Medical Practice Revenue Building
Available Services to Physician Practices
Complete practice assessments/reviews. At periodic intervals, a medical practice needs a complete review and assessment. The goal of this service is to evaluate the overall efficiency of the practice and to determine if it is losing revenue in some form or fashion. A review attempts to improve the bottom line. For example, if a practice has a decrease in cash flow, it may want to hire a CPA to conduct a complete assessment of its practice operations to determine the cause of the decrease.
Coding analysis. A coding analysis determines if the practice is coding all of its services correctly. If the office members do not code the services correctly, the practice may lose revenue. The analysis covers both procedural coding and diagnosis coding.
Managed care contract analysis. A review starts with an analysis of the key aspects of each managed care contract. A review identifies key contract terms, including effective dates, termination dates, claim filing and payment guidelines. It also identifies contract terms that would be considered to be a disadvantage to the medical practice. Next a fee schedule analysis identifies the code specific reimbursement rates for each managed care contract and outlines a plan-by-plan comparison.
Negotiation with managed-care plans. Integrated delivery systems, group medical practices, and even solo practices need to increase their own reimbursement from managed-care plans. The way to do this is to negotiate an increase in price from these plans.
Review of Medicare/Medicaid billing practices. Many medical specialties, such as cardiology, are provided for a large number of Medicare and even Medicaid patients. Specific rules apply to Medicare/Medicaid billing. An office that is not aware of certain billing rules will lose revenue. Therefore, Medicare/Medicaid billing must be reviewed on an ongoing or periodic basis.
Review of the practice’s receivables. To optimize cash flow, a medical practice must manage its accounts receivable. All systems and procedures related to accounts-receivable management must be monitored and reviewed, either on an ongoing or periodic basis. The aging of receivables also must be monitored.
Financial benchmarking. Benchmarking is the process of analyzing the indicators of business success and applying that information to achieve business growth and improvement. For medical practices, it is a way of taking a critical look or “snapshot” of your practice’s health. It provides you with an objective way to measure your practice’s performance. Throughout most of the business world, benchmarking is a key element to strategic planning, a vital necessity to all medical practices. Benchmarking of medical practices helps determine which of your practices and processes are the best and which ones need attention.
Revenue cycle management review. Revenue cycle management means taking steps to assure that you get paid for what you do and that you get paid in a timely fashion. The revenue cycle starts when the patient calls your office for an appointment and your staff captures the patient’s name, phone number, and maybe the name of their insurance company. The cycle ends when the balance on their account is zero. A review of revenue cycle processes can lead to an increase is both revenue and cash flow.
Physician productivity analysis. To maintain or increase revenue, it’s important to analyze physician productivity. Productivity should be compared to market benchmarks to create reasonable productivity ranges for physicians.
Process improvement. It’s important that improvement events take waste out of the physician office and not just move the waste to the doctor’s corner. Efficiently designed and monitored processes can increase revenues.
Embezzlement review. The fear of employee theft warrants some medical practices to seek an embezzlement review. A review can help prevent revenue loss.
Billing service review. Many physicians use outside billing services to bill and collect their services. Often, these agencies are left unaccountable. The physician’s agency should be reviewed periodically to make sure services are being billed out correctly and that the agency is putting in the time and effort it takes to collect these services.
Capitation rate analysis. Capitation is a common way doctors are paid by HMOs and other delivery systems. When presented with a capitation rate, most doctors are unaware whether or not such rate should be accepted and even more important, whether or not such rate will be profitable.
Implementation of QA/UM programs. As managed care grows, doctors and their practices must become “cost effective.” This also applies to integrated delivery systems. Doctors who deliver cost effective care will be the ones who will have the ability to negotiate managed care rates and be in a position to compete for exclusive contracting arrangements. To become and remain cost effective, practices must implement quality assurance and utilization management programs.