First of all, you need some basic information to get started. Obtain a report on your patient activity for the last year. This should be available from your billing supervisor or office manager. Even if you are a first-year hire, you should have little resistance to obtaining the report. Ask your senior partner for permission. Please remember, this information is confidential to your practice, so no sharing for now!
All of these reports are similar. They will summarize your charges, co-pays collected, insurance payments and patient responsibilities. See how you are doing.
Do you have a large number of outstanding accounts and uncollected co-pays? Start taking notes and ask your billing supervisor, office manager or senior partner how to improve. They will respect you for your initiative.
Implement these simple improvements:
1. Collect co-pays prior to the patient visit.
If co-pays cannot be met, reschedule the visit (emergencies excluded of course).
2. Make certain you have insurance company approval to perform the tests and procedures prior to doing them!
Don’t assume you know or will address it later. In most cases, you will not be paid for your work!
3. Understand study and implement the proper coding for your medical work.
Understand ICD-9 and get ready for ICD-10 coming in October. Don’t have a non-doctor do the work for you. It is not their job to do your work. Take a class, read and ask for help. Specialties are vastly different with wildly differing rules and responsibilities. I’m an ophthalmologist, and I know how complex our coding is. This is before ICD-10 starts later this year. So get ready for the antacid! “Pop pop, fizz, fizz, oh what a relief it is!” Just remember you are not alone. Seek help from your specialty society now and prepare.
Next, ask for a payor mix breakdown. This will vary widely depending on your medical specialty. For example, in my practice, our current breakdown is Medicare 45%, commercial insurance 55%. You may have different parameters; for example, chiropractors will have a significant percentage of workers compensation claims. Dentists will have a significant self-pay ratio. In certain areas of the country, one provider or health network may dominate.
Finally, see if you can get a hold of a list of practice expenses, especially those that apply to your particular practice. Now you may not be able to get this data as this would include payroll for all doctors and staff. If you are junior in your practice, you may be barred from this info. Try and get other info if you are allowed. Get involved. If you are the only or senior doctor, then this information should be readily available.
Study it, understand it and make recommendations and changes to improve and protect your practice.
In part 3, we will discuss implementing your tactics and recommendations to make your mark as the CEO.