Don't Leave Money on the Table

June 1, 2014
Brian O'Neill

Every year doctors and surgeons top the annual list of best-paying jobs in America. But, as all physicians know, this comes at a price.

Every year doctors and surgeons top the annual list of best-paying jobs in America. But, as all physicians know, this comes at a price.

Surgeons, for example, routinely earn more than $200,000 a year; but only after spending anywhere from 3 to 8 years in residency and often incurring huge student loan debts. Family practitioners, while still earning far more than the average American worker, have seen their income slide in an unappealing trend due to reductions in government reimbursement, tighter contracts with health plans, rises in malpractice insurance rates, and the not-so-simple costs of running a practice—from staffing to rent to equipment.

This perfect storm of reduced revenues coupled with increased operating costs makes it more imperative than ever that independent physicians and physician groups of all sizes have a strategy in place to maximize their revenue potential and assure they don’t leave any money due them on the table.

Fortunately, there are many things physicians can do to help make this happen. Here are 4:

Coding

One area getting a lot of attention these days is the shift from ICD-9 to ICD-10 coding. Although the conversion date for changeover has been pushed back to October 2015, physicians should have already started to prepare for this dramatic change.

These new codes are not simply greatly expanded and renumbered, but include fundamental differences in terminology and a greater level of diagnosis detail to appropriately reflect advances in medical knowledge. The degree and complexity of these changes underscores the need for physician groups to have the right tools, knowledge, people and foresight in place to make this conversion as seamless as possible. Failing to do so could result in a significant detrimental effect on their cash flow.

Electronic health records

Another area that can greatly impact a physician’s revenue is conversion to electronic health records (EHR). Medicare EHR incentives of up to $44,000 per eligible provider are a strong call for medical practices to move to a digital patient record system that fulfills “meaningful use” requirements.

Meaningful use is categorized as technology that improves care coordination, reduces healthcare disparities, engages patients and their families, improves population and public health, and ensures adequate privacy and security. Offices have much to gain financially by moving over to an EHR as the transition will help practitioners avoid the 9% penalty in Medicare payments that will be imposed in 2015 on offices that have not done so. To take full advantage of the incentive payments under meaningful use, practices must be sure to choose a certified Stage 2 EHR vendor.

Converting to EHRs is only the tip of the iceberg when it comes to the many things physicians can do to increase their revenue potential through office automation. Replacing paper with automation allows for greater efficiencies and more time spent with patients, and that all ultimately translates into more revenue for the practice.

Physician offices can add to their practice’s efficiencies, as well, by providing patients with the ability to interact with a practice online to perform routine tasks such as scheduling and canceling or changing an appointment, as well as request medication refills or view lab results. By automating these mundane but necessary tasks, office staff members can be more efficient in their core functions … and efficiencies translate into dollars saved.

Eligibility checking

Automating an office should also include “eligibility checking,” which allows a practice to validate insurance coverage before the patient ever arrives for an appointment. With the right system in place, staff can obtain information on deductibles, co-pays, and other out-of-pocket charges the patient will need to cover—making collection of these dollars easier and more efficient.

Clearinghouse

So, too, the right clearinghouse can increase cash flow, lower accounts receivables, and assure that providers receive the full reimbursement to which they are entitled for the services they provide. In addition to pre-screening for errors in the information provided by the provider to the payer, a clearinghouse helps in the claims processing because insurance companies that receive claims through a clearinghouse get information in a format that is actionable and easy to understand.

In seeking a resource like this, physicians should look for a clearinghouse that is capable of managing every aspect of the revenue cycle, including claims management, eligibility, and electronic remittance advice. Also referred to as an Explanation of Benefits, electronic remittance advice allows practices to know what they will be paid shortly after claims submission. Not only does this technology save offices time, it greatly aids in managing cash flow and can be extremely useful for tracking any trends in claims submission, such as repeated denials for certain procedures or from certain payers.

Faith in technology

Physicians know that without operating a profitable practice they will simply be unable to continue to serve their patients to the upmost. Just as these physicians have relied on advances in technology to aid in medical diagnosis and treatment, it is now time to put that same faith into office technology where everyone wins.

Brian O’Neill is president and chief executive officer of Office Ally, which serves 330,000 providers in all 50 states and is the only organization in the country offering healthcare providers a full suite of revenue-cycle management services.