Last month, we have identified the most common Revenue Cycle Management critical gaps within medical practices which can be triggered before and after a claim is filed, including:

• Claims are not filed promptly.
• Patient information is not accurate or up to date.
• Claims are sent to the wrong place.
• Coding problems cause rejections.
• Clean claims aren’t paid for 30-120 days by insurance companies.
• Patients owe balances for services not covered by insurance. You become the “bank” and must issue statements and follow up.
• Patients can’t or won’t pay; resulting in write-offs.
• Collection agencies can be bad for patient relations and can cost upwards of 50% of the money collected.
• You have to borrow money to cover expenses while waiting for payments that may arrived in weeks, months, or sometimes – never.
• Some insurance companies refuse or delay payments that are rightfully due.
• Other carriers have low reimbursements that require you to see more patients to net the same money.

To fix these issues, it is necessary to perform a systematic review of every component of the revenue cycle. To begin, have your office staff walk you through every point of patient contact from the initial phone call to a paid claim. You may discover you’ve made assumptions about how things are being handled up front while you’re busy in the back.

Look at every step through the revenue cycle management lens. You’ll see how to
plug many of the leaks that cost money before and during the visit.

Don’t forget to include your back office in the review. Inventory control is crucial, as
well as appropriately treating patients in the most efficient way. After completion of your review, implement these steps to initiate the positive change for your practice:

• Let your staff help you formulate improved systems and office procedures. The people on the front lines always know about problems the boss might not necessarily notice.
• Make employees aware of the factors that stall cash flow. Let them know they have a stake in keeping the practice healthy and profitable.
• Institute simple checklists to make sure all the bases are covered. Make it known these aren’t recommendations, but the expected standard.
• Document the procedures you want implemented and review them with new and existing staff.
• Monitor improvements monthly. Reward the staff for actively improving cash flow and income by using the system, and random acts of efficiency.

Fortunately, there are proven systems to handle the problems stemming from medical claims and patients that owe you money:

• Slash rejected claims from the national average of 30% to an enviable 2% or less.
• Receive the patient’s monthly payments on time for the balances they couldn’t pay at the time of service was provided.
• Collect on the old accounts receivable that you’re about to write off without hiring a lawyer or using a traditional collection agency.

These suggestions are simple and obvious, however it’s easy to simply get stuck in the same old ways, overlooking the reasons for a cash crunch. Medical profession is designed to create cash flow problems. To get the most money into your practice, and most out of it, you must go on the offensive.

To know more about Patient Payment Plans, Patient Payment Portal and Meditouch Practice Management, please visit at www.elitemedbiz.com.

Unlike most other businesses, as a physician or other health care provider, you have several unique challenges that cause tight cash flow, and more often major leaks. Even practices that are believed to be as highly successful, they too can feel the strain of cash- flow problems. Critical cash-flow leaks can be triggered before and after a claim is filed, when any combination of these problems appear in the practice:

• Not enough patient appointments to fill the daily schedule. Typically, this is a marketing problem unless it resulted from lost patients due to alarming operational issues within the practice.
• Failure to pre-authorize claims prior to the office visit rather than prior to filing the claims.
• Not discussing the financial obligation with the patient before the office visit. Unlike during true medical emergencies, patients deserve and expect to be informed about the cost of their care before it is furnished to the patient.
• Failure to double check and update all patient information prior to the visit and upon arrival. This can dramatically slow down reimbursements if there are errors. Also, verifying a match between the patient and the insurance card can catch use by a family member who isn’t covered. Ask for a picture ID for confirmation.
• Inaccurate or incomplete superbill or encounter form. Without the correct diagnosis and treatment information, you won’t get proper reimbursement.
• Failure to make sure all patients check out after the visit to settle co-payments. Patients can unknowingly walk out without paying, assuming insurance will cover the visit. Some knowingly walk out with their superbill or encounter form in hand, making billing impossible. You can also collect co-payments in advance in many cases for routine visits.
• No-shows. Few physicians charge for no-shows because of the fall-out of goodwill between the patient and doctor. However, routine offenders need to be respectfully educated how that behavior adversely affects inability to see other sick patients that could have been helped sooner if missed appointment was available to them instead. Often, a no show can be rectified early with several early automated phone calls, text, and/or email appointment reminders resulting in either confirmation of an appointment or re-scheduling for a next available time. A properly implemented no-show policy and procedure initialed and signed by the patient sets early expectations between the physician and the patient resulting in mutual respect and understanding of mutual responsibilities.
• Lost patients due to poor patient relations or inattention. Each and every one of us, at some point in our lifetimes, came across “that individual” that should have never been allowed to deal with patients or customers; let alone be positioned as the first person setting the tone for the remainder of the patient’s visit at the practice. Management of employee’s bad behavior is not a pleasant task that we all signed up for. However, the approach of “looking the other way” never fairs in a positive outcome. Most patients will keep their bad experience to themselves and will not make us aware of an alarming problem with our employee. Furthermore, disappointed patients will leave our practice, walk across the street to competing practice that they can trust, share their bad experiences with their family, friends, and social media circles. Next thing we know, our bad employee has created and validated bad reputation of our practice which has resulted in fewer appointments and a real threat of the practice closing its doors. Small misunderstandings and big problems can be caught early simply by an implementation of meaningful, independent patient surveys that open channels of communication between the patients and the practice. It has not been uncommon to find valuable ideas and feedback that can lead to improvements ultimately resulting in our patients becoming the best marketing team for our practice.
• Excessive write-offs. The most common write offs in medical practices are contractual adjustments and uncollectible accounts. Write-offs vary for physicians based on who’s paying the bill and the economic status of the local community and its residents.With an HMO or PPO, a practice may lose anywhere between 10% and 36% on regular rates, which depends on the insurance agreement.Uncollectible accounts from self-pay patients can run 5-15% among affluent community, and up to 75% in severely poor areas.

  Medicaid write-offs can be high – over 70% in some areas, and Medicare write-offs are not unusual to be found at around 35%.

  Cash-flow leaks can last a few to several months after the actual visit. Furthermore, a decision to utilize the line of credit to cover immediate operational expenses, result in unnecessary finance charges costing your money and speeding up a debt spiral of the practice. Insurance companies are often not the primary reason of the practice’s cash flow leaks. Often, practices themselves contribute to the problems. Fortunately, there are many ways to speed up payments, collect more of what you’re owed and plug the “internal bleeding” caused within your own practice.

To know more about Patient Payment Plans, Patient Payment Portal and Certified Medical Coding Service, please visit at www.elitemedbiz.com.