When assessing the financial status of your practice, the natural tendency may be to focus on cutting costs. But successful practice managers and administrators know that maximizing revenue should be given priority consideration for its contribution to financial strength.
“Depending on the compensation structure of the physicians, a substantial net income may be expected in order to pay bonuses. For others, simply keeping a positive number to support the current salaries is acceptable. Either way, it is important to manage the bottom line of the medical practice to verify financial expectations of the owners are being met,” explained Dixon Davis, vice president of practice management for AAPC, a company that trains and provides credentials in the documentation and coding audits, regulatory compliance and physician practice management.
According to Davis, six fundamental steps, which follow below, can help practices achieve financial success.
1. Maintain productivity
One of the most important elements of achieving financial success in a clinic is having productive providers. After all, higher productivity results in higher revenue. Effectively monitoring productivity helps manage the provider’s expectation of how it affects compensation and the bottom line. In addition, a manager should always be looking for ways to enhance revenue streams through creating more efficient processes and additional services.
2. Capture all charges
Once services are provided it’s important that all of the charges are captured, Davis said. First, make sure every service that’s performed is identified on the billing sheet or in the EHR. This means that any providers, nurses, technicians or other staff involved in providing services must properly document everything they do. Second, accurate documentation and coding of the services being performed are vital. Medical claims are paid based on procedure and diagnosis codes so they must be accurate to ensure revenue is not left on the table or is put at risk or recoupment. Third, this information should be submitted through the proper channels in a timely matter.
3. Verify clean information is being sent the first time
Correct insurance information, demographics, and code entry are imperative for the initial submission. Incorrect information results in denials and delayed payments, which can directly impact revenue streams and increase costs. Review all processes involved with collecting this information and make it a priority to get it right the first time. This is effectively done with clearly stated processes and expectations followed up with periodic audits to identify areas where improvements can be made.
4. Effective office collections
Being disciplined at collecting patient balances due while the patient is in the office is key. While it’s an easy concept in theory, it is still not carried out well by many health providers. Co-pays, deductibles, co-insurance, or past-due balances are much easier to collect when the patient is in the clinic versus weeks, or months, after their visit. This requires a clear policy on what’s expected, training for the office staff on how to be effective and a culture where patients are held accountable.
5. Effective collection policies and procedures
The effective work of a billing office is vital for collecting all of the money to which a practice is entitled. Billing departments need to have clearly stated collection policies/processes. This includes how to work denials, following up on aging claims, how and when to collect from patients, when to send claims to collections, and when to write off bad debt. Spend time identifying processes that are as simple and straightforward as possible, and then provide education and training so that the staff knows how to be effective in their responsibilities.
A billing office staff is much more effective when working within a structured process than making it up as they go or taking the path of least resistance. A manager should have set metrics that are measured and reviewed with the staff on a regular basis to maintain direction and identify areas needing correction.
6. Regular review of contracted payer rates and operational costs
Healthcare providers should review contracted payer rates periodically. This ensures they are negotiating the best rates available so they may maximize revenue opportunities. Also, it’s important to maintain cost structures. After establishing a strong revenue flow, reviewing costs such as liability insurance, supplies, phone contracts, and other operational expenses helps make certain you are receiving the best prices available.
