We have letters, answers, questions, suggestions - and our usual features, too.  All that adds up to another issue of great content for FootZine subscribers...so read on.....

~ Gayle

From:  Francisco Gomez
re:      Certification Study Manual

I am wanting some information on purchasing the PMAC exam
book and wondering if maybe anyone had a used book that they
would like to sell.

Francisco Gomez
niche20_99@yahoo.com

*_*    *_*    *_*

From:  Michael Z. Metzger, DPM
re:      Free ICD-9-CM Coding Source

This is hard to believe but check it out.  
FREE ICD-9-CM CODING ON THE INTERNET!   Go to:
http://icd9coding.com

Michael
Michael Z. Metzger, DPM

*_*  Editor's Note  *_*

This comment from Phill Ward, DPM:

ICD-9 is free, they charge for other services like CPT codes, however they offer a 30 day free trial. It's worth letting people know and letting them do the trial.

Phill

*_*    *_*    *_*

From:  An Assistant
re:      Formula for Success?

I would like some advice.  I am trying to make the Doctor in my office work more than half days in order to make money.  He is basically a new doctor and he thinks that working half days he is going to do well.  In order for the practice to succeed we need a full time doctor in case a new patient walks into the office.  A new patient is a source of future referrals.  Please help me with ideas how to tell him and make him understand?  Or maybe I am wrong?

*_*  Editor's Note  *_*

See Dr. John Guiliana's Practice Management Pearl below for his perspective on this question.   How have others dealt with this situation?  Please let us hear from you.

 ~ Gayle

*_*    *_*    *_*

From:  Lynn Homisak, PRT
re:     The American Academy of Podiatric Practice Management (AAPPM)

ASSISTANTS, DOCTORS: Mark down these dates (May 2-4, 2003) and try to make plans to be at "Partnering for Success: The Ultimate Office Meeting" held at the Marriott Courtyard in Downtown Philadelphia.  The American Academy of Podiatric Practice Management (AAPPM) has teamed with The Pennsylvania Podiatric Medical Assistants Association to present another dynamo seminar for both doctors and assistants, with topics pertinent to both.  View the program in its entirety by visiting www.aappm.com and click on Educational (upcoming) meetings.  A registration form is also available at this site. 

It is very apparent in speaking with doctors at our meetings, and particularly in the staff discussions during our AAPPM roundtables, that an educated, enthusiastic staff contributes significantly to the success of a practice.  We hear what is being said and are working to integrate staff in our future programs by presenting both joint and independent assistant tracks.  Hope to see you in May....or perhaps at another...real soon!

In the style that attendees are so accustomed to, the weekend of March 1st-3rd was all about SHARING and LEARNING as the AAPPM held its Annual Midwinter Seminar in Pittsburgh, PA.  Approximately 140 doctors attended this always-enthusiastic arena.  Why?  Because they knew they'd be part of a program like none other...guaranteed to provide new ideas, a bunch of warm and friendly faces and (the bonus...) a renewed appreciation for their profession and the growth of their practice.

There were two solid days of practice management presentations from some very
knowledgeable and interesting speakers, and a separate half-day coding seminar by Dr. Phill Ward of North Carolina, which alone was worth the trip!  The "20 minute signature presentations" covered about 25 different topics, and high on that list was a valuable cost-containment presentation by Dr. John Guiliana of New Jersey.  All eyes and ears were glued to his information AND his tastefully entertaining videos.  A variety of non-stop interactive round tables were available with a wide range of topics such as Enhancing Patient Care with DME; AFOs and In-Office Dispensing; Staff Training and Motivation; Internal Marketing and Office Efficiency; Wealth and Financial Management; Win-Win Associateships and Partnerships; and Using Technology to Improve Patient Education.  There was a constant flow of traffic as attendees shuffled from one room to another, to try to hear a little bit of each one.

Another very popular (returning) event was the late-night open forum and Q&A for the New Practitioners.  This unique setting enabled them to ask more focused questions dealing with starting a new practice.  Responses were offered by the experienced panel as well as from the many doctors sitting in the audience offering to share "what worked and what didn't work" for them.  Sunday morning closed with the signature "Breakfast and Learn", something you just have to see to believe!  The moderators all deserve a pat on the back for keeping the motivation set on HIGH! 

