revenue, billing and collections

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

13 for 2013 Tip #9: Analyze payer performance

When is the last time you analyzed your practice's payers? Too often, physicians and practice managers feel powerless against health plans -- and don't even question whether to continue to accept a particular plan. Yet, even if your practice is located in a market in which you've found it increasingly difficult to negotiate higher reimbursement, that doesn't mean you must simply accept all other aspects of every payer relationship without question. Even when reimbursement amounts are similar across payers, differences in payer behavior -- what we refer to as 'hassle factors' -- can actually mean that some payer relationships are unprofitable. What are some of the hassle factors that add hidden costs and reduce payer profitability? They include: Consistently slower reimbursement than other plans Repeated requests for referral or authorization Frequent complaints from patients Poor support when help is needed to resolve problems Are multiple hassle factors a reason to drop a plan on their own? Not necessarily -- if you're reliant on a plan for a significant share of your revenue, or it reimburses better than others for important codes, putting up with the hassle may be necessary. (However, in that case, you will also want to do what you can to address some of the ongoing hassles with the payer.) I shared some further tips on analyzing your payers' hassle quotients in this article for Kareo -- and if you need further help evaluating and segmenting your payers, we hope you'll get in touch to learn more about our capabilities in this area.

By Judy Capko|2022-01-01T22:52:35-08:00January 31st, 2013|

13 for 2013 Tip #7: Reach out to local employers

Many medical practices we work with focus their marketing efforts (if they do marketing at all!) on physicians who refer to them and direct communication with their existing patients. Yet there is another marketing channel that can be extremely effective for physicians that is often overlooked: your area's major employers. It's common to assume that simply participating in an employer's health plan is sufficient to reach the potential patients that work there. But, if you're in a competitive area, you might need to differentiate yourself against dozens of other physicians -- personal outreach to employees is a way to help them choose you. Moreover, you can't necessarily count on the health plan to promote itself effectively to your patient base. Many employers will also consider wellness programs in the coming year, because the Affordable Care Act promises to provide financial incentives for qualifying programs by 2014. Practices that create wellness programs for local employers can simultaneously market themselves to employers and prospective patients, provide valuable wellness information and training to their community, and position themselves as key wellness program providers as attention and support for this type of effort grows. (What kinds of programs might qualify? Some possibilities include non-discriminatory diagnostic or health improvement programs like tools for coping with and preventing repetitive strain injuries; healthy weight management; voluntary health screenings.)

By Morgan|2022-01-01T22:52:36-08:00January 24th, 2013|

Will 2013 be better than 2012? It’s up to you!

A new year has already begun! If you are hoping for significant year-over-year improvement you need to act – and sooner rather than later. Here’s how great practices help ensure that each year is better than the last. Examine past performance. Consider what data points are important to review. As a guide, great practices will compare their performance against at least these benchmarks every year: Total revenue per full time equivalent (FTE) physician Total operating expense as a percentage of total medical revenue Total visits/procedures per FTE physician Percentage of total A/R aged 120 days more Bad debt due to fee for service activity per FTE physician Determine what the numbers mean to you. Compare your performance between 2012 and 2011 to evaluate your year-over-year performance. Are you clearly performing better or worse? Then assess why there is a difference. If you did better was it because you were more assertive? Dit you have clearer established goals to guide you? Perhaps changes in performance can be traced to changes in staff or actions taken to improve contract reimbursement? Did you implement a marketing plan or are differences between years merely chance variation? If there was no change in 2012 or you did worse, you will want to take decisive action to make 2013 a better year. Plan for 2013. Of course, given the challenging business environment, leaders of improving practices make planning a priority. I recommend a strategic planning session be scheduled well in advance. Scheduling an off site meeting in early February can minimize interruptions. If you have a skilled communication facilitator on your staff, and your practice isn't facing especially serious challenges, your practice might conduct your meeting without an outside consultant. On the other hand, a consultant can increase the value of strategic planning sessions by facilitating communications on difficult topics, providing an objective overview of your practice’s performance, helping you understand your position in the marketplace, and assisting leadership in determining goals for the upcoming year. Practice leaders it is not too early to think about the steps you can take to protect and guide the practice’s

By Judy Capko|2022-01-01T22:52:36-08:00January 16th, 2013|

13 for 2013 Tip #3: Cash management quick-check

Do you accept cash payments at your practice? The start of a new year is a great time to review how your practice handles cash -- to determine if your internal controls could use some tightening up. With cash, the biggest temptation is to handle these "small" amounts more casually than other payments. When cash payments are rare -- a $30 co-pay here, a $25 co-pay there -- it can seem that they're less important to the bottom line. But, over the course of a year, even a single $30 cash payment per day amounts to close to $8,000! Keeping tabs on those "unimportant" cash payments is actually very important, indeed. The biggest pitfall: mixing cash receipts with petty cash. This all but ensures these amounts won't be deposited and may not be properly tracked. Petty cash should never be more than about $50 or so -- just enough to handle small payment amounts for the office that cannot be handled by credit card or check. Allowing petty cash to grow creates a temptation for misuse -- or worse, theft. Cash should be deposited regularly -- ideally, every day -- for security and for effective tracking for practice evaluation and tax reporting. Receipt stock should be monitored, and the cash received should be reconciled against the day's postings by some at the practice who doesn't collect it and post it to the billing system (in smaller practices, this might need to be the physician/owner).

By Joe Capko|2022-01-01T22:52:36-08:00January 10th, 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 Morgan|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 Joe Capko|2022-01-01T22:52:38-08:00October 25th, 2012|

New study claims ‘billions’ in Medicare costs may be due to questionable upcoding

A new study from the Center for Public Integrity has identified a trend towards higher coding of Medicare visits over the last decade -- and suggests this increased utilization of higher codes could signal increasing, habitual abuse. The study also notes that medical groups representing doctors assert that treating seniors has gotten more complex over the last ten years -- both because Medicare patients tend to have multiple, complex conditions and because EMR and coordination of care make treating them more time-consuming and make documentation and coding more accurate. A few tidbits from the report that stood out: The report cites the seemingly alarming statistic that "more than 7,500 physicians billed the two top paying codes for three out of four office visits in 2008, a sharp rise from the numbers of doctors who did so at the start of the decade." But, 7,500 is less than 1% of the total number of practicing physicians in the US (829,673, per the Kaiser Family Foundation). Even if every one of these physicians is coding fraudulently, this is a pretty small proportion of physicians who are 'cheating' -- compare that with, for example, the 15% of Americans who've admitted to cheating on their taxes. The report reveals that the lowest code, 99211, typically pays only about $20. Will the reality of how paltry this is -- considering this figure not only compensates the doctor, but pays for the office, technology, clinical and business staff -- be lost in the outrage over more evidence of 'greedy doctors'? (If every single minute of an hour were dedicated to 99211 visits -- ignoring the need for administration, transition and documentation time between patients, late and no-show patients -- that still only amounts to $240/hour. Not much to pay a doctor, cover her overhead, and compensate staff.) The report also notes that, "the number of doctors who billed at least half of their office visits at one of the two most expensive codes more than doubled to at least 17,000 practitioners...[and] those who quit using the two least expensive codes rose 63 percent, climbing to more than 13,000 in

By Morgan|2016-03-04T12:10:30-08:00September 18th, 2012|

Another interesting (dispiriting) take on medical billing

A recent New York Times article and follow-up blog post discuss the challenges patients have understanding medical bills, through the eyes of a consultant named Jean Poole who has made a career of deciphering (usually highly erroneous) medical bills and helping patients recoup incorrect charges or reduce their outstanding bills. Billing is so challenging for practices -- even though specialized staff are usually handling the task, they have to contend with constant changing rules, reluctance of some payers to address issues, and the myriad of payment schemes with varying patient responsibility. But imagine how it is for patients -- who don't have any specialized knowledge to help them deal with the strange language and calculations of their bills. Ms. Poole's service would seem to be a godsend for patients who find themselves unexpectedly owing thousands of dollars (as the article points out, patient out-of-pocket obligations and opaque hospital fee schedules can lead to big surprises). It's great that she offers this service, for sure -- but how frustrating that it's so needed. The frequency of errors and lack of transparency in insurance company documents to patients is a big source of difficulty for practices. When patients feel they've been incorrectly charged or can't understand their bills, it undermines the trust they have in their physicians and other care providers. When your practice provides services in conjunction with a hospital, their billing clarity and accuracy (or lack thereof) can rub off on your patient relationships. While you can't control how hospitals manage their side of billing, you can at least make sure you're communicating as clearly and directly as possible with patients about what your practice will bill and how much of that bill their payer has declared to be the patient's responsibility.

By Morgan|2022-01-01T22:52:39-08:00June 27th, 2012|

New CMS program supports enhanced primary care at $20/patient

Will your practice be taking part in this eight-state pilot? Requirements will include EHR, flexible hours, various preventive and individualized care activities. http://www.innovations.cms.gov/initiatives/Comprehensive-Primary-Care-Initiative/index.html

By Morgan|2016-03-04T12:11:20-08:00June 7th, 2012|

Hotel Hôpital

What if hotel billing were like medical billing? A funny-but-sad video by Costs of Care in partnership with Harvard Medical School and the University of Chicago explores the possibility in a tongue-in-cheek way (click "continue reading" to view the video). "Surprise" medical costs do more than just frustrate patients -- they hurt practices, too. By helping patients understand the costs of their care, practices can help patients make more informed decisions, plan better, and maintain a positive relationship with the practice. And, patients who are better informed and understand what they'll be charged are more likely to pay their bills.

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

Prevent and uncover embezzlement: webinar

Joe and Judy's recent webinar (sponsored by Kareo) was a big hit! If you didn't have a chance to attend 'live,' you can register and view it here: Embezzlment-proof your practice Most medical practices are victims of embezzlement at some point -- yes, you read that right! -- so if you haven't already learned how employees can become thieves and employers become marks, this is a must-watch webinar.

By Morgan|2011-11-18T11:27:10-08:00November 18th, 2011|

The Time is Now for ICD-10 Planning

Regulatory requirements that affect the medical practice are changing rapidly. While the primary focus may seem to be on EHR systems and meaningful use to obtain those stimulus funds, there are other mandatory system changes that need to be addressed now, starting with the conversion to ICD -10 code set. The new code set represents an important advancement in diagnostic coding and conversion to it is required. Limitations of ICD-9 include limited descriptive reporting and inability to adapt to advances in medical procedures and technology. The new system promises more flexibility and descriptive capacity. As a result, more accurate healthcare data reporting is expected. Due to the significant structural differences between the existing ICD-9 diagnostic coding system and ICD-10 coding system, the transition to ICD-10 code set is one of the critical areas of change for physicians in the near future. Medical practices will be required to adopt the use of the ICD-10-CM code set by October 2013. Since the new system is relatively complex, you’ll want to make sure your entire staff receives the training they need as early as possible. One potential benefit for doctors that “under code” is that more precise diagnosis and procedure codes will enable more accurate reimbursement. Additional benefits include an improved ability to measure health care services, reduce coding errors, a decreased for supporting documentation with claims, and the ability to use administrative data to evaluate medical processes and outcomes. October 2013 may seem a long way off, but given the magnitude of this conversion it is important to address this change now in order to avoid severe work disruption and delayed or lost payments. The first step in planning for the conversion to ICD-10 is to assess the organization’s readiness for adapting the new codes and understanding the impact of the change on your practice. Practice leaders should meet with billing system IT representatives and develop an implementation strategy, time-line and budget to accomplish the conversion. The timeline should include adequate time for testing the system and it should contain a plan for providing essential education and training for the team members.

By Joe Capko|2011-10-27T16:54:55-08:00September 9th, 2011|

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

Build Rock-Solid Financial Policies

The foundation for effective management of the revenue cycle is the practice's financial polices - so make yours rock-solid! They need to reflect the practice's culture and payment philosophy. This becomes more critical with the increase in high deductible insurance plans that place more responsibility on the patient. Here are some key factors in developing effective financial policies: Physicians need to agree on what their payment expectations are and let the manager enforce the policies. Include everyone involved in the process in the development of the financial policies and procedures. This often includes the scheduler, receptionist, data entry, coder, billing clerk, collection department and the manager. It is important to get their buy-in to develop policies that will work! Provide consistent training and support. Establish benchmarks for accurate patient registration, charge entry/payment cycle and error ratios, and days in accounts receivable. Provide adequate oversight to recognize when additional support is needed and to hold staff accountable to the standards outlined in the policy. Financial policies unify the practice and improve consistency in collection procedures To be effective, physicians and managers must define their expectations and clarify the processes necessary to achieve those expectations. Capko & Company a leader in medical practice management and marketing consulting. Judy Capko is the author of the runaway best-selling book: Secrets of the Best-Run Practices!

