Look inside a patient’s chart and you’ll find a problem list, maybe one like this: Allergic rhinitis. Migraine headaches. Essential hypertension.
Look inside the average physician’s practice and you’ll find problems, if not an actual list: Revenue-itis. Waiting room headaches. Staff tension.
But most problems have solutions, or at least a way to manage the symptoms, and that’s true for practices as well as patients. With that in mind, we’ve assembled a list of some of the most common business challenges that you face and then asked a panel of experts to prescribe solutions. Their brief recommendations are meant as starting points to improve your operations, not a soup-to-nuts solution to every problem.
You’re bound to recognize a few of your own issues in the following questions and answers. Hang in there.
Finance
I’m seeing more patients than ever, but earning less than I did three years ago. What am I doing wrong?
Ah, the gerbil-on-the-wheel problem: You keep going faster but you never seem to get anywhere. Many of you blame third-party payers — and, indeed, they’ve earned some of your wrath, says practice management consultant Greg Mertz, with meager raises that haven’t kept up with escalating business costs. Your first response is to develop a better work flow that will allow you to see more patients in less time while still practicing good medicine.
“Have you adopted technology to perform tasks that people have always done?” asks Mertz. Automated appointment reminders keep employees off the phone. Likewise, sophisticated practice-management systems can check a patient’s insurance eligibility and benefits without someone having to call a payer or visit its Web site.
Also, consider eliminating patient services that you’re currently providing for free. For example, says Mertz, “Employees will make appointments on behalf of patients for specialty consults and testing. Educate patients to take responsibility for their own care.”
All this streamlining may help you see a few more patients per day, boosting revenue. More importantly, says Mertz, it may allow you to trim your staff headcount, or else free up employees to concentrate on revenue-critical tasks, such as contacting insurers about slow pay.
OK, I get that I need to be more efficient. Still, I deserve better pay from insurers. Is there anything I can do to get it?
Yes, you sometimes can wrangle higher fees, says Mertz, and there’s never any harm in requesting higher fees at contract-renewal. But this works best only if you can convince an insurer that it really, really needs you in its network.
“If you’re one of 12 family physicians in town, will an insurer worry about losing you?” asks Mertz. “But let’s say you’re the only family doc who’s open until 8 p.m. Because of the extended hours, your patients visit the ER less, reducing the insurer’s costs. Now you’re valuable.” Physicians also can separate themselves from the pack — and win better reimbursements — by proving with hard data that they’re delivering superior care, whether it’s a higher rate of mammograms for females aged 40 through 69 or a lower complication rate for knee replacements.
True, a giant insurer may brush aside your request for more money, but don’t assume the worst, says Mertz. “A two-doctor practice in rural Virginia was getting sub-Medicare fees from a commercial insurer. They asked for a raise, and without blinking an eye, the insurer said, ‘We’ll give you 110 percent of Medicare.’ If they hadn’t asked, they wouldn’t have gotten the new rate.” Be the squeaky wheel.
We could live with our payment rate if our payers actually paid us at all. Instead, we’re getting killed by denials. How do we fix chronic denials?
First, uncover the source of the problem says consultant Deborah Walker Keegan, coauthor of “The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid.” She recommends keeping a “rejection log” of a week’s worth of denials for each payer, filling in key data points such as the physician, the patient number, the procedure code, the location where the service was provided, the charge, and, most importantly, the reason for the denial cited on the explanation of benefits.
This exercise will identify the major reasons why claims get canned, and who’s responsible for them. Misspelled names, lack of insurance eligibility, or a missing referral usually points to faulty fact-finding at a chaotic front desk, says Keegan. “Practices traditionally have gathered demographic and insurance information when the patient’s in the office, but they should do it before the visit to ensure accuracy.” Denials based on incorrect procedure and diagnostic codes, in contrast, lead back to physicians who need to be better educated about capturing charges.
While it’s best to do a job right the first time, Keegan suggests using claims-scrubbing software — sometimes built into a practice-management system — to detect and correct errors before claims go out the door.
When claims do get approved, some insurers take months to cut a check. How can we speed them up?
The best defense against slow-payers is dogged follow-up, says Keegan. First, generate an “open claim report” with your practice-management system — most systems can do this — to identify those that haven’t been paid or denied yet. Then contact the insurer. Some practices routinely wait 45 days before they prod a tardy payer, but Keegan recommends contacting the payer shortly after its normal turn-around time for reimbursement has passed on a claim. “If a health plan usually pays you within 25 days, call it on day 26.”
