lost revenue

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 |2022-01-01T22:51:46-08:00July 21st, 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 |2022-01-01T22:51:46-08:00June 11th, 2018|

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 |2022-01-01T22:51:55-08:00July 20th, 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 |2016-03-04T11:25:21-08:00January 7th, 2016|

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 |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 |2022-01-01T22:51:59-08:00October 11th, 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 |2022-01-01T22:51:59-08:00June 14th, 2015|

New technology and services can help you get paid (really!)

It’s no secret that physician practices are challenged more than ever to get paid in full for the services they render. Deductibles keep getting higher – and more patients are facing them. What's more, new research from the Kaiser Family Foundation shows that only about half of insured American families have sufficient resources available to meet a $2,500 deductible with cash. Beyond the financial strain of higher deductibles, there is the ongoing confusion about how they work – confusion that stubbornly persists, even though these types of plans have become more typical. And what happens when people receive bills that confuse them – or are unexpected? Naturally, there’s a good chance the bill could be incorrect – which in turn may make them much less likely to pay it. What does it all mean for medical practices? Above all, it’s important to help patients understand their health plans, and to make it easy for patients to pay. These tasks have not proven to be easy, but help is on the way from a source you might not instinctively rely on: technology. There is such an evident need for tools to help both consumers and healthcare organizations wrestle the confusion created by health plan complexity, technology vendors have been innovating at a furious pace to create solutions – and many of the things they’ve come up with are very promising. Now … I hope none of you stopped reading because I used the dreaded “T” word! For some of you, the upheaval of EMR conversion is still top-of-mind. If that’s your situation, it may be hard to imagine technology as a true friend of the medical practice. But there are some key differences in this new wave of healthcare technology, including: It’s driven by patient needs and practice needs – not a federal mandate. These companies must perform to earn your business! There’s no MU payment to hide behind; New technologies are easier to implement – some are simply apps and websites your patients can use for payment. These familiar interfaces will attract patients and make it easier for them to

By |2022-01-01T22:52:00-08:00June 5th, 2015|

Patient receivables blues? Master time-of-service collections. Join my free webinar

The portion of your revenue that must come from patient collections has skyrocketed.  If you haven't mastered patient collections, you risk losing more of your practice's earned revenue than ever before.  But -- on the plus side -- there are more new ways to tackle this problem than ever before. I've got a new, free webinar on June 9 that shares some of the ways you can collect more while actually improving your patient relationships.  To sign up, just visit this link: https://attendee.gotowebinar.com/register/351571408146784258 We'll have time for questions, and you'll even get to learn about some exciting new technologies.  I hope you can join us!

By |2016-03-04T11:31:17-08:00May 22nd, 2015|

Improve patient collections for immediate bottom-line improvement

The portion of your revenue that must come from patient collections has dramatically increased over the past decade. And higher copays and deductibles aren’t going away – in fact, they’re becoming the standard. A recent Kaiser Family Foundation study determined that average deductibles for patients on employer-sponsored plans have more than doubled, and now average more $1,200 per year. Collecting effectively from patients has gotten harder, and not doing it well has gotten more costly. That’s the bad news. But there’s good news, too! Best patient collection practices are emerging – and technology vendors are stepping up their game, too.  And when  you collect more effectively from patients, you can simultaneously improve your bottom line (without adding more patients or visits!) and even solidify your patient relationships. I've got a new, free webinar on June 9 that shares some of the ways you can collect more while actually improving your patient relationships.  To sign up, just visit this link: https://attendee.gotowebinar.com/register/351571408146784258 We'll have time for questions, and you'll even get to learn about some exciting new technologies.  I hope you can join us!

