The term ‘Healthcare Rationing by Hassle’ as touted by some surgeons showcases the stress caused by numerous changes in the healthcare industry. Orthopedics practice like all others feels the pressure of high costs, new ICD-10 code concerns, low and delayed reimbursements, declining margins, high deductibles, insurance/payer policy amendments, regulations, and other reforms. To combat this and survive, orthopedics billing practice requires diversification and streamlining to protect and increase revenues.
Verifying insurance coverage of in-coming patients, double-checking the patient’s demographics, file claims submission in a timely manner, coding as distinctively as possible, and outsourcing billing and coding can certainly increase reimbursements.
Further Ways To Increase Revenues Are:
Metrics:
Denial Analysis Report:
Due to denials being costly and complex, monitoring and reducing them is the key to improve revenues. The report must comprise denial types, reason and description codes, claim value, insurer details, claim resubmission dates, and the result.
Claims Turnaround Time:
Submit clean claims, scrutinize claim submission delays, and connect with insurance companies at regular intervals for faster payments. The report must encompass insurer details, claim submission and payment date, days left to payments, and average reimbursement TAT.
Physician Productivity:
Due to numerous bundled programs, physicians could be at risk of losing payments. Hence, physicians can set goals/benchmarks against other physicians and decide probable compensation. Aspects required are the number of old and new patient visits, appointments, charges and collections, provider revenue, and output ratio.
AR Analysis:
Assessment, analysis, and reporting of AR regularly are imperative. Understanding patient and insurer AR will further optimize payer performance. Features that need to be taken into consideration are claim number and patient details, DOS, CPT, insurer details, total billed amount and balance, and AR details.
Medical Coding Review Report:
Orthopedics coding is complicated. Knowledge of key anatomy elements and LCD guidelines is imperative to accurate coding. A coding report consisting of insurer details, paying and value CPT and rejected codes, code compliance with NCCI regulations can reduce DFNB and assist in precise coding.
Further Ways:
Investments In A Surgery Center:
To generate additional income, it is advised that surgeons invest (buy) in real estate – office building/ASC. Here, the surgeons tend to receive a higher percentage of compensation for the procedures they perform. Usually, the charges in a hospital are higher than ASCs but profits for surgeons are higher in ASCs. Orthopedic doctors can also work in mini-clinics for additional compensation.
Addition of Imaging Services:
Orthopedic practices can add/purchase an open MRI (rather than one for extremities) and offer on-site imaging. Although initial investments are higher, billing for MRI facility fees becomes easier and safer from insurance payers.
Physical Therapists:
For added care and an increase in profits, the addition of a physical therapist is recommended for the orthopedics practice. Rather than partnering with physical therapy organizations, it becomes easier for risk management when the physical therapist is a staff member.
Electronic Systems and Practice Management:
Tracking payment, claims management, credentialing software, electronic health/medical records though cost high initially, but ensure high returns due to cutting of transcription costs and apt documentation leading to elevated billing.
New Technology/Procedures:
Orthopedic practices have to stay abreast of innovative technologies (in particular for joint replacements) for providing the best and continuum care for patients. Orthopedic practices must check if adding the technology will be a clinical advantage as it will undoubtedly incur high costs. Nevertheless, due to the high costs of implants/high-tech equipment, the orthopedic practices’ billing and revenues can make a difference, while also be beneficial to the patient by reducing the hospital stay and/or avoidance of revision surgeries.
Orthopedic doctors and surgeons must be compensated appositely for the valuable service they provide. Hence, billing and coding must be done appropriately as these services are the backbone of the revenue cycle and the means to flourish in the unstable healthcare space.
