In this 20-minute podcast, Randy Bauman, Author of Time to Sell? Guide to Selling a Physician Practice: Value, Options, Alternatives, recently published by Greenbranch Publishing (www.mpmnetwork.com) discusses the current market forces at play in the wave of physician practice sales, the key things physicians should look for when they decide to sell their practice, what hospitals are looking for in medical practices, and Randy Bauman's expert assessment of the landscape for physicians selling their practices. Randy Bauman - 800 467-3310
In this second installment of a 3-part series, Bruce Lefco, CEO of Health Payment Systems, discusses their innovative financial transactions promising payment to healthcare providers in twenty days, on both the insurance and self-pay portions on a non-recourse basis. In this 20-minute podcast, Mr. Lefco explains HPS's creative ways to communicate charges to patients and he also describes the SuperEOB concept. http://www.hps.md
How Much Does it Cost You to See a Patient?
In this 20 minute podcast, Owen Dahl, MBA, FACHE, CHBC, author of Think Business! Medical Practice Quality, Efficiency, Profits, discusses how much it really costs a doctor (or a practice) to see a patient. No, the answer isn't what you charge for an office visit. A physician needs wise management of costs and an understanding of revenue enhancement to assure long term success for the practice. But how do you analyze costs in a practice? Mr. Dahl addresses fixed, variable, direct and indirect costs with practical examples of what costs you can control. You may think it is your office supplies – but analysis of your payroll may yield larger savings. Also hear his expert comments about patient satisfaction, your no-show rate, overtime costs, and what it means to the practice to see just one additional patient per day. http://www.thinkbusiness.md
How to Get Paid for Hospital Services with Betsy Nicoletti
In this 20 minute podcast, Betsy reviews details surrounding physicians getting paid for hospital services. Can physicians get paid if they have to see a sick patient more than once a day? What does group membership have to do with getting paid for hospital services? What is the difference between observation admission series of codes and the observation with discharge codes? What are the rules for critical care? What about the proper way to bill follow up visits after an initial inpatient consultation?
Judy Capko, President of Capko & Co., based in Thousand Oaks, California and the author of the best-seller, Secrets of the Best-Run Practices is interviewed by SoundPractice.net. In this 20 minute podcast, Judy reviews the concept of monthly strategy meetings in a medical practice, how to get doctors and others in the practice to buy-in to such meetings, how to best structure meetings to share performance data, and the most important issues and benchmark data to cover on a regular basis. She also discusses how to keep focus and momentum up for such strategy sessions.
Bruce Lefco discussed the state of healthcare reimbursements and the features of Health Payment Systems, Inc., a Financial Transactions Company based in Milwaukee, dedicated to simplifying the reimbursement process and lowering the cost-to-collect and bad debt expense.
For more information please visit http://hps.md
Interview with Doral Davis-Jacobsen, Manager with Dixon Hughes, PLLC, based in Asheville, North Carolina. In this podcast Ms. Davis-Jacobsen describes steps that the "better performing" practices take in order to improve AR. She reviews the components of an effective AR monitoring system, describes statistics and useful benchmark comparisons that are available to medical practices and she summarizes the most important steps a practice can take to improve accounts receivable performance. For more about Ms. Davis-Jacobson, visit www.dixon-hughes.com.
David B. Mandell, J.D., M.B.A. is an attorney, author, and educator. He focuses his law practice on asset protection, tax, and estate planning matters. He also is a principal of Jarvis & Mandell, LLC, a financial planning firm focusing on tax, insurance, benefits, and retirement planning matters.
When it comes to your annual coding compliance audits, you have two choices: grit your teeth and get them over with or use them as an opportunity to find lost revenue, discover and solve problems in your revenue cycle and fulfill your compliance obligations at the same time.
I frequently find services that were provided and documented but not billed when I perform compliance audits for my clients. It's easy to dismiss these as single, one-time errors. But, I suspect that they represent recurring problems, not one-time errors. Repeatedly neglecting to bill for services done and documented results in lower cash collections to the practice. What's worse, you have incurred the expense to provide the service!
Here are a few examples of lost revenue I find while doing compliance audits:
Lab services not billed: CLIA waived tests are done, documented in the medical record and reported to the patient, but not billed to patient or insurance company.
Incorrect units: One unit of medicine is billed, when the correct dosage per the HCPCS defines the amount given to the patient is 2 units, or 10 units, or 100 units. The practice paid for all of the units billed, but incorrectly bills for a lower dosage than provided.
Procedures: Some physicians and providers believe that for all insurance companies, only one service can be billed: the Evaluation and Management service or the procedure. They perform and document both, but bill one. I have also found the modifier applied to the wrong procedure, and the charge written off when the insurance denies it.
