revenue, billing and collections

Net collections: Are you waving the white flag?

The subject of net collections seems to be in the ether these days. (For the purposes of this discussion, I'm referring to net collections as the amount your practice is ultimately reimbursed for services it provides, i.e., your net reimbursement after adjustments or credits.) Though it's long been a staple metric, its usefulness in our high-deductible environment may be in doubt. Since net collections measures how much of what you're entitled to has actually been paid, an accurate calculation of it can be invaluable. But therein lies the rub. An accurate calculation of this "simple" metric is increasingly hard to come by. Practice management systems have gotten much better at tracking multiple fee schedules and comparing them against what we've actually been paid--this isn't the problem. The problem is that more of our reimbursement must now come from patients, so it may take months for any service to be fully reimbursed. If you run a report on net collections for a recent time period, this lag in reimbursement will suppress the average net collected for all your payers. If you're running the report primarily to keep an eye on your payers, this lag is enough to make the aggregate data all but useless for that purpose. The report will almost always "show" that your payers haven't reimbursed as promised, even when the reason is simply that it takes more time to bill patients and for them to pay. An executive at one of the larger groups we've worked at confessed to me that "we don't even bother with net collections reports anymore. Entering the fee schedules is a waste of time." While I can understand the frustration, I think there's a risk of throwing the baby out with the bathwater. There's a lot of value in calculating net collections. We want to know--no, we need to know--if payers are reimbursing as agreed. And when slow patient collections drag down the net collections figures, that information is also important to understand. What if patient bad debt is starting to climb? Net collections analysis can help you spot this and take action.

By Morgan|2022-01-01T22:51:43-08:00February 12th, 2020|

Have you seen Laurie’s popular article about the deductible reset?

Laurie's 2018 article for Phreesia's blog is one of their most popular posts. If you haven't seen it yet, here's a link to check it out. It includes time-tested ideas for dealing with the roller-coaster ride that is the transition from the busy-busy fall season to the slowdown in January, including: Identifying the patients who can benefit most from booking services they've postponed before the year ends Making sure staff are trained and confident they can explain the pros and cons of booking care before year end Deploying and taking full advantage of all the tech at your disposal that can make it easier for patients to pay Planning to make conscious use of downtime in the spring--whether by increasing patient visits through promotion, using the time for other important tasks you've put off, or both There's still time to make a plan to have your practice business's best fall/winter season yet. If you'd like to discuss more ways to do so--and how we can help--please get in touch!

By Straight Talk|2022-01-01T22:51:43-08:00November 10th, 2019|

Are you an in-house medical biller or billing manager?

Are you an in-house medical biller or billing manager? We are looking to speak with a few billing professionals (either currently working as in-house billers, or who have been employed by practices in the past) for a project. If you are willing to speak with us for about 5-10 minutes for our research project, which focuses on attracting, motivating, and retaining medical billing staff, please reply contact us. We're looking for five to ten qualified respondents. Besides our gratitude, you'll receive a $5 gift card :) Better still, your responses will also help physicians and practice administrators better lead and manage billing teams. Thank you!

By Morgan|2019-09-12T14:49:06-08:00September 12th, 2019|

Teaching patients about their health insurance shouldn’t be your job–but it is

If you are frustrated by how confused patients can be about their insurance, and by the conflicts this confusion often leads to (especially about patient balances), you have good reason. Insurance is provided by employers, who theoretically should be able to explain it (it's an important part of employee compensation, after all). And it's offered and managed by insurance companies, who set and enforce the terms. There seem to be several good ways, logical ways to get information about insurance rules. So why do many patients misunderstand how it works? A few things are obvious. One is that health insurance can be very complicated. (It is complicated for those of us who work with it every day, even.) And the training and information patients have access to from their employers and insurers is simply not clear or accessible enough for many patients and many situations. This gap shouldn't be your problem. But it ultimately becomes your problem, since you'll have to deal with patients' confusion and corresponding reluctance to pay. All of which is a long way of saying that helping patients understand how their insurance works may not be something you should have to do, but it is something you're better off doing. And the earlier in the relationship you start the education process, the better. The clearer patients are on their financial responsibility before they receive care, the less likely they will be surprised by a large balance they didn't expect to owe. There is an old saw in marketing about how you have to repeat a message seven to ten times before anyone really absorbs it. The seven to ten is not regarded as a scientific analysis by anyone. But the idea that you have to repeat things, usually more often than you expect, and ideally via different media, is well accepted. (There's a reason you see and hear advertising by the same companies in different places and via different channels.) To this end, we often suggest to medical practices that they have some explanatory material at the front desk that covers common insurance issues--things like what

By Morgan|2022-01-01T22:51:44-08:00September 3rd, 2019|

Time for a review of your E&M/office visit utilization? (DOWNLOAD free spreadsheet.)

