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13 Ways You Can Ensure Better Revenue Performance For Your Medical Practice Survives The Challenges And Setbacks Of 2013 !

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Here are 13 ways you can tweak your revenue cycle to get the maximum out of it !

1. Assess your revenue cycle based on five major components. Existing workflow and revenue, future process, key competency needs, key performance indicators and compliance thresholds.

2. Set targets for each department and follow the time-tested carrot and stick approach.

3. Have a specific strategy to collect self-pays and reduce self pay balances. Having an electronic remittance option will enable patients to pay after office hours, easily.

4. Analyze your payer contracts and contracted allowables. There are some insurers who may be paying way below, or not paying your most used CPT codes at all !

5. Pending claims should be worked on and followed up every single day. This will ensure that the window doesn’t close on any claim. To, prioritize begin with the claims that are of the highest value.

6. Inform your patients beforehand, the documents they need to bring in, and if money has to be paid at the front-desk, notify the exact amount and payment options.

7.  Implementing a new technology is a major expenditure and according to a recent study contributes to 68% of a practice’s costs and can initially affect your cash flow adversely. Phase out the implantation, review and correct the pitfalls, of each stage.

8. Conduct training programs and workshops regularly. Educate your staff on regulations, State laws and guidelines. Small oversights can lead to big consequences.

9. Analyze your billing procedures against CMS norms, ratio of adjustments and collections and the reimbursement amount and policies of each insurer.

10. Send prompt appeal letters. Some practices never appeal denied claims and it can lead to not just a dent in your revenue cycle but mar the credibility of your medical practice.

11. Sit with your coders and discuss about bundled and unbundled claims and on how to code to get maximum results. Analyze if your coders have missed out on procedures or codes.

12. Enroll your staff with trade organizations, healthcare educational resources and forums to keep themselves abreast with the latest buzz !

13. Make it a point to run quick audits every month.

Only 38 % of Doctors are Happy with their EMR. Are you one of them?

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EHR-Pros-and-Cons

Have EHR’s Reduced Patients to Faceless Data ?

The jury is still out on this one. Have EHR’s helped in bettering patient engagement or are stealing away the doc’s time? Patients complain that watching a medical practitioner silently collect data is the most frustrating sight on earth! After struggling to get an appointment from your busy neighborhood doc, it can drive you nuts to see that he is busy clicking on templates.

A Crude truth…

CRUD which means Create, Read, Update and Delete is not just another smart abbreviation. It is a sad fact that reflects what goes on in the physician’s office today. Creating information, analyzing it and editing data, eats up an enormous amount of time. Most docs are contemplating retirement to get away from the bureaucratic interference and hum drum of working with systems.

Has Someone lost the Plot ?

There is a growing disillusion with EMR’s because most of them are designed to be high-end data entry machines. A huge doubt is being cast on whether they actually help in bettering healthcare. EMR’s were supposed to reduce clinical documentation mistakes, prescription errors, retrieving data and saving on costs. And according to a few doctors fail on all counts.

Physicians fume that they are doing the same thing, several hundred times a week. Data entry takes time because of the frustrating loading times. E-prescribing is strenuous, as it is one drug at time. The, point, click, wait rigmarole results in point and click errors, and can be a potential hazard for patient safety.

Times they’re a Changing…

This immortal Bob Dylan cult number could well be the anthem of the healthcare industry today. Despite scathing criticism and the flak EHR’s face it is an indisputable fact that there are several upshots to using one. Accountable, traceable care, across all points in the healthcare continuum is a godsend for busy physicians without a photographic memory.

Data structures are improving. Integrated, inter-operable  and more secure data architectures that are more physicians friendly are rolling out. Contrary to what the naysayers complain, this could well be the best time to be a medical practitioner.

Treading with care…

Transitory phases can be tricky. It is the last man standing who comes out at the other end as a winner. Every medical practice should ensure that they sign up for a free trial with the EHR they are planning to use. So it is not the first time they’re handling the system. EHR users must demand better and frequent, tech-support.

It is important that physicians are healthcare IT savvy but we don’t want them to be reduced to impersonal, data collecting, super efficient machines. Do we ?

 

Don’t let your Anesthesiology Practice hog the headlines for the wrong reasons

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Anesthesia

The Inside Story Of Anesthesiology Billing !

What is it about anesthesiology billing that always attracts scrutiny ? Every medical journal worth its salt has been running reports on the alleged riff between CRNA’s and anesthetists. The battle has finally drawn to an end with the latest CMS rule. From 2013 CRNA’s will be able to bill separately for their services.

But unfortunately that hasn’t been the only headline grabbing news on anesthesiology, recently.

