Strategic Management of Physicians’ Day-to-Day Operational Issues

Unlike physician practices of yesteryear’s, physician practices today have found themselves surrounded by a larger pool of stakeholders: patients, government, and insurance carriers. While physicians commitment to quality medical services continues to be unquestionable, their ability to comply with escalating government’s healthcare norms, and insurance providers’ stringent reimbursement policy has been found wanting. As the continued compromise on these issues is sure going to adversely impact on their credibility, sustenance and growth, physicians need to strategize a balancing act that can effectively and efficiently keep the patient-insurance carriers-government grid satisfied. But, if historical references are any indication, any attempt to divert their attention to non-core activities would eventually be detrimental to the core-concern of benchmarked medical services. Therefore, given the repercussions despite investing time and resources, physicians would rather consider outsourcing compliance and reimbursement functions from competent service providers.

Although, there are numerable outsourcing windows available, physicians need to be cautious while choosing as any hurried selection would only extend their plight. The self-sufficiency of your prospective service provider in offering the following portfolio of services should be a yard-stick to measure his competence and credibility: accounting/financial reporting, risk/litigation, billing & collection, managed care contracting, coordinated care center management, practice development, credentialing, practice operations management, finance,information technology, and regulatory compliance. Such prudent selection would invariably be motive for:

  • Uncompromising quality medical service to your faith-reposing patient community
  • Practice management in congruence with Federal Government’s health care norms
  • Compliant medical billing management as per insurance providers’ stringent reimbursement norms
  • Credibility in a highly competitive healthcare industry

Alternatively, judicious recourse to credible outsourced advisory from – known for realigning physician practices to multiple stakeholder-environments through strategic deployment of qualification and competence: certification from American Association of Professional Coders (AAPC); expertise in Advanced Technology Interface for medical billing such as Lytec, Medic, Misys, Medisoft, NextGen, IDX, etc., and the use of latest coding softwares such as EncoderPro, FLashcode and CodeLink; proficiency in applying standard CPT, HCPCS procedure and supply codes, and ICD diagnosis coding as per CMS guidelines and HIPAA compliant medical reporting.

Efficient reimbursement of their clients’ medical bills with leading private insurance carriers such as United health, Wellpoint, Aetna, Humana, HCSC, Blue Cross Group, and Government sponsored Medicare and Medicaid – should not only bring relief from daunting operational functions, but also elevate practice efficiency, and revenue generation through: patient scheduling and reminders, patient enrollment (demographics and charges), insurance enrollment (for physicians and offices), insurance verification, insurance authorizations, coding and audits, billing and reconciling of accounts (payment posting), account analysis and denial management, AR management (insurance and patient), financial management reporting.