Office visits represent a huge proportion of revenue for most practice types. It's easy for small errors in coding to become habitual, and the resulting inaccuracy can be costly for your practice. Under-coding can mean lost revenue -- multiplied by hundreds or even thousands of visits per year. Accidental over-coding can lead to revenue clawbacks that create accounting hassles and make it more difficult to accurately project revenue. Payers are very concerned about E/M accurate coding, too. That's why any variation (not just over-coding) can be a trigger for a payer audit. Checking your E/M coding patterns against Medicare's utilization data for your specialty is a quick way to spot possible problems. If your or your practice's code utilization differs significantly from national data and the reasons aren't immediately clear, it could be time for a closer review or internal chart audit. Getting your hands on the CMS data, then entering it into a spreadsheet, can be a bit time-consuming -- but we've taken care of some of the grunt work for you. Follow the links below to download a spreadsheet that already has the CMS 2017* data keyed. It includes formulas to calculate your clinicians' or your practice's utilization of each code, and compare it with the national averages. Just enter your data and get your results immediately. Allergy and immunology Cardiology Dermatology Endocrinology Family practice Gastroenterology General practice General surgery Internal medicine Neurology Neurosurgery OBGYN Orthopedic surgery Otolaryngology Psychiatry Pulmonary disease Rheumatology Urology Need a different specialty? Contact us and we'll pull it together for you, provided the CMS has published data for it. Besides comparing against the CMS numbers, we recommend you compare your clinicians' numbers against each other. Sometimes, differences in utilization make perfect sense -- such as when the doctors see distinctly different patient populations. But not always. If the variances don't look logical to you, it's time to take a closer look. You may find it's time to bring in an E/M coding expert for a customized refresher course and/or chart audit. (If you need this help, contact us.) *here's a link to

By Morgan|2019-02-27T15:32:20-08:00February 27th, 2019|

Don’t believe the hype: patient portals aren’t “largely unused”

A provocative headline got my attention recently. It proclaimed that patient portals are "largely unused." It caught my eye partly because it didn't sound all that plausible -- and because taking such a headline at face value could be unhealthy for your businesses, dear clients and friends of Capko & Morgan. I decided to dig into the matter. The article text actually mentioned that 37% of patients have recently used portals. Could the author actually believe that 37% utilization is trivial? That seemed to be what they were saying, yet it's hard to imagine they believe that. (Would a 37% decrease in salary leave one's pay "largely" unchanged?) Perhaps, you may be thinking, this was just a forgivable, inadvertent misuse of "largely." But I tend to think not. This type of exaggeration is just too common in modern media, even in our world of the business of healthcare. I tend to think the headline intended to sensationalize. Yet even if that wasn't the intention, it's still not a benign error, which is why I'm calling it out. Mischaracterizing portal adoption has a hidden cost Clients often tell us they've held back on technologies that could make their practices more efficient because they're concerned patients won't use them. But that thinking usually means practices miss out on significant benefits, since the tools they delay adopting (or forgo altogether) could make interaction easier for patients or make their practices more profitable (or both). This tendency to hesitate has been especially true for patient portals, and it's often very costly. Somewhere along the way, the idea took hold that portals aren't worthwhile unless nearly every patient uses them. But this is not true. It's not even close to true. If even a small percentage of patients regularly uses a portal, those patients will benefit -- and their physicians will save time, too. (And that's strictly on the clinical side. Portals have the potential for even more dramatic benefits on the payment and administration side, even when utilization is very low.) What's more, relative to other recent technologies, portal adoption is arguably not that

By Morgan|2022-01-01T22:51:45-08:00December 20th, 2018|

Credentialing: is it time to upgrade your process with software?

Credentialing can be a frustrating, mysterious, time-consuming process. It can seem like a black box: you throw your (copious) data in (with no idea what will happen to it), then hope you'll get what you want out of the other side (eventually -- you have no control over when). Worse, unlike most other administrative tasks your staff handles, credentialing has seemed immune to process improvement. It's no wonder so many practices outsource this tedious, unpredictable paper-pushing. But that can lead to another set of problems. For example, when delays occur, how do you know whether there's a problem with the application, the payer is just slow, or your credentialing service dropped the ball at some point? Constantly checking in with a credentialing service for updates wastes valuable time on both sides -- especially since your credentialing service has no more control over how long it takes payers to respond than you do. Thankfully, dear reader, you and I are not the only people who've observed the built-in productivity drains in credentialing the old-fashioned way. In recent years, technology whizzes have stepped in to improve the process. There are still frustrating pieces of the puzzle that technology can't yet fix -- like the need for physicians to gather all that information in the first place, and like the uncertainty about where submitted applications stand with payers. But technology can help with: maintaining a single source of credentials -- to avoid submitting out-of-date information or incomplete information tracking key dates enabling physicians to enter their own information via a portal -- to avoid double entry of data, and the associated costs and errors automating the completion of many forms in some cases, automatically updating or communicating electronically with important third parties like CAQH If you are not yet using a credentialing software product, now is the time to check your options out. And if you're outsourcing, it may be more efficient to bring the task back in house, supported by up-to-date software. Or if you continue to use a credentialing service, be sure that your partner uses a cloud-based system that you

By Morgan|2022-01-01T22:51:45-08:00December 4th, 2018|

Responding to external trends that threaten practice profitability

When we work with physicians and managers who've found their financial results have inexplicably declined, they often wonder why the profit numbers changed when the practice is still managed in the same careful way as before. It's a puzzle and a disappointment and a huge source of frustration! But therein lies the rub: As managers, our job is often to respond to changes that happen outside our business. Doing things the same way, even when executing perfectly, is often not enough to assure good results. Things are happening in the broader market that affect our patients and their behavior. It's our job to recognize when trends that have nothing to do with medicine still require a response from our industry. One really powerful example of a completely external trend that is nonetheless affecting every practice business is the rapid adoption of online payments by consumers. If your practice hasn't responded to this trend, it's probably already affecting your collections negatively. The shift in payment behavior by consumers has been dramatic. I created the chart to the left using USPS data showing that single-piece stamped mail has declined more than 50% in the past decade. The Post Office attributes this decline to shifting consumer preferences, especially for bill payment. The days when it was normal behavior for consumers to sit down once a month and review paper statements, write stacks of checks, stuff the checks in return envelopes, then stamp the envelopes and drop them into the mail are rapidly disappearing. Patients' strong preference for paying electronically is both an opportunity and a threat to your practice business. Give patients an easy way to pay online -- better yet, give them electronic statements, too -- and you'll get paid faster, with less labor required, and reduced paper and postage costs, all while making patients happier. Now that's some serious upside! But if you don't make online payments possible, you're also risking getting paid more slowly, with higher collection costs. That's because it's not just a matter of patients preferring to pay online. They're organizing their budgets and managing their money in

