revenue cycle

Are you an in-house medical biller or billing manager?

Are you an in-house medical biller or billing manager? We are looking to speak with a few billing professionals (either currently working as in-house billers, or who have been employed by practices in the past) for a project. If you are willing to speak with us for about 5-10 minutes for our research project, which focuses on attracting, motivating, and retaining medical billing staff, please reply contact us. We're looking for five to ten qualified respondents. Besides our gratitude, you'll receive a $5 gift card :) Better still, your responses will also help physicians and practice administrators better lead and manage billing teams. Thank you!

By Morgan|2019-09-12T14:49:06-08:00September 12th, 2019|

Time for a review of your E&M/office visit utilization? (DOWNLOAD free spreadsheet.)

Office visits represent a huge proportion of revenue for most practice types. It's easy for small errors in coding to become habitual, and the resulting inaccuracy can be costly for your practice. Under-coding can mean lost revenue -- multiplied by hundreds or even thousands of visits per year. Accidental over-coding can lead to revenue clawbacks that create accounting hassles and make it more difficult to accurately project revenue. Payers are very concerned about E/M accurate coding, too. That's why any variation (not just over-coding) can be a trigger for a payer audit. Checking your E/M coding patterns against Medicare's utilization data for your specialty is a quick way to spot possible problems. If your or your practice's code utilization differs significantly from national data and the reasons aren't immediately clear, it could be time for a closer review or internal chart audit. Getting your hands on the CMS data, then entering it into a spreadsheet, can be a bit time-consuming -- but we've taken care of some of the grunt work for you. Follow the links below to download a spreadsheet that already has the CMS 2017* data keyed. It includes formulas to calculate your clinicians' or your practice's utilization of each code, and compare it with the national averages. Just enter your data and get your results immediately. Allergy and immunology Cardiology Dermatology Endocrinology Family practice Gastroenterology General practice General surgery Internal medicine Neurology Neurosurgery OBGYN Orthopedic surgery Otolaryngology Psychiatry Pulmonary disease Rheumatology Urology Need a different specialty? Contact us and we'll pull it together for you, provided the CMS has published data for it. Besides comparing against the CMS numbers, we recommend you compare your clinicians' numbers against each other. Sometimes, differences in utilization make perfect sense -- such as when the doctors see distinctly different patient populations. But not always. If the variances don't look logical to you, it's time to take a closer look. You may find it's time to bring in an E/M coding expert for a customized refresher course and/or chart audit. (If you need this help, contact us.) *here's a link to

By Morgan|2019-02-27T15:32:20-08:00February 27th, 2019|

Fix the problem, not the blame [practice management tip: operations and workflow]

“Fix the problem, not the blame” is a well-known Japanese proverb. It sounds like common sense – isn’t fixing problems what we all ultimately want? But when mistakes happen, the search for culprits instinctively begins – and with it often comes demoralization and tension. Worse, the search for a scapegoat usually won’t keep problems from recurring. Bad systems create more problems than bad employees. When workflow is faulty, the mistakes are built into the process. Figuring out who was working the process when it failed does nothing to prevent failure in the future. As organizations grow and silos (i.e., departments) form, so do opportunities for workflow inefficiencies to masquerade as staff incompetence. We’ve worked with medical practices that have grown so fast, they haven’t noticed their processes aren’t keeping up. But even more than growth, market evolution has put new tasks on everyone’s plate. These tasks may not fit well with jobs as originally configured – and that may mean more errors. Here’s a common example. Insurance has become increasingly complex for patients and staff alike. Higher deductibles have also made front desk collections a priority, but it’s a new priority added on top of everything else. Are front desk employees already trying to answer phones, check patients in, answer questions, collect demographic information, and verify insurance? When patients are seen and it turns out they weren’t covered or aware they owe a deductible, it may seem “obvious” that the front desk staff is to blame – especially to your billers, who must deal with the errors. But more likely, front desk employees are simply juggling too much. As jobs evolve, mistakes may increase. Resentments can fester between departments. But the answer isn’t to find someone to blame – it’s to find out where the process breaks down. In the case of the front desk, a better response would be to reconfigure roles, to let staff focus on the tasks in front of them, without multitasking. As work gets more complex, making people feel embarrassed and afraid won’t help them do their jobs better – retraining staff and refining their

