Updated: Dec 10, 2019
One of our main focuses is physician practices. On average, we increase top-line revenue for these practices by 17%, decrease the cost to collect by 34% and decrease days in A/R by 10-15%.
To be able to achieve such figures, here are 5 Strategies that your revenue:
Focus on coding correctly: The costliest step in the revenue cycle is coding. With the varying complexity of procedures, coders must be able to identify all areas for possible reimbursement. There can be wildly different approaches to coding that can vary from organization to organization and even from coder to coder. This means there can be wildly varying reimbursements for the same procedure. Each different incision, approach, and procedure corresponds to a different CPT code. Whether it’s a lumbar decompression, lumbar discectomy, fusion surgeries or radiofrequency ablation, the coders must comprehensively review the clinical data and apply the correct codes and modifiers every time. Staying updated on billing and coding guidelines is another important way to make sure claims are paid out on the first submission.
Authorization and Verification: Denials are more common than ever today. An important task to complete before surgeries or even office visits is pre-authorization. Since guidelines across third-party payors vary on requirements, it may feel like no two procedures are the same. It is important for the scheduling team to be aware of whether the patient visit has, or requires pre-authorization, so they can properly plan and inform the patient of their financial responsibility. For example, we found that while that one large payor was paying out some claims for an office visit, they weren’t paying out others. Through our proprietary data analytics platform, we discovered that the group was not contracted for a specific plan under that payor. While other claims for that payor would process as normal, patients with the specific plan needed to be pre-authorized and the group credentialed under the remaining plans within that payor. Office visits no longer require pre-authorization, saving the time of office staff.
Billing with modifiers: “It seems like medical billing for spine surgery is as complicated as doing the surgery”, said a client surgeon when understanding how medical billing for his services works. Incorrect modifier usage stands as one of the most important reasons for lost reimbursement in complex procedures such as spine surgery. For example, modifier 50 is used for a bilateral procedure where, a bilateral procedure occurs on both sides of a single, symmetrical structure or organ. A spinal laminotomy (such as 63020-63044), for instance, may occur on either side of the spine or, if required, on both sides of the spine at the same level(s). Therefore, CPT provides modifier 50 to identify bilateral procedures not described specifically by individual CPT code. In addition, the correct billing method for the same surgery across payors can be different especially for patients with worker's compensation and commercial carrier plans.
Enhance Collections and lower Accounts Receivables: Revenue collection can be in disarray if the front office does not collect the correct information such as insurance co-pay or deductibles if denied or part paid claims are not given adequate attention or if physician case volumes are too high. Through enhanced registration and patient responsibility processes, third party vendors for Accounts Receivables management and a suitable site administrator, revenue collections for the facility can be increased.
BI Dashboards for Operational and Financial Performance: Physician groups have a lot of moving parts that must operate effectively for them to flourish. Left unchecked, the financial health of the group will decline. To maximize operational and financial efficiency it is important to understand the basic components at work and discern how well each is functioning. Business Intelligence dashboards can be a key technology for deciphering how a group is performing. For example, physician visits are a key KPI that can be tracked through the dashboard; similarly, the referral network should be strong with high quality of care – patients that come in for regularly have to be referred to other specialists or senior doctors.This referral network can be tracked through well-built BI dashboards.