used to maximize a practice's effectiveness and viability.

The evolving business of health care may be a daunting subject for those who want to stay on top of the latest trends. The AAN Winter Conference Practice Management sessions provided valuable information on a number of key issues that will help the neurological community keep on top of new developments.

Session Highlights

Here are some new concepts I learned about while attending all of the Practice Management presentations:

  • It's very important to explore new medical services that you can offer to your patients; at the same time, you should watch carefully to see that you aren’t losing money on your current services.
  • Neurologists with hospital privileges are not being adequately reimbursed for their time, especially those who provide on-call services. At some point hospitals must decide if they want to work collegially with neurologists in the community (by paying them an on-call fee) or hire their own neurologist to see the hospital's patients.
  • An increase in the number of new quality measures for CMS PQRI in 2008 deserves a second look (especially for those who didn't participate in 2007). Thanks to AAN practice resources we are having a much easier time with 2008 PQRI than in 2007.
  • I picked up a really useful pro forma on developing an infusion business, plus lots of experienced advice.
  • The business experience of one large neurology practice with APPs has helped me develop a better model for determining the profitability of our physician's assistant.
  • I now have a better appreciation for the clinical guideline development process and how to use it in discussions with our neurologists.
  • There are many areas to benchmark in a practice: be sure to choose the most important ones.

Author Disclosure

Author has nothing to disclose.