This was my third year attending this program....and I just see it getting better and better!  The underlying theme of an AAPPM weekend is "What can I do to help you?" and the more I see, the more I am convinced that people come more to GIVE than RECEIVE!  Believe me, they can't do enough TO HELP each other!  Well, after all, the AAPPM is not known as the "Friendliest Group in Podiatry" for nothing.

Kudos to our untiring and enthusiastic President, Dr. Hal Ornstein; our awesome speakers; the efforts and dedication of Gary and Suzanne Adams (Executive Director and Director of Member Services respectively); the support of the Board of Trustees; and the generosity of our corporate sponsors for continuing to make this the most lively and celebrated event anywhere!  It is truly an unbelievable team effort and I am thrilled to be a part of all that it has (and continues) to become!

Thank you all for yet another very valuable and rewarding experience!

Lynn Homisak, PRT
S.O.S. Healthcare Management Solutions, LLC
Trustee, American Academy of Podiatric Practice Management

October 2002 came and went with only about 33% compliance to the EDI compliance mandate.  April 14, 2003, is coming and the feeling among physicians is a wait-and-see attitude regarding HIPAA.  Are they really going to enforce these rules?  Are they really going to bother with the small practices?  How are they going to inspect all of the small practices?

Actually, HHS has been advertising and is going to be relying on patients for enforcement.  There has been an effort afoot to educate patients about their “new” rights and how to file complaints.  This is coupled with attorneys aggressively advertising for clients who have been “harmed” by a breach of their new privacy rights.

To date, there have been several court cases that affirmed the right of the patient to not have their PHI sold to a third-party entity without their written permission.  One case involved the unsolicited mailing of prescription samples accompanied by a marketing letter to a Florida resident.  In another example, a major pharmacy chain settled a case in Florida in which customers' signatures were used for third-party marketing without proper customer notification.

In the months to come we will see many such cases of individual privacy violations.  The best medicine for this is prevention.  The cost involved in having a good Policy and Procedure Manual written and reviewed by an attorney will be much less than needing to have an attorney defend you.

Again, just a reminder that April 14, 2003, is more than just the Notice of Privacy requirement due date.   There has to be a full Policy and Procedure Manual in place to back up the Notice of Privacy.

By: Raymond F. Posa, MBA
Technology Advisor to the American Academy of Podiatric Practice Management
President, R. Francis Associates

Any questions or comments can be addressed to Mr. Posa by E-mail: Rposa@Rfrancis.com
You can review previous installments from Mr. Posa at http://www.footzine.com/FZ_H.htm

re:  Practice Management question posed by "An Assistant" above

I would recommend that you first establish your doctor's priority. Perhaps your priority of making money is not shared by him/her. If free time is not the priority, and building a profitable, secure practice is, then your frustrations are well founded.

I would start by demonstrating (in a concrete manner) what the loss is for working only half days. In the "growth phase" of a practice, seeing and accommodating patients in half the day is acceptable ONLY if the other half of the day is spent in a productive, practice-building mode. As an example, a new practitioner would be extremely productive seeing patients on a particular morning or afternoon, and visiting PCPs the rest of the day.  

If this is not happening, then some concrete evidence of the loss may help. Start by quantifying how many calls come in during "off hours" (by virtue of either your answering service or an answering machine).  In a typical podiatric practice, an estimated 40% of new patient calls desire to come in that day. If you miss 5 new patient calls , 2 of them would have come in during this "off time". By simple analysis, if you are not able to commit all five calls to an appointment once you are back in the office, you can assume that you have lost that 40% to a competitor.

Now for the concrete part...convert that lost fraction to a dollar amount each week. I estimate that each average new patient has a "value" of somewhere around $1500-$2500 (these numbers include all services as well as future referrals).  By presenting it in this manner, your doctor may soon realize that the expense of not being open far exceeds that of adding hours!

Good luck.

John V. Guiliana, DPM, MS
Footzine Advisor
Fellow and Trustee, AAPPM

Dr. Guiliana's articles and Pearls can be found on the FootZine web site on the "Feeture Article" page:  http://www.footzine.com/FZ_P.htm


*_*     "Good communication is just as stimulating as black coffee, and just as hard to sleep after."   -  Anne Morrow Lindbergh     *_*

In a busy podiatric office there are times when things happen that need to be explained to the insurance company.  An example of this is when, during a global period for a surgery, a situation arises that requires the doctor to take the patient back to the operating room for an additional surgery.  If the insurance company gets the claim without a modifier, they will assume that the claim is part of the original surgery and will not pay additionally for it.  The way to inform them of the situation is by appending the correct modifier.