By Morgan|2022-01-01T22:51:46-08:00July 21st, 2018|

Fix the problem, not the blame [practice management tip: operations and workflow]

“Fix the problem, not the blame” is a well-known Japanese proverb. It sounds like common sense – isn’t fixing problems what we all ultimately want? But when mistakes happen, the search for culprits instinctively begins – and with it often comes demoralization and tension. Worse, the search for a scapegoat usually won’t keep problems from recurring. Bad systems create more problems than bad employees. When workflow is faulty, the mistakes are built into the process. Figuring out who was working the process when it failed does nothing to prevent failure in the future. As organizations grow and silos (i.e., departments) form, so do opportunities for workflow inefficiencies to masquerade as staff incompetence. We’ve worked with medical practices that have grown so fast, they haven’t noticed their processes aren’t keeping up. But even more than growth, market evolution has put new tasks on everyone’s plate. These tasks may not fit well with jobs as originally configured – and that may mean more errors. Here’s a common example. Insurance has become increasingly complex for patients and staff alike. Higher deductibles have also made front desk collections a priority, but it’s a new priority added on top of everything else. Are front desk employees already trying to answer phones, check patients in, answer questions, collect demographic information, and verify insurance? When patients are seen and it turns out they weren’t covered or aware they owe a deductible, it may seem “obvious” that the front desk staff is to blame – especially to your billers, who must deal with the errors. But more likely, front desk employees are simply juggling too much. As jobs evolve, mistakes may increase. Resentments can fester between departments. But the answer isn’t to find someone to blame – it’s to find out where the process breaks down. In the case of the front desk, a better response would be to reconfigure roles, to let staff focus on the tasks in front of them, without multitasking. As work gets more complex, making people feel embarrassed and afraid won’t help them do their jobs better – retraining staff and refining their

By Morgan|2018-06-11T16:36:02-08:00June 27th, 2018|

Reducing the cost of no-shows at your medical practice

(c) Sheri Swailes - fotolia.com No-shows can be a huge drain on medical practice finances. Time that is booked but ultimately generates no revenue is a loss that comes right out of your bottom line. It’s similar to what airlines experience when they have an unsold seat – which is why airlines so often resort to overbooking, and some practices do, too. But if you've seen the negative media coverage about the impact of flight overbooking on passengers, you already know what a stressful gamble the double-booking “solution” is. It's all but impossible to predict which patients will fail to show up -- so you could end up with too many arriving at the same time. Even when overbooking helps reduce lost revenue, it can create other problems -- like long waits, rushed visits, and stressed out physicians -- that lead to unhappy patients and higher marketing costs. Practice managers and physicians often throw up their hands in frustration about how to deal with no-shows, especially if they’re already taking steps to remind patients, or perhaps even charging a no-show or late-cancel fee. There’s no doubt about it, trying to improve your practice no-show rate can be challenging. But there are a few ways to look at the problem that practices sometimes miss. Consider if any of these ideas might help you reduce the cost of no-shows to your bottom line. Reevaluate Your Appointment Slots Practices often have standard appointment slots that they haven’t reviewed in a while. We recently worked with a practice that had used only two slots for over a decade: 30 minutes for established patients and 45 minutes for new patients. When we looked at how long visits were actually taking, we found that more time was usually set aside for the visit than was necessary. Besides reducing the overall number of productive slots the practice had available, these over-long slots amplified the impact of any no-shows. Even a single no-show usually left a 45-minute hole in the middle of the schedule – ouch. By tweaking the timings just a bit (30 minutes for

By Morgan|2022-01-01T22:51:46-08:00June 11th, 2018|

Improving front desk performance

Chronic problems at the front desk are a way of life for medical practices in most specialties, and it seems there to little effort resolve these problems. The painful reality is that the demands on the front office are often unrealistic. It’s unlikely that the staff can handle a high volume of inbound phones calls at the same time they are helping patients check in and out, updating patient information, collecting patient payments, scheduling follow-up appointments, and answering patients’ myriad questions – and do it all well. No wonder a recent MGMA survey reveals that the front office has the highest rate of staff turnover in the typical medical office! Front office staff is set up to fail These tasks all demand more attention and time than your front office staff have. Since there is never enough time to give any task the attention it requires, front office staff is set up to fail. There is never enough time to get the work done and give patients the service they expect and deserve. It’s time to get realistic about front office workflow Start by understanding the distribution of tasks in the front office. Instead of front staff being generalists that all do same thing, divide the work in a way that makes each of them an expert and gives them sufficient time to manage their workload. Study the job description(s) for members of the front office team and diagnose workflow. Include the team in the process of improving the function of the front office. Compare the written job descriptions to the actual tasks and responsibilities of the position. Probe staff to get their input about workflow and what happens during the work day that makes the job difficult and demanding. Map out the current workflow, identifying bottlenecks and what causes them. Seek to divide and group tasks sensibly. For example, doesn’t it make more sense for patient inbound calls to be taken away from the front desk, so the patients can be checked in and out without interruptions that irritate patients or allow patients to slip out the door without

