The concept of offensive medicine offends some physicians. However, offensive medicine (as in the opposite of defensive) is not unpleasant for patients and it is beneficial to the practice.
Going on the offense means running your practice like a business and being proactive instead of reactive. In my experience, most physicians are not particularly comfortable running their practices like a business. To their credit, they prefer to practice medicine. They do not want to be aggressive about billing. They do not want to play hardball in contract negotiations. They are even reticent to evaluate employees objectively.
As we settle into one of my favorite times of year, March Madness, I am struck by the parallels between basketball and medical practice management. The teams that do well have passionate, focused professional leadership in place. Teams are able to win only when they have developed good plays and the entire team knows those plays well. Successful teams are aggressive on the court and relentless in their offense because, in the end, only offense can score points.
The fact is, modern day healthcare is a business and when physicians don’t treat their practices as such everything suffers. Revenues suffer. Time management suffers. Patient care suffers. Employee morale suffers.
Taking an offensive approach to practice management can alleviate the suffering and help your team succeed.
Top 7 Ways You Can Improve Your Revenue Cycle This Year
1. Take a good, hard look—Assess your practice
In order to face the truth about your practice you need to understand it. Everything you need to know to assess the financial health of your practice is in your data, specifically your explanation of benefits and accounts receivable.
Aging accounts receivable, A/R greater than 120 days out, is an excellent indicator of the financial health of your practice. According the Medical Group Management Association’s Cost Survey Report, a typical single specialty practice has 17.17 percent of their A/R over 120 days. The preferred benchmark is 8.75 percent. You need to know where your practice is before you can work on improving your A/R.
Comparing your explanation of benefits (EOB) to your contracts will let you know if payers are meeting contract obligations. It will also tell you what kind of turnaround you can expect on claims in order to manage your revenue cycle effectively. EOB also shows you how clean your claims are and is square one for reducing denials.
2. Check and double check—Accurate data collection is essential
Knowledge=money. When you improve your data collection you will automatically improve your revenue cycle. Nephrology poses some unique challenges in the data collection arena because patients are frequently not in office but visiting dialysis units and hospitals. This is a challenge, not an excuse, to getting the data you need in order to get the money you deserve.
In order to bill and code correctly, staff will often need to act as detectives. Make sure that your registration forms are complete and up-to-date so that you are collecting all the information you need to make a clean claim. Verify insurance and co-payments each and every time you have contact with your patient.
Make sure billing staff has access to the patient data systems at the hospitals and dialysis units that your patients use so that you can verify insurance through these primary sources. Many payers have online systems to verify patient coverage—ask about these services and use them.
When you do your homework ahead of time (not after a denial) on authorizations and referrals you ensure more timely, efficient payments. This homework includes reviewing fee schedules annually and superbills whenever services are added. Data is knowledge and knowledge is money. Be sure you are collecting all of yours.