Hospital services: The charge capture process for out of office services lacks controls in many practices. On audit, I find wrong dates of service, and no service billed for hospital visits.
When you do your compliance audits, be on the look out for these lost billing opportunities. If you find the error once, actively look at your revenue cycle processes, identify why the charge wasn't billed and implement changes to capture those charges every time they are billed.
The easiest money your practice will ever make is by billing for services already done.
Roth IRAs have become an extremely popular option for those who prefer the unique advantage of being able to withdraw funds during their retirement years on a tax- free basis, as opposed to traditional IRAs where withdrawals are taxed as ordinary income. The only real downside to Roth IRAs is that contributions are made on an after- tax basis, and are not tax deductible like with a traditional IRA. Unfortunately, most urologists have not been able to utilize Roth IRAs due to their relatively high income levels. Roth IRA eligibility phases out between $95,000 and $110,000 for single filers and $150,000 to $160,000 for married taxpayers filing a joint tax return. Starting next year, however, highly compensated individuals who are currently not allowed to contribute to Roth IRAs, as well as younger workers expecting to be in higher tax brackets during their retirement years, will be able to take advantage of a new type of tax- advantaged savings plan called the “Roth 401(k)”.
As its name implies, the Roth 401(k) incorporates elements of both traditional 401(k) plans and Roth IRAs. Part of the Economic Growth and Tax Relief Reconciliation Act (EGTRRA) of 2001 and available beginning January 1, 2006, the Roth 401(k) allows workers to make greatly expanded Roth IRA contributions but without any income restrictions impacting eligibility. Contributions for Roth IRAs in 2006 are limited to a maximum of $4,000 for taxpayers under age 50, and $5,000 for those 50 and older. The Roth 401(k) maximum contribution level, on the other hand, will be subject to much more generous elective salary deferral limits. Beginning in 2006, workers under age 50 will be able to contribute up to $15,000, while workers age 50 and older will be able to contribute as much as $20,000 in the new Roth 401(k) plan. At that point, an employee currently contributing to a traditional 401(k) plan would have the option of simply having their contributions diverted to a Roth version of the plan. That election would impact the amount of take home salary since the contributions will be made on an after-tax basis, as opposed to pre-tax contributions made into a traditional 401(k) plan.
It is also important to understand that you cannot simply assume that your plan will be amended to allow after-tax Roth contributions. Employers should contact their plan administrators to determine the feasibility of adding the Roth feature. Interested employees should inform their employers that this is an option they would like to see included in next year’s retirement plan structure.
Time-of-service collection is a critical component of the financial success of your practice and its customer service mission. The benefits are:
Provides information to the patient – prior to the first visit – enabling them to do personal financial planning q Provides a forum and process for communicating your practice’s financial expectations and mission q Expedites cash flow from patient portion by an average of 60 days q Lowers bad debt expense through effective financial counseling and credit risk management q Heightens staff productivity through reduced self-pay collection follow-up q Lowers cost through reduced statement processing q Fulfills utilization controls of managed care firms (Deductibles, co-payments and co-insurance are designed to remind patients healthcare is not free and to be part of the utilization management process – in fact, many contracts require practices to collect co-pays at time-of-service)
If you have in place an effective pre-visit registration process, a collection at the time-of-service program is already 99% complete. Prior to walking through your door, the patient will be aware they are expected to pay at the time of the visit, any alternative financing option you may offer (i.e. installment plans, financing programs, etc.), and the amount of their expected payment. It will be the mere act of asking, “Will you be paying by cash, credit card or check?” to complete the process.
The Psychological Advantage
A person’s thinking about paying a healthcare bill changes radically the moment they leave the clinic without paying. Before service and at the point-of-service, their health is the number one priority and they have the mind-set of a patient. They are motivated to make payment because they are motivated to maintain or restore their health.
When they leave the clinic, they are no longer a patient – they are now an economic animal with obligations to many different creditors – mortgage payments, credit card payments, utility bills, and their children’s education needs. Your bill will begin competing with all other bills, and, if the patient’s financial situation is tight, your clinic’s bill will always come in last.
Do not lose the psychological advantage. Ask for payment when the patient is most motivated to pay.
The Largest Obstacle to Implementing Time-of-Service Collections
Effective time-of-service collection programs are all about attitude – to be effective your staff has to believe in and sell the program. Programs fizzle because the staff is just too uncomfortable with the idea of asking someone for money. Therefore, take the time to facilitate meeting(s) with your staff to discuss their concerns and to help them develop their collection skills.
Concerns which you may encounter – and a response:
“Asking people for money is bad customer service.”