By Judy Capko|2022-01-01T22:51:48-08:00August 2nd, 2017|

Distrust of medical bills: another obstacle in collecting from patients

Did you happen to catch this New York Times Magazine article last month? It begins with a moving story of an uninsured patient who suffers a terrible brain hemorrhage. Thankfully, she gets timely, effective treatment -- but her condition requires many expensive services, including an air ambulance. Her bills totaled about $500,000. Although the patient had assets like a vacation home and savings, the amount she owed was greater. As the article describes the patient's profound stress in dealing with huge, unexpected bills while recovering, it seems clearly headed toward a case for single payer. However, it takes a rather astonishing twist along the way. The twist? The piece proclaims that little-known villains are secretly contributing to skyrocketing patient bills and healthcare costs: medical coders. "The guerrilla tactics of providers' coders," the article argues, involve deliberately manipulating physicians' codes -- i.e., diagnosis codes -- to create higher bills. If you are a practice manager, biller, coder, or independent physician reading this for the first time while sipping your coffee, perhaps you just spit it out in shock (like I did). Because while there may be billers and coders out there who have been urged to make up diagnoses to generate higher bills, I've never encountered one. I can only imagine "guerrilla coders" are exceedingly rare. The billers and coders we work with have enough to do just trying to get their physicians properly paid for the work that they've actually done (!). Physicians, billers, and coders have to work with the codes our entire industry uses to determine payment based on services rendered. If they aren't careful and don't check that all services are properly coded, practices (and hospitals) will receive less than payers have promised them for the work that they do. This is the problem billers and coders are trying to solve: Making sure their physicians and organizations aren't underpaid for services performed. That a trusted voice like the New York Times is promoting such a sinister impression of medical coding (among other inaccuracies in the piece) really bothered me. But something else bothered me more. Among the

By Morgan|2022-01-01T22:51:51-08:00April 24th, 2017|

When did you last review your E&M/office visit utilization? (DOWNLOAD free spreadsheet.)

Office visits represent a huge proportion of revenue for many practice types. Consistently accurate coding of office visits is important to avoid costly under-coding or inadvertently coding above the level that applies, which could lead to revenue take-backs. Since the E/M range constitutes such a huge piece of the overall reimbursement pie, payers are very concerned about accurate coding, too. That's why E/M coding can be a trigger for a payer audit if your practice's utilization appears unusual. One way to check your office visit coding patterns to see how they conform to other practices in your specialty is to compare your utilization of each code to published CMS data. If you find that your clinicians' coding diverges noticeably from national data, and the reasons aren't immediately clear, it could be time for a closer review or internal chart audit. Besides comparing against the CMS numbers, you can compare your clinicians' numbers against each other. In our consulting, we often find that physicians in the same practice will gradually skew in different directions (some coding a little higher than the average, some a little lower) over time. Sometimes, differences in utilization make perfect sense -- such as when the doctors see distinctly different patient populations. But not always. If the variances don't look logical to you, it's time to take a closer look. You may find it's time to bring in an E/M coding expert for a customized refresher course and/or chart audit. (If you need this help, we can refer you to excellent resources. Just contact us.) Getting your hands on the CMS data, then entering it into a spreadsheet, can be a bit time-consuming -- but we've taken care of some of the drudgery for you! Follow the links below to download a spreadsheet that already has the CMS data keyed, plus is set up with formulas to calculate your clinicians' or your practice's utilization of each code, and compare it with the national averages. Allergy and immunology Cardiology Dermatology Endocrinology Family practice Gastroenterology General practice General surgery Internal medicine Neurology Neurosurgery OBGYN Orthopedic surgery Otolaryngology Psychiatry Pulmonary

By Morgan|2017-03-27T08:11:52-08:00March 25th, 2017|

Avoid payment confusion while maximizing the service advantages of preventive care

When we work worth practices in adult primary care, OB/GYN, and pediatrics, we often recommend they consider proactively recalling patients for preventive visits. Because preventive visits are usually reimbursed entirely by insurance with no patient cost-sharing, helping patients stay current with preventive care can be a win-win for patients and the practice. A preventive visit recall effort can also help your practice address challenges like: Lower demand and productivity during the first quarter of the year, when patient deductibles reset Summertime revenue shortfalls because of lower visit volume Excess demand for pediatric check-ups during back-to-school and back-to-camp seasons Disengagement of patients who have lost touch with the practice and aren’t monitoring their own health Uncertainty about whether some patients are still connected to the practice Recalling patients for preventive visits allows you to better balance the demand for your clinicians’ time. If you add more preventive slots and book them during times when your practice is slower, you’ll also add predictable revenues. Your patients will benefit, too, because they’ll see their physicians when the practice is less hectic and more appointment options are available. When practices reach out to patients to book an overdue preventive visit, it’s usually a marketing effort that is well-received. Often patients hold off on booking a check-up because they are unaware that many preventive services are covered without a copay—so they’re delighted to hear that an annual physical is something that won’t cause financial pain. There is one avoidable snag in booking preventive care that often trips practices up, however, and it’s a pitfall that puts patient relationships at risk: Not all services that could be provided in a typical check-up are considered preventive from a billing perspective. That can lead to “surprise” patient costs and bills. These unexpected costs can be very upsetting. Even though the causes are usually just innocent oversights, some patients will feel they’ve been cheated or deceived. One way unexpected out-of-pocket costs occur is when a problem is discovered or revealed by the patient during a preventive visit. If the problem requires additional work or tests, that usually means an

