Building a successful practice in the new millennium is more difficult than in the past. Or is it? I see some consultants offer “Cash Practice,” others offer the “PI Practice.” With the insurgence of managed care, the healthcare world is a maze we must navigate through. Be a provider to all and a slave to none. Don’t lock yourself in a corner. Be capable of providing services to all patients, regardless of their financial carrier or lack thereof.
This is a good time for chiropractic. I have many clients doing in excess of $2 million annually. That’s collections, not just billings. Many doctors bill but do not get paid. There is a big difference. The key is only bill the patient for what they need; if they need it, bill for it. If you bill for it, collect the money. It does not matter whether insurance pays your claim or not. The patient must be ultimately responsible.
January is a good time. New deductibles are due. Some may roll over, so check with the insurance company; but most do not. The key to billing is collecting. If you are not collecting the cash component or the deductible, this is a violation of the Office of the Inspector General (OIG) guidelines. Collecting every dollar that is your due can add 20% to your bottom line.
There are many ways to make more money. The key is to treat patients as you would want to be treated. Review your fees. Are they fair? Would you pay them? Would you refer a patient to your office? Or, are you embarrassed by your fees? If you are, you will not try to collect what is due you, as you do not want to be challenged. The greatest thing about any new year is, it is a time to implement a new paradigm of practice.
There are eight basic ways to make more money this year.
1. Raise your fees.
2. Provide more services. (This does not mean using a new code that you may get paid on.)
3. Bring in more new patients.
4. Increase patient visits.
5. Collect monies owed to you.
6. Provide better service.
7. Add an MD or a PT to your practice.
8. Add a new technology.
There are many new technologies today that can add cash components to your practice. Whether you’re thinking of adding Endermologie, Spineforce rehab, spinal decompression, all come with unique marketing programs. All can be sold as cash components when insurance is not available.
All of the above will work, but you must have collections systems in place. Many doctors bill insurance companies and hope to get paid. They look for new codes, not new services, to add to their repertoire. The OIG says you can only bill for what you do and it must be charted accordingly. If you only billed patients for what they sincerely needed and did not care whether they were cash or insurance patients, then you could collect all monies owed to you with a clean conscience. Dentists and MD’s have worked that way for years. IF the patient owes a portion not covered by insurance, collect it. This means developing a system and sticking to it. This means putting in the time and not just accepting what insurance companies decide to pay you.
What Is the Key to Small-Practice Billing Success? Carve Out Time to Prioritize.
A biller can wear many hats and make them all look good.
Larger practices are able to split duties among many billing staff members; but smaller practices often ask one or two employees to shoulder all of the billing office’s burdens, plus receptionist and chiropractic-assistant duties. The answer? Find a segment of uninterrupted time each day to devote to the top billing priorities.
1. Make sure you enter and account for charges each day.
2. Transmit charges regularly. Even if your office sees only 25 patients a day, you should transmit charges often, perhaps even daily, to keep your payment flow even.
3. Enter payments quickly. Don’t set denial aside. If you didn’t receive payment on a claim, you need to act quickly to correct the problem.
4. Work your Accounts Receivable Report. Small practices neglect this step most often. You can lose a lot of money if you send out charges and enter payments but never follow up on denials, unpaid claims and outstanding balances.
Find More Time for Billing
You know what you have to do, but you have to find the time to do it! There are a lot of things you can do that will cut an hour or two out of the week. A few hours may not seem like much, yet that can be enough to increase your practice’s revenue, if you address neglected billing duties. Here are some timesaving tactics to try:
• Shut the phones off early, either an hour before lunch or an hour before closing time. This works best if your office has an answering service, because you can direct any emergencies to the back-office line. Without the distraction of phone calls, you’ll be able to spend some time entering the day’s charges, appealing denials, etc.
• Chart your workweek activities to identify where you could save time or be more efficient. Divide each day into morning and afternoon slots and then write down everything you do and how long you spend on each activity. You’ll discover that there are times during the week when you could be more productive or when you could use other resources to free up more time.
You might also realize that you just have too much on you plate. In that case, you’ll have everything written down and be prepared to entertain the possibility of hiring more help or investing in better timesaving technologies.
• Plan ahead to focus on billing. Examine the week’s schedule in advance and take advantage of any time when patients won’t be in the office.
• Hire part-time help to assist with redundant, time-consuming tasks, like filing and pulling charts, answering the phones and taking messages. This will free up some of you precious time to spend on more important billing matters that require your expertise. Paying a biller good money to file charts just doesn’t make sense. Many high schools will provide seniors, at no charge, for credit hours and job experience; contact you local schools.
• Use a lock box at your bank. For a fee, your bank will receive your payments in the mail and deposit the checks into your account, then send you all the original documentation. This reduces the risk of mistakes and mishandling when one staff person opens the mail and posts payments.
• Take advantage of clearinghouse services. If you print your statements in-house and spend a lot of time stuffing envelopes, you would be better off asking your clearinghouse to do this for you. Then you can spend more time working accounts you’ve avoided and recouping more payments.
How to Implement an Efficient Cross-check for Monitoring Cash
Physicians aren’t auditors.
Carefully tracking the cash that comes in through your practice’s front desk makes good sense. The problem is that you could “use $300 of a physician owner’s time overseeing $100 in revenue.”
The solution: Establish front-end cash-monitoring procedures that strengthen control without converting physicians into auditors. You need three basic components in your cash control procedures:
• Separating cash management duties, so one person doesn’t control the entire process between the front desk and the bank.
• Reconciling daily cash receipts to bank deposits.
• Including periodic physician oversight.
How to do it.
Here’s a practical approach: Make sure your front desk staff maintains a daily cash receipts journal that includes cash amounts, the patient paying and the reason for the payment.
At the end of each day, have a different person–usually your lead billing person–prepare the daily bank deposit. He or she must reconcile the cash taken in with the amount deposited and present that report to the manager (or the physician, in very small practices).
If your practice has a computerized scheduling system, use it to perform a simple crosscheck. Most systems let you create a report containing the daily patient schedule and each patient’s insurance plan. Have your manager review the patients scheduled and their insurers. If you scheduled twenty patients and seven of them are HMO patients, you’d expect seven co-pays. If you see Medicare and Medicaid patients, you must collect co-pays at the front desk. Your billing staff knows how the plans you service work. This quick review estimates how much cash you should expect in a given day.
Have your manager compare that crosscheck information to your actual cash receipts. Doing so improves control two ways:
• It discourages theft, by comparing the day’s anticipated cash to the amount received.
• It suggests how well your front desk people carry out their collection duties.
Do it openly
Periodically (and randomly), a physician should do this crosscheck, too. Don’t make this step a secret. You want everyone in your practice understanding that several people are keeping watch over incoming cash. Doing it openly positions it as a prudent business practice, not sneaking around behind the backs of distrusted employees.
These quick steps don’t guarantee ironclad control, but provide realistic, implementable protection without consuming too much of a busy physician’s time.
This New Year, collect what is owed you. Remember, only provide services that are medically necessary; if you do it, chart it. If you do it, chart it—then collect it.
Dr. Eric S. Kaplan, is CEO of Multidisciplinary Business Applications, Inc. (MBA), a comprehensive coaching firm with a successful, documented history of creating profitable multidisciplinary practices nationwide. For more information, call 561-626-3004.