Wednesday, March 31, 2010

FOR SALE BY OWNER - Maine - Optometry practice for sale

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Unique Optometric practice for sale in Maine. Busy practice with exceptional location, great patient base, and low rent/overhead. Advanced care practice offering an extensive mix of general optometric, contact lens, as well as oculo-medical care. Very impressive patient numbers, track record, and net income. Newly renovated office and attractive setting for patients. Significant professional and financial success for any experienced or newly graduated optometrist as practice continues to grow and has ongoing potential. This area offers a unique opportunity to live, work, and recreate near the mountains, national parks, and perhaps the east coast's most beautiful coastline and islands. Low cost of living and safe communities.

FOR SALE BY OWNER LISTING - To be put in touch with the seller directly, please forward your info via web inquiry or call 800-416-2055.

Tuesday, March 30, 2010

Billing Medi-Cal for Vision Care Services - The 10 most common Vision Care denial messages

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Medicaid can be challenging to properly bill and collect for vision care services. Optometrists and ophthalmologists with Medicaid patients need to be aware of specific payor nuances and correct methods to avoiding denials and get reimbursed for their services. I recently attended a seminar for California's Medicaid program (Medi-Cal), and learned some interesting tidbits. Medi-Cal recently compiled data from their denial records to track the 10 most common denials for vision care claims. Here they are by top denial (#1-#10), RAD Code, and corresponding denial message.

(#1) - 0139 - Procedure/service is invalid for claim type on date of service
(#2) - 0314 - Recipient is not eligible for month of service billed
(#3) - 0036 - RTD (Resubmission Turnaround Document) was either not returned or was returned uncorrected; therefore, your claim is formally denied
(#4) - 0002 - The recipient is not eligible for benefits under the Medi-Cal program or other special programs.
(#5) - 0033 - The recipient is not eligible for the special program billed and/or restricted services billed.
(#6) - 0392 - Rendering provider number/license number is not on the Provider Master File. Contact rendering provider to verify number.
(#7) - 0042 - Date of service is missing or invalid.
(#8) - 0062 - The facility type/Place of Service is not acceptable for this procedure.
(#9) - 0351 - Additional benefits are not warranted per Medi-Cal regulations.
(#10) - 0010 - This service is a duplicate of a previously paid claim.

The proper follow-up procedures for these vision care claim denials depend on the type of denial message and the underlying problem with the claim. The source of the problem may be easily found through simply review and follow-up. Here are some follow-up procedures suggested and billing tips for each RAD Code:

0139 - Rebill the claim
*
Check if procedure code is valid; Check date of service; Read provider manual for billing changes*

0314 - Submit appeal within 90 days
*Verify date of service on the claim; Verify recipient's eligibility; If recipient has a Share of Cost, then collect and spend it down; Refer to Share of Cost section in Part 2 of provider manual*

0036 - Rebill the claim
*Return the RTD by the date indicated at top of RTD; If claim was resubmitted, disregard the denial.*

0002 - Submit appeal within 90 days
*Verify recipient's eligibility; Check recipient's date of birth and date of issue on the BIC card; Verify that recipient's 14-character BIC number matches the number billed on the claim and/or the RAD*

0033 - Submit appeal within 90 days
*Verify recipient's eligibility; Check recipient's eligibility; Verify recipient is enrolled in the appropriate programs; Refer to provider manual under Services Restrictions section of Part 1 of manual for restricted codes and messages.*

0392 - Submit appeal within 90 days
*Check NPI; Verify if provider is in Provider Master File for the particular services billed; Check if provider is still active; Contact DHCS provider enrollment division*

0042 - Rebill the claim
*Verify the date of service; Check for previous payment; Check if procedure code is still valid;*

0062 - Rebill the claim
*Check the facility type/Place of Service code; Verify procedure code; Check from-through dates of service; Check Part 2 of provider manual for list of valid facilities codes*

0351 - Rebill the claim or Submit an appeal with 90 days
*Verify that the number of days or units for the services billed on the claim do not exceed acceptable maximum; For interim eye examinations within the 24-month coverage period, refer to the Professional Services: Diagnosis Codes section in the Vision Care provider manual for a list of valid diagnosis codes that must be billed with CPT-4 codes 92004 and 92014 for payment.*

