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The Sentinel: October 2017

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The Rest of the Story

Closed Claim Review  |  Kenneth W. Rucker, JD

“The memories of men are too frail a thread to hang history from.” John Still Paul Smith[1], a 52-year-old male, presented to the emergency room in a small community-based hospital with complaints of chest pain, shortness of breath, and nausea. Mr. Smith was quickly triaged and shortly thereafter...

An Analysis of Otorhinolaryngology Closed Claims

Specialty Spotlight  |  Shelly Weatherly, JD

A review of paid otorhinolaryngology claims from 2009-2016 revealed that inappropriate surgical technique/treatment and failure to diagnose were the most common allegations.   Often times the failure to timely diagnose was not the result of a lack of clinical judgment or medical expertise, but rathe...

It's Not Too Late to Vaccinate

Risk Pearls  |  Julie Loomis, RN, JD

Last month, the CDC issued a letter to healthcare providers asking for help to ensure patients receive influenza vaccines by the end of October. The letter states “…To avoid missed opportunities for vaccination, providers should offer vaccination during routine health care visits and hospitalizat...

Billing Medicare for Preventive Services

Practice Management  |  Elizabeth Woodcock, MBA, FACMPE, CPC

Can I bill Medicare for Depression Screening? What is the CPT® code for Medicare’s Initial Preventive Physical Exam? How many smoking cessation sessions will Medicare cover for my patient? Do all males qualify for Prostate Cancer Screening? Which counseling services can I provide via telehealth?...

Charting Your Success in Employee Disciplinary Actions - Best Practices for Managing Staff Performance

Practice Management  |  Kathy White, FACMPE, PHR

No doubt employee discipline can be one of the most challenging aspects of human resource management. Perhaps this is due to the term “discipline” and the negative connotation associated with the details of disciplinary actions.  Much of the stress related to managing staff disciplinary actio...

Hardship Application - ACI Category

Practice Management  |  Elizabeth Woodcock, MBA, FACMPE, CPC

You can apply for a hardship exemption for the “Advancing Care Information” (ACI) category of the Quality Payment Program’s Merit-based Incentive Payment System. ACI counts for 25% of the composite performance score for eligible clinicians (ECs) in the government’s new payment program....

Know in Advance What a Patient Wants You to Do When They Can't Tell You

Practice Management  |  Justin Joy, JD, CIPP

As the patient population ages, the likelihood of encountering a patient unable to make decisions regarding his or her care will increase. Unexpected and emergency situations however can obviously affect a patient at any age, rendering the patient unable to make care decisions for themselves. Whether treatin...

2018 Penalties: PQRS and VBPM Informal Review Available Through December 1

Practice Management  |  Elizabeth Woodcock, MBA, FACMPE, CPC

On September 18, 2017, the Centers for Medicare & Medicaid Services (CMS) released the feedback reports for the Physician Quality Reporting System (PQRS) and the Value-based Payment Modifier (VBPM or VM). Both programs concluded at the conclusion of 2016, however, the impact on reimbursement continues thr...

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