Manage My Practice

January is a tough time for independent medical practices for several reasons:

• In private practices, the physicians typically don’t carry over any cash from year to year, so the practice starts in January from a cash position of zero.
• Most deductibles begin in January – if practices don’t collect deductibles at time of service, they find themselves hurting because their revenue goes way down.
• The Medicare debacle every year creates improper (lower) reimbursement as Congress struggles to the last possible minute over physician payments. (Here’s a simple yet helpful exercise for Congress. Congress, close your eyes and think of your favorite Medicare-age person. Is it you, your wife, your mother, your father, your neighbor or best friend? Now think of that person not being able to see a doctor when they need to because all doctors have opted out of Medicare and the only place they can get care is the local Emergency Room. It is a very ugly picture. What other profession is MADE to accept payment that is less than it costs to provide? Who do you love, Congress, who won’t be able to get care?)
• Many annual maintenance contracts come due in January
• Deals on large purchases are good (think EMRs) as vendors try to book revenue in the current year. Practices tend to make commitments to purchases now that will have to be paid for in the new year

What’s a practice to do?

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Mary Pat’s Note: This post has always been popular because it answers one of the most burning questions in Healthcare: “How can I improve my bottom line?” If you have used any of these ideas in your practice- or have some of your own to share- let us know in the comments below!

BUILD ON WHAT YOU’RE CURRENTLY DOING:

1. Add physician hours – add evening or weekend hours; start your office hours earlier and end hours later.

2. Reduce physician time off – decrease vacation or change weekly days off to 1/2 days off.

3. Set a minimum number of providers to be in the office seeing patients at all times the office is open.

4. Have each provider add one new patient visit to his/her schedule weekly.

5. Add ePrescribing to recoup additional Medicare revenue and streamline prescribing (there are free ePrescribing software packages available, but evaluate them carefully so they don’t add more complexity to the system instead of less.)

6. Report PQRI measures to recoup additional Medicare revenue.

7. Charge patients an out-of-pocket fee for completing patient forms – disability forms, etc. and reserve office visits for treating patients.

8. Choose an EMR that qualifies your practice for the ARRA money (although it has been widely promoted that in a larger practice, an EMR and its associated work will cost more than you will get from the government.)

9. If you are in an underserved or rural area, check to see if there might be grants or funds available locally, in the state or federally, for adding a service to your practice.

10. If your practice does Independent Medical Exams (IMEs), reviews records or depositions, make sure that your fee schedule for such services is current and that the fees are collected before the physician provides the service.

ADD TO YOUR CURRENT SERVICES:

11. Allergy testing & treatment

12. Dispensing pharmaceuticals

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As we finish off another month here at MMP, we wanted to go back over some of our most popular posts from the month and get ready for another busy, productive, and meaningful month. Presenting, The Best of Manage My Practice, October 2011!

• Are you ready for the holidays? How about the New Year? Even though it’s still a few months off, make sure you don’t see an interruption in your practice’s cashflow by getting ready for the January 1st 5010 deadline!
• CMS has released the Premiums and Deductibles for Medicare patients for 2012, so you can start informing staff and patients now. More importantly, will 2012 be the year that you get serious about collecting deductibles at the time of service?
• Mary Pat’s “Collection Basics”series about the fundamentals of Revenue Cycle Management in Physician offices is now at part three! Check out Patient Collections Basics: Developing a Financial Assistance Program.
• One of Healthcare’s most misunderstood and underutilized documents- the Medicare Advance Beneficiary Notice- is changing for 2012. Make sure you’re ready.
• And finally, the Office of the Inspector General (OIG) of he department of Health and Human services has released its 2012 Work Plan for areas it will concentrate on investigating. Better safe than sorry! Mary Pat goes over the highlights here.

We’ve started this monthly wrap-up to make sure you don’t miss any of the great stuff we post throughout the month on Manage My Practice, but we also want to hear from you! What were your favorite posts and discussions this month? Did we skip over your favorite from October? Let us know in the comments!

After Mary Pat’s “Coding for the Rest of Us” post this July, she sat down with Lyndsey Coates from Nuesoft as part of their monthly Healthcare IT Podcast to discuss more about how even a basic understanding of coding among patient contacting and administrative staff can improve patient experiences as well as the group’s bottom line. Check it out!

