revenue, billing and collections

Webinar Tuesday (free): Patient Financial Responsibility (And How to Cope)

There's still time to sign up for my webinar "Patient Financial Responsibility: Tackling Your Practice's Biggest Profitability Problem." It's Tuesday, 6/9, at 10AM Pacific/1PM Eastern -- and it's free, thanks to our sponsors at Spendwell Health and Wellero. There will be time for questions, and the webinar will also be recorded, so you'll have the chance to view it later if you register and can't make it at the live time. Click here for details and to sign up.

By Morgan|2022-01-01T22:52:00-08:00June 7th, 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 Morgan|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 Morgan|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 Morgan|2016-03-04T11:32:21-08:00May 7th, 2015|

Small can be strong when negotiating with a payer

Many physicians we work with face the tough decision of whether to keep their practices independent or join a larger organization. Oftentimes, physicians and practice managers believe they must consider such a move to "gain a larger footprint" for negotiations with payers. The advantages of larger groups in payer contract negotiations versus small and solo practices are generally accepted. But should we assume larger groups automatically have an edge? Negotiating power can come from different factors. The most basic is having something the other side wants (or, ideally, needs). But it can also come from not wanting what the other side offers too much (i.e., being able to walk away). It can come from having something to offer that is better than alternatives. It can also come from the ability to be flexible. Bigger groups may give payers a convenient way to negotiate rates for a larger geographic area in one deal -- a plus the payer will appreciate. The group may be empowered to push for a higher rate for all providers in it -- and it might work. And the payer may feel it must deal with this large group, without the option to walk away, because it needs the coverage it provides. But the group will also likely be less willing to walk away in the face of a deal it perceives to be poor, because the negotiators have to represent the interests of everyone. The fact that neither side can easily walk away takes away some of the leverage that more size might otherwise provide. On the other hand, if a smaller practice has special qualities that a payer might value -- say, specialty coverage in an under-served area, or newer services that are rare in their market -- the payer might be willing to pay more, at least for certain codes, for that small practice. But that could be less likely if that small team is part of a larger group negotiating rates across multiple markets. Similarly, if a small group of physicians scores well on a health plan's internal quality measures, or if patients

By Morgan|2016-03-04T11:32:52-08:00April 16th, 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 Morgan|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 Morgan|2022-01-01T22:52:02-08:00January 3rd, 2015|

Patients are worried about high deductibles — here are some ways to respond

Even this late in the year -- when we typically assume many patients will have met their deductibles -- we are hearing from practices that some patients seem to be delaying or avoiding care because of concerns about costs. This is not limited to the ACA plans, which tend to have high deductibles, especially on the 'bronze' end. Even patients with corporate plans are now facing enough out-of-pocket responsibility that it affects their decision-making. Some patients who may have had a trivial deductible in past years now have one with real teeth-- one that is less likely to be fulfilled unless a major illness or injury happens during the year. As a result, some practices aren't seeing the expected influx of patients who want to get needed care before the end of the year -- and some physicians and practice managers are concerned about the well-being of both their patients and their practices as a result. Patient caution and awareness of cost may be a good thing in some cases (if it helps patients become more judicious about using optional services, and or encourages more engagement with providers and health plans). That's certainly one of the goals of high deductibles. But the problem is, in some cases high deductibles might also discourage patients from getting care that they really need. And, of course, it certainly doesn't help your practice to establish and maintain a relationship with patients when they're afraid to come in for a visit(!). It can be frustrating to know how to respond, since physicians and practice managers can't do anything to change the terms of the health plans their patients are on. What's more, if you've been watching this blog, you already know that it's very important to stay within the lines of your payer contracts (e.g., selective discounting or waiving of co-insurance is likely verboten). There are a few things you can do, though -- and it's a good idea to take a look at some of these things now, because the deductible reset (January 1) is right around the corner. Preventive care: If you are

