Are doctors the best decision makers for the financial health of their practice?

The practice of medicine is all about specialization. Doctors spend more than a decade of practice necessary for getting specialization in any field of medicine. Plus with the technological advances, ever-changing protocols in the specialty, they need to stay abreast so as to provide the best care to their patients.

But despite all the hard work and potential, there are many practices that operate below their performance and revenue potential. Why?

Simply because most of the time is consumed in doing day-to-day tasks like submitting claims, reviewing claim status and reports, etc instead of focusing on improvements and optimizing their practice. Given the complexity being faced in today’s coding and billing processes, it surely is not something someone can do to fill in the time between scheduling and rooming patients.

There was a time when billing was very simple. Payers used to change their rules and policies once a year and gave plenty of time to practices to adjust to their changing processes. That time, denials were less than 5% of the total claims against today where if you don’t have sophisticated claim scrubbing software, your claim rejection rate may increase to more than 30% and may require extensive as well as the expensive follow-up, resulting in poor cash flow.

Why financial health is getting hard to achieve?

 The challenges of internal billing operations and the complexity of today’s revenue cycle processes do require a specialized skill of medical billing professionals to ensure the economic success of the practice and its compliance with the changing government regulations.

With increasing costs and declining reimbursement rates, the practices often lack access to financial and clinical performance data which is important for staying competitive and improving the overall financial health of the practice.

What really is required is the ‘right information, the right approach, and the right assistance.’

Some of the tips that could help you improve the financial health of your practice:

• Examine the nature of the tasks your practice performs. Segregate them on the basis of tasks that can be done by your staff directly, tasks that can be outsourced or offloaded to a vendor, and tasks that can be centralized.
• Make detailed, structured processes of the tasks that are essential for the overall financial health of your practice and that need to be performed by your staff accurately.
• Analyze the time consumed by staff on tasks that can be economically offloaded to a practice management vendor. The right partner can increase your revenue by submitting and reviewing claims in real-time, better patient throughput, improving staff efficiency, easy-to-manage reporting, etc. Services offered by a practice management partner along with the software can help to reduce your time spent in managing paperwork such as remittances and payer correspondence.
• Technology too is a huge cost center for any individual practice. For example, it’s important to keep the payment tables accurate to ensure proper payments are incurred as per the fee schedules. Similarly, denial management tools are required to track and eliminate the root cause of denials.
• With the plethora of regulations that now affect billing and collecting, it’s better to hire full-time professionals to handle your coding and billing.
• Follow-ups related to unpaid claims are burdensome and time-consuming and so are incorrect discounts applied to patients’ accounts. Both these activities lead to a loss of revenue.
• No doubt, hiring and retaining competent staff personnel, who can handle all the billing related work is tough. As per the Society of Human Resource Management, the cost of recruiting, hiring, and training a new employee is approximately $3,500. Utilizing a professional billing company eliminates this expense completely. These professional medical billing companies offer economies of scale, which makes their services less costly than a practice’s internal operation.

Finally, remember these two golden rules – First, “Do what you do best and outsource the rest” and second, “Do not spend your time and energy on anything that can be done by someone else more efficiently and at a lesser cost”