By Morgan|2018-06-11T16:36:02-08:00June 27th, 2018|

Distrust of medical bills: another obstacle in collecting from patients

Did you happen to catch this New York Times Magazine article last month? It begins with a moving story of an uninsured patient who suffers a terrible brain hemorrhage. Thankfully, she gets timely, effective treatment -- but her condition requires many expensive services, including an air ambulance. Her bills totaled about $500,000. Although the patient had assets like a vacation home and savings, the amount she owed was greater. As the article describes the patient's profound stress in dealing with huge, unexpected bills while recovering, it seems clearly headed toward a case for single payer. However, it takes a rather astonishing twist along the way. The twist? The piece proclaims that little-known villains are secretly contributing to skyrocketing patient bills and healthcare costs: medical coders. "The guerrilla tactics of providers' coders," the article argues, involve deliberately manipulating physicians' codes -- i.e., diagnosis codes -- to create higher bills. If you are a practice manager, biller, coder, or independent physician reading this for the first time while sipping your coffee, perhaps you just spit it out in shock (like I did). Because while there may be billers and coders out there who have been urged to make up diagnoses to generate higher bills, I've never encountered one. I can only imagine "guerrilla coders" are exceedingly rare. The billers and coders we work with have enough to do just trying to get their physicians properly paid for the work that they've actually done (!). Physicians, billers, and coders have to work with the codes our entire industry uses to determine payment based on services rendered. If they aren't careful and don't check that all services are properly coded, practices (and hospitals) will receive less than payers have promised them for the work that they do. This is the problem billers and coders are trying to solve: Making sure their physicians and organizations aren't underpaid for services performed. That a trusted voice like the New York Times is promoting such a sinister impression of medical coding (among other inaccuracies in the piece) really bothered me. But something else bothered me more. Among the

By Morgan|2022-01-01T22:51:51-08:00April 24th, 2017|

When did you last review your E&M/office visit utilization? (DOWNLOAD free spreadsheet.)

Office visits represent a huge proportion of revenue for many practice types. Consistently accurate coding of office visits is important to avoid costly under-coding or inadvertently coding above the level that applies, which could lead to revenue take-backs. Since the E/M range constitutes such a huge piece of the overall reimbursement pie, payers are very concerned about accurate coding, too. That's why E/M coding can be a trigger for a payer audit if your practice's utilization appears unusual. One way to check your office visit coding patterns to see how they conform to other practices in your specialty is to compare your utilization of each code to published CMS data. If you find that your clinicians' coding diverges noticeably from national data, and the reasons aren't immediately clear, it could be time for a closer review or internal chart audit. Besides comparing against the CMS numbers, you can compare your clinicians' numbers against each other. In our consulting, we often find that physicians in the same practice will gradually skew in different directions (some coding a little higher than the average, some a little lower) over time. Sometimes, differences in utilization make perfect sense -- such as when the doctors see distinctly different patient populations. But not always. If the variances don't look logical to you, it's time to take a closer look. You may find it's time to bring in an E/M coding expert for a customized refresher course and/or chart audit. (If you need this help, we can refer you to excellent resources. Just contact us.) Getting your hands on the CMS data, then entering it into a spreadsheet, can be a bit time-consuming -- but we've taken care of some of the drudgery for you! Follow the links below to download a spreadsheet that already has the CMS data keyed, plus is set up with formulas to calculate your clinicians' or your practice's utilization of each code, and compare it with the national averages. Allergy and immunology Cardiology Dermatology Endocrinology Family practice Gastroenterology General practice General surgery Internal medicine Neurology Neurosurgery OBGYN Orthopedic surgery Otolaryngology Psychiatry Pulmonary