By Morgan|2022-01-01T22:52:03-08:00November 14th, 2014|

You’re only one bad login away from trouble

Physicians and practice managers love using online tools to help run their practices. Whether you’re submitting payroll, doing some online banking, reconciling a credit card statement or confirming patient eligibility you’re using a connected network of devices, any of which could pose a serious threat to the well-being of your practice. While I’ve blogged here on the importance of strong and regularly changed passwords, it’s every bit as critical to be disciplined and conservative with respect to connecting to Wi-Fi networks. Every time you venture out to a hotel, conference or café you’re likely seeing a variety of Wi-Fi networks with nothing to identify them other than a short name. Should you connect to “Starbucks-FREE” Wi-Fi? The following link describes just how simple it is for a hacker to set up a simple network with the goal of stealing the passwords and data of people just like me and you. The straightforward best policy is to never connect to an unknown network (and it’s hard to “know” a network if you’re away from home and work!). For this reason, I strongly recommend using the “share internet” feature of many smartphones – typically there is a monthly cost, perhaps $15 for access, and data usage counts against your monthly phone allowance. Click to learn just how one hacker gains control over computers like yours.

By Joe Capko|2022-01-01T22:52:03-08:00October 30th, 2014|

Free stuff! Amazon promotion offering Laurie’s billing service ebook

Interested in learning how to get more from your relationship with your third party biller? Or considering hiring a medical billing service? "Get the Best From Your Medical Billing Service" is Laurie Morgan's most popular ebook -- and Amazon is offering it for free on October 29. Although the book is optimized for the Kindle platform, it's no problem if you don't have a Kindle device -- the free Kindle software allows you to read on virtually any tablet, computer or smartphone. Don't miss your chance to receive "Get the Best From Your Medical Billing Service" at no charge. Mark your calendar to download this valuable guide on October 29! (Feel free to forward this message to anyone you know who might be interested. And to stay on top of all promotions related to Laurie's Management Rx ebook line, follow her on Twitter @managementrx and Facebook.)

By Morgan|2022-01-01T22:52:03-08:00October 28th, 2014|

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

Did you miss “Front Desk Collections: the New Linchpin of Profitability?” View the recording now

If you missed Laurie's webinar, "Front Desk Collections: the New Linchpin of Profitability" last month, you can now view the recording online (free). Here's a link to the sign-up page: https://capko.com/miss-front-desk-collections-new-linchpin-profitability-watch/ Enjoy!

By Morgan|2022-01-01T22:52:03-08:00October 26th, 2014|

Front desk collections and patient-centered service

Would you believe that failure to collect consistently and adequately at the front desk can actually create a negative impression of your practice's patient service? And that skipping financial conversations to keep the focus on patient can actually backfire? Money conversations can be hard for all involved. And, when a practice staff is very focused on patient-centered service, it can seem counter-intuitive to emphasize financial details -- especially when patients are ill or injured. But, ironically, not being clear about financial terms and not collecting appropriately can actually cause your patients to feel worse about your practice than a conversation about money ever could. When you fail to collect adequately at the front desk, your patients will receive a bill -- and, if you are waiting for their insurance to pay its portion first, that bill may not even be mailed until a month or more after their visit. By that time, the patient may have forgotten all about the visit -- and never even considered they would owe a balance, especially if staff never mentioned that they would or provided an estimate. It's likely they've already allocated their monthly budget to other things. And maybe they're confused about the bill -- and now will spend time trying to figure it out, perhaps on hold with their health plan, or feeling they have to call your biller. All of this adds up to aggravation. And if they don't believe (or don't want to believe) they owe the money, they can become quite angry with your practice. Nobody likes unexpected bills. Properly estimating patient costs and alerting patients that they have financial responsibility for all or part of their service is one of the kindest things you can do for them -- and critical to maintaining a positive relationship. Learn more about front desk collections at my upcoming webinar on 9/23/14 (9AMPST/12PMEST) -- sponsored by Wellero and hosted by Physicians Practice. It's free! Register here.

By Morgan|2022-01-01T22:52:06-08:00August 26th, 2014|

Reminder: Tips for choosing and managing a medical billing service (free webinar)

Reminder: I'm presenting a free webinar this Wednesday, June 18 (10AM Pacific, 1PM Eastern) with Kareo, offering tips to maximize the benefit of outsourcing your medical billing . Whether you're already using a third party billing service or just considering switching to one, this webinar will provide you with ideas, insights and pitfalls gathered from Capko & Morgan's years of experience working with practices that have chosen the outsourcing route. PLUS, best of all, 100 lucky attendees will get a free copy of my ebook on the subject, Get the Best From Your Medical Billing Service (Management Rx). Woohoo! Hope you will join me next week! Click here for the sign-up page on Kareo.com.