The 76 modifier means repeat procedure by the same physician
The 77 modifier means repeat procedure by another physician
The 78 modifier means a return to the operating during a global period for a related procedure.
The 79 modifier means an unrelated procedure was performed during a global period

A few examples of how to use these modifiers follow:

A bunionectomy was performed on the right foot on March 1, a bunionectomy was performed on the left foot on April 1. The first bunionectomy would be coded 28296-RT. The second bunionectomy would be coded 28296-LT-76-79.

A bunionectomy was performed on the right foot on March 1. The patient fell and dislocated the osteotomy site had to be taken back to the operating room for fixation. The first procedure would be coded 29296-RT. The second procedure would be coded 28485-78.

A different physician performed a bunionectomy on March 1. In June the patient presented to you for a redo bunionectomy. You would code your service as 28296-77.

Correct use of modifiers will often get the claim paid on the first submission and increase cash flow in the office.

Crystal-Clear Coding tips are posted on the FootZine web site on this page:
http://www.footzine.com/FZ_C.htm

The perception of time spent with your patient is related to your energy directed toward them.  Their psychological and medical needs can be fulfilled in a short time with simple techniques.  This starts with their perception and expectations.  Their expectations can be exceeded by making their perceptions reality.  Much of this information shows common courtesies our parents taught us as children, which are frequently lost in adulthood.

Each and every patient encounter should begin with eye contact and a friendly smile as you cross the doorway into the room.  Follow this with a handshake even if you've seen the patient a hundred times This delivers a clear message of warmth and caring and helps to reduce the fear factor patients often experience.  This opens their minds and ears to what you then tell them about their conditions.  These simple skills say to the patient that you are friendly and relate to them at the same level, not from the ivory tower where many physicians seat themselves.

As you begin to speak with them, place both hands on their feet.  Studies have consistently proven that human touch portrays compassion.  Begin your conversation with a question relating to their overall well being such as “How have you been?”.  This may lead to an extended conversation so be sure to control the conversation by switching to how their podiatric problem is doing, i.e. “So how’s the heel feeling?”.  At this point LET THEM SPEAK and get it all out.  The typical patient will do this fairly quickly.  However, if you interrupt them early on in the encounter to move the visit along they will feel you are rushing.  If they speak their piece, the rest is yours to control.

Time spent with the patient will be reduced if you take control of the visit.  This sounds obvious, but too often the patient leads the visit.  The patient is in the office because you are the expert.  Deliver your treatment plan with confidence and the patient will be more likely to accept quicker and with less apprehension.  Stay away from statements such as “you may benefit from.…” and “I think this may work….”.  Emphasize the importance of the treatment by using phrases like “this is critical for you to have relief.” “This will make a significant difference is how you’re feeling” and “our goal is to get you better as quickly as possible so you can return to your normal activities and reduce the chance of surgery.”

Perception of time is an amazing thing!

Previous "Gems" can be found on their own pages of the FootZine.com web site, at
http://www.footzine.com/FZ_90.htm

*_*   "When people talk, listen completely.  Most people never listen."  -  Ernest Hemingway   *_*

Thanks to all the "regular" contributors, and to the "occasional" writers, too.   We look forward to hearing more from you!

  ~Gayle

Copyright 2003 Gayle S. Johnson, PMAC All Rights Reserved.
DISCLAIMER: Acceptance and publication of any letter, article, news item or advertisement does not necessarily constitute or imply approval or endorsement by myself of the product, idea, or content therein. I reserve the right to edit or to not publish any material received. Any letters published are the property of Footzine. Any health- or legal- and financial- related information is for educational purposes only and should not be construed as medical, legal or financial advice, or a substitute for the advice of a healthcare professional, attorney, financial advisor or any other consultant or professional. Information pertaining to legal matters should not perceived as legal advice, nor should discussion about such issues as Medicare, coding, and billing be considered as definitive. All content is presented as being only the opinions of the contributors and is for educational purposes only.

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