It all comes down to three things; education, communication, and positive behavior. Practices that consistently award and promote these traits are profoundly successful. Every single person in a physicians practice is a part of the revenue process. Learning is perpetual in healthcare and technology.  Networking is a great free resource for knowledge and generating increased patient volume. This helps employees feel empowered, proud, and ownership of their career. Professional associations are excellent resources and usually have great benefits for their members. 

These associations, insurance companies, vendors, and the hospitals sometimes sponsor educational programs for staff members. These are great opportunities for staff and the practice. This is a great way to learn, and your practice gets recognition by networking which potentially brings in new referrals.  Knowing others in your specialty or field that you can call upon to share is always valuable. Ask how others do things, compare services you may utilize; everyone has different resources, connections and tools that we are usually happy to share. Practices of the same specialty or location can sometimes encounter similar issues and may be interested in a collaborative effort to obtain a contractor or outside source. It is usually the same price or discounted to do several of the same instead of one at a time. There are plenty of resources for free education and training. 

Log into www.cms.gov and look at all the materials that you can request. 

Various insurance company websites have e-classes on them and printable materials. Some organizations provide free speakers. Reps and vendors sometimes offer free provider training. Make sure your practice is utilizing all the automation you have at your disposal. When you think of a feature that you think your software or products should offer go straight to the source with it, call your support people.  When you ask another employee and the answer is, "it can't do it" the translation may actually be "I don't know how to make it do it".  If indeed the feature is not available I have found many companies that were thrilled with the ideas/suggestions and make changes to their product to meet your suggestions. The companies rely on us in the field to tell them on how their product could benefit us the most. 

Bringing in a consultant for a coding evaluation, reviewing your collection practices for ways to increase your receivables, or to evaluate your fee schedules, can uncover allowable charges that are not currently being billed, under coding, or contracts that may need to be renegotiated.  Sometimes it is less expensive to outsource some of these projects. In the office there are interruptions and distractions that the outsource will not have and this can result in savings for payroll in overtime expenses. When you bring in speakers or consultants, you should always be provided with sources and/or documentation to support their information.  

Time and again I find practices that pay for services they never use, products that were never delivered, or service people to perform services that were not requested. Creating an inventory control log helps to reduce costs.  When you run out of things you usually have to pay more to get them. Communication is important for patient financial information as well. Evaluate your processes and see if there are any lags or delays that you can improve. 

Just like with your body, an ounce of prevention is worth a pound of cure. The biggest source of loss of revenue for a practice is lack of verification of eligibility prior to service. Without knowing what a patients benefits are you gamble with the collectability of that visit. Expenses do not differentiate between a collectable and a noncollectable patient encounter, each one costs the practice the same amount however. 

It is just as unfair to the patient when you don't verify benefits. Wouldn't you want to have the choice of receiving a service before it is rendered instead of having an unanticipated bill? If a patient is found to have an eligibility or authorization issue prior to service, do your best to communicate that before they arrive. There are a lot of free and low cost resources available to help with this as well. Availity is a wonderful tool for verification, and most insurances allow providers to request access to their websites, and there are companies like American Health Data Services, Inc whom have a fantastic web based service. 

AHDS verifies Medicare and will even tell you amount remaining toward deductible and benefit limitations over the internet so you save valuable time on the phone. In addition to doing precertification, a review of your schedule for accounts with prior balances helps staff collect effectively at time of service. Often preventing just one or two uncollectible visits will recover the cost of your investment. If your staff needs improvement on collecting, you may want to give them an in-service to improve their techniques. Merchants and consultants are valuable resources for training tools and assistance. Look for training tools on sales techniques as well; after all collecting is trying to sell someone on paying their debt that is owed to your practice. By offering financial counseling to a patient and providing information on local programs for reduced electricity costs, telephone expenses, free transportation, or help with prescription drug coverage, you may make it easier for them to pay your office. You only need to research this once and it takes very little time.  Some counties even provide printed resource directories. 

Take advantage of free resources for locating patients whom you may have lost contact with. Services like www.usps.com, www.switchboard.com, to name a few. Try referring to physician's offices or offices whom you have referred the patient to, and ask for current contact info. 

Make efficient use of your time. Ask for help when you need it and never try to cover up or hide when you find an error or a backlog of work to be done.  When you have to make repetitive calls to an insurance company; calling one to do five or six patients at a time saves you time. Participation with the externship programs helps to with tasks like returned mail and claim status.  These are perfect training for externs as well. Make sure you show them the steps that you take after so that they can learn the big picture; externs are there for an education.

Great customer service will set you apart. Staff should call patients back for follow up exams if they have no showed in the past or did not schedule when they left. This is a form of internal marketing.  You want to set an example of positive behavior as a practice toward your patients and your staff. There is nothing wrong with making work fun by providing small incentive prizes for chores in the office nobody wants to do. Be professional, do not keep your patients waiting unnecessarily with no explanation and make sure that you follow up with patients or referring doctors after a patient is seen with a thank you. As a patient, you prefer an office that genuinely cares about you.  Some practices like Suncoast Family Medical Associates in Largo, FL have a great system in place for monitoring their high risk patients or patients whom previously have run to the ER frequently. They hired a full time Shari Antonell, RN whom for years was a patient advocate at a local hospital to monitor these patients closely and make sure that they were on formulary medications to reduce out of pocket for patient, etc. 

That is such a win-win policy. It keeps the patients happy and healthy, it reduces healthcare costs for the insurance companies and the patients, and it saves the practice money in the long run in the number of incoming calls or unnecessary appointments. Shari triages all of these patients to ensure they are getting what they need. As we move into pay-for-performance, I am sure their practice manager Sue Haverty, CMM is going to have no problem when negotiating contracts. In addition, when you can keep your customers (patients) in your practice it is a lot less expensive than having to search and bring in  new business. 

For ideas or resources on any ideas presented please feel free to email me at mimi2331@earthlink.net.

Merrilee Severino, Notary, CPC, CMM
MS Physician Practice Management and Revenue Consultant
727-408-0225
mimi2331@earthlink.net