By |2016-03-04T11:32:21-08:00May 7th, 2015|

Maintaining medical practice cash flow in Q1

As we've posted here before, almost all practices face the risk of a cash flow crunch in January and, really, through all of Q1, thanks to the deductible reset.  (January's revenue collections are sometimes also hit lower volume in December because of the holidays -- a double whammy.) In our experience, the decline in revenue can be anywhere from 10-20% for primary care practices (pediatrics and family medicine typically get a little 'help' maintaining Q1 volume from winter viruses) to more precipitous drops for surgical specialties (especially when there's little downside to patients for delaying surgery). The most important step practices can take to cope with the drop-off is to plan -- now that it's February, well, it's a little late for planning for Q12015, but if you're suffering from shrunken revenues that you didn't expect, mark your calendar now to start planning for Q1 of 2016 at the end of this summer.  With enough notice you can plan to set aside cash reserves so that you don't need to tap lines of credit, cut expenses or delay needed purchases when the squeeze hits.  You can also make sure you're ready to take advantage of the upside of the deductible reset: patients will be anxious to schedule procedures in Q4, after they've met (or come close to meeting) their deductible.  Alert staff that vacation time will be limited in the fall quarter -- perhaps even offer staff extra time off in January.  And, above all, start marketing procedures and mining your EHR for patients who may have wanted and needed a procedure, but put it off for financial reasons. Even though we're now in the thick of crunch time, there are still a few steps you can take to nudge the cash flow back up. If your practice's bread and butter is high-fee procedures,  look into financing options and review your financial policies.  If you're able to offer payment plans, that can take the sting out of patient responsibility payments.  Technology solutions that can help you offer payment plans that comply with HIPAA and other security requirements are more readily

By |2022-01-01T22:52:01-08:00February 10th, 2015|

Preventive services can be the antidote to the deductible reset

The deductible reset is looming in January, and it's poised to wreak its usual havoc with cash flow. Cash-flow impact could easily be even worse this year, given that deductibles have likely increased and become more of a problem for many of your patients. Naturally, alerting patients to the possibility that they will be responsible for a significant portion or even all of their service costs at the time of booking is a necessary first step -- as is ensuring that front desk staff are trained on taking payments at the time of service. But, if you are a primary care practice or other specialty that offers preventive services, there's one more thing you can do to protect your cash flow: you can identify patients who are due or overdue for preventive services, and encourage them to book during Q1. Because services identified as preventive by the Affordable Care Act almost always* carry no patient financial responsibility (not even copay), patients may be more eager to use these services -- especially if they've recently started paying for coverage and haven't perceived much value for their premiums. Annual/scheduled preventive care can be a win-win for patients and practices. The revenue is often higher than a standard office visit, and it's usually reimbursed promptly. Reaching out to patients to remind them about preventive care is a way to communicate that you care about them. And, you'll be giving them good news about their health plans -- some patients may not realize that they can get a preventive service such as an annual well-adult exam, screening colonoscopy or mammogram without cost-sharing. One caveat: be sure that patients understand that some lab tests your physicians may want to utilize may not be covered. Patients also need to know they'll be responsible for their normal portion of costs if a visit scheduled as 'preventive' actually turns out to be a problem-oriented visit. And it's always a good idea to remind them that these payment terms are part of their health plan and the ACA -- not the whims of your practice. *grandfathered plans may be

By |2022-01-01T22:52:02-08:00January 3rd, 2015|

If you missed Laurie’s webinar, “Front Desk Collections: the New Linchpin of Profitability,” here’s how to watch it now

If you missed Laurie's webinar, "Front Desk Collections: the New Linchpin of Profitability" (sponsored by Wellero) -- one of her most popular webinars ever! -- you're still in luck.  Sign up here and watch it whenever you like. This practical presentation hits on some ways you can immediately increase profitability while avoiding pitfalls that can erode your practice's financial health. Take a look (it's free to sign up), and, if you have questions or comments after watching, please don't hesitate to contact Laurie. [yks-mailchimp-list id="87d94b707e" submit_text="Submit"]

By |2022-01-01T22:52:03-08:00October 27th, 2014|

“We are not a bank” — Lessons from CNBC’s “The Profit”

I just got around to watching the episode of  The Profit focused on A.Stein Meats. Now, you may be wondering why on earth I'd be posting about a meat business here -- what could that have to do with medical practice management?  Well, The Profit deals with a variety of small businesses, and there are often take-aways that apply to almost any business, but the A.Stein Meats episode really hit some notes that are so important for managing the business side of a physician practice -- especially the under-appreciated perils of poor management of accounts receivable. When Marcus Lemonis arrives at A.Stein Meats, he learns that the 75-year-old company is losing $400,000 per year -- despite $50MM in annual revenue.  He's initially confused about how the company's expenses could be exceeding their revenues.  But he soon figures out that the biggest missing piece lies in the back office: accounts receivable.  The office manager -- who nominated the business for the show -- reveals that the receivables are more than $4MM.  And Lemonis quickly notes, many are so old, they'll likely never be collected.  The owners, meanwhile, seem almost unaware of why they should be concerned about accumulating A/R -- after all, they're just trying to "work with" customers, many of whom are "friends." But, as the old saying goes, with friends like that, who needs enemies? The business's inattention to collecting the money they're owed was putting their solvency at risk; revenue is almost irrelevant if it isn't realized as cash coming into the business promptly.  Moreover, the business was essentially financing its customers -- without getting paid to do so.  Lemonis stated clearly, "we are not a bank" -- the same message we give our medical practice clients when they're too quick to say, "sure, we'll bill you" instead of asking patients for a credit card at the time of service, or a credit card on-file for procedures that need to be paid for over time. Medical practices are perhaps a bit luckier than a business like A.Stein Meats in that insurance payments still usually provide the biggest portion

