What doctors need to know

Practice owners know that most returned insurance claims often become Unpaid Insurance Claims.

Most of the time the problem is in-house. Too busy to correct and resubmit it or/and not that devoted staff member ignores the returned claim, puts the claim aside hoping it will go away. After all there is work involved to resubmit the claim and keep an eye on it.

Some of the older providers, or their managers, may be afraid of change when it comes to electronic billing and using a billing service. They may be set in their ways, and don’t want to change, until the day comes when they realize they aren’t collecting as much as they could/should be. You don’t see the problem until you look for it, or until someone points it out.

Some of the providers that are starting out may think they don’t have enough volume to justify using an outside service. This is not true, a new provider would be wise to use an outside service, rather then pay an employee.

New regulations have changed the way we submit claims to all government carriers, and there are more changes on the way.

There are two simple ways medical practices make money. The source is Insurance and the Patient.

“Some doctors spend more time filling out forms than taking care of patients.” – Dr. C. Everette Koop, former Surgeon General.

When filing claims using paper forms, you are decreasing your cash flow, anyone can see that.
Turn around time can take up to 60 days, if you ever get paid.
-There is a very high rejection rate. The National rejection rate is about 35%.
-The cost of the average paper claim is about $12 – American Medical Association Survey

Given the new electronic Claim Submission System and using a Billing Service you can easily increase your cash flow and productivity.

-Average rejection rate from a billing service with well trained staff is under 3%.
-Your billing costs in some cases can be lowered by 50%.
-You would see faster payment of claims. The Average is 14 to 20 days in most cases.

I am not saying that you can’t achieve the same results in-house, given above average paid billing staff, with proper training, the right support staff and up to date hardware and software. Don’t forget, you will need a dedicated manager to keep an eye on it all.
Yes, there is an initial investment and time needed, to set up proper in-house billing system, but it can be done.

Your other option is to let the professionals handle it, in most cases they have everything setup and most billing services are well motivated, because they don’t get paid, if you don’t get paid.

I am sure you can think of ways to increase your bottom line, when your staff can concentrate on other aspects of the business and you have extra space to work with, when you are no longer doing your own billing.

What a relief!

Posted by a Practice Management Consultant at Real Practice Solutions, LLC. in New York.

We specialize in making your practice work more efficiently and more profitably.http://www.realpracticesolutions.com/

HIPAA, OSHA and your Medical Practice

Some things about HIPAA and OSHA that you need to know in today’s medical practice, or when you are opening a new practice.

The most important Aspect of HIPAA is the privacy protection act.
The HIPAA privacy rule went into effect on April 14, 2003 for “covered entities”
“Physician practice is almost always a covered entity, subject to the HIPAA Privacy Rule.” As such, the practice must implement
The Privacy rule applies to health plans, health care clearinghouses, and health care providers. It applies to employers to the extent when they operate in one or more of those capacities.

Your medical practice should have:

• Notice of Privacy – to advise patients about the practice’s HIPAA compliance policies.
• Preset agreements with outside entities that will need access to client information, while providing services on the behalf of the practice.
• You must maintain a system to handle patient information, providing security of patient information in physical and/or electronic form.
• Establish a system that allows patients access to their records.
• Establish a process for patients to use in filing complaints and for dealing with complaints.

These are just some of the things to think about when it comes to HIPAA.

OSHA ensures safe and healthful workplace.

The parctice manager/owner has to make sure that the staff knows where/what your emergency procedures are.

On the list should be Emergency exits, Emergency Phone Numbers, First Aid, All the Required Posters(HAZ-Mat, Hazards, Fire Extinguishers …)

Your staff should know where the nearest eyewash station is, and they should be educated in sterileparctices and decontamination procedures.

We recomend speaking to a healthcare consultant, or an occupational safety & health consultant about these procedures.

Posted by a Practice Management Consultant at Real Practice Solutions, LLC. in New York.
We specialize in making your practice work more efficiently and more profitably.

http://www.realpracticesolutions.com

Visit my New Blog on my Site

Please visit my new blog, hosted on my site www.realpracticesolutions.com.

Updated posts every week.

Enjoy!

YSNY

Medical Practice with Poor Collections

Many practices are having a tough time, and face variety of challenges, considering today's economy.

Accounts receivable is a major concern for any practice in today's market.

Many practices struggle with self-pay patients and insurance companies that don't pay on time, or at all.
There are pluses and minuses when it comes to in-house billing and using a Billing Firm(3rd party). It all depends on the owners preference and the bottom line.

Some practice owners are convinced that the best way to is to have an in-house person do their billing. It might depend on how busy the practice is, how knowledgeable the biller/billers are, do you have a dedicated biller, how well is the biller compensated for the work that he/she is doing, how knowledgeable is your practice manager, or who is doing monthly analysis. These are all factors that go into how well your practice is doing when it comes to collections.

Something to think about:
Are you really saving money?
Do you have extended A/R?
Is it a trust issue?
Is your practice as busy as you want it to be?

According to the Darnell Institute of Business Research, the average cost of working an account internally, over six month period, is $31.60 per account.

Some practices spend so much time on their past due accounts, that by the time they get paid, if they get paid, the cost to collect on the account surpasses by far the value of the collected amount.

