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reimbursement

Net collections: Are you waving the white flag?

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

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

When business problems trigger emotions, facts and data are paramount

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

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

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

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

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

Copays are declining, but that’s not good news

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

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

The legal risks of waiving copays are very, very real

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

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

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

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

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

Ready for the deductible re-set?

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

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

How empowered is your medical billing service?

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

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

Are you getting the best from your medical billing service?

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

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

Upcoming free 30-minute webinar on choosing a billing service

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

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

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 |2022-01-01T22:52:00-08:00June 7th, 2015|

Maintaining medical practice cash flow in Q1

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

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

Preventive services can be the antidote to the deductible reset

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

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

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 |2022-01-01T22:52:07-08:00June 12th, 2014|

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

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

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

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

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

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

Choosing and managing a billing service

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

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

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

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 |2022-01-01T22:52:40-08:00March 25th, 2012|

Practice management tips to stop the shrinking reimbursement

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

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

Fight for your money

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

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

Get What You Deserve

Are you taking a hit on revenue?If you are not analyzing your reimbursement from different payer source and don't have a clear understanding of what it cost to see a patient you may be taking a hit that you can't afford.Start with understanding the basic cost for you to see a patient. Take your practice operating expenses for the past twelve months and add in the physicians' salary and payroll taxes to know your true costs. Divide this by the number of patient visits last year and you have a good starting point.Next examine payer performance. You can determine the average per visit reimbursement by payer by dividing the number of visits by the total payments for each particular payer. Now you you have a concrete number you can compare to your cost to see a patient. If you aren't getting paid more than it cost to see a patient and make a reasonable profit its time to think about what actions you can take to reverse this.Need help? Contact Judy CapkoJudy is one of America's leading practice management and marketing consultants. e mail judy@capko.comAnnouncing the release of the 2nd edition of the runaway best-selling book Secrets of the Best-Run Practices. To check it out go to www.capko.com and click on the book icon.

By |2011-03-13T12:22:56-08:00May 10th, 2010|
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