By |2022-01-01T22:52:08-08:00March 31st, 2014|

Free promotion from Amazon: Laurie’s new medical billing service ebook

Laurie Morgan's just-published ebook -- Get the Best From Your Medical Billing Service (Management Rx) -- will be available *free* on Amazon.com from October 25 - October 29. If you're using or considering using a medical billing service, this detailed, 15-page guide is for you.  Learn tips for screening services, managing the relationship, and evaluating billing service performance. The regular price is just $6.88, but why not get it for free during the promotion?  (In exchange, it would be a nice gesture to share a rating/review of the book.)  Mark your calendar! The book is published in Kindle format -- easy to read not just on Kindle devices, but on any smartphone, PC, iPad or other tablet using the free Kindle software. (Incidentally, if you are a Prime member of Amazon, you can borrow the book for free at any time -- not just during the promotional period.  Use this link if you'd like to sign up for a free trial of  Amazon Prime.)

By |2022-01-01T22:52:13-08:00October 19th, 2013|

Still not collecting at time of service? New AMA data shows what it can cost your practice

The AMA's National Health Insurer Report Card (NHIRC) for 2013 was released today.  In addition to illuminating data comparing the burdens/benefits of doing business with eight major US health plans, the report added a new metric that caught our attention: patient responsibility as percentage of allowed amount.  Among the eight major insurers studied, patient responsibility was more than 20% of the allowed amount for all but one.  Even Medicare now comes in at about 25% -- as shown on the NHIRC chart below: If you needed another reminder that your collections process is critical to your practice's profitability -- and getting more so every year -- here it is!  Patient responsibility payments are here to stay.  If your revenue cycle management processes don't include effective time-of-service collections, now's the time for improvement.  (And if you don't know where to start, we can help -- contact us for more information about consulting services.)  

By |2022-01-01T22:52:31-08:00June 19th, 2013|

Choosing and managing a billing service

Hiring an external billing service can be a huge source of relief, especially for smaller practices that worry they won't be able to keep up with staff training needs on technology and coding (e.g., ICD-10).  But, too many practices we work with tend to "forget about" billing once they have hired a service -- thinking that it's "no longer our problem."  This usually means that the practice will derive much less benefit from the service than they could have. There are many straightforward things you can do to manage your billing service to achieve a positive and productive relationship -- it's not hard to do it right, and both your biller and your team will benefit.  I've shared some of Capko & Company's ideas for managing the billing service relationship for maximum value in a new paper, "Getting the Most From Your Medical Billing Service," available on the Medical Product Guide (it's free, but you have to register).

By |2016-03-04T12:06:35-08:00May 30th, 2013|

When it comes to no-shows, think like an economist

As medical practice management consultants, we're naturally always looking for 'best practices' we can share with all of our clients.  There is often a rub, though: what's 'best' for one practice (or one practice type) may not be right for everyone.  When it comes to the best way to solve practice management problems, sometimes the only correct answer, as economists like to say, is 'it depends.' No-shows -- how to deal with them, how to minimize them -- are a great example of this sort of problem.  I've been participating in a lively discussion on the subject on LinkedIn in the medical office managers group.  The discussion was kicked off via a link to an article that seemed to have the definitive list of to-dos (and not-to-dos) to maximize show-rate -- except that the comments from participants in the group suggested it wasn't so simple. Example: "don't use postcards as reminders -- they're a waste of money and don't improve show rates."  But, the data cited in the article pertained only to a residency-based  family practice, and the study didn't provide any information about the wording of the reminders.  But, other studies that weren't restricted to academic family practices showed otherwise, although the relative benefits of postcards versus other reminder methods were less clear.  And other data show that multiple reminder types used together -- a combination of postal and SMS text, for example -- might deliver still better results. Given the lack of clear data on an issue like no-shows, you may need to try different approaches and aim to continuously improve your practice's performance.  The answer to the problem of the right mix of reminders for your practice is likely to be "it depends" ... but, on what?  The good news is, you can think through some of the possible factors that will influence reminder success pretty readily, since you already know a lot about your patient base. For example, you know something about the age of your patients.  A practice with mostly older patients -- say, cardiology -- might find that postcards are still among the best

