I work with medical practices all the time, and they don’t always seem to have all their bases covered.  This means they are spending their days fighting fires, while they provide patient care, but they are not able to spend their time proactively thinking about how to make things better.

Here are some questions you should ask yourself to see if your medical practice is performing at the top of your game:

1. Do you have command of your numbers?  And do you know what those numbers mean?  Between your accountant, and your practice management and billing systems, you should be able to know all kinds of metrics about your practice.
2. Do you know where your patients come from, and do you know which patients you’d like to have more of?  Less of?
3. What is your internet presence, and what do patients who are looking for your services, or looking into your practice, find when they do a search?
4. Are your contracts and fee schedules all up to date, and have you negotiated the highest reimbursement from your payors?
5. Are all your forms, superbills, EHR templates, billing reports up to date so you can maximize your capture of the most current documentation, coding, billing and remittance information?
6. Are you providing only those services you’ll get paid for, and referring patients to other specialty providers when their insurance plan won’t pay you?  For example, many insurance companies today don’t pay for imaging services in the office and require patients to go to specially contracted imaging centers.  Many providers have the equipment and figure it doesn’t really cost more to do it themselves, however, have you really done a return on investment analysis?
7. Are you documenting and coding and billing correctly for all the services you DO provide?  Many providers are so wary of being accused of over billing or over coding that they are cheating themselves.
8. Are you getting paid, and paid correctly, for all services you do provide?  If you use an outside billing service, how do you keep track of this?  What do you do when reimbursement falls short?
9. Do you perform regular internal audits of your entire revenue cycle to identify any areas in need of improvement?
10. And, this is a new one over the past couple years.  Are you KEEPING the payments you do get?  Every insurance company, especially the governmental payors like Medicare and Medicaid, have hired outside firms to work on a CONTINGENT FEE BASIS to identify ‘fraud and abuse’ and recover payments already made to providers, and many times these are for services provided YEARS AGO!  These companies cast a wide net looking for any potential discrepancies and many providers are so afraid of getting onto the radar of the government in any way that they may actually be doing themselves a disservice by not assertively responding to these refund requests.

I met with a practice yesterday that had met just about all these criteria, and it was so refreshing!  With so many practitioners being challenged by all the change going on in the healthcare arena, it is inspiring to see that it isn’t getting to everyone.

How about you?  If your practice needs a tune up, or if you’d like an assessment of the most cost effective improvements for your particular practice, contact us for a free consultation at info@HabaneroInc.com

If you are a patient, and you need to connect with a provider for a particular condition, how do you choose from the many providers out there?  If you’re a provider and you want to be able to connect with new patients, how do they find, and then select you?  Here are just a few options:

Insurance Company Lists

If a patient is fortunate enough to have access to health insurance, the insurance company maintains a list of providers who participate in their insurance plans.  These lists may be available in hard copy form, or more commonly, on the insurance company’s website.  Patients can use these lists to narrow down their choices based upon name recognition or geographic location.  Providers should regularly confirm all their practice locations are properly listed for all the insurance companies with whom they participate, and promptly update any inaccurate or insufficient listings.

Internet Searches

There are MANY sources of provider information available online.  Patients today can post their experiences, both good and bad, on one of dozens of healthcare opinion and experience websites, such as healthgrades.com, vitals.com and ratemds.com, to name just a few.  Providers, what information is prospective patients seeing about YOU when they do an internet search?

Word of Mouth

Often the first choice for a patient is a provider who comes with a glowing recommendation from a friend or family member.  Sometimes, the recommendation is so compelling, the patient doesn’t care if the provider is in their insurance network or not, and they are even willing to pay out of pocket and seek reimbursement from the insurance company after services are rendered.  The same word of mouth system can have the exact opposite effect, where a bad experience can steer a patient away from a prospective provider.  Providers, ask yourselves honestly, what are your current and prior patients telling their friends and family?  And keep in mind, unsatisfactory experiences with office and billing staff can negatively reflect on otherwise good medical care!

The concept of Telemedicine is that the health care system could save considerable money, and patients could experience a heightened level of support for particularly delicate conditions, if the patient could be accessed remotely by the provider.

Obviously, this won’t work well for physical therapy and other hands on healthcare modalities, but certain treatments and conditions, such as continuous oxygen, patient history of non-compliance, high risk of emergency care interventions, medication management, etc. lend themselves to this new technology.

As technology has gotten more sophisticated and less expensive to deploy, telehealth services have become more appealing to all parties – patients, insurance companies and providers of healthcare services.

Medicare has issued very comprehensive guidelines, and many Medicaid agencies have adopted CMS’ guidelines as well.  Commercial insurance carriers address it in their provider manuals, but always with a litany of caveats as to when, if and how much they might pay.  And the documentation, coding and reimbursement rules are likely to trip up providers as they attempt to participate in this new healthcare delivery system.

The good news is that if this technology is able to deliver as promised, we could be welcoming a new breed of medical monitoring devices in our homes in the very near future.