By Morgan|2022-01-01T22:51:53-08:00January 26th, 2017|

When business problems trigger emotions, facts and data are paramount

It's a fact of medical practice management life that unilateral decisions by other organizations can show up out of the blue and negatively affect the practice business, such as when a payer changes reimbursement terms or stops paying for a code that was previously reimbursed. In situations like these, practices have no obvious short-term option but to accept the decree or perhaps vow (through gritted teeth) to drop the payer at the next opportunity. These episodes can be understandably frustrating, even downright infuriating. Sometimes, though, the emotions triggered have the potential to turn a third party's adverse decision into an even more harmful one you make yourself, if you're not careful to take a breath and evaluate all the data you can get your hands on before responding. A recent case in point: a client of ours found that Medicare had suddenly decided that a particular CPT code for administration of a biologic drug was inappropriate and could no longer be billed for that purpose; the substitute code pays only about 20% of the one the practice (and others across the country) had been using for several years. At the same time, a national health plan that is the practice's top payer announced that it will continue to pay the higher-value code, but will only permit one use per patient per day. This is a problem for the practice because the medication in question often has to be administered twice during a single treatment, and each administration requires that the medication be individually mixed and prepped. The practice has found this therapy to be increasingly important and beneficial to a growing proportion of its patients. More staff time has been allocated to it as demand for it has climbed steadily over the past few years. Because of this, these unhappy reimbursement surprises sparked a strong reaction from the physician owner and his practice manager. With respect to their national payer, they were all-but-ready to drop the plan entirely."If we can't bill twice when we administer two shots," the manager was immediately certain, "we'll lose money! We're going to have to

By Morgan|2022-01-01T22:51:55-08:00October 29th, 2016|

Deductible reset: you have choices

Q4 is here! For many practices, it's the busiest time of the year, as patients who've been timing their care to maximize the value of their insurance coverage or their tax deductions are now ready to schedule. During this period, a greater proportion of reimbursement will usually be collected from health plans, rather than patients. That means it's a good time to maximize productivity and generate revenue that can be collected more easily -- both to close the year out on a high note, and to prepare for Q1, when the pattern reverses. In January, patients are more likely to put off services if they feel they can, thanks to the double whammy of the deductible reset and holiday bills coming due. Looking out over the coming five-six months, it may seem like much is out of your control. And it's true that the hard deadline of December 31 isn't something you can change. But you do have choices to make. When you consider how you'll prepare for the deductible reset, will you fight the slowdown with marketing? Or will you plan to use the downtime in other ways? If you decide to go to combat the deductible reset slowdown with marketing, much depends on your specialty and your local market. And if you decide instead to go with the flow, you'll still need to start planning now, to be sure your opportunity isn't wasted. Either way, your first step should be a thorough analysis of how the deductible reset has affected your practice's workload in the past, and a projection for the impact in Q1 2017. Then if you're planning to try to boost volume, you'll need to consider your strategy (preventive care? elective services?). And if you want to take advantage of an anticipated slowdown, be strategic about it and plan for scheduling adjustments now. In my upcoming webinar (October 20, 10:00 Pacific), I'll delve into some of these ideas and possibilities. It's free, thanks to my generous host and sponsor, Kareo. Click this link to sign up. Look forward to your participation and questions!

By Morgan|2022-01-01T22:51:55-08:00October 2nd, 2016|

Upcoming free webinar: Choosing and Managing an Outsourced RCM Service

Considering outsourcing your medical billing? Not sure you know all you need to know to choose wisely? This upcoming free webinar will help you refine your screening strategy as you look for the perfect billing partner, and prepare to set a productive relationship. Some of the topics we'll hit on: why technology matters; what's the best type of service (small, large, local, national); what to look for in contracts; and other important decision elements. This webinar is free -- sponsored by Care360. It's happening September 20, 2016 at 9AM Pacific. To sign up,visit: http://page.care360.questdiagnostics.com/K0000GJ00Il94na0003G0P0 For more information on choosing your next (or first) medical billing service, check out my ebook "Get the Best from Your Medical Billing Service." A new edition (with 40% new content) was released just this week.

By Morgan|2016-09-09T09:06:55-08:00September 9th, 2016|

Appreciating the art of the possible

I stumbled upon this quote by Facebook CEO Mark Zuckerberg recently: I think a simple rule of business is, if you do the things that are easier first, then you can actually make a lot of progress. This makes so much sense for any enterprise. If you're stuck, try chipping away at the easiest part of a problem. It also strikes me as especially relevant to front office tasks and automation in medical practices. The need to embrace automation, to use technology better, to provide more self-service, etc., is, I think, becoming more understood in practices of all sizes. But that doesn't make the thought of these things any less daunting! Practice managers and physicians may hear "technology" and immediately think, "Oh no, not that again." Visions of EHR implementations that wreaked havoc are vivid and pretty easily recalled. It can be hard to imagine an ROI large enough to make reliving that pain seem worthwhile. But in the front office tech space, many solutions are emerging that are easy to implement -- either wholesale or in parts. And ticking off just one box at a time can give your practice business a boost, even if you're not ready to take on a full-scale automation overhaul. For example, payment portals and email statements have become much easier to implement. Many PMS vendors offer these as built-in tools. Activating these features may (literally) take only a few moments. And if even just one patient finds the convenience encourages him to pay more promptly, the effort you and your team invested will likely be repaid. One of the very best things about how technology for the front office is evolving is that there are more and more targeted solutions to specific, costly problems. You usually don't have to engage in a massive conversion to a new platform to take advantage of any one solution. Chipping away at front office inefficiencies by trying one or more new technologies is a very realistic way to tackle problems that seem very complicated and daunting when taken as a whole.

