“An apple a day keeps the Doctor away.” But, what if you are the doctor? Who keeps watch over how healthy your practice is?
A healthy practice means a thriving business. However, most practices today are barely getting by financially. With declining reimbursement from government and private payors and increasing operating expenses associated with new mandates such as Meaningful Use and ICD-10, many practices are seeing profitability – and sometimes their own salaries – decline dramatically. Collecting every last dollar earned is critical to your future survival and success.
However, according to the MGMA, most practices leave up to 30% of their potential revenue on the table every year due to inefficient billing practices. That 30% can be the difference between staying open and staying independent.
Here are 5 tips on how to keep your practice healthy:
1. Eligibility Checking: 25% of denials are caused by lack of eligibility. Train your staff to ask for proof of coverage prior to the patient’s appointment. Implement technology, or work with an RCM partner that has the technology, that will automatically check for eligibility while the appointment is being scheduled.
2. Patient Responsibility: Today, 25% of the total bill is the patients responsibility. Collect co-pays from patients at check-in with check scanning and credit card processing machines. Post-care, offer patients convenient, online access to electronic statements as well as a secure payment portal, making it easier for them to view their bills and make payments after the visit.
3. Coding Errors & Omissions: Implement and utilize a rules-driven claim scrubber to verify codes and identify errors before claims leave the office. Sending incorrect codes will result in increased denials, more back end work and delays in payments.
As we approach the ICD-10 deadline, correctly coding encounters will take on even greater importance. AR is expected to increase 20-40% with the transition to ICD-10. If you haven’t started ICD-10 training, now is the time to start. Doctors, nurses, PA’s and all providers, billing and coding staff as well as other office personnel will need to be brought up to speed on the new coding rules.
4. Denial Management: According to Elizabeth Woodcock of the MGMA, 65% of denials are never appealed. Working denied claims is a complex process that requires considerable knowledge. At a minimum, staff working denials for your practice need to understand how to:
- Ensure that proper contractual adjustments are made to each line item.
- Verify that CPT and ICD-9 codes selected are for covered services.
- Check modifiers with a focus on measuring global periods, unrelated procedures on the same date of service, and separately identifiable evaluation/management services.
- Review insurance authorization and physician referral requirements to determine if an authorization is (or needs to be) in place.
- Determine when the bill should be moved to a secondary insurance or the patient.
5. Underpayments: Up to 10% of claims are not paid correctly according to the AMA. When there are mistakes, it is often to the benefit of the insurance company. Yet, most practices are simply so pleased to be paid at all that they don’t bother to appeal these underpayments giving up revenue that is rightfully theirs . The right partner can help you adjudicate these claims leveraging technology and expertise that flags and appeals underpayments for your practice. It’s important to monitor the big picture. Revenue cycle management is not a sprint -- it’s a marathon and every leg of the race is important. If the industry average of potential revenue left uncollected is 30%, where does your practice rate against that average. Dig deep and know your numbers. Conduct a detailed practice assessment to truly understand and identify the steps in the revenue cycle that are leaking money. Then make changes by implementing new technology, adopting new processes and invest in training staff. Better yet, consider an RCM partner with technology, expertise and processes proven to maximize collections. You’ll increase revenue, reduce costs and reduce the workload on already over-taxed staff. Bottom line is every dollar counts so plug the holes in your leaky revenue cycle today.