0010 - Submit appeal within 90 days
*Check the NPI; Verify recipient's 14-character BIC number; Check from-through dates, Chedk records for previous payment. If no previous payment, then verify all relevant information such as procedure code, modifier, and rendering provider number/NPI.*

I also took some additional notes pertaining to billing and Medi-Cal in general:
  • In May 2010, Medi-Cal will start offering online webinars and virtual classes.
  • Medi-Cal Regional Representatives can be scheduled come to your medical office for in-person seminars and to help with particular billing questions.
  • All lab work must be sent to PIA optical laboratories....the California Prison Industry Authority (PIA) which fabricates all eyewear for Medi-Cal recipients.
  • In general, if a denial is eligibility related, it is generally suggested to go to an appeal (if you have proof of eligibility).
  • When sending an appeal for eligibility, also send the Proof of Eligibility (either the internet print-out or physical copy).
  • If the recipient has no BIC and no SSN, contact the regional Social Services Office and they will be able to look-up the BIC number for you.
  • If you miss the 90 day appeal, submit a CIF (claims inquiry form) and get a fresh denial in order to re-appeal.
  • If it passes 6 months, send a CIF.
  • The full provider manual is online as well as the vision care section.
There is a lot of information to cover with Medi-Cal, but if you're an optometrist or ophthalmologist with Medi-Cal patients you'll certainly want to stay informed.

Sunday, March 28, 2010

Managing medical practice overhead expense

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Shrinking reimbursements are a progressive reality of the healthcare practice environment. Under these conditions private practices need to make smart decisions about how to manage their overhead expenses. Reduced growth in income means that previously manageable expenses may envelop a larger percentage of potential earnings. In addition, normal business expenses are expected to rise naturally through inflation and other factors affecting price indexes. There a number of ways to reduce overhead expense but a few which come to mind are A) lease re-negotiation B) vendor contract re-negotiation and C) practice expense sharing arrangements or medical practice mergers.he

Many private practices lease the office spaces in which they are located. These leases may have been negotiated in more favorable economic environments. Reduced demand and lower occupancy has persuaded many landlords to be flexible to new and existing tenants. If possible, practice owners should approach their landlords for reductions or other concessions, even if their practices are faring well. The uncertainties of healthcare payor reimbursements going forward may make this a wise future option while still potentially available in today's environment.

Another step which practice owners may consider is the renegotiation of contracts with vendors and service providers. This can be helpful in reducing a wide range of practice expenses. The outsourced medical billing company may be one place to start, especially if their percentage fee of collections has not been adjusted to account for changing norms in the medical billing industry.

An additional option which may be helpful to some medical practices is entering into an arrangement with another medical practice. This can range from a basic cost sharing agreement between practices to a full-fledged business merger. The medical practice merger is a way to leverage economies of scale, negotiate more favorable payor contracts, gain unique competitive edge in a particular market, or extend reach into new markets. A less-binding alternative is cost sharing with another medical practice. This could be as simple as a single shared expense or common piece of equipment, or as involved as a full split of all practice expenses including staff and lease. Major factors to consider when entering into such arrangements are the financial health and staying power of the practices involved as well as the business strategy, trust level, and risk threshold of the respective practice owners. Naturally, a competent medical practice mergers and acquisitions team should be involved in such dealings.

Tuesday, March 9, 2010

Entering practice – Buying a medical practice or starting-up fresh?