By Morgan|2022-01-01T22:51:55-08:00July 21st, 2016|

Avoiding insurance errors, problems tops the list of medical billing priorities

Capko & Morgan has had the honor of collaborating with the MedData Group on several recent MedData Point surveys. This month, we worked together on one of our favorite subjects: billing and collections. The results may reflect some subtle but interesting changes to recent trends. For the past few years, it has seemed that the dramatic increase in patient payment responsibility was the focus for most practices. According to this new survey, patient payments are still a very pressing concern for most practices (53%). But this issue was edged out for the top concern by coding errors and other denial causes, which 59% of respondents considered very pressing. We wonder if this is related to narrowing of networks, increasing pre-authorization demands from some payers (mentioned by 49% as a pressing issue), lingering ICD-10 issues, or some combination of the three. Not surprisingly, AR and bad debt are still top-of-mind medical billing problems (49%). We were a bit surprised, though, that preparing for new payment models was only a pressing concern for about a quarter (28%) of respondents. But the CMS is also projecting that most practices will hold off on alternatives to fee-for-service payment, at least for now. Only 25% of respondents put adding or enhancing billing technology on the list of key concerns. We’d love to see more practices take advantage of the growing array of innovative, affordable tools to improve collections from patients and health plans alike. These results seem consistent, though, with what we found in another recent MedData Point survey: practices may not be aware of all the new front office solutions that can make their practices more efficient and profitable. Our consulting group is delighted when we get the opportunity to help practices get more from technology, including systems they've already invested in, especially to improve billing and revenue capture. Contact us if you'd like to explore how we can help.

By Morgan|2022-01-01T22:51:55-08:00July 20th, 2016|

Copays are declining, but that’s not good news

A recent Peterson-Kaiser Health System Tracker study revealed an interesting finding: average copayments are declining. Their study, which analyzed claims data from Truven MarketScan, found that average copay amounts paid by patients decreased by 26% from 2004 to 2014. Seems like a positive trend for patients and practices ... except that it's not. It's part of a shift that's actually making out-of-pocket costs harder for patients to prepare for and understand. That makes them harder for practices to collect. The Peterson-Kaiser analysis found that while copays declined by 26%, coinsurance increased by much more, 107%.* Payers may be emphasizing coinsurance because it is assumed, like deductibles, to be a more powerful tool to discourage unnecessary utilization of services. But for patients who need care, coinsurance can be another cause of 'surprise' obligations, since it's not always easy to calculate the amounts due. Patients may also easily confuse copays -- which are standard amounts for services like office visits, prescriptions, or the ER -- with coinsurance, which can only be calculated after determining what services are needed. This difference can lead to reluctance to pay, or fear of being incorrectly charged, especially when the amounts are significant. Here's a chart from the Peterson-Kaiser report: Coincidentally, but not surprisingly, the report also found that total cost-sharing continued to rise steadily and steeply. The analysis found that total out-of-pocket costs rose 77% from 2004-2014 -- much faster than wages. Besides the 107% coinsurance increase, deductibles increased 256%(!). For practices, this means that effective patient collections continues to be crucial to profitability. Not only are patients accounting for an ever more significant proportion of earned revenue, their payment responsibility will almost certainly continue to be confusing. It's crucial to help patients understand and prepare for the amounts they will be expected to pay. Be sure you also offer options like credit-card-on-file, mobile payments, payment portal, and payment plans to encourage their compliance. *I also wonder how much of the decline in copayments is due to patients using more preventive services, which carry no copay by law under the ACA. This could bring the average

By Morgan|2022-01-01T22:51:55-08:00July 10th, 2016|

The legal risks of waiving copays are very, very real

Effectively collecting copays (or coinsurance for procedures) has become much more important in recent years. One reason is that they've become a bigger proportion of total reimbursement. Once just a token $5 or $10 payment, office visit copays have increased to $30, $40, or even $60 in many cases. They now often account for a third or more of the revenue your practice can receive for these services. Not collecting them reliably is a threat to your profitability. Besides ensuring full reimbursement, there's another, equally compelling reason for your practice to master time-of-service copay collections: Your payer contracts almost certainly require it. If you've been in the habit of waiving copays or billing for them, you are probably violating these agreements. Health plans view copays differently than you probably do. Copays are not just a way to reduce their portion of your fees; they're designed to discourage patients from receiving services they don't need. Copays are supposed to help keep patients on the side of the payer in the battle to reduce costs. That's why your contracts will usually state that you agree to collect them, and often further state you should do so at the time of service. (Some waivers may be allowable, but only when certain hardship conditions are verified.) Contracts also often contain language about the plan being entitled to the same discounts you give other parties -- so that if you give the patient a discount by waiving any amount they owe, you need to give the plan the same discount. (This might mean you owe the plan 100% off if you waived a patient's full copay!) For these reasons, routinely waiving copays can lead to serious problems in the event your practice is audited. If your practice frequently waives these payments -- or if some of your clinicians choose to -- it's important to get everyone up to speed on why you need to collect as you've agreed to in your contracts. I've written quite a few papers recently on front office technology that can help you collect more easily and reliably, while keeping the focus

By Morgan|2022-01-01T22:51:56-08:00April 29th, 2016|

Deductible reset blues? We’ve got a few medicines for you to try.

Ahhh, January. We're already six days in, and it's still hard to believe we're a week into a brand new year. Perhaps especially so if low volume has you moving through your days more slowly -- and worrying about what your revenue numbers will be at month- and quarter-end. The January effect on medical practices can be a source of stress, but it's not too late to do something about it if you're worried about lower revenue in the first part of the year. In fact, with patients changing up plans and making health-related resolutions, the beginning of the year can offer opportunities for growth, even if the patient financial responsibility features of modern health plans are working against you. Join me for a fun, fast-paced webinar on January 14 to learn a few tricks to help you improve your volume at the start of 2016. Even if you've been caught off-guard and unprepared, there's still a lot you can do -- and the ideas I'll share are both easy and mostly free. To sign up (for free!), visit this link at our sponsor Kareo's website.