By Morgan|2017-03-27T08:11:52-08:00March 25th, 2017|

Deductible reset: you have choices

Q4 is here! For many practices, it's the busiest time of the year, as patients who've been timing their care to maximize the value of their insurance coverage or their tax deductions are now ready to schedule. During this period, a greater proportion of reimbursement will usually be collected from health plans, rather than patients. That means it's a good time to maximize productivity and generate revenue that can be collected more easily -- both to close the year out on a high note, and to prepare for Q1, when the pattern reverses. In January, patients are more likely to put off services if they feel they can, thanks to the double whammy of the deductible reset and holiday bills coming due. Looking out over the coming five-six months, it may seem like much is out of your control. And it's true that the hard deadline of December 31 isn't something you can change. But you do have choices to make. When you consider how you'll prepare for the deductible reset, will you fight the slowdown with marketing? Or will you plan to use the downtime in other ways? If you decide to go to combat the deductible reset slowdown with marketing, much depends on your specialty and your local market. And if you decide instead to go with the flow, you'll still need to start planning now, to be sure your opportunity isn't wasted. Either way, your first step should be a thorough analysis of how the deductible reset has affected your practice's workload in the past, and a projection for the impact in Q1 2017. Then if you're planning to try to boost volume, you'll need to consider your strategy (preventive care? elective services?). And if you want to take advantage of an anticipated slowdown, be strategic about it and plan for scheduling adjustments now. In my upcoming webinar (October 20, 10:00 Pacific), I'll delve into some of these ideas and possibilities. It's free, thanks to my generous host and sponsor, Kareo. Click this link to sign up. Look forward to your participation and questions!

By Morgan|2022-01-01T22:51:55-08:00October 2nd, 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 Morgan|2022-01-01T22:51:55-08:00July 20th, 2016|

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

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

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

Obsessing about front office technology

Anyone who encourages me knows they'll get an earful about front office technology tools -- they've become a passion of mine. I'm referring to things like: Patient responsibility payment estimators (e.g., Wellero, Navicure, Zirmed) Check-in tablets and kiosks (e.g., Phreesia) Online patient payment tools like portals and pre-payment sites (e.g., SpendWell) Patient payment apps (e.g., Wellero) Online scheduling (e.g., Zocdoc, DoctorBase, EHR portals in some cases) Basically, I'm talking about add-on tools that work mainly with practice management systems and/or on the Internet to improve your practice's likelihood of getting paid by patients, reduce steps in front office workflow, and even make patients happier in the process. I am a big fan of these kinds of tools, for all kinds of reasons. One is that they're unshackled from the government's goals for EHR -- they basically live only to serve practices and patients -- and I think that's what makes this segment of the market so much dynamic than the EHR segment. The players have competition, and it drives them to innovate more; you see these vendors experimenting with many different ways (and platforms) to solve these problems. And these tools really make a difference in the workflow and collection rates of the practices that embrace them. I recently wrote a white paper that delves into the important role technology can play -- and is starting to play -- in front office operations. It's called "Technology to the Rescue: Putting the Flow Back into Front Office Workflow." Wellero sponsored it, and you can download it free on their site. I hope you'll check it out -- and get in touch if you'd like to talk about any of the ideas in it.

By Morgan|2022-01-01T22:51:58-08:00November 3rd, 2015|

How empowered is your medical billing service?