By Morgan|2022-01-01T22:52:07-08:00June 16th, 2014|

Working with — or considering — a medical billing service? Here’s what you need to know.
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Working with — or considering — a medical billing service? Here’s what you need to know.

billing services, medical practice business, reimbursement, revenue, revenue cycle, revenue, billing and collections

Working with — or considering — a medical billing service? Here’s what you need to know.

If you're considering working with an outside medical billing service -- or are working with one now -- my free webinar next week with Kareo can help you get the very most from outsourcing. Using a third party medical billing service can be a great way to improve cash flow and collections, and minimize hassles for your practice -- provided you know how to choose wisely and manage the relationship. Perhaps the biggest mistake practices can make when deciding to outsource to a medical billing service is to lose focus and interest in the billing process -- making sure your practice gets paid is still ultimately your responsibility, even when you've got an outsourced team helping you make it happen. The key is knowing what questions to ask and to establish a relationship of communication and teamwork with your billing service partner. To explore these ideas -- and many more ways to maximize the benefit of outsourcing your medical billing -- please join us next Wednesday, June 18, for a free, lively and informative webinar that will help your practice work with an external medical billing service to improve profitability -- and your peace of mind! PLUS, best of all, 100 lucky attendees will get a free copy of my ebook on the subject, Get the Best From Your Medical Billing Service (Management Rx). Woohoo! Hope you will join me next week! Click here for the sign-up page on Kareo.com.

By Morgan|2022-01-01T22:52:07-08:00June 12th, 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 Morgan|2022-01-01T22:52:08-08:00March 31st, 2014|

Using benchmarks wisely: staff, staff expense per provider

Our work with medical practices often involves analyzing a practice's data against benchmarks from sources like MGMA, NSCHBC, specialty society surveys, etc. But, it's not enough just to compare against the averages and percentiles; you have to know whether meeting or beating a benchmark is a good thing. Believe it or not, this is not always obvious. Among the benchmarks most subject to misinterpretation are staff per provider and staffing expense per provider. Most physicians and practice managers we work with are very focused on keeping headcount and staffing expense low -- and so they're pleased to learn they're in the lower tiers for headcount and staff expense ratios. The pleasure shifts to confusion, though, when we explain that squeezing staffing down to the lowest possible expense is not usually a path to higher profitability -- and can often be associated with lowering profitability! There are several reasons for this. The most important is that well-trained, well-paid, motivated staff -- and enough of them -- free up providers to focus all their attention on the tasks only they can do. Coincidentally, the tasks that only providers can do are almost always also the only tasks that generate revenue for the practice. Increase provider time spent on revenue generating activities (and not on unpaid tasks that don't require their training), and you're on the way to more profitability. Consider that an additional medical assistant might cost a practice about $100-$150 per day. If that additional assistant allows a practice to see as few as 1-2 more patients per day, that's a profitable addition. Often, one additional assistant can help more than one provider -- and help the practice quickly generate more revenue than is needed to make the addition a profitable one. When a practice is focused primarily on expense control and minimizing headcount, sometimes that results in providers doing too many tasks that could be handled less expensively by staff -- an opportunity cost for the practice and a direct hit to revenue potential. What's more, when a practice is too reluctant to add headcount, existing staff can quickly become