By Morgan|2016-03-04T11:25:21-08:00January 7th, 2016|

Ready for the deductible re-set?

It's almost that time again: deductibles re-set in less than a month. Got your game face on? For many practices, the end of the year is so busy, it's hard to think about planning for slow business in January, February and March. Ironically, the cause of the busyness in Q4 is related to the cause of slower demand in January: deductibles. At year end, patients are eager to bring any known problems or elective procedures in to practices, because their deductibles have been met or nearly so; in January, many patients delay care because their deductibles re-set to their original amounts (or even higher amounts in many cases). It may also seem like there's little you can do to deal with the deductible re-set. But you do have options, and making even a small dent in the downturn can make a big difference in overall profitability. So isn't it worth trying? If you're in a pediatrics, adult primary care, or OB/GYN practice, of course one of the best steps you can take to smooth your revenue is to let patients know you have availability for preventive services in the beginning of the year. Let them know that your practice may be less crowded (barring, of course, a wave of flu or another virus coming through your neck of the woods). Make sure patients are aware that preventive services usually come with no copayment or deductible. (It can be helpful to create a list of common tests and vaccines that are preventive per the USPSTF, to avoid confusion.) Here's where your EHR can shine: use list-generating capabilities to identify patients that are due for preventive services, or who have chronic conditions are overdue for a regular visit. For example, it's usually easy to isolate healthy patients you rarely see that are overdue for pap smears, hepatitis screening or check-ups. Tapping your system a little more creatively, you can identify patients that have just crossed a threshold to qualifying for a preventive service such as herpes zoster, pneumococcal pneumonia vaccine or cancer screening. Patients that turned 65 in 2015 may also be identified and offered an

By Morgan|2022-01-01T22:51:58-08:00December 8th, 2015|

Obsessing about front office technology

Anyone who encourages me knows they'll get an earful about front office technology tools -- they've become a passion of mine. I'm referring to things like: Patient responsibility payment estimators (e.g., Wellero, Navicure, Zirmed) Check-in tablets and kiosks (e.g., Phreesia) Online patient payment tools like portals and pre-payment sites (e.g., SpendWell) Patient payment apps (e.g., Wellero) Online scheduling (e.g., Zocdoc, DoctorBase, EHR portals in some cases) Basically, I'm talking about add-on tools that work mainly with practice management systems and/or on the Internet to improve your practice's likelihood of getting paid by patients, reduce steps in front office workflow, and even make patients happier in the process. I am a big fan of these kinds of tools, for all kinds of reasons. One is that they're unshackled from the government's goals for EHR -- they basically live only to serve practices and patients -- and I think that's what makes this segment of the market so much dynamic than the EHR segment. The players have competition, and it drives them to innovate more; you see these vendors experimenting with many different ways (and platforms) to solve these problems. And these tools really make a difference in the workflow and collection rates of the practices that embrace them. I recently wrote a white paper that delves into the important role technology can play -- and is starting to play -- in front office operations. It's called "Technology to the Rescue: Putting the Flow Back into Front Office Workflow." Wellero sponsored it, and you can download it free on their site. I hope you'll check it out -- and get in touch if you'd like to talk about any of the ideas in it.

By Morgan|2022-01-01T22:51:58-08:00November 3rd, 2015|

How empowered is your medical billing service?

Outsourcing your medical billing to a billing service has the power to make your practice much easier to manage. It can also increase your profitability. But as the world of reimbursement continues to evolve, it's important to stay involved with the process. If you've adopted a "that's off my plate now" approach to using a medical billing service, it's possible your service is too empowered. A properly utilized medical billing service will be an extension of your team. Your office staff must work well with them in order to maximize the benefit you gain from outsourcing. When everything billing-related is dropped into the billing service's lap, it's impossible for them to do their best work for you. And they may feel compelled to make decisions for you that they really shouldn't be taking on unilaterally. Here are a few examples we've seen over the past few years of billing services believing it was left up to them to make key decisions on behalf of practice clients -- leading to sub-optimal decisions as a result: A billing service for a primary care/infectious disease practice with predominantly older patients with multiple chronic conditions received documentation about the chronic care management (CCM) reimbursement opportunity from the CMS (i.e., code 99490). But the billing service already had trouble getting properly prepared claims and sufficient documentation from providers, even for office visits. Plus, the practice manager was inexperienced with billing, and typically deflected the service's questions with "you decide - that's your job." The service owner decided for the practice that pursuing CCM "wasn't worthwhile." She felt that the providers wouldn't have been willing to do additional documentation. The physician owner was unaware that the practice was likely leaving at least $120,000 of revenue on the table in 2015 -- revenue which could have helped the practice repair its difficult financial position; A pediatric practice assumed its billing service would "handle" all payer contracts. The billing service thought "handling" them meant simply dealing with information requests from payers, and alerting the practice when something needed to be done -- they certainly didn't expect to be negotiating new contracts, since that was far

