By Nancy R. Smit, MBA, RPT, RRT
Guest Contributor, Partner, RS&F Healthcare Advisors
Changes in the health care insurance and regulatory environment are occurring at a much faster pace than changes in most medical practices. One of the greatest challenges facing your practice today is maintaining profitability in the face of declining reimbursement and increasing insurance challenges. Here are the first 5 of 10 easy ways to help ensure that you receive the revenue that your practice deserves!
#1 – Strengthen your front-end processes to reflect the changing insurance environment.
Most practices staff their front desks, and therefore their patient intake process, with entry-level personnel. In the past, these employees were less critical to your revenue cycle, but as more payers shift financial responsibility to their members (your patients), the job of collecting coinsurance and higher deductibles must become a priority. That job starts when the appointment is made and your front desk staff first greet your patients.
The Fix: Place billing staff at the front desk or have your billing and front office staff partner with each other through training and support programs. Practices that do this have achieved significantly cleaner claims, lower A/R and significantly higher collections.
#2 – The billing process, also known as the Revenue Cycle Management process (RCM), must be seen as a “team” or practice-wide process.
Billing has traditionally been viewed as a “back office” function. Today, unless every member of the practice understands how he or she impacts the overall RCM process, revenue will not be maximized.
The Fix: Bring your entire clinical and administrative staff together to review each step of the RCM process, show where revenue can be missed, and discuss what each person can do to improve the process.
#3 – Update and formalize your financial policies.
As a result of higher co-pays, deductibles and co-insurance, patients today are responsible for as much as 40% of a practice’s total revenue, compared to about 10% in 2007. At the same time, many practices have not reviewed their fees or updated their fee schedule in years.
The Fix: Create clear, written financial policies that can be communicated to the patient, ideally before a service is rendered, at the time of service, or as soon as possible afterwards, to increase collections and to decrease patient dissatisfaction later. As more payers shift financial responsibility to their covered beneficiaries, the job of collecting coinsurance and unmet deductibles must become a priority for your practice.
#4 – Monitor provider coding to avoid under-coding E/M services provided.
Provider education on proper documentation and coding must be an ongoing process. Providers often think that down-coding or under-coding their services will help to avoid an audit. It does not, and only causes substantial lost revenue to the practice.
The Fix: Establish an internal audit process within your practice. Create an Audit Committee with representation from your providers, billing and administrative staff. Have an independent certified coder (CPC) conduct a baseline audit and then work with the Audit Committee to establish an ongoing internal audit process.
#5 – Create clinical teams to maximize provider productivity
When providers are doing the work that properly trained support staff can do, your practice is losing productivity – and revenue.
The Fix: Evaluate provider workflow and determine where support staff can more effectively be used to increase productivity. Partner clinical support staff with specific providers rather than rotating staff among all providers to create a stronger clinical team. Increase the ratio of support staff to providers – studies have shown that better performing practices have higher support staff/physician ratios than their peers.
Stay tuned for Part II – Coming in June!
Nancy R. Smit is a Partner with RS&F Healthcare Advisors, LLC (RSFHA). She leads RSFHA’s strategy, operations, and quality services for physicians and healthcare service organizations. Nancy can be reached at [email protected]. John Pappas, her colleague in South Florida, can be reached at [email protected] or 561.860.6093.