By Morgan|2022-01-01T22:52:09-08:00March 3rd, 2014|

Internal chart audits, the basics, part 2: conducting the audit

Conducting an internal chart audit require team effort to plan, execute and analyze the results. You will get far more out of the audit by involving team members from different departments and presenting it as an exciting time to learn more about the inner works of the clinic visit and their implications on practice finances. A team of five is perfect; a receptionist or scheduler, a biller, a nurse or medical assistant, a medical records or data entry person and a physician or other provider. Begin by gathering five random patient records per each provider and selecting one date of service for each patient; the date of service should be three to six months prior. This allows adequate time for insurance processing and receipt of third party payment on the records being reviewed. Staff should break into teams of two – preferably one administrative staff and one clinical staff person. Each team should review a minimum of five charts and document discrepancies. When the review is completed, they should analyze the results to determine if the same errors are recurring or if there are different areas of the practice or service where problems occur. They should then calculate the potential cost of the errors over a twelve month period. The next step is to make a recommendation on how to approach correcting the deficiencies for long term benefit. Common problems detected: Discrepancy in evaluation and management level of service (E&M code) Wrong diagnosis Missing dictation Incomplete charge slip Missed office charges: Procedures, lab, x-ray Missed hospital charges: ER visits, consultations Insurance write offs taken that are not justified (payment overlooked or discounted by payer) Patient balances written off on Medicare patients All of these problems have the potential to both cost your practice money in the short term (e.g., by causing denials or delays or down-coding) or in the long term by triggering an audit by Medicare or a private payer. By conducting your own internal audit, not only will your staff learn what kinds of mistakes you've unwittingly been making (and be able to correct them), everyone will understand

By Judy Capko|2022-01-01T22:52:09-08:00February 20th, 2014|

Internal chart audits: the basics, part 1

Auditing charts is nothing new; Medicare has been doing such audits for years. They are looking for coding irregularities within a practice to determine if they want to do a more extensive audit. That's when a practice gets the dreaded notice to prepare and submit charting documentation on a selected number of charts and submit them to CMS for a detailed review. Often when this happens the stakeholders in the practice have no idea what they have done to trigger the audit. We suggest you take a proactive approach to understand your coding patterns and whether you are coding appropriately based on the services rendered and the documentation essential to support the codes you billed for. Here are steps you can take to prepare for a practice-wide internal audit, which may help you avoid the dreaded Medicare audit – or at least be ready to pass with flying colors. Empower staff to understand the importance of their individual actions in helping the practice get paid for the services performed. A mini audit involves everyone in analyzing charge and payments for services rendered. The staff teams up to examine documentation of services rendered, diagnostic coding for encounters and the payment received for those services. Increase the staff’s awareness of the significance of accurate documentation and its relationship to revenue generated in the practice. By examining charts and billing information the staff will begin to understand how important it is to account for every single service rendered. With reduced reimbursement no office can afford to drop a charge or to neglect following up on an inappropriate reduction in reimbursement. For example if you missed charging for one EKG and one Urinalysis a day, it would add up to as much as $12,000 a year in lost revenue. If you missed charging for one hospital consultation a month per doctor in a four doctor practice, you would take an annual hit of $6,000. Increase the reimbursement IQ of reception and nursing staff, as they examine EOB’s and see a 30 to 40% adjustment in the payment rendered by third party payers. This will

By Judy Capko|2016-03-04T11:56:39-08:00February 14th, 2014|

Patient payments: In 2014, it’s ‘pay as you go’

2014 will be a winning or losing game for medical practices – depending on their patient payment policies and efficiency with collecting patient payments. Patient responsibility has spiked over the years and has taken a quantum leap in 2014 with annual deductibles of $5,000 and more. Patient share of responsibility beyond the deductible can be as much as 20%. So if you haven’t already done so, it’s time to beef up your patient collection procedures and track performance to ensure you are collecting at the time of service. Here are a few key ways to get paid sooner rather than later. Train staff on how to ask for money. Give them scripts and practice so they are comfortable. Help them understand it is appropriate to expect payment at time of service. I mean, like where else do you go and not pay for services at the time you receive them? Start at the beginning. Staff should explain your payment policies when they are scheduling a new patient. For established patients that are scheduling appointments on the phone, remind them of an existing balance and inform the patient that payment of an existing balance must be paid at the time of their scheduled visit – if not paid in advance. You might even consider asking the patient to pay their previous balance with a charge card at the time they are scheduling their appointment and be ahead of the game. Plan ahead. Every day assign someone in the office the responsibility of reviewing the next day’s schedule to verify insurance coverage and plan for Use technology. Automate confirmation phone calls or text messages to be placed 48 hours before a patient appointment. The script used should include a message reminding the patient that any balance remaining on their account must be paid at the time of the visit. Avoid exceptions. Keep providers out of the payment discussion. Help physicians by giving them the script for a reply to patients that want to talk about payments. Something as simple as “Mary, my main concern is your health, our billing department manages collection.

