There are several steps orthopedic and spine practices can take to increase revenues and improve collections, says Michael Franks of Physician Business Services in Tampa, Fla., a company that partners with physicians to handle back office and administrative responsibilities for more than 50 physician practices. Mr. Franks discusses seven tactics to manage orthopedic and spine practice revenue cycles.
1. Collect payment at the time of the appointment. Orthopedic and spine practices should collect co-pays from the patients before they leave the building, says Mr. Franks. "You won't see the money if the patient leaves," he says. "You need to have firm policies in place." To increase the chance of receiving the entire payment, a practice staff member can check the patient's eligibility before the visit occurs and then notify the patients of co-pays before services are rendered. The practices should also be able to accept credit cards for increased patient convenience, says Mr. Franks.
2. Renegotiate business contracts. Examine your different contracts and consider renegotiation, says Mr. Franks. These contracts include payor contracts, contracts with implant companies and the contracts for building space. "If you've been in one location for a while, you can go to the landlord and ask for a reduction in payments," he says. For device contract renegotiations, bring three different products to the table, including the one already being used, and compare the value of each device before deciding which to purchase.
3. Focus on insurance claims and carrier contracts. When practices don't renegotiate contracts with payors, the contracts will typically roll over for another term and the practice loses the chance to improve reimbursement rates, says Mr. Miller. Once the contract is negotiated, follow the claims to make sure the payor is reimbursing at the agreed upon rate as well as honoring any other terms of the agreement.
4. Conduct chart audits for accurate coding. Audit the medical charts to ensure the surgeons are capturing all the codes possible and correctly describing or coding the services rendered. The surgeon needs to know every different step of the treatment that is billable and how to describe the treatment accurately to receive the highest amount of compensation. "Make sure the physicians are getting paid for the amount of time they are spending with the patient," says Mr. Franks. "If there are any negative patterns, change them immediately. The billing and claims submissions need to be constantly monitored."
5. Work on improving accounts receivable. When a claim is denied, examine the information and determine why it isn't getting paid, says Mr. Franks. Claims are denied for several reasons, including an inaccurate coding, incorrect spelling of a name or inappropriate coverage for the services rendered. "You must correct the errors and re-file the claim," says Mr. Franks. "If the claims aren't submitted correctly, it impacts the practice."
6. Offer ancillary services onsite. Consider adding physical therapy or imaging services to the practice because those services are convenient for the patients and require very little of a surgeon's time, says Mr. Franks. The onsite physical therapist can oversee a large portion of the non-surgical or rehabilitative care so the physician can focus on performing surgeries. Offering physical therapy and imaging services onsite is also convenient for the patient and has the potential to bring extra revenue into the practice. However, before adding these services, practice administrators should assess whether the additions are practical.
"Look at how much the new technology will cost, whether it can be leased and over what period of time and whether there is a place for it," says Mr. Franks. "If you will lose an exam room to house the additional technology, you take away from the value of the product. You also need to consider who will staff that machine and who will schedule patients to use it. If you're doing things correctly and building a business model, you'll have been doing that before the decision is made."
7. Reiterate the importance of surgery when it's appropriate. Some patients are now deciding to put off surgery until their deductible is less, even if undergoing surgery would help them a great deal, says Mr. Franks. Remind the patients that surgery is recommended because it's necessary and waiting could result in more pain, damage and worse symptoms. Additionally, if the condition degenerates, the corrective surgery could become more expensive for the patient and the payor.
Learn more about Physician Business Services.
Read other coverage on revenue cycle management for orthopedic and spine practices:
- 4 Technologies to Improve Orthopedic Practice Revenue Cycle Management
- 9 Ways to Improve Your Practice's Revenue Cycle
- 6 Techniques for Maximizing Revenue Cycles at Orthopedic Practices
1. Collect payment at the time of the appointment. Orthopedic and spine practices should collect co-pays from the patients before they leave the building, says Mr. Franks. "You won't see the money if the patient leaves," he says. "You need to have firm policies in place." To increase the chance of receiving the entire payment, a practice staff member can check the patient's eligibility before the visit occurs and then notify the patients of co-pays before services are rendered. The practices should also be able to accept credit cards for increased patient convenience, says Mr. Franks.
2. Renegotiate business contracts. Examine your different contracts and consider renegotiation, says Mr. Franks. These contracts include payor contracts, contracts with implant companies and the contracts for building space. "If you've been in one location for a while, you can go to the landlord and ask for a reduction in payments," he says. For device contract renegotiations, bring three different products to the table, including the one already being used, and compare the value of each device before deciding which to purchase.
3. Focus on insurance claims and carrier contracts. When practices don't renegotiate contracts with payors, the contracts will typically roll over for another term and the practice loses the chance to improve reimbursement rates, says Mr. Miller. Once the contract is negotiated, follow the claims to make sure the payor is reimbursing at the agreed upon rate as well as honoring any other terms of the agreement.
4. Conduct chart audits for accurate coding. Audit the medical charts to ensure the surgeons are capturing all the codes possible and correctly describing or coding the services rendered. The surgeon needs to know every different step of the treatment that is billable and how to describe the treatment accurately to receive the highest amount of compensation. "Make sure the physicians are getting paid for the amount of time they are spending with the patient," says Mr. Franks. "If there are any negative patterns, change them immediately. The billing and claims submissions need to be constantly monitored."
5. Work on improving accounts receivable. When a claim is denied, examine the information and determine why it isn't getting paid, says Mr. Franks. Claims are denied for several reasons, including an inaccurate coding, incorrect spelling of a name or inappropriate coverage for the services rendered. "You must correct the errors and re-file the claim," says Mr. Franks. "If the claims aren't submitted correctly, it impacts the practice."
6. Offer ancillary services onsite. Consider adding physical therapy or imaging services to the practice because those services are convenient for the patients and require very little of a surgeon's time, says Mr. Franks. The onsite physical therapist can oversee a large portion of the non-surgical or rehabilitative care so the physician can focus on performing surgeries. Offering physical therapy and imaging services onsite is also convenient for the patient and has the potential to bring extra revenue into the practice. However, before adding these services, practice administrators should assess whether the additions are practical.
"Look at how much the new technology will cost, whether it can be leased and over what period of time and whether there is a place for it," says Mr. Franks. "If you will lose an exam room to house the additional technology, you take away from the value of the product. You also need to consider who will staff that machine and who will schedule patients to use it. If you're doing things correctly and building a business model, you'll have been doing that before the decision is made."
7. Reiterate the importance of surgery when it's appropriate. Some patients are now deciding to put off surgery until their deductible is less, even if undergoing surgery would help them a great deal, says Mr. Franks. Remind the patients that surgery is recommended because it's necessary and waiting could result in more pain, damage and worse symptoms. Additionally, if the condition degenerates, the corrective surgery could become more expensive for the patient and the payor.
Learn more about Physician Business Services.
Read other coverage on revenue cycle management for orthopedic and spine practices:
- 4 Technologies to Improve Orthopedic Practice Revenue Cycle Management
- 9 Ways to Improve Your Practice's Revenue Cycle
- 6 Techniques for Maximizing Revenue Cycles at Orthopedic Practices