Yes, surprising people by asking for money - without informing them of your expectation of payment at the time-of-service - is bad customer service. But in the pre-visit registration process you have set the stage for them to expect you to ask them for payment. Any objections have already been overcome. Giving people information to make informed decisions about their financial obligations is great customer service.
“I feel uncomfortable asking people for money, it seems rude.”
In every other phase of a patient’s life they expect to make payment (or arrange for payment) at the point of sale. Staff needs to understand the patient will not be offended, and their fears of the “hostile” patient are unfounded. Have the staff, as a group, write scripts responding to their worst fears. Have them act out the scripts until they feel comfortable. Some staff will be more comfortable (and better at) than others in asking for payment. Rotate staff to see who can get the highest collections – ask the top performers to share their secrets to success with the others.
“I feel uncomfortable handling money, if it gets lost, I’ll be blamed.”
Explain to staff there are accounting procedures to ensure cash is reconciled. These procedures protect the people who handle cash from being accused unfairly of losing or stealing the money. Show them the cash receipts process and how cash will be safeguarded.
Helpful Reminders – Signs and Brochures
You can’t say it too often or in too many different ways. Discrete signs indicating payment is expected at the time-of-service should be displayed at the reception and cashier areas. If, under your managed care contracts, the practice is obligated to collect co-payments and deductibles at the time-of-service, this very helpful information should be displayed.
Brochures, which describe the financial expectations for the patient, should be developed. It should also include information for the patients who are under financial duress and would like financial counseling. The brochure can be effectively used in the financial counseling interview process to walk the patient through the policies of the practice and provides them with a document for future reference. At the patient’s first appointment, have the patient sign an acceptance of the financial policy further enhances a patient’s understanding of the practice’s financial expectations.
The ultimate goal for time-of-service collections is 100% of all payments for non-insured patients’ self-pay balances and insured patients’ co-payments, deductibles, and co-insurance. However, the first step in the process is to establish a current experience as a baseline for improvement. If your current experience is 10 percent collection of non-insured balances and 30% of co-pay collections, it is unreasonable to expect 90 percent effectiveness next week. In this case, set interim goals leading up to your practice’s effective 100 percent over an appropriate period of time.
High Risk Credit Patients
There will always be patients who present special problems. Despite your best efforts at patient counseling before service, some patients will not be prepared to pay. As your pre-visit registration process improves, the number of patients filling this category will diminish – but what do you if…
…If they are a consistent problem and appear with prior accounts unpaid; it is time to do some financial counseling.
q Find a confidential area where you can talk to the patient q Explain to the patient the policy of the practice and ask them what special circumstances they are under which prevent them from paying their accounts q Listen to their concerns. Only three percent of patients who do not pay are true delinquents – the other 97% have good intentions but need help in their personal finances q As the patient explains their financial situation you will see opportunities which could aid the patient in fulfilling their obligation q Be prepared with the alternative financing options (interest-bearing installment plans, outside financing, or credit cards)
The financial counselor’s mission is to provide information to the patient so they are better able to make decisions. It is also the mission to overcome any obstacles to payment and – before the patient leaves – get a commitment (time of payment and amount).
If, after an examination of their financial status, and it is determined they are able to pay - but refuse – or are habitual credit delinquents then you may come to the conclusion they need to seek services elsewhere. In your Credit & Collection policy address the conditions under which a patient would be terminated. In the Termination Policy detail procedures for notification, time periods, and exclusion for emergency services.
I Left My Wallet in My Other Pants…
For those well-meaning patients who forgot to bring their credit card, checkbook, or cash, there is a technique which makes it easy for your patients to make payment while emphasizing the practices financial policy of payment at the time-of-service. Give to the patient a form, which indicates the amount owed and the payment method (check or credit card). Also, include a self-addressed stamped envelope. Request as soon as the patient returns home they fill in the credit card information (or make out a check), put it in the envelope and mail it back to the practice – today. Hopefully, they won’t forget their credit card or checkbook next time.
I have a theory about human behavior and productivity in the work place -- specifically concerning health care business offices. This theory -- my theory -- if rendered true (or even half-true) is troubling. Here it is:
The thesis rests on the assertion that business offices resources need to be expended in support of the three C's of the revenue cycle: Cash, Cost and Customer Service.
If activities (behaviors) do not lead back in support of one of these raisons d'etre, then they should be abandoned -- or, at least prioritized below those who do.
The wasted productive time is not the time spent hanging around the water fountain, or personal phone calls, or just plain cussedness--rather it comes from disorganization and lack of prioritization of critical activities. It is due to a lack of an understanding of success indicators, and non-assertive management of problem employees.