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How effective is your billing team while negotiating payer contracts

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wbCARTOON_gallery__470x311Contract negotiation: Start on the right foot!

You file claims regularly and follow up on them diligently.  But why are the collection figures so dismal? It becomes a challenge to make ends meet and make a decent profit. Don’t look at your collections report. The cracks lie elsewhere and it’s never too late to make course corrections.

Payer contracts are usually overlooked and this oversight can cost your medical practice thousands of dollars a month. The major reason why negotiating payer contracts are usually never paid the attention it deserves, is because of a convoluted process that can take months on end to reach fruition.

At a busy medical practice nobody has the time to pore over contractual agreements, deduce fine-print and follow up with insurers. But medical billers should pay attention to payer contracts so revenue doesn’t slip through the cracks.

Are you making these 5  contract negotiation mistakes?!

#1. Not getting out unproductive contracts can put practices at a serious disadvantage. Billers should educate medical practices about how some “evergreen” contracts that get automatically renewed are detrimental to the organization and the procedures to break away from them.

#2. Most medical billing teams or firms do not run comparison reports with other medical practices. Not doing so can result in a stagnant revenue cycle and archaic payment structures. It is essential to keep an ear to the ground and change contracts according to recent payment regulations.

#3. Most billers do not perform consistent revenue analysis. Reimbursement analysis has to be performed regularly to check if the current prices are not outdated or under-priced.

#4. Payment models will have to be chosen according to the workflow, patient population and compliance requirements of the clinic. Contacting insurers and performing contract negotiations beforehand can actually be counter-productive.

#5. Not following up regularly with insurers regarding contractual changes is another major flaw. Medical billing teams or companies should follow up regularly with insurers to wrangle out the best possible contract.

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Quick tips from the experts… 

Foster relationships  Like physicians, health insurers are under pressure to control costs and improve quality of care, and you can help them achieve those objectives.Discuss about areas of concern and how you can join hands to contain costs and improve quality of care

Stand out from the crowd  The geographical location, size and specialty of a medical practice can affect the value an insurer places on your business. Look for what sets your medical practice apart and use it as your USP to negotiate better payments. 

Read the fine print  Make sure there is an annual renewal option . Also, pay attention, to notices of   changes from your insurer. Every communication from the insurer should be scrutinized as it can contain important reimbursement information. 

Beware of silent PPOs  A silent preferred provider organization (PPO) can access discounted rates for services without your authorization, preventing you from billing patients for amounts above the contracted fee. So beware of them!

Source: http://www.physicianspractice.com/revenue-cycle-management/payer-negotiation-little-preparation-goes-long-way

 

How Medical Practices can Boost HIPAA Compliance Efforts and Improve Professional Skills?

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HIPAA Data Breach

It is time for medical practices to revamp their security model!

On Monday, Community Health Systems announced that an external group of hackers attacked its computer network and stole the non-medical data of 4.5 million patients. The news proves that you cannot turn a blind eye towards data breach.  It has not stopped and this one is the second largest HIPAA security breach. Security breaches have affected more than 500 individuals. The security breaches till date, reported to the Secretary of Office of Civil Rights are listed in a detailed summary.

It’s time for a reality check!

The security of patient health information is a top priority for any healthcare service not only to be in compliance with HIPAA but also to assure that patients don’t switch services. The subcontractor who’s business associate of the hospital fails in some cases to ensure that the server which holds patients medical/non-medical data is secure.

What programs need to be conducted by top IT leaders to improve their security model?

Every business associate promises and serves its best to protect its data from all sorts of thefts. But is it right to pass the buck to the business associate or the subcontractor? Shouldn’t the hospitals keep track of updates with their associates from the day they sign the deal? The CIO, CISOs and CSOs of the organisation can learn and run the following programs to improve their security model:

  • It’s time for the top security officials of an organisation to understand the various threats that have happened and the need for skilled and accomplished professionals to manage data security.
  • The IT security officers should gain more expertise in dealing with risk management. Making the privacy policies tight can change the face of the security model of the organisation.
  • The time has come for the doctors, payers and the vendor members to discuss together about their security breach experiences, which will help them come with a stronger security model.
  • The members of healthcare organisations need to have a deep understanding of types of security and theft intelligence.
  • The security force needs to be educated about the most penetrating threats and how they can protect any security breach.

 

Infographics: Automate.Integrate.Outsource the new mantra of the healthcare industry

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Automate.Integrate.Outsource the new mantra of the healthcare industry

Work smart; automate and outsource business processes!

The much anticipated Black Book survey findings are out and they indicate a strong possibility of medical practices undergoing a completer makeover! For years together physicians handled two very different and almost contradictory aspects of their workflow. It was a tight-rope walk between patient care and managing the business side of their medical practice.

