As FiercePracticeManagement has reported previously, private medical practices can lose up to 15 percent of their profits through cracks in their revenue cycles. And in today's difficult healthcare environment, just a few small leaks can threaten to sink even the most well-run practices.
The trouble is that there are at least a myriad of ways practices can lose money, from poor patient collections to out-of-date charge and code data to letting themselves get jipped by payers. It can be overwhelming, but you can't afford to give up. A great guide to kickstart your repairs, if we do say so ourselves, is FiercePracticeManagement's new FREE ebook, Dollars Make Sense: Proven Strategies to Increase Medical Practice Revenue.
While concise, this 14-page resource addresses practice finances both in terms of collecting from patients and working with third-party payers. According to the collective wisdom of experts, including Mary Pat Whaley, Owen Dahl, Michael Cassaro, Robin Fisk and others, there are several effective ways practices can collaborate with patients and payers alike to get the money they deserve.
Much of this comes down to communication. For example, a top revenue drain among practices comes from failure to collect patient fees other than copays. When staff don't collect and patients also aren't prepared to pay coinsurance, deductibles and past-due balances at the time of service, billing costs, staff time and never-paid debts can quickly add up. The solution: Be proactive and clear. "We almost always know down to the penny what their responsibility will be," says Cassaro, a solo pain specialist. "My staff takes a firm approach and [will] reschedule anyone who's unable to meet their full financial responsibility that day."
In a similar vein, simply pushing papers around often fails to get payers' attention, notes Atlanta-based consultant Elizabeth Woodcock. Rather than simply resubmitting denied claims, for example, and hoping for the best, take the time to write a letter that proves medical necessity and references the CPT Manual as appropriate. A similar, more communicative approach also can help practices fight inappropriate requests to refund overpayments, Cassaro adds.
Another aspect of a healthy revenue cycle is remembering that ignorance is not bliss. In other words, don't assume bills are paid correctly when they come in, says consultant Mary Pat Whaley. To check payment accuracy, however, you first have to have your reimbursement rates and payment structures loaded into your computer. Not doing so is "the biggest reimbursement mistake" Whaley says she sees.
In addition to these and other tips, Dollars Makes Sense provides detailed advice on negotiating payer contracts. At the top of the list is simply having the wherewithal to ask for improvements--and without delay. "All contracts are negotiable, and [practices have] more leverage now because payers want to bid in the [insurance] exchanges. This leverage won't come around again," says Maria Todd, president and CEO of medical tourism network Mercury Health International.
This is just a small sampling of the critical advice you'll find in this valuable report. Enjoy, and please share with us any additional revenue-cycle tips or feedback! - Deb (@PracticeMgt)