Take a Look Under the Hood

So, you’re a medical practitioner and you want to ‘take a look under the hood’ to see how things are going.  Identify areas where you may be able to tweak your existing practice, work flow, job responsibilities, etc. to be able to smooth out your operation, maximize your revenue, increase your margin (profit), decrease turnover, lessen your headaches.

A great place to start is to examine the life of a patient visit along the entire revenue cycle (OK, well, that’s the term that is used).  All the way from how the patient winds up in your office, to keeping the money that has already been paid to you.  (Patients, are you aware that just because your insurance company paid your doctor, she doesn’t always get to keep the money?  Where do you think a ton of the healthcare savings are coming from these days?  The government – both states and the feds, and commercial insurance carriers are all doing massive audits and recoupments.)

Now of course, if you speak to the doctors insurance companies are just trolling and picking on them and they are powerless against the big bad insurance companies, but if you talk to some of the insurance auditors they will tell you that there are a whole class of providers who feel the insurance companies are their own private ATM machines.

Let’s get back to analyzing your revenue cycle.  The first step is to clearly understand how everything flows and interconnects.  You do this by meeting with all the different staff members, or if the organization is large, a representative from each department.

Query staff for operational & reimbursement improvement ideas.  This is one of the most important untapped resources – in ANY organization!

Patient Life Cycle

  1. How does the doctor find patients?
    • Outreach
    • Referral program
    • ED
    • PCP
    • other
  2. How do patients find doctor?
    • Insurance lists (verified?)
    • PCP referrals
    • Prior patient referrals
    • Website
      • Provider site
      • Review sites
      • Hospital
  3. Who are the BEST patients?
  4. Appointments
    • Understand patient screening process, including metrics – KEY!!!
      • Number of patients per day
      • Room in schedule, or squeezed tight?
    • Scheduling scheme (special days/times/allocations for new, F/U, procedures, rounds?)
    • How many new patient requests per week/month?
      • Is there a goal/target?
      • What are yes’?
      • What are no’s?  Quantified/reviewed?
        • What are patient who are turned down told?
        • Insurance
        • Patient rejections?
        • Other
    • How many new patient appointments per week/month?
    • Non-new patient appointments
    • Patients lost due to lack of convenient appointments?
    • ‘booked’ somehow to compare to/project revenue?
  5. When/how is eligibility confirmed?
    • What happens with eligibility problems?
  6. Referral/authorization process
    •  What happens with problems?
  7. Arrivals
    • how long do patients wait to be seen?  Complaints?
    • Payments collected?
  8. Services performed
    • ‘booked’ somehow to compare to revenue?
    • E/M – new patients/follow ups
    •  Surgical procedures
    • Office procedures
    • Other
  9. Coding
    • Via superbill?
    • Who does it?  Is it specialty oriented?
    • Any conflicts with hospital coding for procedures?
    • When last reviewed?
  10. Billing
    • Control totals back to appointments and forward to revenue?
      • % paid first time through
      • % paid in full within 45 days
    • Fee schedules used to determine expected revenue per service?
  11. Remittance posting
    • Where posted?
    • Time frames/SLA
    • Control totals
  12. Billing follow up
    • Denials
      • How tracked and analyzed?
      • Feedback loop to front end?
    • Underpayments
      • Identified?
      • Corrected?
      • Feedback loop?
    • Unpaid
    • Write offs – who approves?
    • Control totals
  13. Patient balance collections
    • who and how?
    • Control totals
  14. Follow up appointments
    • Procedure
    • Secondary issues
    • Long term
  15. Recoupments – understand history

You need a plan, and you need to touch all the bases.  We can help you pull it all together.  Identify areas of opportunity, and vulnerability. Call us today at (631) 244-5661 for a Free 15 minute consultation.

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