When David Bonner, R.N., and his wife, Andrea Goodwin, M.D., opened an independent weight-management practice in Meridian, Mississippi, five years ago, they were full of enthusiasm.
The couple had met when they both worked in a hospital emergency department and had dreamed of stepping out on their own and running their own practice. She had years of experience treating patients, and he was a registered nurse with 20 years of experience as a nursing administrator.
What they didn’t have was experience collecting money from patients and getting claims paid by insurance companies, he says.
Within a short time, the Meridian Weight Management Center practice was pretty close to bankruptcy, Bonner said in an interview with Fierce Healthcare. While the practice struggled in those early days, Bonner turned to outside help with those administrative and billing tasks. Today, the practice is profitable and has grown rapidly with 10,000 patient visits per year and a second weight-management clinic location. Things are going so well, the couple plans to open an urgent-care center in Meridian this week.
Bonner says he learned a lot from those initial struggles of opening an independent practice. Here are some of his lessons:
Know what you don’t know. Don’t overestimate your own skills, Bonner says. While you may have the clinical skills to take great care of patients, that doesn’t mean you know how to get bills through the insurance process.
That lack of expertise almost doomed the weight-management center. Cash payments from patients kept the practice in business, and Bonner didn’t take a paycheck for a couple of months. He says the insurance system is designed to be difficult to use. “It’s the elephant you don’t know about," he says.
Mistakes in medical bills and claims denials are bad business for medical practices and can lead to a loss in reimbursement. The American Medical Association found some staggering statistics when it comes to medical practice billing: 29% of claims are returned with zero payment, and 50% of denied claims are never reworked. However, the AMA also asserts that 90% of denials are preventable and 67% of denials are recoverable.
Don’t be afraid to look for outside help, but use caution. Meridian Weight Management Center turned to an outside company to help with its revenue cycle management (RCM). But Bonner says he picked the wrong company. “It was a disaster. We had no money coming in,” he says. When he called to find out what was happening, he learned that the person assigned to his account had gone on maternity leave and no one was managing his case. He quickly dropped that company and turned to another that offers software and managed billing services.
Before selecting an outside company, Bonner advises practice leaders to call around and make contact with other practices that have used a company. “You’ve got to do your homework,” he says. And make sure the company will assign a specific person as your liaison, he advises. “You need a person you can call and talk to,” he says.
Meridian uses the company’s integrated electronic health record with its practice management and billing management software. Meridian’s accounts receivable days are down significantly since adopting the integrated RCM solution. Bonner says most of the practice’s accounts receivable are current within 30 days. “And, with [our RCM vendor] working our receivables, there’s at least 20% less going into the over-120-days category,” he says.
As it has grown, Meridian is now in the process of taking some of that process in-house and building its own billing group for its three clinics.
Start off slowly when it comes to staff. “If you are a small practice, don’t hire 10 people when you are first starting out,” he says. There’s a temptation to hire lots of help, but until you have money coming in, a large payroll will drain a practice, he says.
In today’s healthcare environment, every penny can count. “It went from a nightmare to where I now love the whole process,” Bonner says of his experience setting up and running practices.