March 28th Update


Revenue Cycle Items

A lot of questions have come up related to the revenue cycle department. One is the reasons why patients sometimes get refunds, despite all the checking/authorizations that happen before they are charged. As it turns out, even the copay amount listed on their insurance card can be wrong, as some of the payers have “tiers” of providers, and the amount on the card is not necessarily accurate for all tiers. Sometimes other data we are provided in advance of the service changes or was wrong, so the amounts charged can change. Also, the amount that the patient is actually responsible for may not be accurately known or the copay amount can change based on the diagnosis code at time of service.

Another area of discussion is how payments made get allocated – to the place of service (department) at which the payment is made or to the oldest payment?  The current system is a mix of the two. A patient paying a copay during an appointment, for example, will have that copay directed to the provider they are seeing that day. If a patient sends in a payment with a paper bill it has a specific charge number that routes the payment to a specific date of service that was provided. If a non-earmarked payment is made to a total Starling balance, it goes to the oldest payment.

Some partners have objected to this practice. There are certainly arguments both for and against this. The most compelling is that if we do it any differently, we can have situations where patients are surprised when they are sent to collections, because they think they are paying aging balances but their payment isn’t applied to them. This scenario trumps the other considerations.

Our New Chief Financial Officer

Gary Golliher begins work with us as our new Chief Financial Officer on 4/8. He comes to us from the Hutchinson Clinic in Kansas with his dog, Toto (just seeing if you’re paying attention), and has an excellent background in financial leadership in medical groups as well as contracting and risk experience. We eagerly await his arrival. Although we expect great things from him, please allow him a few hours to settle in and learn his way around before the deluge of phone calls. We do expect him to spend time initially going around to departments and meeting the physicians to hear their concerns, although many of those were certainly made clear to him during the interviewing process.

Reimbursement for phone calls and other not-in-person activity

There is understandable excitement about the potential to bill for services other than direct/in-person patient care, including the codes we mentioned a few months ago for phone calls. There are still legal and Medicare guidelines trickling out. One issue to be aware of is consent. We are examining a recently published guideline from the government that seems to assert that consent must be obtained verbally and documented for these services. This is logistically problematic:  it could be awkward both to ask for consent and also to handle the situation if the patient refuses and you are already on the phone with them knowing they have a medical issue. Click here to see the document we are reviewing. I suspect this will evolve over time but hopefully providers will be able to successfully use this avenue to bill for their time.

Long Term Disability

The Finance team would like to make you aware of two changes in the process for posting and calculating your policy payments. This affects those of you participating in our standard LTD group policy with The Hartford. The changes will ensure that claim payments can be received tax-free, and at the full benefit level.

  1. The LTD taxation schedule was updated 1/1/19. Previously, physician premiums were taxed at the full amount with a year-end posting in ADP. We have updated this process to a monthly posting in ADP to ensure that physicians applying for LTD at any time during the year will receive this benefit tax-free. (Remember that if you use after-tax money to pay the premium, the benefits should you ever need them are not taxed; whereas if you use pre-tax money the benefits are taxed).
  2. The premium calculation has also been updated. To guarantee that a physician applying for LTD receives the maximum benefit, the premium calculation will be based off of prior year gross wages (still capped at $300,000), because that allows for payment of the maximum monthly benefits allowed by the policy. Previously, draw was reported to The Hartford rather than gross wages including bonuses. Updating this calculation may increase your premium, but will provide the full benefit. The maximum monthly benefit remains at $15K, which is 60% of the $300K cap.
Nondisclosure Agreements

The Starling Board of Directors all signed the attached NDA and endorsed a new policy under which partners on committees will do the same. There is actually a basic nondisclosure agreement in the shareholder employment contract, but this is more explicit. We live in interesting times, and it is important to keep our state secrets and laundry within the group.

Click here for the new agreement>

Salt Lake City

A few people have commented on the payments by mail going to Salt Lake City, UT. Despite the obvious additional distance for the mail, using this service will save time and resources. They put all the payments together into an electronic file that is easily assimilated by our RCD systems, rather than the old way involving a lot more manual labor and therefore personnel expense.

Optum CME

Below is an invitation to a series of CME events organized by Optum, intended for primary care providers: