Transcript Tips to Better Practice Management

Tips to Better Practice
Management
Creating a Health Practice
Managing a medical practice is hard work!
The practice of medicine is both an art and a
science that is constantly evolving.
So too are the rules involving insurance payments,
claims filing procedures and other aspects of
managing the practice
Our communities where medicine is practiced are
also continuously evolving.
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In this climate of increasing economic, regulatory, and
demographic pressures, it’s more important than ever to
streamline processes and work effectively.
• There are some simple things you can do to make life
easier. We’ve compiled a list tips to better practice
management, gathered from experts who have lived
these challenges and consultants who work with
practices to increase productivity, affect the bottom line
and retain the right employees.
• As you’ll see from reading them, simple changes often
can have a profound effect on your ability to manage
within the health care environment.
Managing Your Accounts Receivable
Enter Fee Schedules Into Your Computer To Monitor
Reimbursement
One way to assure you are getting reimbursed as your contracts
with major payers say you should is to monitor your reimbursement
from these payers. Mary Le Grand, a consultant and coding
specialist with Karen Zupko & Associates, Inc. suggests that you
enter your payer fee schedules into the computer to allow staff to
easily spot when a payer reimburses below schedule or applies the
wrong discount. If your system does not allow payment schedules to
be entered, create an Excel spreadsheet showing your major
payers, high volume CPT codes, and expected reimbursement. If
you do not have payment schedules for your high volume payers,
survey your payers for your high volume procedures. Try to obtain
fee schedules for at least 80% of your volume
Watch Out For These Common Errors When
Creating Claims
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Learn from collective wisdom about what not to do in
submitting claims. Some of the most common errors in
submitting claims are missing or incorrect patient
subscriber number, different name and address for
patient from what the insurer has, missing physician tax
ID or Social Security number, diagnosis that is not coded
to the highest level of specificity, and illegible claims,
says Sarah Larch of University Physicians Inc.
• Set up a process to check for these common errors on
all claims and save yourself some grief.
Create Meaningful Reports
One effective way to get better A/R stats is to share data
about your business operations with everyone in your
office. But that means creating reports that are
meaningful and communicate the situation precisely.
Don’t overwhelm employees and physicians with too
much detail about your cash flow and claims history. Use
graphs to illustrate key points. Remember that people
have different learning styles and try to accommodate
different styles in how you present data (for example
pictures vs. words). Explain all abbreviations and
definitions used, pull out trends so they are clear and
understandable to your audience, and issue reports on a
regular basis so that your office will come to expect them
and know what to look for, advises Sarah Larch of
University Physicians Inc.
Audit Your Payers For A Healthy A/R
• You should develop an audit process to see which payers need your
attention to keep your A/R healthy. You can collect 96 to 98 % of
your net charges if you set up your audit process the right way. First,
look at those payers that are slow to pay. Anything more than 60
days in A/R should definitely be given attention. Then, look at what
percent of your business these payers represent. Then, look at
whether they are paying you 100 % of the fee schedule, or whether
they are trying to get by with paying you less. Set up a database to
keep track of these data elements and stay on the back of the
payers who aren’t living up to their contract. The more information
you have to take to them to justify your complaints about slow pay or
inadequate money, the more effective you will be in your efforts to
get them to pay you what they have agreed and in a timely manner.
If you can’t monitor all payers effectively, start with the ones who
represent the largest share of your business.
Develop A Threshold for Contracts
One of the secrets to healthy accounts receivables is
auditing your accounts to make sure you’re getting paid
in accordance with what the contract stipulates. But
equally important, a healthy A/R begins with contracts
you can live with. Develop thresholds beyond which you
will not sign any contract, advises Terri Welter. Pay
attention to the details of all contracts and make sure
that if the insurer does indeed pay you as stipulated in
the contract, you are being adequately reimbursed.
Otherwise, you’re better off not signing the contract. Your
decision will be based on how much market share a
payer represents, of course, but your group should
decide what you are willing to tolerate before you go into
negotiations.
Avoid the OIG, Send ABNs
Make sure your Medicare patients are
notified of their payment responsibility
through the Advance Beneficiary Notice
and audit your practice to see that ABNs
are sent when they need to be. Keep
copies in your patient’s chart.
Motivate Staff To Improve Cash
Flow By Developing Benchmarks
How can you motivate your office to improve cash flow and collect
more? First, establish key indicators, recommends Mark Farrington,
a consultant with KarenZupko & Associates. If measurable
standards result in improving your billing and collections, those
elements become benchmarks for staff. Remember that billing and
collections isn’t the responsibility of only the billing and collection
staff. Front-end staff and clinical staff can make a huge difference in
how much and how quickly you collect. For example, key indicators
for registration staff might include the number of rejected or delayed
claims due to inadequate information taken during check-in or lack
of authorization, the number of statements returned due to bad
addresses, and the percentage of co-payments collected. Clinical
staff might be measured on how regularly they turn in their charge
slips and how complete the information is.
Enhance Collections by
Managing Charge Slips Right
Here’s a simple tip to speed up your collection efforts from Betsy
Nicoletti of Helms & Company of Springfield, Vermont: Your
physicians can assure more money is collected faster by always
telling the billing office what services were performed and the correct
diagnosis of the patient directly after seeing the patient. In most
offices, says Nicoletti, the check out clerk has to track down
information for the charge slip more than a few times a week.
Sometimes the slip gets put into a folder for later follow-up and the
charge may not get entered into the computer system right away.
Make sure physicians carefully complete charge slips and track slips
that are returned to physicians with questions so you can see where
the weak spots are in your system for reporting charges. Also,
monitor hospital and other out of office services to see whether
physicians are submitting their charge slips on a timely basis. If a
charge slip is sitting in a physician’s pocket, it obviously isn’t getting
paid.
Take A Look At Your Medicare Business
In Light of New Reimbursement Schedule
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As Medicare continues to ratchet down payments, practice expenses are exploding.
Malpractice premium hikes, a continuing trend of employee health insurance
increases,
and a need to retain talented employees with competitive salaries put the pressure
on. Jennifer Bever of Karen Zupko and Associates (http://www.karenzupko.com) says
it is important to define:
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• Which commonly provided services are affected most by Medicare cutbacks.
• What the expected impact on revenue is.
• Whether the practice can absorb the decrease by tightly managing expenses.
Bever recommends you start with these steps: Run a payer mix report to determine
how much of your business is Medicare-based. Take an inventory of your commercial
managed care contracts. How many are based on Medicare’s payment methodology?
Apply the expected reduction to revenues from Medicare and those commercial
carriers adopting the new payment rates. Add in expected revenue from other payer
sources to calculate total, projected revenues for the following year. Now review
expenses from this year. Can you absorb the decrease in revenues by tightening
down expenditures? Develop a task force to brainstorm ways to cut costs.
Benchmark Your Billing Office Against Better
Performers
• To benchmark the performance of your billing office,
measure yourself against better performers as reflected
in data gathered by the Medical Group Management
Association in a recent survey of medical practices. How
long are your bills in accounts receivable? Better
performers have 49 % of their A/R that is 0 to 30 days
old, 17 % that is 31 to 60 days old, 8.5 % that is 61 to 90
days old, and 5.3% that is 91 to 120 days old on
average. They have only 17% over 120 days in A/R on
average. If they can meet these benchmarks, your office
most likely can too, but it may require some
reengineering of your collections processes.
Don’t Let Your Patients Off The Hook
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Stacey Haynes and Carolyn Duncan of BKD in Kansas City (www.bkd.com) advise
that when collecting patient balances, begin with the largest accounts first. Determine
what steps your office will take at accounts that are 60 days, 75 days, 90 days and
120 days old. Set your computer to drop a bill to the patient within three days after
posting the insurance payment. Send a second notice 30 days later. Fifteen days
later you can send a collection letter. When negotiating a payment schedule with the
patient, have a “bottom-line, smallest amount acceptable for payment policy; have the
patient sign a contract; and explain the exact agreement to the patient. Track patient
payments each month. Follow up with letters and calls if the patient misses a
payment.
Here’s a sample letter payment agreement from Haynes and Duncan:
This letter confirms your (monthly/weekly) payment agreement you made with us to
resolve your unpaid account. You agree to pay $____ to be received in our office by
the ______ of each month. The first payment will be due _____. We agree that no
interest will be charged as long as the terms of the agreement are met. If there is
either a problem with the amount of the payment or the beginning date, please notify
us immediately. No further collection action will be taken as long as the agreed upon
payment is received. Additional charges you may incur are not subject to this
agreement.
Your Scheduler Can Play An Important
Part in Creating A Healthy A/R
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Don’t discount the importance of the person who schedules office appointments in
collecting A/R, say Stacey Haynes and Carolyn Duncan of BKD, LLP in Kansas City,
Missouri (http://www.bkd.com). Your scheduler obviously should know the reason for
the patient’s visit, the patient contact information, whether the patient expects the
practice to fill an insurance claim, and the name of the patient’s insurance company.
But the scheduler also should know what insurance programs the provider
participates in, what companies require referrals and for what services, what services
need prior authorization or patient re-certification, and what co-payments the
insurance plan requires. That’s a lot of information and requires appropriate training
for your scheduler.
Armed with the right information your scheduler can help you collect. First, the
scheduler can advise the patient who doesn’t have insurance that payment is
expected at the time service is rendered. Second, the scheduler can get the person
the right information about responsibility for the bill before the patient even sees the
doctor. Third, the scheduler can make it clear to the patient that the practice expects
to be paid. When the scheduler calls to remind the patient of the appointment, he or
she should know whether or not a referral is required and if it is, get it (which can
avoid claim denial later on), and whether the patient has an outstanding balance, and
if the patient does, politely remind the patient that payment will be expected at the
time of the appointment.
Take A Collection Quotient Exam
• 1. Our practice collects cash equal to or greater than 90
% of the collectable (net charges).
• 2. Our practice verifies insurance eligibility prior to every
ambulatory care service.
• 3. We verify eligibility and obtain preauthorization/referrals as needed for all inpatient
services.
• 4. We know when co-pays are due and collect them at
time of service.
• 5. We collect cash each day.
• 6. Our staff is well-trained in registration and insurance
requirements.
• 7. We have management reports that enable us
to review the quality of our staff’s registration
data.
• 8. The staff believes the registration data is
accurate and high quality.
• 9. Our claims are rejected by payers less than
10 % of the time.
• 10. Our practice offers credit cards as a payment
option at all sites and on patient statements.
• 11. Both staff and physicians know what contracts we
have and what the critical elements of those contracts
are to ensure compliance and appropriate
reimbursement.
• 12. Our patient statements are easy to read and
informative.
• 13. Our days in A/R are in line with best practices.
• 14. Our practice has cash controls in place to ensure all
money is accounted for each day.
• 15. Our practice captures the referring physician for each
service provided.
• 16. We review all patients’ accounts for previous
balances due prior to their appointment and
inform patients.
• 17. Our payment posting staff tracks rejections
and provides feedback to front desk staff.
If you marked any unknowns, find out the
answers. Then count your “no” answers: 10-17-dramatic improvement in cash possible, 4-9-significant improvement possible, 1-3-- some
improvement possible