Making your pitch for higher payments

Susan E. Charkin, MPH

Let your proposal letter make the case The first step in negotiating reimbursement rates with third-party payors is assembling the data. The second step is putting those data to work with a simple but substantive proposal letter. Addressed to the payor’s contracts manager, the proposal letter introduces the practice, requests a rate increase and, most importantly, makes the case for the proposed increase.

Updating office E/M coding

James Davidson, MD

Updated guidelines and tables for 2010 In May 2007, AAOS Now published “A simple system for coding E/M services,” a series of guidelines and tables for correct coding of evaluation and management (E/M) services. But the rules have changed since then, so this article updates that information. Orthopaedists and practices may use these guidelines to assist in internal compliance. New rules such as “no consults for Medicare” and emphasis of current red flags for audits are included.

Is your EMR fueling risky record keeping?

Cheryl L. Toth

Not all timesavers are helpful Simply implementing an electronic medical record (EMR) system won’t necessarily reduce your risk of an audit. On the contrary, if you don’t use the system’s documentation features properly, EMRs may actually increase your risk of an audit. Bubble sheets Bubble sheets—preprinted response sheets similar to those used in academic testing or research surveys—are used in some EMR systems for patients to report their family and medical history.

Taking lessons from barbarians

Thomas J. Grogan, MD

The best-selling book Barbarians at the Gate: The Fall of RJR Nabisco, by Bryan Burrough and John Helyar, chronicles the ascent and demise of F. Ross Johnson, CEO of RJR Nabisco. It’s a fascinating read about the depths of human greed, with a most appropriate title. Orthopaedic surgeons in private practice are facing tumultuous times and are under siege, much like the citizens of Rome were. We struggle to balance declining reimbursements in the face of ever-increasing overhead costs.

Electronic medical records: Liability is lurking

Howard Mevis

The two sides to using electronic medical records With more than 75,000 medical liability lawsuits filed annually, does the electronic medical record (EMR) provide physicians with some security against an action? It certainly can. But with new rules and regulations on protecting patient information, can an EMR put physicians at risk for additional liability? Almost certainly, yes. According to Douglas W.

Building the case for checklists

Howard R. Epps, MD

Remaking the “to do” list for patient safety The Checklist Manifesto: How to get things right by Atul Gawande, MD. Metropolitan Books, Henry Holt and Company, LLC, New York, 2009, 209 pages. ISBN: 978-0-8050-9174-8 Many surgeons have noted a recent change in protocol at their hospitals from the relatively simple preoperative “time out” to the seemingly more burdensome World Health Organization (WHO) Surgical Safety Checklist.