By |2022-01-01T22:52:32-08:00April 18th, 2013|

13 for 2013 Tip #2: Analyze your E&M code utilization

For most practices, E&M codes represent a significant portion of billings -- and, for some practice types like pediatrics and other primary care, E&M codes can approach 100% of billings.  Physicians and non-physician providers are often so sensitive to the risk of down-coding, denial or audit that they develop a bad habit of 'defensive' E&M coding -- i.e., sticking to the lower range of the codes for virtually every patient.  Far from being an effective defense, though, this type of habitual coding may actually create more audit risk, since it leads to a distribution of codes that is skewed rather than the expected bell-shaped curve.  And, it does so while also leaving thousands of the practice's dollars on the table! The end of one year and the beginning of another is the perfect time to analyze your practices E&M coding patterns -- and set new habits for the new year.  Run a report for each physician by code for the full year, and you can create a table like this that totals how many times each provider used each code: code 99201 code 99202 code 99203 code 99204 code 99205 Total Anderson 12 252 900 12 24 1200 Buford 0 132 996 348 0 1476 Cochrane 12 996 96 0 0 1104 Delaney 0 36 732 432 120 1320 Elliott 12 48 1092 156 24 1332 From this data, you can easily calculate percentage utilizations to get a clearer idea of distribution -- and from there create a chart to spotlight any skewed coding: E&M Distribution Chart E&M Distribution Chart Notice the skewed utilizations of Cochrane, Anderson and Elliott?  It's unlikely these codes are accurate -- especially Cochrane, who appears to be habitually and defensively under-coding.  (Note, also, the addition of the CMS averages to the chart -- available from the CMS website.  This is a great double-check to see the typical coding mix based on all practices billing Medicare -- and to get a sense if your coding patterns will look odd (or audit-worthy) to the CMS.) Next step: identify the number of instances of

By |2022-01-01T22:52:37-08:00January 8th, 2013|

Scheduling for Profitability and Patient Satisfaction

Many practices fail to appreciate how critical a role scheduling has in a practice's profits and the way patients perceive care.  As an example, consider how an ineffective reminder system can cause a cascade of ill consequences for your practice: the patient forgets their appointment -- the provider sits unproductive -- patients can't get into see their "fully-booked" provider.  Both practice profitability and patient care are compromised. To avoid these scheduling problems, it's important to periodically review your scheduling operation from a patient's perspective. For each step make sure you have a comprehensive understanding of the full range of outcomes. Do you know, for example, what happens when your reminder system fails to deliver to a patient?  Is someone on your staff charged with following up? Do you effectively track "no-shows?" Do you have goals for reducing them? Whether you conduct a review of your scheduling procedures using an outside consultant or your own staff, you may be surprised to see a boost in morale because scheduling staff have a tough job and are rarely consulted by management. Understanding the challenges that your scheduling staff face and their ideas for improving processes are great first steps toward increasing your practice's finances and improving the mood of patients and staff alike.

By |2022-01-01T22:52:38-08:00October 25th, 2012|

Inspiration from small businesses

I recently completed a series of articles for Kareo's Getting Paid blog about how small business management issues relate to practice management.  While medical practices have an important mission that reaches beyond business, they can't achieve that mission without succeeding on business terms.  And, in many fundamental ways, medical practices are not so different from other kinds of small businesses.  There's a lot to be learned from examining the success factors that apply to seemingly-unrelated businesses.  Plus, it's kind of interesting and fun to think about other businesses in the 'real world' and how they deal with their challenges -- almost like looking at your own organization through a different lens. If you're interested in checking out the Small Business Lessons for Physician Practices series, here are the links: Small Business Lessons for Practices: Human Resources Getting Started with Marketing Financial Basics Operations Management for Physician Practices

By |2022-01-01T22:52:40-08:00January 9th, 2012|

Why aren’t more physicians wealthy?