The Storm Over PPO’s…

An anesthesiologist based in New York has brought to light, the alleged billing malpractices of two major hospitals. According to his statement the 37x code had been misused repeatedly to inflate charges. He also felt that PPO’s prevented insurers from performing claim audits. The dust is unlikely to settle down soon and has brought into focus, the complicated task that is anesthesiology billing.

It is important that anesthesiologists pay attention to contractual obligations and ensure they bill correctly.

Easier Said Than Done !

Billing for anesthesiology is tough, complicated and if you don’t get the basics right, downright crazy ! It is a known fact that most physicians find themselves in a spot, for over billing inadvertently. Or, for not performing regular audits to spot the errors before somebody else does. With revised regulations demanding more accountable care, it is time for the doctors to pull up their socks.

Let your Biller walk you Through the Paces…

Knowing what happens in the engine room is the best billing practice ever. Several factors play a key role in the process. Here is a quick walk-through of the important components that make up your billing.

1. Keep tabs on the various types of anesthesia administered. Using an unnecessarily expensive or stronger drug, can result in billing malpractice.

2. The formula that is most commonly used to bill anesthetic procedures is

Base units + Time units + Modifying units) x Conversion factor = Anesthesia procedure cost.

3. The base unit value is based on the difficulty of a medical procedure and the complexity of the medical decision involved.

4. Time units are another unique component of anesthesiology billing. It denotes the time taken for administering services and modifying units are used to reflect unusual circumstances

5. Maintain updated financial reports.

Medical Practice Managers Needn’t Sulk ! Take It One Step At A Time.

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Medical Practice

What are your Plans this 2013 ?

Agreed ! It is probably too late in the year to make a resolution list, and berate yourself the whole year for not following it. But it is never too late for change. The year brings with it lots of changes to the way you work. From working towards Meaningful Use requirements to choosing those nine CQMS you want to qualify for !

Ten Steps you must take to Ensure you roll with the Punches !

1. Being the first one off the block does have its advantages! Whether it is testing ICD-10, or educating patients on your EHR do it now !

2. Choose clinical quality measurements keeping your patient population, practice workflow and specialty in mind.

3. Perform an audit. It needn’t be an extensive one that brings everything to a standstill. But make a vow that you conduct “mock audits” on important processes such as billing, regularly.

4. Try to reduce costs on every aspect of your medical practice’s food chain. From stationary supplies to revenue cycle management.

5. Focus on maintaining accurate clinical documentation. RAC audit might just be around the corner.

6. Hire a financial counselor or if it’s too expensive, train your front office staff on financial counseling to collect self pays. Remember it consists of a significant revenue opportunity.

7. Have a clinical discussion with your pharmacist to reduce drug costs.

8. Analyze your AR reports, revenue cycle management reports and look for ways to optimize your workflow and exploit revenue opportunities.

9. Be active on social networking sites. That could be the easiest way to engage with your patients.

10. Instead of setting an ambitious annual goal, set small, practical and immensely achievable monthly goals to increase collections !

Has the Doc-Fix formula saved Physicians but put Hospitals in a Quandry?

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[AnythingPopup id="15"] CFO-Hospitals

Happy New Year !

The year started on a high note for healthcare professionals. The SGR formula that meant 26.5% cuts in reimbursement has been averted. But nobody is popping the champagne just yet. It is a temporary reprieve and only means that physicians can continue seeing Medicare patients, without the fear of working for free. Till the end of this year.

Left to pick up the Tab !

As the healthcare industry, should by this time know, no reform comes without a heavy price to pay! Hospitals have been forced to face the brunt of the “Doc fix solution”. Heavy operational costs and compliance pressures are giving hospitals, sleepless nights. An additional pain of decreased payment is certainly not what they need, at this juncture.

Bedridden Hospitals…

Many feel that the recently released deal to avoid the fiscal cliff is only going to help in pushing pressing problems, down the stream. The 10 million dollars reduced Medicare payment to hospitals, coupled with the ACO cuts, can lead to bedridden hospitals.

Both Peter and Paul are unimpressed !

The latest move by the government has come in for scathing criticism.

With Chif Kahn the president of the Federation of American Hospitals, to famously quoting that it was like “robbing Peter to pay the fiscal cliff of Paul”.

Though physicians are happy about escaping from the deathly blow of almost 30% cuts in reimbursement. The growing need and frustrating lack of a permanent, workable solution has left neither physicians nor hospitals particularly thrilled with the new arrangement.

Can hospitals manage to stick their neck above water ?

In the present climate it is important for hospitals to take a stock of the situation and act quickly. Hospitals will have to create an annual budget that excludes unnecessary costs. Utilize every resource available whether it is manpower or healthcare IT, to the maximum.

Operational costs need to be reduced to at-least break even for most hospitals. Outsourcing is an option that can cut back on expenses. It requires smart out of the box thinking. Identifying and eliminating money drainers. And start the year with a new and revamped revenue cycle, lots of positivity and a smart annual budget.

