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presentation

Analyzing Revenue Management Techniques for Ophthalmologists

February 08, 2012



“While Ophthalmologists seek to reinvent their clinical and operational model, the booming prospect of patient influx – 43 million by the year 2020 comprising age-related eye diseases, including cataracts, diabetic retinopathy, glaucoma and age-related macular degeneration– should also be encouraging to their hearts. But, the issue of realigning their clinical and operational model to the push and pulls  of the healthcare reforms and market dynamics can best be managed by competent outsource providers as, along with the catalyst-importance, Medical Billing Companies can also relieve Ophthalmologists’ of the likely pressure to be encountered during such turnaround exercises.”

Ophthalmologists in the US, who are already hit by dwindling practice revenues, stare at another bigger challenge to their sustenance and growth – the imminent Medicare cuts amongst a plethora of Federal Government’s radical healthcare reforms likely to impact all medical disciplines including Ophthalmology. While the profit margins have been down from 40% to 25%, the overall physician’s revenues have been down by $50,000 or more. And when you consider the imminent threat of double-digit Medicare cuts amongst many other sweeping healthcare reforms, the situation looks more complex than ever before.

Amongst many other challenges, the immediate challenge will be to comply by Medicare’s Resource Utilization norm, where in Medicare reserves the right to publish comparative resource utilization of all the ophthalmology practices.  As the Medicare’s Resource Utilization norm has the potential to either promote or demote your practices’ in the market, Ophthalmologists will be required to be highly efficient when it comes to resource utilization.

Along with the Medicare’s Resource Utilization scheme, Ophthalmologists, beginning with 2013, will also have to give honest report about their relationship with suppliers of medical inputs. And, if some Ophthalmologists are found to have unfair intentions of using certain medical inputs even though they happen to be costlier than similar products, they will have to face grave consequences, such as adverse impact on their practices’ reputation. And then, starting between 2015 and 2017, data on quality and efficiency will be directly tied to reimbursement, meaning linking Ophthalmologists’ fee-for-service part of Medicare to quality and efficiency gains. As a controlling tool for elevating quality in service, the initiative approaches with carrot-stick policy of either penalizing or rewarding: ophthalmologists with more than two standard deviations with no quality will get a big penalty in their payments; those achieving quality but without efficiently, will get a smaller penalty; and those with quality as well as efficiency, will stand to get encouraging bonus.

As Ophthalmologists try to seek possible answers for these imminent challenges, realigning their clinical and operational model could prove be a vital task amongst many other operational overhauling. Ophthalmologists, with aid from streamlined scheduling, can be efficient, and expect to reach out to a larger patient base. But, ophthalmologists still need to see every patient; an integrated eye-care delivery model can prove to be more efficient and effective:  ophthalmologists, optometrists, ophthalmic technicians, and opticians can doubly enrich the patient experience. Moreover, the model comes with unprecedented utilities, such as efficiency, cost-effectiveness, and technically superior coordinated medical service.  Consequent to such ingenious service model, practices can expect to be benefited from long-term clinical and operational efficiency.

While Ophthalmologists seek to reinvent their clinical and operational model, the booming prospect of patient influx – 43 million by the year 2020 comprising age-related eye diseases, including cataracts, diabetic retinopathy, glaucoma and age-related macular degeneration– should also be encouraging to their hearts. But, the issue of realigning their clinical and operational model to the push and pulls  of the healthcare reforms and market dynamics can best be managed by competent outsource providers as, along with the catalyst-importance, Medical Billing Companies can also relieve Ophthalmologists’ of the likely pressure to be encountered during such turnaround exercises.

Medicalbillersandcoders.com – whose credentials have, time and again, come to the fore in such testing times, could yet again make the difference. Its proven credentials in Revenue Cycle Management for clinical and operational excellence –complete with   Patient Scheduling and Reminders, Patient enrollment, Insurance Enrollment, Insurance verification, Insurance Authorizations, Coding and audits, Billing and Reconciling of Accounts, Account Analysis and Denial Management, AR Management, and Financial Management Reporting – can effectively complement realignment endeavor for augmenting cost-optimization and revenue-maximization.

 

Category : Revenue Cycle Management