The business side of medicine has almost become a catchphrase in the healthcare industry. There was no clear definition or a strategic plan to manage it. What was once regarded as a niggling pain, that one had to live with, has snowballed into a serious issue that demands to be dealt with. And dealt with immediately!

Shifting landscape makes it vital for practices to buckle up or die a quiet death!

There was a time, not very long ago, when physicians had to just take care of patients. The filing and transmitting of medical claims was something that the biller did. A cursory glance over the month’s collections was all that physicians did, as managing their medical practice’s finances was not their job.

The Affordable Care Act, which opened the doors to millions of uninsured, PQRS and Meaningful Use measures, an entirely new coding system and increased financial pressures, have shaken physicians out of their comfort zone. The alarming rate at which small medical practices shut their doors and the growing threat to the survival of independent practices, are a huge wake-up call across the entire healthcare continuum.

Desperate times call for desperate measures. The Black Book study that includes the perspectives and opinions of 400,000 respondents has indicated three emerging trends that are going to challenger the traditional way medical practices are going to function.

Upgrade, integrate, outsource…

This seems to be the magic formula that can save medical practices from drowning under a sea of reforms. Though most medical practices have finally got the hang of technology and are experimenting with different workflow models, there hadn’t be a clear sense of direction or collective change insofar.

Challenging old notions…

The Black Book survey challenges the common belief that physicians are still unwilling to let go of archaic methods of working.

There is a huge move to eliminate outdated software and about 21% of medical practices surveyed, are planning to upgrade their RCM software within the next 6 to 24 months.

91% of medical practice business managers feel that EHR systems that are not integrated with a full- fledged revenue management system can back their practices, further into a corner.

Facing the bitter truth!

The study also clearly illustrates that physicians are no longer in denial mode. About 90% of physicians surveyed admitted that their billing systems needed a facelift. There is also a huge demand for integrated systems so physicians will have to coordinate with a single point of contact. Speeding up workflow is the major objective of most medical practices and automating their workflow seems to be the perfect solution.

Utilizing system intelligence to perform business functions such as appointment scheduling, insurance eligibility checks, sending patient reminders and payment posting can quicken tasks and reduce headcount. Most medical practices still hire FTEs to perform tasks that their systems can do. Automating tasks can not only shorten the time taken to perform tasks but can also help in resource optimization.

Automating administrative functions: the way forward…

The administrative functions of medical practices can drive up efficiency. Prior to automating a process draw up a checklist of objectives and see whether through automating you actually end up saving time. Automating for the sake of automating can do more harm than good. Like investing in an automated voice recognition system and wasting productive time editing and correcting the transcripts.

Have a clear work-plan, educate staff about the software and strategy you are going to use and compare your existing process to the revised one, to make sure your switch to automation is successful. A spread-sheet that details the transition can ensure everybody in the medical practice is on the same page.

Creating a flow-map can standardize your automated processes and improve efficiency. You don’t want your staff to be bewildered by the sudden change in workflow processes. Listing out repetitive tasks is the easiest way of freezing on tasks that can be automated.

Here is what to automate…

Automating can be healthy but it can quickly turn into a major headache if not handled with caution. Medical practices should take care not to let their workflow processes spiral out of control. Though automation of tasks is common in other industries, automating workflow in the healthcare field is still at a nascent stage.

Here is a list of tasks that can be automated efficiently…

  • A patient portal can automate everyday tasks to a large extent. Implement a patient portal that enables patients to fix up appointments based on available time-slots. Prescription refill requests can also be sent online. Patients can also be encouraged to pay online through a secure payment gateway.
  • Setting up error prevention alerts and a thorough claim scrubbing tool or software can eliminate denials.
  • Charge review alerts can reduce no-charges.
  • E-prescribing allows physicians to communicate directly with pharmacies and can save medical practices from the tripwire of misplaced prescriptions.
  •  Setting up an email reminder or automated call reminders can reduce no-shows and late appointments.
  • The ability to gather the financial performance data of a medical practice and track metrics will result in actionable and current financial being just a click away! This will help set targets and benchmarks.

There is no magic wand that can wipe away manual efforts completely!

Great! So now all physicians can just shop for software, or tool that can automate practice functions and go back to taking care of patients. But it is not as simple as that. The heterogeneity of workflow processes in a medical practice demand different methods of working. Automating completely, a practices business functions can prove to be counterproductive. As many as 90% of small medical practices and 95% of independent physicians are planning to outsource their medical billing and revenue cycle management functions and that could be because relying on tools alone cannot deliver the goods.

An increasing number of medical practices are downsizing to cope with financial bottlenecks and processes that were previously handled in-house are being outsourced. The increased need for outside expertise has been the major driver behind the shift to outsource business functions.

The bottomline…

It is the survival of the fittest out there! Healthcare organizations that successfully, integrate, automate, and outsource processes, will come out at the other end, more streamlined, productive and compliant.