Michael Zhuang, an investment advisor with a focus on physicians, offered an interesting point of view in a recent post on Physicians Practice.  He observed that doctors often fail to accumulate significant wealth in large part because they place too much emphasis on living a "doctor-appropriate" (i.e., fancy) lifestyle, they're so busy they don't have much time to focus on finances, and they tend to believe they can "do it all themselves."  His recommendations include living within (or below) your means, dedicating time to financial planning, hiring a qualified financial advisor (he promises to provide some tips for doing so in his follow-up post) and focusing on what you do best (i.e., delegating non-revenue activities). We have a few things to add to his list, based on our work with small- and medium-sized practices: Fund your retirement first. Employee physicians usually have 401(k) plans so they can start the habit of "paying yourself first" for retirement.  Practice owners are often challenged to develop these habits, first because their early years of investing in their practices may not permit much savings, and then because any retirement plan would require a bit of effort on their part to research and establish.  Once you're earning income from your practice, don't let inertia prevent you from setting up an SEP (or other qualified plan), and funding it on a regular basis -- think of it as a regular bill that must be paid. Save your savings. Implemented a process improvement that increased profitability? (Say, for example, something you learned by engaging consultants for a practice review, or CPAs for a financial audit.) Much like salaried employees are advised to put their raises into savings automatically (so they don't adjust to the higher take-home pay by spending more), doctors can turn gains from improving their practices into investments for the future.  (If your practice needs the funds reinvested for growth -- say, into marketing or an EHR -- then those needs might come first.  The point is just to avoid the pitfall of spending at a higher level if your income moves up a stable

By |2022-01-01T22:52:42-08:00August 29th, 2011|

Where Accounts Receivable Headaches Begin

Collection problems don't begin with a rejected insurance claim or a patient's failure to make prompt payment.  The headache of managing the accounts receivable starts with  the patient registration form - data collection. It' s the  receptionists and schedulers failure to  gather sufficient  and accurate financial data when patients first contact the office. Why does this occur?  It happens because we fail to train the receptionists and schedulers on billing matters. They need to view the patient registration form and the insurance cards as financial documents - much like a credit application.   Spend more time on the upfront training with these staff members and educate them about the consequences of poor data collection: rejected claims, delayed payments and an inability to collect the patient's portion of the bill after the fact.  Set up accountability standards for data collection. Establish a reporting mechanism that tracks the reason for rejected claims.  Start looking over this information to identify the most common errors that cause claims to be rejected.  Then train staff  on better data collection techniques to overcome these problems and show them their progress each month.   The staff of good intentions. In reality the scheduling and reception staff have good intentions, but if you don't train them and help them understand the details essential to collecting accurate demographic and insurance data, then you are a part of the problem.   Help staff's good intentions turn into better performance. You will  improve revenue and save time! Capko & Company, experts in medical practice management and marketing. 

By |2022-01-01T22:52:55-08:00April 22nd, 2011|

Practice management tips to stop the shrinking reimbursement

 Know how much  it really cost you to see a patient. Divide your annual operating costs  plus the physicians wages by the number of patients you see each year. That's the number you need to know. Analyze payer performance.  Look at your top 10 CPT codes and how the  five  highest volume payers are reimbursing for those codes.  It the average on those top 10 codes does pay above the cost to see a patient you need to negotiate a better deal or drop the contract and see patients out of network. Develop strong relationships with  payers: Y our provider relations person can  help you get to the go to person for negotiating a contract that works.   Understand what a payer wants from you - Better access, getting patients better quicker and patient satisfaction! Capko & Company - We are on your side  and will help your medical practice shine!  

By |2022-01-01T22:52:55-08:00April 11th, 2011|

Stop Wasting Energy & Money

Medical practice revenue is tighter than ever. It's time for you to take critical steps to keep costs under control and improve profits. The first step to fixing the bottom line is to look for the waste. Wasted energy results in a loss of potential revenue and lots of frustration.  There is waste throughout the typical practice, but most of it is silent and doesn't get the attention it should.  Here's some common threads we see in your world: A lack of clearly defined job responsibilities that result in duplication of effort. Accepting poor performance and inferior outcomes Mistakes that one person makes and another one corrects because it seems faster or easier. The good news is all these things are fixable.   Make the commitment.   Look at the action that needs attention. Is it the scheduling, patient visit or billing and collections, or something else? Then  flow chart the processes involved and identify the cause for errors and inefficiency, discuss the possible solutions and pick the one that makes the most sense.  Then  [and this is important]  assign someone the responsibility to see it through, set a reasonable time-line to get each change completed and  schedule meetings to review progress along the way.  You may need to hire a consultant to get the ball rolling and develop a process improvement plan, but it will be worth the effort.  Start thinking lean and reduce the waste! Once you see improvement it's time to celebrate.  Your bottom-line will improve, staff will enjoy their work more and patients will be happier.  Sounds like a win-win-win.   So just  do it! Capko & Company, experts in practice management and markeeting - We are here to help make your practice shine. s

