Something went very wrong a few years ago when ­Michelle Malizzo Ballog underwent surgery to replace a temporary stent in her liver at the University of Illinois Medical Center (UIMC) in Chicago. Tim McDonald, MD, chief safety officer, says he remembers vividly the text he received from a nurse as Ballog stopped breathing: Come quick. Things going badly. Cardiac arrest.

Health insurance exchanges will shake up the healthcare system, and physician practices will feel the effects directly in their managed care contracts and reimbursement. Don't be misled by the fact that the big impact from exchanges won't happen until 2014, because now is the time to influence how the systems are designed and soften the blow to your practice.

Dave Gans thinks every physician group needs to be an HRO-a high-reliability organization. HROs handle emergencies well because they recognize danger signals and respond in such a way that their systems continue to function and catastrophic outcomes are avoided.

Physician groups looking to be more efficient should develop patient safety lists that address emergent events and routine activities, according to Elizabeth Wertz Evans, RN, executive director of professional practice for the Oncology Nursing Society in Pittsburgh.

You now have an extra 30 days to get ready for the HIPAA 5010 transition regardless of whether you’ve successfully tested your claims by December 31, CMS announced in a MLN Matters article on Dec. 14. Providers who haven’t tested 5010 claims can send 4010 claims after Jan. 1, 2012 but only after submitting a transition plan to CMS in the next 30 days.

As much as you want 100% upfront copay collections, the reality is you will always have exceptions. Prepare different reactions to each of these situations – all with careful documentation – with a protocol for attempting to either collect at a later date, help the patient qualify for a copay exemption or discharge the patient if necessary. The first variable you must consider once you are certain a patient cannot pay upfront is the severity of the patient’s condition.

You can increase your revenue and boost your reputation in your area by regularly adding new patients to your roster. But you must develop a proactive public relations campaign to get the word out about your practice. Your best recruiting tool is word of mouth so you must get involved with your community, says Mike Robertson, practice manager for Internal Medicine of Southeastern Indiana in Batesville, Ind.

You may bill single-use vials of drugs and biologicals one time for one patient for one treatment. Anything more will land you in hot water, a Kentucky physician recently learned. Steven H. Stern, MD, and his practice, Kentuckiana Center for Better Bone and Joint Health PLLC (KCB), Louisville, Ky., recently agreed to pay $349,860 to settle allegations of overbilling Medicare for vials of the drug Infliximab (Remicade^®).

Amid all of the worry about looming Medicare cuts, here’s a kernel of good news: President Obama has repealed the 3% pre-payment tax withholding that would have applied to your Medicare payments. The repeal law, titled “3% Withholding Repeal and Job Creation Act” and signed Nov. 21, kills a little known change in the tax law that would have withheld 3% of your Medicare reimbursements and applied it to your federal taxes owed for that year.

You will be getting an extra year to prepare for the next level of meaningful use requirements, HHS officials say. Right now, you only have to meet stage 1 meaningful use rules, but in 2013 you would have to meet tougher stage 2 requirements. Stage 2 is being delayed to 2014, giving you an extra year to enjoy federal electronic health record (EHR) incentives while meeting only stage 1 requirements.