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Healthcare Practice Strategies – Winter 2012 - 5 Steps for Maximizing Revenue

It’s the goal of any practice: To be more profitable while still providing high-quality, patient-centered care. Unfortunately, reimbursement cuts, withholds and increasingly complex payer requirements have placed more and more downward pressure on provider incomes and profitability. 

Increase Your Profitability
Consider these five practical steps for shoring up practice profitability:

  1. Schedule for density – Many practices wind up with chunks of unutilized time in their schedules simply due to no-shows and last-minute cancellations. These account for 40 percent of available appointment time, according to an Athenahealth, Inc. study of appointments at multi-specialty medical groups.
    1. Consider using one of the many automated patient appointment reminder services to prompt adherence to scheduled appointments.
    2. Maintain a list of patients requesting earlier appointments to call for filling in last-minute cancellations.
    3. Add online scheduling functionality to your practice website or link to a portal where patients can schedule and re-schedule themselves.
  2. Schedule for the right mix – While you’re scheduling for density, also schedule for a profitable mix of appointment types (new patients, follow-ups, procedures, etc.). Understanding the likely reimbursement rate for the provider’s time, you can actively schedule to ensure that the most profitable procedures and patients are included.
    1. Capture procedure codes, insurance eligibility and demographic information as appointments are scheduled. Then monitor revenue by appointment type to determine which services are most profitable and which payers reimburse at the highest rates. 
    2. Using this data, proactively schedule more of these profitable procedures and actively target patients from high-reimbursing health plans.
    3. Proactively schedule follow-up appointments, using the same reminders you would with an initial appointment.
  3. Leverage mid-levels – Consider increasing capacity by leveraging nurse practitioners, physician assistants, nurse anesthetists and other midlevel providers. Studies consistently prove that quality outcomes are the same for mid-levels and physicians across many tasks. 
    1. Of course, don’t hire a midlevel provider until you have checked reimbursement rules and know that your group of insurers will pay for the provider’s services.
    2. Monitor third-party reimbursement rules and bill under the physician’s provider number when appropriate for higher reimbursement. Many plans will only pay 85 percent of allowable rates for mid-levels but will pay 100 percent of allowable if the midlevel bills under the physician’s number (when supervision requirements are met). 
    3. Provide your mid-levels with the same level of support that you would other top-level providers (support staff, phone coverage, etc.).
  4. Maximize point-of-service charges and collections – When patient visits are not accurately documented in real time, it’s easy to overlook modifiers and additional procedure codes. In addition, in this era of consumer-directed health plans, patients are increasingly responsible for a larger portion of charges (e.g., high-deductible plans, substantial copayments, etc.). If you fail to master the art of point-of-service collections, you risk losing revenue.
    1. Use detailed superbills and forms (paper or electronic) that are customized to your specific needs. Then, use them to document patient encounters in real time. At the same time, review your practice’s system of internal controls to ensure that all superbills are accounted for and all charges are entered into the billing system accurately and in a timely manner.
    2. Use payers’ online tools to verify eligibility and determine patient responsibility for payment. Put procedures in place to consistently collect this amount at the time of service.
    3. Investigate payment solutions that authorize you to capture the patient’s credit card information at the time of service and then apply charges once the payment has been adjudicated.
  5.  Get paid what you’re owed – Capturing all the charges and using the right codes is only part of the revenue-generation process. The next step is making sure payers actually pay what they owe you.
    1. Use payers’ “rules engine” software to identify billing errors and make corrections before claims submission. 
    2. Analyze actual reimbursements against contracted rates for your top procedure codes.
    3. Audit and appeal all inappropriately paid or denied claims (daily, if possible).

Better Bottom Lines 

The key for providers seeking a better bottom line often lies in the fundamentals of improving scheduling, tightening up on coding and collections, and developing services that will generate additional income. Take care of these issues, and the revenue will often take care of itself.

 

Getting to the Bottom of Lagging Financials 

These two helpful tools can work together to tell you where and why your practice might be lagging financially:

1Gap analysis - Using this tool, you can identify key areas of underperformance, highlighting the relative contribution of various factors. Utilizing widely used measures (Encounters Per Hour, No-Show Rate, Gross Charges, etc.), compare your practice’s performance against appropriate benchmarks (national, regional, by specialty, etc.). The difference between your performance measures and the benchmark is the “gap.”

For example, analysis of your revenue cycle may show a substantial gap between your collections and those of better-performing practices in the same specialty. Through this analysis, you can identify opportunities for improving operational and revenue cycle workflow, and put a plan for improvement into action.

2Root cause analysis - This tool tells you why your practice performance measures are lagging - whether it’s patient safety or net income per Full Time Equivalent (FTE) physician. Here, you break down the performance issues uncovered in the gap analysis into components that can each be benchmarked in turn.

For instance, further analysis of a revenue gap may point to inaccurate coding as a contributing factor. Digging deeper, you may uncover multiple additional factors, creating a tree diagram of errors. For example, you might find that coding staff lacks sufficient clinical knowledge to code to the highest level. Further, a provider may be providing ambiguous or nonspecific documentation. At the administrative level, lack of a standardized HIM workflow model may be compounding these errors.

 

Healthcare Practice Strategies – Winter 2012 

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