Peter Polack, MD of Medical Practice Trends interviewed me recently for a series of podcasts for his site. Here we talk about “How To Tell If Your Practice Is Well-Managed.” Click here to listen.

• Warning signs that your practice has management issues
• Why hiring your spouse as your manager may cost you in the long run
• Standard benchmarks that typical practices should be aware of
• The importance of being a calm practice

If you’ve read parts 1 (Know Your Payers) and 2 (Implementing Your Financial Policy) of this series, you are ready to consider a financial assistance policy for those patients without insurance.

Patients without insurance fall into one of three categories:

1. Patients without insurance who have the ability to pay their medical bills but refuse to pay them.
2. Patients without insurance who have the ability to pay their medical bills and are willing to do so.
3. Patients without insurance who do not have the financial resources to pay their medical bills.

Patients in category #1 are easy to identify. We’ve all encountered them and we know that they do not value what the physician or care provider offers, or they believe that for some reason they should not be required to pay. They will waste your valuable time and should be discharged from your service if possible.

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Just in case you haven’t had a chance (what have you been doing?) to focus on the January 1, 2012 deadline for the transition to 5010, take 5 minutes to read this post and make sure your healthcare group is on track. It is critical to have NO interruption in cash flow in January – a time when cash flow is already lower due to the new deductibles in play for many plans including Medicare.

The American Medical Association (AMA), in its “5010 Implementation Steps: Getting the Work Done in Time for the Deadline” recommends the following to protect your cash in January:

• Submit as many transactions as possible before Jan. 1, 2012.
• Decrease expenses before Jan. 1, 2012, to increase cash reserves.
• Consider establishing a line of credit with a financial institution.
• Research payers’ advance payment policies.
• Consider using manual or paper processes to complete transactions until the electronic transactions are fixed.

Note that HIPAA standards, including the ASC X12 Version 5010 and Version D.0 standards are national standards and apply to your transactions with all payers, not just with FFS Medicare. Therefore, you must be prepared to implement these transactions for your non-FFS Medicare business.

Beginning January 1, 2012 all electronic claims, eligibility and claim status inquiries must use Version 5010 or D.O.

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I have known of Transworld Systems for almost as long as I’ve been in healthcare – a long time. But it wasn’t until I got to know Karen Cooper from Transworld Systems that it came home to me what a difference a company representative can make in the ultimate success of the service.

Karen has been with Transworld for 10 years (the company has been in business for 41 years), moving to a sales job with the company after getting her MBA and getting her kids started in elementary school. She looked for the right job for a year and a half and even though she had never been in sales before, she knew she could leverage her professional experience and education to great advantage in full-service collections.

Although not exclusively working with healthcare clients, Karen loves the medical market and enjoys the “lingo” that is so specific to medical practices and hospitals. She has seen many changes in healthcare over the past 10 years, particularly physicians’ interest in and acceptance of a business approach to collections. With patients having responsibility for more of the healthcare bill, physicians and managers are turning to specialists to do the staff-intensive chore of collections.

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How does a medical practice meet the patients’ healthcare needs while operating a highly-regulated business on less income? Start by examining one of the most expensive processes in the practice – billing. Billing requires skilled employees, sophisticated technology, and constant vigilance from everyone in the office. Let’s explore processes that can reduce your billing expense as well as increase your collection percentage.

Clear Financial Policy

If you don’t have a written financial policy, how do patients know when and how to pay? Your practice should have a very understandable (8^th grade level or less) financial policy that explains what your practice will do and what the financial responsibilities of the patient are. If you want a copy of the format I like to use, email me at marypat@managemypractice.com and I’ll send it to you. Use the same financial policy to train your entire staff on your policies. If any employee does not support your policies, that employee should not work for you.

How you save money: Everyone is on the same page, so there is no way a patient can game the system by claiming a staff member or physician told them no payment was needed. By the time the patient receives a service, they should have heard verbally about the policy 3 times (appointment, appointment reminder, check-in) and should have received at least one written copy of the policy, which they’ve signed.

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