Maintaining a strong bottom line is key to a successful business. The complexities found running a medical practice today make maintaining a strong bottom line an overwhelming challenge. Here are six fundamental steps to achieving financial success.
- Maintain productivity – The most important part of achieving financial success in a clinic is a provider team whose higher productivity result in higher revenue. Effectively monitoring provider productivity helps to manage the providers’ expectation of compensation and the business’ bottom line. Regular reports tying productivity to revenue should be reviewed with providers. A manager should always be looking for ways to enhance revenue streams by creating more efficient processes and services that add to the revenue stream. Maximizing revenue (charges) is number one for financial strength.
- Capture all charges - After services are provided, all of the charges must be captured. First, make sure every service performed is identified and captured on the billing sheet or in the electronic health record (EHR). Providers, nurses, technicians, and any other staff involved in providing services must properly document everything they do. Second, medical claims are paid based on procedure and diagnosis codes; therefore, documentation and coding must be accurate to ensure revenue is not left on the table or put at risk for recoupment. Third, capturing and submitting this information in a timely fashion is important.
- Verify clean information is being sent the first time (demographics, ins, coding, etc.) – Correct insurance information, demographics, and code entry is imperative for the initial submission. Incorrect information results in denials and delayed payments, which will directly affect revenue streams and increase costs.
- Effective office collections – An office must be disciplined at collecting patient balances due while the patient is in the office. Copays, deductibles, co-insurance, or past due balances are much, much easier to collect while the patient is in the clinic versus weeks or months after the visit. Establish a clear policy and culture where this is done consistently.
- Effective collection policies and procedures – A billing department must have clearly stated and written collection policies and processes, including how to work denials, following up on aging claims, how and when to collect from patients, and when to send claims to collections and write off bad debt. Spend time to identify simple and straightforward processes. Office staff are much more effective when working within a structured process than when “making it up as they go,” or choosing the path of least resistance. Set metrics that are measured and reviewed with the staff on a regular basis to maintain effectiveness.
- Regular review of contracted payer rates and operational costs – Review payer contracted rates periodically to make sure you are negotiating the best rates to maximize revenue opportunities. After ensuring a strong revenue flow, review costs such as liability insurance, cost of supplies, phone contracts, and other operational expenses to make sure you are receiving the best prices available.
January 16th, 2013
To better allow physicians to manage the uncertainty of threatened Medicare fee reductions slated for the 2012 Medicare Physician Fee Schedule (MPFS), the Centers for Medicare & Medicaid Services (CMS) extended the 2012 Annual Participation Enrollment Program. Fortunately, a two-month Congressional suppression of the mandated pay cut followed.
Physicians narrowly escaped a 27.4 percent reduction in Medicare rates that was scheduled to begin Jan. 1 after the House of Representatives returned from hiatus long enough to pass the Senate’s amended version of the House bill. The Senate bill extends the 0 percent update for just two months, through Feb. 29. The House bill would have averted the negative update for two years and provided a 1 percent update in 2012 and 2013.
December 30th, 2011
The Sustainable Growth Rate (SGR) cut of payments to physicians servicing Medicare payments is not going to happen, at least for two months.
The House of Representatives passed a bill similar to one passed by the Senate on Dec. 17 that postpones the impending 27.4 percent cut to physicians’ Medicare reimbursement rates for two months.The Senate’s amended version of the House bill, called the Temporary Payroll Tax Cut Continuation Act of 2011, would have extended the 0 percent update through Feb. 29, 2012.
Both House and Senate bills would extend a number of other health provisions, including:
Sec. 302. 2-month extension of MMA section 508 reclassifications.
Sec. 303. Extension of Medicare work geographic adjustment floor.
Sec. 304. Extension of exceptions process for Medicare therapy caps.
Sec. 305. Extension of payment for technical component of certain physician pathology services.
Sec. 306. Extension of ambulance add-ons.
Sec. 307. Extension of physician fee schedule mental health add-on payment.
Sec. 308. Extension of outpatient hold harmless provision.
Sec. 309. Extending minimum payment for bone mass measurement.
Sec. 310. Extension of the qualifying individual (QI) program.
Sec. 311. Extension of Transitional Medical Assistance (TMA).
Sec. 312. Extension of the temporary assistance for needy families program.
December 19th, 2011
The Congressional Budget Office (CBO) projects that, under current law, payment rates for physician services provided to Medicare beneficiaries will be reduced by 29.4 percent in 2012. The large pay cut follows several years of legislative action to either maintain or increase physician payment rates under the Medicare Part B program when those rates were otherwise scheduled to decrease under the Sustainable Growth Rate (SGR) mechanism. Is it time to pay the piper?
July 1st, 2011
Health and Human Services (HHS) Secretary Kathleen Sebelius wrote a letter to governors and state insurance commissioners May 4, urging them to re-examine any WellPoint, Inc. rate increases in their states. The letter was in response to a California Department of Insurance report stating that rate increases Anthem Blue Cross was proposing were based on inflated medical costs projections.
May 14th, 2010