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Many new graduates completing residencies and fellowships seek guidance on how to start a medical practice or buy a practice. Prior to program completion it is advisable for prospects interested in medical practice ownership to extensively research and evaluate all available practice options regardless of their first inclination. After further research some doctors simply discover that medical practice ownership is not their ultimate desire and they may prefer to work as employed physicians. It is important to look at a variety of market indicators including available job openings for doctors, statistics on the best cities and states to practice medicine, demographic information on medically underserved areas, current listings of medical practices for sale, and the type of assistance available for financing a practice start-up or acquisition. When pursuing the independent practice route it is vital to get grounded in basic accounting and the management aspects of running a small business. Though medical practices differ greatly from the average small business, a practice is still subject to many of the same factors influencing other small businesses. Business skills are not typically acquired in medical training and finding a balance between business management and clinical practice can be tricky. Regardless of the practice decision made, proper due diligence and learning opportunities related to physician employment, practice purchase options, and startups take sufficient time. For those who set their heart on ownership the difficult decision of whether to buy a practice or start one from scratch can be challenging. Depending on the availability of opportunities on the market it may be more practical to buy a medical practice instead pursuing a start-up, or vice versa. The decision to start-up versus making an acquisition is also dependent on where the doctor is looking to practice medicine and how they envision building their private practice. Buying an established practice with existing patients and cash flow is often cited as a better option than beginning fresh, but a start-up medical practice can be equally rewarding and profitable.

Monday, March 8, 2010

Cosmetic services, the recent economic downturn, practice value, and pre-sale planning.

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Practices provide a varying mix of services depending on the markets in which they are located as well as the practice style and preference of practicing physicians. Patient demand is also a major driver that dictates these services. The demand (or perceived demand) for cosmetic services was driven into a frenzy during the pre-collapse economic period, and many physicians were more than willing to accommodate this demand by adding cosmetic services. For most physicians, providing services which were highly demanded was simply logical. Furthermore, there was no shortage of vendors, medical practice consultants, and others who blindly recommended that practice owners add cosmetic services. The economic situation of the last two years has brought much of this into question, as many practices suffered due to a service mix disproportionally weighed towards cosmetics. Many cosmetic services were heavily tied to discretionary consumer spending and practice financials suffered as a result. Cosmetic work is generally not covered by insurance and can be subject to wide variation in the discretionary spending habits of consumers. Many sellers of medical practices during this time were forced to postpone their practice sale because of massive downturns. Other found themselves selling their practices at less than favorable price and terms. While the economy is in recovery mode and demand rises again for cosmetic services, hard lessons can be soon forgotten. While cosmetic services can be an extremely valuable addition to a practice and it is logical to provide services as demand dictates, it is crucial to assess how the service mix can affect practice value. When selling a medical practice it is of utmost important to work with a transition consultant to create a meticulous pre-sale strategy and transition plan in advance of bringing the practice to market.

Multiple objectives when deciding to sell a medical practice

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The decision to sell a medical practice can be based on a number of factors. A medical practice sale may be driven by retirement, financial considerations, employment opportunity, lifestyle issues, or other transition objectives. Finding a buyer for the medical practice and arranging a successful sale is often a crucial milestone towards reaching the next step. The particular objective of the seller and his/her time-frame will dictate how the medical practice broker will put together a selling strategy and may determine the type of deal structure to expect. A seller needs to be firm but flexible. It is important to obtain the ideal price and terms for the practice but not to shut-out a potential deal by ignoring buyer desires and the market realities for selling a medical practice. This is where the communication and trust between practice broker and seller becomes crucial. A broker's expertise (or lack thereof) can ultimately affect the saleability of the practice and reflect in the final price and terms obtained. Balancing personal and professional objectives with sound business decisions is the difficulty which practice sellers face. In short, practice owners should take the following into consideration when selling:

  • Reason for selling the medical practice
  • Personal and professional objectives related to the sale
  • Time-frame to achieve objective
  • Price, terms, and time-frame desired in a deal
  • Flexibility or rigidity in obtaining desired price, terms, and time-frame
  • Decision to work with a medical practice broker / medical practice consultant
  • Expertise, trust, and communication of the broker / consultant and seller

Tuesday, March 2, 2010

New Dermatology practice opportunity in Queens New York

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Sale of Dermatology Practice - Part-time Opportunity
Queens, NY

• Collecting ~$180,000 on 1 day/week of MD coverage
• Ideal alternative to a practice start-up or expansion
• Established over 20 years with solid patient base
• Low overhead expense
• 95% Medical Dermatology
• Much room for potential earnings growth
• Seller will assist with transition period
• Very competitive asking price

Part-time Dermatology Opportunity in Queens New York