Have You Planned Ahead ? It Is Important That CFO’s Have A Plan Of Action Ready To Handle 2013.

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CFO-TipsDon’t Work, Like Everybody Else !

Being the CFO of a hospital is challenging enough. Every minute is spent slogging it out to increase revenue and insuring your medical practice against financial blizzards. But sometimes working till you drop, is sadly, barely enough.

Blame it on reimbursement cuts. On a government policy that’s come in, for a lot of flak. Or, stop blaming and work on a strategy that will help you weather out the storms. And come out at the other end, a more financially sound practice.

Include Patients In The Equation…

The mistake that most medical practices and hospitals make is to never discuss financial details with patients. It is a fact that almost 30% of a practice’s revenue come from patient responsibilities.  Caring for your patients is important, but so is getting paid for it.

Fresh Approach !

If you are following the old fashioned approach of sending out confusing patient statements and making mildly threatening calls. It is time to change. Educate your patients on co-pays, deductibles and their healthcare plan. Instruct your staff to insist on collecting balances and offer payment options, your patients are comfortable with. Promise yourself you wouldn’t leave money on the table, ever !

Gazing Into The Crystal Ball !

Analyzing and tracking important financial metrics can be the crystal ball that offers a glimpse into your practice’s future. This is easier said than done. Request, your, billing staff, to provide a detailed financial spreadsheet of your practice.

Reflect , Strategize…

Develop work lists and set specific targets for your billing team. Understand what your weaknesses are, it could be no-shows or ineffective payment collection process. Identify the Achilles heel of your practice. Insist on a thorough, insurance verification process, medical necessity checks and authorization management.

Conduct regular labor productivity assessments. Follow department to department benchmarking. CFO’s can use this data to make informed decisions about labor force and clinical improvisations.

Make Everybody Contribute Their Two Bits !

Nothing, quite, succeeds like teamwork. This is not just another bumper sticker slogan ! Encourage everybody in your practice to participate in weeding out money drainers and developing sustainable solutions. It is after all, the responsibility of a CFO, to ensure not just a better financial future for their practice, but to make sure everybody contributes, to that end !

Its Time To Resuscitate Healthcare !

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[AnythingPopup id="13"] Time to Resuscitate Healthcare

The odds are stacked against physicians. Rising operational costs, hours lost due to data entry and compliance thresholds have made practicing medicine a nightmare for physicians. An increasing number of them are contemplating early retirement. With so much to deal with and a lot more to come, it is a testing time for the healthcare industry.

Buckling Under Pressure…

Slashes in reimbursement and compulsion to gravitate towards EHRs are the major reasons why medical practices are ailing. With divided opinions about ACOs and everybody blaming everybody else, the healthcare field resembles a war-zone. A recent study conducted by Bloomberg points that there is an estimated shortage of 13,000 doctors.

It is time the policy makers take remedial measures to help resuscitate physicians.

Over taxed slaves ?

Disincentives and pressures have made doctors feel like over worked slaves. After a long and expensive education, it is a bleak and challenging future that lies ahead. It doesn’t work for the doctor who is gasping for change and for patients who feel a strain in the physician-patient relationship.

Increasing Costs For Doctor Owned Practices !

The operating costs of a physician working in a full time in a physician owned multi-specialty climbed to 1.3% from last year. The commercial fee for service amounted to 51% of total charges.

A Few Bitter Truths…

  • Operational costs for running  a practice have increased over the last year.
  • Labor costs are the major money drainer for medical practices.
  • EHRs increase the amount of time spent on data entry tasks.

Solutions That Might Just Work…

  • Outsource to cut down on labor costs and operational expenses.
  • Train staff or vendors on using EHRs to reduce data entry pressures.
  • Select an EHR that automates workflow to a major extent, to save on time and resources.

Are Doctors,The Casualty Of Recent Healthcare Reforms?

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Doctors in Critical Condition !

Hate spending time in the waiting room of your physician’s office ? In a few years time you should count yourself to be lucky if you get to meet a physician at all! A recent study by the, The Physicians Foundation brings home an uncomfortable truth. That physicians are overworked underpaid, and, most are planning to leave the profession all together.

The Ailing Healthcare Industry…

Healthcare experts’ critic the latest reforms in the healthcare field and predict that there would be fewer physicians, in the years to come.

Though there may not be a mass, dramatic and headline grabbing exodus, if the current trend persists there could be 44,250 doctors lost in the next 4 years.

This coupled with 32 million newly insured Americans, can lead to longer waits to meet the doctor. And, less or no, patient engagement.

Has the Healthcare Industry Become too Expensive and Complicated?

Escalating costs of healthcare and mind bending regulations have made doctors, ailing patients desperately looking for a cure.

In a survey by Shana felt and colleagues of the Mayo clinic, a shocking 46% of doctors suffered from signs of a burnout.

