Make sure someone in your practice is coding-certified. The American Academy of Professional Coders offers certification and continuing education — well worth the time and effort, not only because you’ll know how to code higher and collect more, but also because “you’re protecting your practice,” Cobuzzi says. “If you’re audited, you can show that you spent that extra effort. You can show you’re trying to do the right thing.”

As for billing, you certainly want to send out clean, complete claims. As complicated as claims are these days, claims scrubber software has pretty much become de rigueur.

Ramp up your patient collections. With more of the cost of healthcare resting on patients’ shoulders, you’ll want to shore up your collections practices. Simply put, collect while your patient is standing in front of you. Physicians should count on a 17 percent to 30 percent loss chasing patients’ money if they don’t collect up front, says Madden. “Obviously, if they’re chasing money it costs them.”

Breeze also notes that “it has become truly mandatory to know your allowables. That requires some work ahead of time. You need to make sure the patient actually has the benefits he says he has.”

If a patient truly has a financial difficulty, you can set up a payment plan. “In general, people want to pay for their services; they’re not trying to shirk,” says Breeze. Regardless, the more time you let go by, sending statement after statement, the more likely you’ll never see any of that money. So make it easier on everyone by considering these solutions:

• Use the ACH debit system for patient accounts on a payment plan. “We find they actually like it,” Breeze says. “Or we use their credit card. … It takes it out of their hands.” And into yours.
  
  
• Point patients toward healthcare-specific financing options, such as CareCredit. This is similar to a regular consumer credit card, but with flexible no- or low-interest offerings to leverage a patient’s out-of-pocket costs. Once obtained, a patient can use his CareCredit card repeatedly, although he should be highly cognizant of honoring the terms, as a late payment could result in a jacked-up interest rate or some other penalty.
  
  
• Verify, adjudicate, and collect all in one place. Check out InstaMed, a Web-based outfit that offers real-time insurance verification to 430 payers, real-time claims adjudication, and electronic payment from both patients and payers. Bill Marvin, president of InstaMed, says the service brings the worlds of banking and healthcare costs together. It’s fully HIPAA-compliant, highly secure, and fast. “When you do an eligibility transaction, you’re going to get an answer 99 percent of the time, as the patient is sitting there.” Generally, says Marvin, you can expect to save $10,000 to $20,000 per physician, and a 200 percent increase in collections. “The biggest benefit comes in the reduction of staff time,” he adds.

Speak up

Mertz thinks that “there’s no national understanding of this whole reimbursement thing, on either the physician or the public side.” And truly, he says, payments are all over the map. Fabrizio has noticed most of his consulting practice shifting to integration — practices joining together, or getting bought by hospitals. “They’re [each] just one doctor,” he says. “They don’t have time. They can’t be politically active. Patients walk in the door morning, noon, and night.”

Breeze agrees. “Physicians are trying to be physicians, trying to take care of patients. To get their compensation, they need a JD or an MBA. … As I’m seeing changes in healthcare, it’s becoming more and more difficult to sustain as a single practitioner.”

Joining together can be beneficial operationally, but be careful not to negate the power of one, says Madden. She strongly advocates writing letters of objection to payers, politicians, and anyone else who should be listening. It can be a standard “I disagree” letter, where you mail-merge your local, state, and national medical associations, governing state bodies, and the like. Don’t assume they’re already well-apprised of your issue. “I’m often surprised at political people,” says Madden. “They just don’t know.”

And don’t write one letter from your group; instead, have everyone in the group write one individually.

Is this worth the trouble? Absolutely.

“I know many physicians who say, ‘Oh, what’s the use?” says Madden. “But it’s really important that physicians communicate with as many people as possible. Don’t just let it be a small subset of rabble-rousers, or they get marked as such.”

And don’t discount the public. Even the supposedly politically shrewd physician organizations “grouse and lobby,” says Mertz, “but nobody goes to the public. Nobody says, ‘Hey, we’re going to have a 200,000-physician shortage. If you live in a rural area, you’re going to have no doctor.’”

One crowd that could potentially do some damage is the senior set. “They’ve got the time to understand the issues,” Mertz says. “They could have a gray army out there, pounding on the doors.”