How are you dealing with this year's flu season?

Many medical practices take a lot of precautionary steps to ensure that they collect from patients prior to rendering services. However, one factor in a patient's policy is as unpredictable as the weather, the patient's annual out of pocket. This part of the patient's policy is as confusing as politics, so much so that not even the insurance plan themselves can you help you when attempting to estimate what to collect ahead of time from the patient. For this reason, it is paramount that a solid patient receivables plan of action be discussed between Doctor, management and office personnel. At the end of the day, ignoring patient receivables will not make them go away, and practically giving a collection agency free money is a disservice to your practice and yourself.

One way to protect your practice from ever increasing patient receivables as well as to help your practice overhead by saving in fees paid to a collection agency, is to provide all your patients with a clear Financial Policy as well as a Credit Card Authorization Form that will be kept secure with the patient's credit card information. This form will of course specify to the patient under which circumstances this credit card will be used. However, prior to implementing such a policy is it imperative that this new policy be carefully executed. Ensuring that only key employees have access to this information or having all employees sign confidentiality agreements is one way to protect yourself. Also, all staff members that deal with patient scheduling and/or coordination need to be properly trained on how this new policy will be enforced.



Implementing this policy has many advantageous results, such as saving on postage, reduced days outstanding of patient balances, etc., however, it also has very serious repercussions if not properly executed. If you need to help on successfully executing this policy in your practice KabriniMed Group, Corp. can help. We can be contacted at KabriniGroup@gmail.com for more information.

Many changes either taking effect in 2013 or requiring preparation in 2013 for implementation in 2014 can have a huge financial impact on the health of your practice. Are you ready? This is the time to take stock of the resources you already have and those which you will need to consider.

Medicaid Reimbursement

With a new influx of lives being added to the Medicaid pool of patients, many PCP and Internists are going to see a large increase of new patients. So in order to compensate physicians for the new workload, fees for evaluation and management services as well as immunization services will be increased to 100% of Medicare allowables for 2013 and 2014.

Supply and Demand

With more patients being added to our system, due to the individual mandate and the increase of Medicaid qualified individuals, some physicians will see a heavier load of patients in their practice. Adding the fact that many of these patients are new to the system and therefore will require more work, practices need to have a plan in place as to how they will be adapting.

OIG 2013 Work Plan

The OIG will be taking a close look at claims from 2002 to 2011 billed with G modifiers (GA, GY, GX and GZ) to determine erroneous payments issued to physicians. These modifiers are used by practice when submitting claims to Medicare, indicating that a denial is expected for these services. However, in a review performed by the OIG, they found that a significant amount of claims submitted with these modifiers were paid in error. There is potentially $4 million of erroneous payments.

ICD-10

What was to be an effective date of October 1, 2013 has now been extended to October 1, 2014. However, practices will need start preparing for the changes soon or at least have an implementation plan in place. Many practices will wait until the last minute to start the planning and preparation because the deadline may once again be extended. However, with the complexity of the new coding system, there are certain areas that your practice may want to consider preparing, to aid in a smoother transition.

So what do these four issues have in common? They all have a potential to impact your practice financially. Too often medical practices choose to ignore changes to the until it is too late. The time to prepare your practice is now.

Are your employees venting about having too much work and not enough time? Are they expressing that they never having enough time to finish all of their work? Is the office paying too much overtime because your employees are having to stay late or come in early?

Many medical practice employees find themselves playing catch up on a daily basis. We as managers have tried several times to help. We have scheduled training sessions, thinking that maybe the employee is simply just not adequately trained to do the job. We have reorganized their desks, created daily tasks lists and taught them how to manage their day, only to find that they are still not able to complete their work. This is where the hard part comes in. Is it time to consider terminating the employee? Can you honestly say that the employee has been given all the resources to perform his/her job and is still not able to do so?

Here is an exercise that I have done in my office that has been an eye opener several times: I will observe my employee all day long. There, that simple. Now, what do I look for? Is the employee being interrupted numerous times? Is he/she properly supplied with the correct resources (computer, office supplies, information) Is he/she taking unnecessary steps or doing another employee's work? You'd be surprised how much information you didn't have before by performing this simple task.

It is imperative that all office roles are identified, but you have to be realistic about it, simply saying these are the responsibilities for this position isn't going to do it. Understanding what that person does already and what areas are suffering due to he/she not having enough time do it is very important in reorganizing your office roles. It not only is unfair to the employee since you are really just setting them up for failure but it could potentially create revenue leakage in your practice. I know you are probably cringing at the thought of hiring more people, but have you looked at the overtime you're already paying. If one employee is working 10-20 hours of overtime every 2 weeks (lets say she gets paid $14.00/hour) thats equivalent to $210-$420 at $21.00/hour, again for for only 10-20 hours. How about you hire a part timer to work those 10-20 hours at $12/hour? That's only $120-$240 for the same amount of hours of work. This person can come in to work on the small tasks that are taking time away from that full time employee. For example, maybe your front desk is spending a lot of time calling patients to remind them of their appointments or answering phones. If your office has a high volume of patients on a daily basis, having someone performing these two simple tasks can really help your front desk provide better service, be more thorough about checking benefits, and so on.