We’ve Become Data Entry Clerks !

Money is hard to come by. But that is not the only reason physicians are contemplating early retirement. Family practitioner Mark Laza, in a recent summit, said that he’d cut 15% of his patient load.

He’d stopped seeing patients with low paying plans. But one major complaint he had was that doctors had become data entry clerks. The number of hours lost due to data entry made it harder to practice medicine, he complained.

It is a Crisis and not a Passing Phase…

This is a crisis that demands collective attention and action. It is a bitter truth but a truth nevertheless, that caring for patients isn’t the only priority of the doctor. To help a sick industry recover, it is essential that every physician maps out a game-plan.

It could be the tried and tested outsourcing solution or revamping compensation formulas. To hire part time staff to handle data entry tasks or working with a billing company. Whatever needs to be done needs to be done now ! To help physicians tide over challenges and emerging fiscally fit !

Free EMR Critics Are Advised To Really Think Hard Before Painting A Dreary Picture

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[AnythingPopup id="4"] FreeEMR

Does Free Always Come With A Heavy Price Tag ?  

Of late there has been a spate of attacks against perfectly free EMR, on grounds that such a product is actually not free; that the increased hours/money spent on getting trained in such an EMR offsets the benefits of free implementation.  Also, another popular line of attack is that such an EMR is not certified for meaningful use and may beat the purpose of installing them in the first place.  Finally, doubts are being cast on the revenue generation models of such a product, in that they may be selling out classified patient information to all and sundry.

But there are some who argue that nothing can be further from the truth.

A free EMR like Practice Fusion has been voted the No 1 EMR among primary care physicians for two years in a row (2011, 2012,) and obtained meaningful use certification from ONC-ATCB in 2011.

Insufficient Support ?

The accusation of extra hours being spent in getting trained in a free EMR, because the support services are inadequate, is an ungrounded myth. Free EMRs n are simple to learn and free of unnecessary frills. There are a few billing vendors who pay for or offer free practice management software. This leaves the doctor with a tight budget, a choice to adopt an EHR without losing sleep over costs.

Unfounded Criticism…

Although the attack about the revenue generation model is the weakest of them all, let us make things clear here.  Free EMRs generate revenue primarily by running ads of Pharma companies etc.  As additional revenue, even if mined data is shared with federal healthcare bodies, it is suitably masked.  But hey ! Isn’t inter-connectivity of all patient databases one of the goals of the EMR project?

We really think that in the future, it would be wiser if the critics of the free EMR model to do bit of homework before firing their salvos.

Is Consolidation an Imperfect Solution for Small Practices ?

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Are Small Practices Given A Rough Deal ?

Your friendly neighborhood small practice could soon belong to the hazy past. The growing regulatory and financial pressures on independent practices have made most of them gravitate towards big hospitals. Economic realities and a spate of regulatory thresholds are making small practice owners seek shelter under the relative safety of big practices.

Hurried Goodbyes…

Almost every recent stat released recently, Point to just one thing, The demise of small practices.

According to a study by Accenture only 36% of physicians will have a practice ownership stake in 2013. 87% of participants complained that sky-high operational costs were the major reason for most of them to bid goodbye, to, The independent model of working.

Acquisition of small practices is growing at an alarming rate. But will this be the remedy for struggling physicians?

Bigger Not Always Better !

Mergers and consolidations are hoped to bring about positive change. The much needed respite for small practices battling a lopsided battle. But they aren’t a foolproof solution. A recent controversy surrounding a major healthcare provider, has posed a question that nobody has an answer for. What is the future of small practices ?

A, Whole Lot Of Dust Raised…

If somebody told that the calm metropolis of Boise, would stage a fierce medical battle, It might have sounded like a joke a few years ago.

Cut to 2012 St Lukes health system, found itself in the midst of controversy.

Independent doctors complained that referrals were dropping steadily and of almost complete domination by the health system.

An Echo Of A Hundred Other Voices !

Repeatedly, large scale health systems have been in the news for dominating and pressurizing small practices to attain difficult financial goals. Everybody is blaming everybody else and very few physicians are happy with the whole set-up.

Opening New Avenues !

Experts argue that it is too early in the day to give ‘consolidations and acquisitions’ the thumbs down. The trend is still young and can lead to better care and lower costs in the long run. It can also put an end to fragmented patient care and documentation.

For Those Who Want To Remain Independent…

What about the doctor who doesn’t want to wait for a pay check every month? There is got to be a way! This is most definitely a challenging time for small practices. But with every challenge comes an opportunity to turn things around !

Operating in less populated, remote, areas that cannot accommodate huge organizations, can provide steady income and clientele. Independent practices can also Outsource Billing to contain costs. In the end what matters most is that small practices must focus on offering a distinct, tangible value for its patients.