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

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

Choose the right billing service, get more than professional billing

Choosing a new medical billing service is stressful. Few activities have more of an impact on practice profitability, after all. But with the risks of choosing comes upside, too -- and not just in the opportunity to have your billing handled by dedicated professionals. Switching to a third party billing service (or a new service) offers an opportunity to upgrade your technology at the same time. By making the platform(s) your new biller uses part of your evaluation, you can improve other parts of your practice business besides billing itself. Today's billing technology has continuously improved in recent years. Competition has spurred innovation and a wealth of new features. The cloud platform, especially, allows these vendors to roll out upgrades more cheaply and easily (and make them mostly painless for customers, too). Billing services that use the most up-to-date billing platforms can offer these advantages to their clients as part of the service. When you use a practice management system as part of your billing service relationship, that usually provides you with scheduling, reporting, reminders, verification, and other tools automatically. A more flexible, modern scheduling system can help you maximize provider productivity and reduce costly no-shows. Better reporting allows you to easily analyze the value of your contracted health plans. Verification tools built right into a practice management system save staff time and reduce costly booking mistakes. These are just a few of the benefits you can get by making top-tier billing/PMS technology a requirement of any new billing service you're considering. Of course, you don't necessarily even have to switch services to switch up technology -- if you made a good choice of partner in the first place, that partner will work with you to make a transition if you need to. (A small, independent billing shop -- even a one-person shop -- can be a wonderful solution for your practice, but it is very important that they commit to keeping up with technology trends and opportunities. In fact, great technology is one of the best tools independent billers can use to shine, by allowing them to focus on

By Morgan|2022-01-01T22:51:59-08:00August 10th, 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 Morgan|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 Morgan|2016-03-04T11:28:26-08:00June 21st, 2015|

The worst thing that can happen when patient deductibles aren’t well managed

What's the worst thing that can happen when you staff aren't trained to manage patient deductibles and collect up front? It's not that you won't ultimately get paid. There is something worse that can happen, and it's not that uncommon: your practice can end up losing the revenue for the service and losing the patient. Here's how it can happen. An ill patient comes in for a service and doesn't realize she's financially responsible for the entire cost. No one who interacts with the patient ahead of the service -- not the scheduler, not the person who calls her to remind her -- lets her know she'll be financial responsible, or estimates her costs. The patient arrives, hopeful she'll be paying just a copayment. And the front desk makes her day by charging only a copayment! "You might have a balance, we're not sure. Don't worry. We'll bill you," the receptionist assures her cheerfully. The patient relaxes. But when the patient receives the bill -- six weeks after that service she really needed -- she's shocked to find out that she owes hundreds of dollars more. Her insurance didn't cover any of her visit or her tests, because she has a $3,000 deductible to meet first. By now, though, this patient needs another visit for follow-up care. She calls to schedule the appointment. "WARNING: PAST DUE" pops up on the scheduler's screen. "Oh! I need to alert you that you'll be expected to pay your past due balance in full when you come in for your visit," the scheduler reminds the patient seriously. The patient is embarrassed -- and worried that she can't pay that full amount at her next visit. She needs the care, but, on the day of her appointment, she thinks about the prospect of being confronted at the front desk for an amount she can't pay in one lump sum -- and about the fact that she'll be adding to the balance due. She weighs her options -- and no-shows on her appointment. She needs to be seen, but the embarrassment outweighs that need in that

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

Thinking of outsourcing your billing? Or choosing a new service? Mini-webinar for you

If you've been thinking about outsourcing your medical billing -- or switching medical billing services -- my upcoming mini-webinar can help. "Eight Questions to Ask When Evaluating Medical Billing Services" will be presented on June 25 at 10AM Pacific/1PM Eastern, and will last about 30 minutes -- a quick hit of knowledge and you'll be on your way. 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 pointed questions to help you evaluate prospective medical billing services for your practice, there will be ample time at the end of the webinar for you to ask me your questions 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 Morgan|2015-06-13T10:47:48-08:00June 14th, 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 Morgan|2022-01-01T22:52:00-08:00June 7th, 2015|

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

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

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

Improve patient collections for immediate bottom-line improvement

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

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

Small can be strong when negotiating with a payer

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

By Morgan|2016-03-04T11:32:52-08:00April 16th, 2015|

Maintaining medical practice cash flow in Q1

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

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

Preventive services can be the antidote to the deductible reset

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Front desk collections and patient-centered service

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

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

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

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

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

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

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

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

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

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

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

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

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

Remember, EFT is best

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

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