By Judy Capko|2022-01-01T22:52:54-08:00July 23rd, 2011|

Get a clear picture of practice performance: Part 1

To begin your quest to understand how well the practice is performing is to compare last year’s financial performance to the prior year, examine shifting trends and identify the reasons these shifts are occurring. For example, are you doing less of a particular procedure and, if so, is there a reasonable explanation – or if one physician’s production took a dip was it due to more scheduled time out of the office or is it an abnormality that needs to be addressed. Perhaps one urologist’s aged receivable has spiked because of a payer contracting issue. Identifying these types of issues is a good start to managing finances better. It is also important to compare performance to your peers by obtaining the Medical Group Management Associations Cost Survey (if it includes your specialty), www.mgma.com and The annual Joint Statistics Report from the Society of Healthcare Business Consultants, www.nschbc.com. In a group practice it is important to look at the group as a whole, as well as the some specific numbers and benchmarks for each physician. Examine group performance based on the per physician averages to evaluate and manage income and expense trends and staff levels. For example, how does the practice compares to the average practice in your specialty around the country? • Number of full-time equivalent staff • Gross charges • Percentage of contract adjustments • Gross revenue, expenses and net profit • Operating expenses as a percentage of gross revenue If you simply want to know # of FTE (full time equivalent staff) and percentage of operating expenses against revenue let me know: Go to www.capko.com Capko & Company your source for practice improvement

By Judy Capko|2011-06-08T13:22:21-08:00June 8th, 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 Judy Capko|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 Judy Capko|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 Judy Capko|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 Judy Capko|2011-03-18T14:52:21-08:00March 17th, 2011|

Profit with a Clear View of Your Practice’s Competitive Landscape

Whether you're contemplating expanding your practice, starting a new practice, or simply wondering what your practice's profit potential might be, your profits depend on your understanding of local patient demographics. With a host of free online services available, it's easier and less expensive than ever to understand your area's demographics and how they might represent threats or opportunities. You need to know how well your area is being served by your practice-type! One very useful website is www.city-data.com that supplies wide-ranging demographic information on thousands of communities. Among the most telling information is the population and growth trends of your service area -- where your patients come from or nearby areas new patients could come from. Often service areas are defined by geographical barriers, valleys, rivers, etc.. When we work with medical practices, we find that compiling data from the various communities in their service area (and other areas of interest) in a spreadsheet is invaluable. First, we take note of these population demographics: total population, population growth, income and, naturally, any demographic segment particular to your type of practice, such as women, children or the elderly. Next, combine the separate community data so that you can have a single figure for "service area" for each demographic segment. Now that you've compiled data to define the demographics of your service area, you can compare how your service area compares to nearby or similar-sized areas anywhere in the country. Is there a relatively high, low or average number of your practice-type in your service area when compared to similar other regions? You'll need to employ your first-hand knowledge to help you define the "service areas" that compare to yours. Be mindful of population density, income and geography and you should be able to identify at least two competing service areas. You can plug these data from their respective communities into your spreadsheet to calculate the same measures you have for your service area. Now that you've become somewhat of an expert on the population, it's time to gather information on the physicians. You'll goal is to find the number of physicians (FTEs)

By Joe Capko|2022-01-01T22:52:56-08:00March 8th, 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 Judy Capko|2011-03-08T12:36:41-08:00February 26th, 2011|

Marketing Your Practice with a Code Update Event

By Joe Capko, Capko & Company Every year, changes to the CPT codes take medical practices by surprise -- even though everyone knows the updates are coming. Whether it's because doctors and administrators assume that coding changes won't likely apply to their specialty, because it's hard to find time to go through the materials, or just due to old-fashioned procrastination, most of the practices we work with wind up ignoring the new codes until they start finding out the hard way that the codes they've been using are no longer valid -- i.e., once claims start to be rejected. Naturally, this is a costly problem for all practices, as these rejected codes can mean payment delays of six months or more. Here's the good news. Since most (if not all) of the other practices you work with as referring partners are facing the same pain-in-the-neck, why not turn this hassle into a marketing opportunity? You can do it by hosting a Code Update Seminar -- call it a "code party" if you want to be less formal about it -- and invite the practice managers and administrators from the other practices you work with to learn about the changes. You arrange for a coding consultant to present an overview of the changes, along with a meal or some snacks -- depending on the size of the group you're inviting, you may need to rent out a large conference or event space at a nearby hotel or business center. Depending on your preferences (and those of your colleagues), you could schedule an early morning breakfast event, a lunch event, or an evening or weekend seminar. If this seems like too much effort or expense, you can try the "lite" version: a smaller, more intimate, group hosted in the office reception area during non-clinic hours. Helping to solve a problem that your colleagues all share while also giving your administrative staff the chance to network with their counterparts at your key referring partners is a wonderful way to promote your own practice without "selling." Be sure to have some tchotckes (pens, post-it