By Morgan|2022-01-01T22:51:59-08:00October 11th, 2015|

Choose the right billing service, get more than professional billing

Choosing a new medical billing service is stressful. Few activities have more of an impact on practice profitability, after all. But with the risks of choosing comes upside, too -- and not just in the opportunity to have your billing handled by dedicated professionals. Switching to a third party billing service (or a new service) offers an opportunity to upgrade your technology at the same time. By making the platform(s) your new biller uses part of your evaluation, you can improve other parts of your practice business besides billing itself. Today's billing technology has continuously improved in recent years. Competition has spurred innovation and a wealth of new features. The cloud platform, especially, allows these vendors to roll out upgrades more cheaply and easily (and make them mostly painless for customers, too). Billing services that use the most up-to-date billing platforms can offer these advantages to their clients as part of the service. When you use a practice management system as part of your billing service relationship, that usually provides you with scheduling, reporting, reminders, verification, and other tools automatically. A more flexible, modern scheduling system can help you maximize provider productivity and reduce costly no-shows. Better reporting allows you to easily analyze the value of your contracted health plans. Verification tools built right into a practice management system save staff time and reduce costly booking mistakes. These are just a few of the benefits you can get by making top-tier billing/PMS technology a requirement of any new billing service you're considering. Of course, you don't necessarily even have to switch services to switch up technology -- if you made a good choice of partner in the first place, that partner will work with you to make a transition if you need to. (A small, independent billing shop -- even a one-person shop -- can be a wonderful solution for your practice, but it is very important that they commit to keeping up with technology trends and opportunities. In fact, great technology is one of the best tools independent billers can use to shine, by allowing them to focus on

By Morgan|2022-01-01T22:51:59-08:00August 10th, 2015|

Are you getting the best from your medical billing service?

I'll be presenting a free webinar on Thursday, July 16, with tips and strategies for managing your medical billing service. If you're thinking of outsourcing your billing, or if you already outsource it and aren't sure you're getting everything you hoped for from the relationship, this webinar is for you. This is part two of a serious of shorter, more digestible webinars on choosing and managing a billing service, sponsored by Quest Care360. I'm excited about this shorter, 30 minute format, because it's easier to attend during a lunch or coffee break (while still having time to grab a sandwich!). No fluff, just the information you need. As you may know, I wrote an ebook on this subject called "Get the Best From Your Medical Billing Service," and this webinar draws from it, as well as from recent experiences with real clients using outsourced medical billing to run their practices. I hope you'll join us!

By Morgan|2022-01-01T22:51:59-08:00July 14th, 2015|

Upcoming free 30-minute webinar on choosing a billing service

If you've been thinking about outsourcing your medical billing -- or switching medical billing services -- my upcoming 30-minute webinar can help. "Eight Questions to Ask When Evaluating Medical Billing Services" will be presented on June 25 at 10AM Pacific/1PM Eastern. If you've been wondering how to quiz your billing service options -- or just want to be sure you haven't left something out -- this short webinar will help you get ready for the evaluation process. This mini-webinar is part of a two-webinar series. (The second in the series, "Best Practices in Managing Your Third Party Billing Service," will be presented July 16.) This mini-webinar is free! And in addition to arming you with eight useful questions to ask prospective medical billing services for your practice, there will be time at the end of the webinar for your own questions to me about the process of screening and hiring a revenue cycle management partner. To sign up, visit this page -- hosted by our sponsor, Quest Care360.

By Morgan|2016-03-04T11:28:26-08:00June 21st, 2015|

The worst thing that can happen when patient deductibles aren’t well managed

What's the worst thing that can happen when you staff aren't trained to manage patient deductibles and collect up front? It's not that you won't ultimately get paid. There is something worse that can happen, and it's not that uncommon: your practice can end up losing the revenue for the service and losing the patient. Here's how it can happen. An ill patient comes in for a service and doesn't realize she's financially responsible for the entire cost. No one who interacts with the patient ahead of the service -- not the scheduler, not the person who calls her to remind her -- lets her know she'll be financial responsible, or estimates her costs. The patient arrives, hopeful she'll be paying just a copayment. And the front desk makes her day by charging only a copayment! "You might have a balance, we're not sure. Don't worry. We'll bill you," the receptionist assures her cheerfully. The patient relaxes. But when the patient receives the bill -- six weeks after that service she really needed -- she's shocked to find out that she owes hundreds of dollars more. Her insurance didn't cover any of her visit or her tests, because she has a $3,000 deductible to meet first. By now, though, this patient needs another visit for follow-up care. She calls to schedule the appointment. "WARNING: PAST DUE" pops up on the scheduler's screen. "Oh! I need to alert you that you'll be expected to pay your past due balance in full when you come in for your visit," the scheduler reminds the patient seriously. The patient is embarrassed -- and worried that she can't pay that full amount at her next visit. She needs the care, but, on the day of her appointment, she thinks about the prospect of being confronted at the front desk for an amount she can't pay in one lump sum -- and about the fact that she'll be adding to the balance due. She weighs her options -- and no-shows on her appointment. She needs to be seen, but the embarrassment outweighs that need in that

By Morgan|2022-01-01T22:51:59-08:00June 14th, 2015|

Thinking of outsourcing your billing? Or choosing a new service? Mini-webinar for you

If you've been thinking about outsourcing your medical billing -- or switching medical billing services -- my upcoming mini-webinar can help. "Eight Questions to Ask When Evaluating Medical Billing Services" will be presented on June 25 at 10AM Pacific/1PM Eastern, and will last about 30 minutes -- a quick hit of knowledge and you'll be on your way. This mini-webinar is part of a two-webinar series. (The second in the series, "Best Practices in Managing Your Third Party Billing Service," will be presented July 16.) This mini-webinar is free! And in addition to arming you with eight pointed questions to help you evaluate prospective medical billing services for your practice, there will be ample time at the end of the webinar for you to ask me your questions about the process of screening and hiring a revenue cycle management partner. To sign up, visit this page -- hosted by our sponsor, Quest Care360.

By Morgan|2015-06-13T10:47:48-08:00June 14th, 2015|