By Derrick Stark, CPA, CVA - ClaraVista LLC

I started mountain bike riding about 2 years ago with a buddy of mine. I was amazed at the cost of certain bikes. The guy at the store explained that it had to do with the quality of the components and the ultra-light materials used to shave seconds off the clock. “Oh,” I replied. “I just want to finish the course without throwing up.” Apparently that desire is the difference between a $5,000 bike and a much, much less expensive used model.

The basic ability to complete a task has to exist before it makes much sense to try and get better or faster. Time and again, however, I see providers upgrading software or billing personnel to become more efficient but left with the same disappointing results. Why? Because they were focused on being efficient when they weren’t yet effective.

Start with a most basic of equipment to determine effectiveness; a pencil and paper. Sketch the life cycle of a typical claim from initial inquiry or intake to final resolution. Include every stop along the way. Who completes the initial paperwork? Who runs down missing information? Who transmits claims and works front-end rejection reports? Who manages denials? Who makes sure payments and denials are posted timely and accurately?

I bet you will find that most things fall through the cracks because they make their way to an area for which no one has specific responsibility to follow up. That is, it is not that your current software cannot flag or report these items. It’s not even that your billing personnel were incapable. It’s that no one knew to be on the lookout for the claims that never made it to the next station.

Once claims are reliably reaching a final resolution, then and only then, is it worth shaving seconds off the clock.

Recently, MiraVista was contacted by a concerned supplier who found differences between the .csv and .pdf PECOS files they downloaded from CMS. The number of physicians in the .csv version didn’t match those in the .pdf. Naturally, we wanted to know why. So we rolled up our sleeves and did a little digging.

On June 29^th, Maureen Bacon, the controller for our sister billing company ClaraVista, went back to CMS’ website and downloaded the zipped .csv file. As it turns out, CMS modified the file after we first informed you about it on the 24^th. Here’s what we found: 

• The original file that was made available on June 24^th was named OrderReferringJune2010.csv. It was 18.0MB in size, and contained 687,819 lines. (Note: This is the one we first wrote about and is likely the one you downloaded.)
• The file that is now on the site was created by CMS on June 25^th at 8:41am and is named OrderReferring_June2010v2.csv. It is 18.1 MB in size and contains 719,024 lines.

Based on these findings, Bacon sent an inquiry to CMS asking if the .csv file, which now contains an additional 31,205 lines, would continue to be updated more frequently. CMS confirmed that the file will indeed be updated on a regular basis.

“If we don’t have any issues CMS plans to put a new file up twice per week,” wrote one CMS official.

Long story short, it looks like the .csv PECOS file will be updated more frequently than the monthly updates originally scheduled for the .pdf version. To our knowledge, CMS is not yet releasing announcements to let suppliers know each time a new file is posted.

The new .csv Zip file may be downloaded the same way as the previous version, by visiting:

http://www.cms.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp.

Please be sure to bookmark this site, www.miravistallc.com/blog, and check back regularly for future PECOS news alerts and announcements!

When given the opporunity, we like to tinker with new ideas and get our creative juices flowing. Recently, our marketing department started to experiment with creating short clips to help advertise what we do. We thought these turned out pretty neat and wanted to share them with you. Enjoy!

Can’t see this clip? Visit: http://www.youtube.com/user/MiraVistaLLC#p/a/u/1/lVpDOrNee6M.

Can’t see this clip? Visit: http://www.youtube.com/user/MiraVistaLLC#p/a/u/0/9DMnDMejapI.

By: Derrick Stark, CPA, CVA – ClaraVista, LLC

A few days ago, our servers went offline due to inclement weather.  Although our hardware and security protocols are designed to shut the machines down purposefully to prevent damage or data corruption, it is still a process to bring everything back online in an orderly fashion.  I hate that kind of universal down time.  I normally fill it with an overdue staff meeting or other time killer, but I was out of town and the staff was left on its own to kill time.  For the most part, they handled light organizational and filing matters that need to be done but rarely command priority.  I thought these were acceptable and ultimately expected choices.  One staff member, however, took the opportunity to research and prepare a proposal for a new service offering.  Sweet! 

The particularly surprising issue to me was that this particular staff member is pretty close to the bottom of the tenure totem pole.  In fact, she was prompted by nothing more than overhearing an informal conversation between managers.  The idea had merit to her, and with her prior experience, she thought she had something to add to the discussion so she did the work without asking or being asked to do so.  That, Friends, is the embodiment of what we at Vista call a load bearer.

A load bearer is an employee or group of employees comprised of individuals that you can rely on most when the sh@t hits the fan…the going gets rough…enter your cliché here.  Your managers are not necessarily all load bearers, and that probably means you over-promoted someone based on perceived value or simple tenure.  A load bearer can be the receptionist or a level one staff person that has proven themselves as reliable thinkers and/or executors in clutch situations.  You cannot really know if you are hiring a load bearer because there is no real guarantee that past performance is indicative of future performance, but you should always be looking out for the traits of a load bearer.

We are fortunate to have more than our fair share of load bearers, I think.  I can tell you about the time my controller teamed up with a brand new communication specialist to launch a state association campaign or the time they conceptualized an idea for one our most popular webinars ever.  I can tell you about the time my systems manager created a GenResponse report parser program over the weekend to help our data entry department work front end rejections in a fraction of the usual time, all based on a sidebar conversation in the kitchen one Friday afternoon. 

[He said he just thought it was a cool idea and the overall code structure came to him in the shower; he couldn't wait until Monday.]

You have load bearers, I suspect, whether they are your employees or charges or subordinates.  The AR staff member that stays until 10:00pm to fix a patient account or work a special project…load bearer.  The delivery guy that stays late to stage the truck so he can get an early start in the morning…load bearer.  The people who know that what is good for your company will ultimately be good for them personally and have no qualms about showing their commitment first instead of demanding compensation for what they promise to do in the future…load bearer.  If you are struggling or stagnant, go to your load bearer(s) and give them an opportunity to make some momentum.