revenue

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|

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|

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|

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|

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|

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|

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|

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|

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|

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|

Collections rule the day

It doesn't matter how busy you are if production doesn't turn to revenue - collections rule the day! Here's what you can do to keep the money flowing. First, establish solid financial policies. Put them in writing, communicate your expectations of staff, give them the training and the tools to succeed, and then hold them to the task. It can be done, but your success depends on you giving staff the support they need and paying them what they are worth.Next, review and analyze collection performance. It is wise for the manager and physician to review these reports together each month, compare performance to historical trends and look for hot spots that should be addressed.1. Unpaid claims 2. Aging reports3. Aging by payer class 4. Patient balance report 5. Payer performance reportsAnalysis of these reports should include several months with graphs to identify trends. The trends revealed help you understand how the practice is performing and determine if a change in procedures or policy might improve performance. These actions are essential steps to ensure you are getting paid for what you do. Contact Judy Capko, one of America's best known practice management consultants; www.capko.com

By Judy Capko|2022-01-01T22:52:59-08:00March 2nd, 2009|

Marketing on a dime in a turbulent economy

Medical practices are feeling the impact of the looming recession, as patients become more concerned about personal finances. They thiink twice before scheduling an appointment and put off treatment that doesn't seem urgent. Yep, with gaps in the schedule, revenue starts to slide and practice economics become uncertain. So how can you fill those gaps and pump iron into practice revenue without spending big bucks on marketing? Read on...1) Mine your data base. Find those patients that are overdue for an annual visit, follow-up care or screening tests the practice offers. E-mail or give these patients a jingle. Don't just remind patients to schedule appointments, offer each one a specific time slot to increase your odds for filling the schedule. Be sure to confirm appointments 48 hours in advance with verbiage that accentuates the importance of keeping appointments.2) Be visible. Participate in community social and fund-raising activities. The more you (and your staff) are in front of people, the more you remind them of who you are and what you do.3) Be a media darling. Get to know the writers focused on healthcare for local newspapers and regional magazines. Become the "go to" person when they are seeking physicians to quote. It's easier to do than you might think. Go on line to their websites and e-mail the writers that cover features on healthcare business and clinical issues. Invite each one to contact you when they need a source, and direct them to your website so they can check you out. When a medical topic becomes of interest to the community and you can offer solid advice, e-mail your media contacts. 4) Be active with the hospital and local medical association. Communicate your interest in being their media source for information and interviews.5) Be responsive. When someone needs something from you or makes a query, respond without delay, whether its the media, another medical practice or your patients. Be timely and dependable. Now watch your practice thrive!Contact Judy Capko, one of America's best known practice management and marketing consultants: www.capko.com

By Judy Capko|2022-01-01T22:52:59-08:00February 24th, 2009|