Can you imagine having your own personal biller assigned to you?
That’s essentially what each physician and nonphysician provider at Hawthorn Medical Associates had two-and-a-half years ago, when Matthew Nivison came on board as the practice’s patient business manager. With 60 people in the billing department and 68 providers, “it was almost a one-to-one ratio,” he recalls.
Yet that ratio was necessary given the setup at the time. “The clearinghouse we were using couldn’t get to some of our payers. We would send electronically, but then they would drop to paper and send. We were getting tons of [timely] filing limits.”
Today, the Dartmouth, Mass.-based multispecialty practice uses Navicure, a Web-based clearinghouse with a rules-based claims scrubber. Denials now come back within hours or even minutes, not 30 to 40 days — the previous standard. Average days-in-A/R is a low 34 days. Cash-on-hand is up 7 percent. And with a current billing staff of just 36 people, Hawthorn Medical Associates has saved more than a half-million dollars in salary and benefits by not needing to pay a larger staff.
Persisting with the wrong technology is one of many in our list of common ways practices lose money — usually without knowing it. Most practices are committing one or more of the money-sucking mistakes on our list. Is yours?
The wrong billing technology is just one of many IT-caused cash drains killing practices. Want another? Well, is your front desk using an old-school light or flag system to alert your nurse to a patient’s arrival? We say that’s a no-no, because these tools divulge so little useful information: Which patient? Why is he here? Do you need to check for his lab results? Your staff must spend extra time on these questions before rooming the patient, slowing down their work flow and reducing — significantly over time — the number of patients you can see. Instead, use readily available tracking software to flow your patients through appointments quickly and accurately.
Here’s another example: Getting patients back in for annual physicals, rechecks on PSA levels, and the like is difficult, as is keeping track of who needs to come in for what. Take the tedium and time waste — read: money waste — out of this by using the appointment recall function on your practice management system. You do have an up-to-date practice management system, right? Keeping this practice underpinning as technologically leading edge as possible will save you big money, simple as that.
You let others take your money
Two out of three physicians will be victimized by embezzlement at some point in their careers, says practice management expert Elizabeth Woodcock: “And most embezzlers don’t want five dollars. They want $50,000.”
Apparently, stealing from busy docs is disturbingly easy. A common scenario? An employee — perhaps a nurse in charge of exam room inventory — sets up a fake company with a collaborator, often a relative, at the helm. She regularly “orders” supplies from there, and you sign off on the invoices. The price on the invoice is inflated by, oh, 30 percent or so, which she and her partners pocket before paying the real vendor through the fake company.
Another way to pick your pocket is through bogus refunds. Legitimate refunds are common within practice finances — overpayment on a copay, for example. Trouble is, says Woodcock, there’s usually no oversight of refund processing, so it’s easy to approve fraudulent payments to associates. All it takes is setting up a real-looking patient account to start the erosion.
Put controls in place. Make sure at least two people are involved in any transaction where money changes hands. Also, review your accounts regularly, looking for patterns. Patient refunds are common, but not to the same person over and over. Finally, be wary of the dedicated employee who refuses to take a vacation: It may seem like dedication, but thieves know they are more likely to get caught when they lose oversight, even temporarily, of whatever operation they’re stealing from, so they often guard it zealously.
You’re a pushover with payers
Renegotiating payer contracts is as much fun as cleaning the deep fryer at Burger King, only greasier, so it’s no surprise that it ranks below the bottom of many practices’ to-do lists. Cheris Craig, practice manager for the six-physician, Atlanta Women’s Obstetrics & Gynecology, says it’s particularly tough if your practice is small, offers a common subspecialty (such as obstetrics), and has a lot of nearby competition. “Many carriers won’t even start negotiations with our practice,” she says.
What to do? Stop selling yourself short, stop taking your cues from what “they” say, and don’t allow the assumption that you won’t succeed to be your excuse for not even trying. Occasionally, you will succeed in affecting changes in payer policies — and those changes will add up, but only for the practices that ask. Woodcock says that in her city (also Atlanta), “we have a lot of Medicare Advantage plans. They [tend to] pay 85 percent of Medicare, but if you pick up the phone and say, ‘You’re Medicare. You’re supposed to pay me Medicare rates,’ they usually say ‘Oh, OK’ and do it. But nobody picks up the phone.”
Before you pick up that phone, though, arm yourself with the facts. Gather all the numbers you need, including reimbursement rates and denial rates compared to other payers. Wills Family Clinic in Sherman, Texas, purchased Abaxis’ Piccolo in-house lab about a year and a half ago. Every time a payer contract comes up for renewal, the clinic’s office manager, Becky Sanders, contacts the carrier and requests reimbursement coverage for the practice doing its own labs. She explains how X percent of the clinic’s patient load is with that payer, and if the clinic does its own labs, it saves the payer [enter-calculated-amount-here]. “I really don’t get much resistance,” she says. “They’re willing to look at the numbers.”