5 Common Patient Collection Flaws to Avoid

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Stay Away from Patient Payment Collection Gaffes

Is Your Collection Rate Unhealthy?

Many clinical and non-clinical departments of the medical practices overlook the payment collection from the scratch and most of the times you may combat for the collectibles at the eleventh hour. If it is so, you have some useful stuff here, to hone your collection strategies.

Small mistakes cost you more…

Collecting your hard earned money shouldn’t an end term activity. The collections of physicians, pathology or radiology labs, pharmacies, if unattended on-the-dot, your Accounts Receivable (ARs) would become unmanageable leading to piled-up bad-debts. Thus, point of service (POS) payment is very crucial for a robust healthcare business.

Notably, most physicians want to stay away from the financial dealings and deem that time involved in the finance management could be utilized for patient care and updating the clinical knowledge. But finally, you may land up in big troubles like unmet payroll, unrewarded hard work, dwindled profits or increased bad-debts.

Take care of your funds with these collection tips:

#1 – Ignorance of co-pays

Physicians need to be more attentive and understand that co-pay collection from the patient must be a demand instead of being a patient’s choice. As per the insurance payer contract, the doctor must collect the co-pay from the patient in each visit.

 #2 – Bill Generation for Co-pays

Another common co-pay collection mistake is that you may bill the patient’s co-pay which once more goes against the payer contract policy. Missing the POS collection calls for unnecessary addition of the administrative cost in bill generation, follow-up and collection.

 #3 – Information Deficiency

It is the highly frequent yet imperative issue due to the negligence of the front-end staffs. Important patient’s information like date of birth, insurance carrier and policy details, scanned copy of insurance cards, exact billing address, contact number and many demographic data, if left out at the patient check-in, eligibility issues may arise and hamper your reimbursements.

 #4 – Lack of Payment Pattern Discussion

Mailing the bills directly to the patient and upon patient’s rejection seeking the help of the collection agency may help you, of sure. But, conversing with the patient up on encounter, to make payment arrangement is a much better option to collect your dues.

 #5 – Missing Further Step

When your collection methods are not working out, you need to proceed further either through collection agency or legal proceedings. Of note, this is the point at which doctor-patient relationship may get broken. If the aforesaid 4 steps are followed impeccably, you won’t find any lapse in the serene patient care.

2013 Ahead ! Will your Practice fly across the Fiscal Cliff or fall into an Abyss?-Infographic

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Beware Medical Practices 2013 Ahead !

And we are not exaggerating. The whole nation is gone into a huddle, discussing about the eminent Fiscal Cliff. Medical practices, small independent practices in particular, are going to be the worst hit. Across the board sequestration cuts and a 2% reduction in Medicare reimbursement, have left physicians fuming.

716 Billion Payment cut over the Next Ten Years…

The patient protection and affordable care act are aimed at improving the quality of patient care and reduce duplication. But, at what, cost ? From 2013 to 2022 it is going to be one rollercoaster ride for medical practitioners. Hospitals are increasingly merging and affiliating to handle the reimbursement cuts.

Declining reimbursement means, acquiring and consolidating independent practices seems to be the most viable and sustainable model. Doctors, who want to continue to be independent, are facing the possibility of becoming endangered species.

Small Practices Shutting their Doors…

A recently published whitepaper by the Physicians Foundation and Merritt Hawkins suggest that small practices will be uniformly replaced in the coming years. It is a known fact that physicians are under-compensated.

Small and medium practice owners should focus completely on maintaining RUV production at a sustainable level to tackle operational costs.

A Few Ways to Survive the Tough Years Ahead !

  • Review and rework on existing physician compensation formulas.
  • Renegotiate contracts with payers.
  • Develop a strategic plan. Every staff member should remove themselves from the everyday workday, to reflect, and devise strategies to stay profitable.
  • Concentrate on meeting Meaningful Use standards to receive MU incentives while they are still around.
  • Consider outsourcing certain aspects of the Medical Billing Workflow such as  to cut back on costs.
  • As reimbursement models place a greater share of financial risk on physicians, it is important that they focus more on their Revenue Management Cycle.
  • Conduct internal analysis and identify throughput issues.

Bracing for Change !

Change is the only constant. This is the time for medical practices to scale up and meet the financial pressures placed on them. And wait for the regulatory changes to see how they play out !

In-fact, the Fiscal Cliff can even prove to be a good thing. According to a poll conducted by TCB around 51.7 % respondents felt that going over the cliff, could prove to be a good thing after all !

It could induce people to look beyond the tried and tested, and focus on coming up with novel solutions. The reimbursement and tax cuts can help a staggering economy get back on its feet. And, like they say when you hit the bottom the only is up ! As with every New Year, this is the time for reflection, resolutions, and most importantly, hope.