By Judy Capko|2022-01-01T22:52:09-08:00February 14th, 2014|

ACA out-of-pocket costs: Vindication isn’t always sweet

The New York Times reported today that "On Health Exchanges, Premiums Maybe Be Low, But Other Costs Can Be High." This is something we've been talking about for a couple of months now -- often getting skeptical looks here in our super-blue home-town. But it's not about partisanship. The ACA is simply accelerating the trend of payers pushing more responsibility onto patients -- a trend that has been gathering momentum for many years. It's not unexpected if you've been watching how health plans have been evolving. Still, it is discouraging if you had hoped the exchange plans would offer better patient protection against big out-of-pocket costs -- and it also means that the burden that practices face to collect more of their revenue from patients keeps growing. The AMA's 2013 National Health Insurer Report Card (NHIRC), published earlier this year, revealed that health plans across the country were placing about 25% financial responsibility for cost of care onto patients: Aetna Anthem Cigna UHC Medicare 20.40% 23.10% 25.90% 23.40% 24.60% The target 2014 patient responsibility proportions that were set for all ACA plans skew even higher than this -- even the "silver" level, where subsidies are targeted, pegs patient responsibility at 30%: ACA Bronze ACA Silver ACA Gold ACA Platinum 40% 30% 20% 10% These "actuarial values" were fairly widely reported prior to the exchanges even opening (here's one link from MSN), so it's a bit of a mystery why the Times is reporting this as news at this point. It's critical that consumers understand what they're getting into when they sign up for coverage, and the media should have been on top of this key information. (Especially if you've not purchased coverage before, the terminology behind patient responsibility payments -- co-insurance, deductibles, copayments, out of pocket -- can be very confusing. Many new patients are likely to be confused and possibly quite disappointed.) We expect that this means practices will need to be even more careful and sensitive in dealing with privately insured patients, especially in January, when deductibles re-set. Some patients will be more confused than ever --

By Morgan|2022-01-01T22:52:11-08:00December 9th, 2013|

Remember, EFT is best

Mary Pat Whaley at Manage My Practice has posted great information about payers 'encouraging' practices to accept payment by virtual credit card, instead of by check or EFT. This method of payment is not a good deal for practices. Merchant fees are deducted from credit card payments -- meaning a further reduction in the reimbursement received from health plans that use this credit card method. Additionally, it adds costs because the virtual cards have to be manually keyed (increasing potential for errors and hassles -- and usually meaning a higher merchant fee than a swiped transaction as well). If the credit cards are set aside to be keyed in batches (as it seems they would inevitably be in many busy practices), that introduces another delay in receiving payment that would already be in the bank if transmitted by EFT. And, as the AMA pointed out in its letter to the CMS objecting to the use of virtual cards for VA reimbursement, credit card remittance advices are not standardized as payer EFT remittances are -- another source of inefficiency and cost. EFT is still the best way for practices to receive payments quickly, without any extra fee deductions, and without requiring additional, costly staff handling. (Minimizing staff handling also reduces embezzlement risk.) All payers are required to meet federal standards for EFT in 2014 -- and that means that you can request EFT from any payer you work with. As you know, we always recommend that practices use EFT with every payer: no checks in the office means less chance of one 'disappearing,' less aggravation taking them to the bank, etc. Virtual credit card payments are just one more inferior alternative to EFT. As Mary Pat noted in her post, it's important to check any new contract you sign to be sure you're not inadvertently agreeing to credit card reimbursement. (And, as we're always reminding you, this is another reason for a tickler to review your contracts annually, to be sure they don't already contain language that allows changing reimbursement mechanisms. And watch those amendments and other mailings from plans, too!)

By Morgan|2022-01-01T22:52:12-08:00November 11th, 2013|

Could the ACA-mandated grace period be problematic for your practice?