Some insurance companies have been known to delay payments. This increases the number of aging sheets, and reduces the chances for recovery.

In most cases using a third party for insurance billing will increase recovery.

It has been stated, if you take one in-house employee that is handling your billing and have them make three calls per day, with each call of about 20 minutes on hold, the in-house employee working 50 weeks per year at $16.00 per hour is paid about $4,000.00 a year just being on hold!

If you take a real look at your day to day operation you will see how much money you are losing.
The same in-house employee can be bring in revenue handling marketing for your practice, or improving your patients care.
If you have the same person handling your front desk and billing at the same time, your practice is suffering!
Every practice can improve their operations by evaluating the day to day process and modernizing.

Most third-party billing services that you can find in your area are not paid until you get paid, something to keep in mind!

The incentive is there for them to do everything possible to get you paid.
I am not saying that every billing company operates the same way, some work on volume.
You have to find a third party that you would be comfortable with and get proper care, same type of care you give to your patients.

There are way to improve your bottom line, everything starts with reviewing your practice policies on billing and collections and educating your front desk staff.
Your staff must educate your patients about your payment terms prior to appointments and be able to spot early warning signs, before an account could become a problem.
It helps to have dedicated employee's.
The use of a collection agency is something that can't be avoided in some cases. If the account is past due 60-90 days from the due date and you tried all the usual options, this account may require third-party collection intervention.

Keep in mind in most cases "Ninety percent of the collections budget is spent to collect 10% of past due accounts." - Dartnell Institute

Remember - Nobody Collects Every Account!

The typical collection agency, collects on the accounts that are six months or older at a cost of 30-50%.

Education and understanding of your day-to-day operation, is the only way you will be able to save your practice time and money, at the same time you will benefit from improved cash flow.

Posted by a Practice Management Consultant at Real Practice Solutions, LLC. in New York. We specialize in making your practice work more efficiently and more profitably.
http://www.realpracticesolutions.com/

Starting a Medical Practice Part2

Whether you are starting a new practice or growing an existing practice you need a plan of attack.

Dwindling insurance reimbursements coupled with rising medical expenses pose a serious threat to every physician practice, something you can't ignore.

The right practice management is one of the most important steps you can take to insure your success.
During the establishment of your new practice, or an addition of a new location, there are many planning, operational, administrative and management tasks that need to be addressed.
Something to consider would be to bring in a practice management consultant to get things up and running.

Who is handling your credentialing process?
Lets hope it is a practice management consultant, or someone that has experience with the process. Credentialing can be a long and tedious process that can be simplified, if you let the right person handle it. It has to be done the right way to avoid complications.
Yes, there is an initial expense, but just think how much time and money you can save by doing things the right way from the start. It will also free up your time to handle the things you yourself must be able to do.

Some physicians are conflicted about whether they should have in-house billing, or outsource this process.
Yes, you can do your billing in-house, you will need to dedicate space, time and resources.
Can you find the right practice manager that will be able to handle a busy practice, stay on top of all personal, most importantly your front desk (because that is where most problems start in the office), stay on top of all the administration needs and on top of that billing.
Can you afford a practice manager of that caliber, can you afford a few mistakes(major/minor) in today's economy.
If you are not able to hire a dedicated professional biller and a good practice manager, I would highly suggest that you outsource your billing to a professional.
Yes, trust is an issue, but I am sure you will be able to find the right billing company to work with. In addition if you for some reason don't like the billing company that you are with, there is no reason not to switch and as soon as possible.

There are some companies that handle the billing aspect and can also provide valuable advice on your practice management.
Practice management and billing go hand and hand. One affects the outcome of the other.

Proper billing process starts as soon as the patient walks into, or calls your office.

Outsourcing your billing, will also free up your very valuable and price space, which can be utilized with additional testing equipment and/or examination room and so on.

Evaluation and additional planning should be done monthly to optimize your goals.

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Posted by a Practice Management Consultant at Real Practice Solutions, LLC. in New York. We specialize in making your practice work more efficiently and more profitably.
http://www.realpracticesolutions.com

Starting a Medical Practice

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Today's goal would be to have your New Medical Practice up and running as fast as possible. Easier said, then done.

Whether you are starting a new practice or growing an existing practice you will need a plan of attack.

Yes, you will need a business plan. Starting a new medical practice is very similar to starting any other business. Designing a business plan is not just something you use when you are seeking venture capital.

You need a business plan that will contain all the steps and schedule you will need to complete your tasks in a rational and a timely manner.


OK, lets say you have years of clinical training, but what do you know about the business side of the medical practice.


Time to start your research, if you have the time. If not then you will need professional help in starting your new venture. Start Up consultants cost money, how much, will all depend on the service you use. In the long run, you will save money using a consulting company that can help you implement your ideas and move things along at a faster pace.
Highly recommended!


You can also save money by handling some of the tasks on your own, or using some of the professional adviser's that you are familiar with.

If you have a familiar attorney, banker, accountant, real estate agent, practice management consultant and any other consultant that is familiar with medical practices, use them.


Each one of these professionals can play a vital part in getting your new business up and running. It is also an ideal way if you would like to improve, or expend your business.

Posted by a Practice Management Consultant at Real Practice Solutions, LLC. in New York. We specialize in making your practice work more efficiently and more profitably.
http://www.realpracticesolutions.com/