Do these simple tasks to determine what if any roles in your office need to be revised: Observe the employee; analysize your office's overtime and how this can translate into a part timer being hired. You'll find that you can run a more efficient office when you do this. Many times overworked employees are unhappy employees. This results in low office morale, bad customer service and a bad experience for your patients.

Having an airtight authorization process is extremely important in ensuring reimbursement for services provided in the office. Too often an in office procedure is done with out the correct verification and the services are denied for no authorization on file. However, understanding the patients' policy is also important. One important piece of advise I give  is, if your not sure if needs an authorization, just call and ask. At times, those online verification services are too vague when it comes down to services like injections, DME, fracture care, in office procedures, etc. Call the patient's healthplan and verify this. If you are told that an authorization is NOT needed, document a reference number and name. You may need this for an appeal if services are denied when the claim is processed. Other advise I give is:

VERIFY MEDICAL NECESSITY
This is often a step missed in the decision making process of an in procedure. Now, I don't expect the physician to stop what he's doing to verify if the services are medically necessary. However, someone in the office has to take this very important step. I can not stress this one enough. I small step can save your office a lot of trouble and money.

All insurance have their own guidelines for medical necessity. Take the time to explore the websites of all insurances accepted in your practice and located the policies of your most common services. Put these together in a clear and concise spreadsheet so it can be used as a reference. Too often this is not done and a practice finds themselves with a denial and no idea why. Only to find out after the fact that the diagnosis used does not support medical necessity.

VERIFY THE DEDUCTIBLE
Many times a patient's policy will have different deductibles. Today medical policies are so complex that it is very difficult to obtain all of these deductibles at the initial verification. One verifying whethere or not an authorization is needed you should also be asking if the patient has a deductible for these types of services.

COLLECT UP FRONT
Its unfortunate, but true, if you do not collect from the patient at the time of service, it is very likely that you will have a very difficult time after the fact. Collect an approximate out of pocket for the patient. If the procedure has an allowable of $214.00, and the patient has a deductible of $125.00 remaining, collect the $125.00. It's always better to give a refund than to have to chase a patient or pay a collection agency for their service.

Wether you are an office manager or the billing/collections manager, proper revenue management begins with understanding the way your practice flows. It's very important to know what each one of your key positions do on a daily basis. If you're managing your practice's revenue from your position's point of view, you may not be identifying certain potholes in your practice's flow that are in turn, affecting the practice's revenue.

COMMON POTHOLES IN A MEDICAL

1. The registration process

Careful analysis of your practice's registration process is the most important step in identifying possible potholes that could affect your revenue down the line. There are several key steps taken at this stage.

A. Collecting patient data:
     Once the patient completes the registration paperwork, is this information being reviewed by your check in staff member and confirmed with the patient? Ilegible apartment numbers, zip codes, street names, etc., these are all things that many times are disregarded and thought of as irrelevant, but if the patient needs to be billed for a coinsurance charge, deductible, etc., you will not be able to accomplish this due the invalid information collected and entered.

B. Recording patient insurance policy:
     Taking a photocopy of the patients's  insurance card is a vital step that can not be missed. Any questions about claims mailing addresses, group numbers and so on, can be confirmed later on in the collections process if needed. Additionally, making sure that the correct insurance profile is selected in your billing program is also key. Many carriers have several mailing addresses depending on the policy and ensuring that the correct address is recorded is crucial. In a day where almost if not all claims are going electronically, the address isn't needed for the intial claims submission for any future appeals or medical records that may need to submitted.

C. Proper Insurance Verification:
     Checking for a copay is pretty simple to verify and many online services like Emdeon and Availity will provide this quickly. However, when we enter the world of a PPO, POS, EPO and anyother type of non HMO policies, you now many need to verify the patient's deductible and/or coinsurance. Too often practices think that you verified and collected the patient's copay, so everything is fine. Unfortunately, many individual policies nowadays have very limited benefits. From a flat allowed amount paid (vs a percentage) to a high individual deductible, these are areas that catch medical practices by surprise. Instead of receiving a payment for an office visit of $65.00 because you've already collected the copay, you find that you only received a payment for $42.00 and need to bill the balance to the patient because they have a 60/40 policy. This type of error made one time seems irrevelant, but when done many times a month it adds up. Making sure that Check-In understands medical policies and its components (deductible, limitations, coinsurance, etc.) is imperative to ensuring that as much money is collected upfront to avoid delay in payment in the future.

Observing your Check-In staff member for a couple of days to see what their process is could serve as an eye opener. Maybe you had no idea that he/she had no knowledge of a very vital step that needed to be taken. Communicating to him/her how important their role is in the practice's revenue process can also help them feel as though they are part of something bigger. That what they do has a large impact in the entire process.

Stay tuned for other potholes and processes that will be discussed:

Authorizations
Customer Service
Effective Communications
Check Out
Scheduling/Appointments
Care Coordination
Referrals

....And many more