Many practices already suffer losses from surprise payment retractions by health plans. These can occur when patients attempt to exploit system update lags after leaving their employer (and therefore the employer's plan) or the grace period after failing to maintain payments on their own policy. (So, the patient knows he's not paid his premium or that he's left the employer plan, but also knows he's still "covered" because of payment grace period or because of the 30-day window to elect COBRA coverage -- even though the coverage will eventually be retroactively cancelled to the last paid day.) Any retraction of payment for services already rendered is a blow for providers and their practices, but most state policies regarding timely payment of claims and premium grace periods help limit the exposure for retraction of reimbursement to 30-45 days. However, the Affordable Care Act (ACA) contains a provision that mandates a much longer grace period -- 90 days -- for subsidized plan participants. The ACA authors intended that plan members who receive subsidies be allowed more leeway for missing payments because of lower incomes and possible hardship -- but, the longer grace period also creates opportunity for abuse and financial exposure for practices. Hospital and physician groups made note in the ACA comment period of the potential for the grace period to result in uncovered services being rendered. Extending the grace period increases the likelihood that significant services can be provided before a plan can be cancelled for unpaid premiums. Providers argued that plans should have to bear these costs -- especially in the case of subsidized membership, since plans would presumably be receiving at least part of the premium cost from the government. However, in the final rule, the CMS allowed plans to deny claims in months two and three of the grace period. This means that payments already issued to providers could be retracted -- leaving practices and hospitals on the hook for the cost of care already provided. How can practices prepare for and protect themselves from these unexpected costs? A few things to evaluate: Has your state negotiated

By Morgan|2013-11-09T18:08:14-08:00November 11th, 2013|

Medicare Advantage plans dropping doctors: what does it mean?

News reports have been trickling in over the past couple of weeks -- growing in number -- about Medicare Advantage (MA) plans dropping doctors. First, we heard about UnitedHealthcare in CT dropping doctors -- then news came out about the same carrier dropping patients in NY, FL, RI, NJ, and, just yesterday, OH. Sam Unterricht, MD, the head of the State Medical Society of New York, said in a Fox Business interview a few days ago that other plans like Empire Blue Cross and Emblem were following UHC's lead in his state -- and that he expects this MA plan activity to spread nationwide. What's driving this (by all accounts, extremely sudden) behavior on the part of MA plans? The Tampa Bay Times reports that UHC attributes it to quality ratings ("[providers that] demonstrate the highest quality at the greatest value will be rewarded for their efforts.") But, the effort to trim MA costs as part of the funding plan for the ACA probably plays a role. Unterricth said that one of the plan representatives he spoke with said that an anticipated 8% reduction in reimbursements to MA plans from Medicare as part of the ACA was at least partly behind all the physician cuts. The timing -- coming on the heels of news of thousands of patients dropped from individual health plans -- does suggest a connection to ACA-mandated changes in 2014. Certainly, UHC's statement that quality ratings drove the decisions isn't incompatible with Unterricht's view that ACA cuts to MA reimbursement were behind them. After all, if reimbursements to MA plans from the CMS are going to decline, then quality related bonuses are going to be that much more important to plans going forward. It makes sense that they would try to goose their rankings to make up lost ground on reimbursements through bonuses. What does this mean for practices that serve MA patients? Some practices in some markets might have argued that MA is a pain: it's like the restricted, non-negotiable reimbursement of Medicare combined with the hassles of dealing with a private payer. But, we suspect

By Morgan|2022-01-01T22:52:13-08:00November 5th, 2013|

Medical billing service ebook promotion starts today!
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Medical billing service ebook promotion starts today!

medical practice business, reimbursement, revenue, revenue, billing and collections

Medical billing service ebook promotion starts today!

Laurie Morgan's just-published ebook -- Get the Best From Your Medical Billing Service (Management Rx) -- will be available free on Amazon.com starting today! This one-time promotion runs from October 25 - October 29. This detailed, 15-page guide is the easy way to get up to speed on selecting and managing a billing service. You'll learn tips for screening potential services (including 30 screening questions), managing the relationship, and using reports to evaluate billing service performance. The regular price is just $6.88 (already a bargain :)), but you can get it free over the next four days. (In exchange, it would be a nice gesture to share a rating/review of the book.) 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. (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. If you miss your chance to download for free during the promotion, a free trial of Prime can allow you to borrow it.) We hope you appreciate this free promo from Amazon, and that you will check the book out and share your thoughts on it with a review!