By Joe Capko|2011-01-17T19:03:22-08:00January 17th, 2011|

For better or for worse

The economy remains unpredictable. The outcome of health care reform is unknown and health care leaders keep on wondering what the future holds. Young physicians entering the market will proceed with caution when making a decision about their future. Employed physicians may sit on the sideline and watch the ball game, but if you are in private practice and entrenched in the community chances are you'll stick it out - for better or for worse. Take heart, there are steps you can take to make things better. Know your position. Examine practice finances; how well money is being managed in terms of improving revenue, controlling expenses and managing accounts receivable. Are you better off than you were this time last year? If not take strides to make a difference by setting financial goals and establishing methods to attain those goals. Embrace the future. Look at what's happening around you and the changes that are coming down the pike. Read, listen and explore the impact of these changes. Use this information to develop a strategic plan that positions you for the future. Identify what resources you need to accomplish this and turn to experts to help you out It's all about being prepared and responding sensibly. Act, don't react and you'll make better decisions for your future! Capko & Company, a leader in healthcare management and marketing consulting.

By Judy Capko|2022-01-01T22:52:57-08:00December 29th, 2010|

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

What’s Your Time Worth?

Doctors and managers work hard to keep the practice afloat and provide good care, and service to the patients. But it's not just about working hard, it's about working smart!Ask yourself what your time is worth? Physicians and managers are the drivers of the practice and need to work at the highest level to generate and protect the revenue that keeps the practice running. Too often when working with practices, I see sabotage that results in poor management of your most important commodity - Time! Here's what you can do about it.Stop the interruptions: Sometimes they are valid, but often they are not. Pay close attention and you may discover that you are being interrupted unnecessarily. Set some guidelines that keep interruptions at bay. Delegate more: If you are doing tasks or assuming responsibility for things that can be done by someone else, it's time to evaluate why. It may be a matter of just not wanting to take the time to provide proper instruction or train someone to do a task, but it costs plenty. Delegation provides an opportunity to enrich a staff members job while freeing your time. Physicians just might see one more patient a day and that adds up to as much as $50,000 a year. When managers free up more time it gives them the opportunity to be strategic in planning for the future and ensuring revenue is not compromised.Now it's your turn - give our bloggers your best tips on managing time better.Judy Capko is one of America's leading practice management and marketing consultants. e mail judy@capko.com.

By Judy Capko|2022-01-01T22:52:57-08:00September 28th, 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 Judy Capko|2011-03-13T12:22:56-08:00May 29th, 2010|

Five things you can do to bring money in the door

Staff Can Make a Difference!Set up solid financial policies the physicians will endorse and establish methods to improve collection of patient payments. Here's six actions you can take:1. When a patient schedules an appointment verify address, employer and benefits. Also remind him or her the amount due on the account.2. Review patient accounts the day before their scheduled appointments and verify insurance eligibility and benefits.3. Make it easy for patients to pay: Accept credit and debit cards.4. Determine average percentage of daily revenue now being collected from patients against the average amount actually owed and set specific goals for improvement.5. When patients arrive and depart, don't ask if the patient wants to pay - ask how they want to pay; check, cash, credit or debit.6. Identify who the go to person if their is a dispute about the bill while the patient is in the officeBe consistent in applying these actions and watch patient revenue soar.Do you have other collection tips? If so, please share them with the followers of this blog.Announcing the release of Judy Capko's runaway best selling book Secrets of the Best-Run Practices, 2nd edition. To check it out go to www.capko.com and click on the book icon.

By Judy Capko|2022-01-01T22:52:58-08:00May 14th, 2010|

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