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.

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