By Morgan|2022-01-01T22:52:13-08:00October 25th, 2013|

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

lost revenue, medical practice business, reimbursement, revenue, revenue, billing and collections

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

ICD-10: The only thing to fear is fear itself
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ICD-10: The only thing to fear is fear itself

billing and practice management software (PMS), coding, EMR | EHR, finances, medical practice business, technology

ICD-10: The only thing to fear is fear itself

Did any of you catch the ICD-10 TweetChat Kareo hosted on Tuesday? I participated representing our team(@capkoandcompany); three other panelists from different segments of the medical management world joined in as well (@brad_justus, @modmed_EMA, @hitconsultant). Kareo does a wonderful job reaching out to its clients and the entire practice management community with events like these -- and we were delighted to have the opportunity to participate! (Kareo published a summary on its blog -- and you can also search all the tweets using #kareochat .) As expected, there were many smart, informed comments -- and some really good questions by the Kareo folks in particular. But, I was struck by the relative silence from people who weren't from the billing/practice management/technology expert community (i.e., from actual billers, coders and practice managers) -- especially because one of the themes that emerged from our chat was the sense that small and medium private practices (in particular) have been holding off dealing with ICD-10. Did the audience that could benefit the most shy away from the chat altogether? The drumbeat of journalists, bloggers and other experts about the need to deal with ICD-10 NOW (or face likely disaster!!) has gotten louder and louder in recent months, and I sometimes wonder if it sometimes has some negative unintended consequences. In our zest to create helpful urgency (and dispel the dream that ICD-10 will be delayed again), are we pushing people towards fear-induced denial and procrastination? Seemingly every week, we work with medical practices that have not begun to prepare for ICD-10 at all -- and they're scared. But while their foot-dragging has not been ideal by any means, it's also not a guarantee of disaster. Converting to ICD-10 is not going to be easy, but it's also not something that's beyond the reach of any practice to manage -- especially because so much help will be available from vendors and payers (provided you ask!). It seems from our vantage point that too many practice administrators, billers and coders have already decided -- without even really getting started -- that ICD-1o will be an unavoidable

By Morgan|2022-01-01T22:52:16-08:00September 13th, 2013|

New exchange plans will make time-of-service collections even more important

(c) John Kwan - Fotolia.com The AMA's National Health Insurer Report Card for 2013 provided powerful reinforcement for the need for physician practices to master time-of-service collections: average patient responsibility is now topping 20% for all but one payer evaluated in the survey, and some were approaching 30%. Even Medicare is requiring patients to contribute about 25% of the cost of their care. Now the unveiling of the health exchange plans in some states, including here in California, underscores the point further. All of the new Covered California plans include cost-sharing to keep premiums affordable, including copays for all visits except the annual wellness exam. Modern Healthcare reports that other state plans that have been revealed also feature significant patient responsibility. For people new to purchasing insurance and using it to gain access to care, the patient responsibility portion to providers (on top of premiums they may be unused to paying) may come as a surprise and cause confusion. (After all, patient responsibility payments routinely confuse people who've had such plans through their employers for years!) If collecting copays and other patient responsibility payments at the time of service is not SOP at your practice, you're leaving money on the table -- and could soon be giving up even more profit that is due your practice. Plus, if copays are routinely waived or ultimately written off, you're probably violating the terms of your payer contracts -- and, with more new members joining plans that require patient cost-sharing, plans could be expected to be even more attentive to these violations as the exchanges roll out. It's time to finally master front desk collections! (If you need help understanding how well your front desk operation is managing these collections, or with rolling out new procedures, Capko & Company can help with a one-day billing and collections review -- contact us for more information.)

By Morgan|2022-01-01T22:52:18-08:00July 8th, 2013|

Timely article about billing for locum tenens

Physicians: are you planning a vacation this summer, and worrying about coverage? Or, have you thought about bringing in extra help so you can take time off, but are worried about lost revenue? Hiring temporary physician help doesn't have to mean a deadweight loss of revenue for your practice. This helpful article from Physicians Practice spotlights billing for locum tenens help that you pay on a per diem basis. Take that much needed vacation! Get Revenue for Your Practice Even While on Vacation

By Morgan|2022-01-01T22:52:31-08:00June 21st, 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 Morgan|2022-01-01T22:52:31-08:00June 19th, 2013|

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