Tips to Better Practice Management

1. Tips to Better Practice Management Creating a Health Practice

2. 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.

3. 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.

4. 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

5. Watch Out For These Common Errors When Creating Claims • 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. Take A Look At Your Medicare Business In Light of New Reimbursement Schedule • 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: • • 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.

13. 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.

14. Don’t Let Your Patients Off The Hook • 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.

15. Your Scheduler Can Play An Important Part in Creating A Healthy A/R • 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.

16. 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 pre-authorization/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.

17. 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.

18. 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.

19. 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