By |2022-01-01T22:52:56-08:00April 5th, 2011|

Fight for your money

Did you know that 30% of  the insurance claims submitted for payment of  medical services in the United States are denied and of that amount 15% are  never resubmitted?  According to Medicare, 40% of their claims denials are never resubmitted. These are daunting statistics. Experts state that 70-80% of appealed claims are eventually paid - That's a good reason to fight for your money!  It may be time for you to audit your billing practices to make sure you aren't throwing money down the drain. Prepared by The Capko Team- Our missision is to make your practice shine! Sources: Healthcare Business Advisors, LLC, Albany, NY Centers for Mediare and Medicaid Services

By |2011-03-18T14:52:21-08:00March 17th, 2011|

Rate Practice Performance

Does your practice know how well it is performing - and if not, why not?   It's important for physicians and managers to examine performance each month by looking at specific Key Performance Indicators, KPIs.  This will help you understand your position and is powerful in guiding decisions to improve performance.  Medicine is a business and it's time to take this seriously. Here are a few basic KPIs  to look at each month: Income and itemized expenses as a total percentage of income. This will tell you where the money goes.  The highest expense is likely to be staffing costs. If this shows a jump it may be due to inefficiency that results in staff working overtime or adding another staff member to support the inefficiency. Then again it might be poor morale, resulting in lower productivity. Accounts receivable.  The average A/R for physicians runs around 1.5 months of charges, if yours is more than 2 months it is important to examine billing procedures and find out what's causing the problem.  Is it becomes someone is on vacation, the computer crashed, claims rejections or a lack of attention to aged accounts?  Speaking of aged accounts if  the amount 90 days aged of more is above 18% get more assertive with collection pursuit. Productivity reports are included in the month-end management reports typically produced by the practice manager and reveals the total charges, receipts and adjustments for the practice and should also compare each physician's individual production.  Keep an eye on fluctuations that need to be explained. Sure, one docs charges will be down if on vacation or ill,  but otherwise start looking  for the cause.  If adjustments are climbing, dig to be sure staff understands legitimate insurance adjustments and fights for your money when insurance plans make errors.  Industry expert, Healthcare Business Advisors, states that 30% of claims in the US are denied and of that 15% are never resubmitted, despite the fact that 70-80% of appealed claims eventually get paid.  Be proactive and get what you deserve! Missed appointments cost the practice plenty, so track them. More than one or two a day is not okay. 

By |2011-03-08T12:36:41-08:00February 26th, 2011|

Five Steps to Improve Patient Collections

Here's how you can make patient collections better in 2011: Do your homework upfront. Research patient balances before the patient arrives for his or her appointment and know what the patient owes. Then you are prepared to ask for payment at the time of visit.  This is when the patient is the most motivated and when you will get the best result! Establish consistent financial policies. Clarify your expectations of staff and patients. This means the stakeholders agree on the policies and establish methods to support and enforce the policies. Provide tools and training.  Part of supporting those policies is providing staff with the tools and training essential to do the job right. The billing department can train reception and scheduling staff on how to review and understand a patient's account. Management can have in-services and role play to give staff the right words and confidence to ask for payment. Define responsibilities.  If you want a committed staff that gets results it is important to clarify the processes involved in collections.  Determine which staff members will perform those tasks. This includes who does what before the visit, at the time of the visit and following the visit. Establish and meet collection goals.   Examine past performance when it comes to collecting at the time of service and set the bar higher.  If you have typically collected an average of $1,000 a day from patients that owed $2,000 you have been collecting 50%.  Why not set the goal 10% higher each month until you reach 80 or 90%?  Then when you reach the goal thank your staff and celebrate your success.  Capko and Company is one of America's leading health care management and marketing consulting firms.   We are here to serve you.

By |2022-01-01T22:52:57-08:00November 30th, 2010|

The Lunch Hour Debacle

If you shut down the phones during the lunch hour you are on the fast track to losing potential new patients and aggravating existing ones. It also results in greater phone traffic when the lines open up again, resulting in chaos.Other service industries would never dream of closing down their phones at lunch. Why? Because being available opens the door to serve their customers better and to gain new business. If you lose 2 new patients a week it could cost you more than $36,000 in lost revenue a year. Employees can stagger their lunches to give you telephone coverage. So stop the lunch hour debacle!Judy Capko is one of America's leading practice management and marketing consultants and author of the runaway top-selling book Secrets of the Best-Run Practices now in its second edition. Check it out by clicking on the book icon at www.capko.com

By |2011-03-13T12:22:56-08:00May 29th, 2010|
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