It takes a team of individuals skilled in business, customer service and orthopedic surgery in order to successfully and efficiently run a physician-owned orthopedic practice. The physician CEO must be able to juggle providing the best quality medical care to his or her patients while also ensuring quality business practices, which sometimes means outsourcing tasks or trusting others with practice responsibilities. Jay Nussbaum, CEO of Healthcare Watchdog, a medical billing and advocacy group with offices in New Jersey and California, offers seven tips on the best practices for efficiency in physician-owned practices.
1. Delegation. Though physicians are capable of tackling practice management and billing responsibilities, it is inefficient use of the physician's time to deal with these types of issues. Physicians should entrust a capable individual(s) with practice management responsibilities or outsource these tasks in order to focus on providing the best treatment for their patients. "The trick is to make sure you're delegating to the right people. The policy of forcing everything to run through a central authority makes the company stagnate because it just isn't efficient," says Mr. Nussbaum. "The doctor needs to learn to delegate both internally and externally. The doctor should be focused on medicine."
2. Establish checks and balances. Split tasks among practice staff with some overlap in order to establish redundancy and ensure the tasks are completed accurately. This means staff members should establish a system of checking each other's work for mistakes. If tasks, such as billing, are done correctly, the practice saves money.
At Watchdog, Mr. Nussbaum says there are several checks and balances among the employees. "We always need to make sure that no one instance of human error will cost a client of ours a dime."
3. Keep coders updated. Incorrectly filed claims and faulty coding can incur heavy costs on orthopedic practices, especially in today's rapidly changing medical environment. If the practice keeps in-house billing, the coders should receive consistent recertification in order to remain informed on the latest coding techniques. Practices that outsource billing responsibilities need confidence in the billing company's knowledge and certification requirements. "In 2012, ICD-10 will contain some 15,000 additional codes. That’s why keeping our coders on the cutting edge of knowledge is essential to our business."
4. Simultaneous reporting. Physicians should document each procedure immediately after the procedure. When a physician waits until the end of the week to document their procedures, they risk forgetting the details of the procedure or writing an insufficient report for the coders to create a claim. Detailed reporting is crucial for the coders to accurately bill for correct reimbursement. "Coding is an art, it's not an exact science," says Mr. Nussbaum. "A lot of times, what you're going to code depends on what the doctors write in the documentation"
Additionally, if a claim is denied because the payor found a procedure unnecessary, detailed notes help physicians defend their choice to follow through with the procedure. "If the physician has taken good notes, they can make a good claim as to why the procedure was necessary to the insurance companies. Making that strong case really can turn a lot of denials into approvals," says Mr. Nussbaum.
5. Outsource denied claims. When claims are denied at practices with in-house billing, physicians can outsource the claims so outside organizations can work on them for further approval on a case-by-case bases. Outsourcing companies work on contingent fees, which mean the employees work at no cost until the physician has collected on the claim. "Because companies like Healthcare Watchdog work on a contingent fee — whether they’re providing comprehensive billing services or just advocacy work on previously denied claims — they have more motivation to collect every dollar that’s due."
At a billing company, if employees take sick days or vacation time, their claims are processed by another one of the company's employees. This means there will always be an employee available to complete the practice's billing responsibilities.
7. Maintain up-to-date payor patient information. Before performing a procedure, ensure the patient's payor information is current and the patient is still paying for his or her insurance. Additionally, make sure the payor will cover some of the procedure and the patient understands his or her copay in order to ensure complete reimbursement. "In orthopedics, if you don't check the payor information you stand the chance of spending four hours in the operating room you aren't going to be paid for," says Mr. Nussbaum. "Just by collecting the information you should be collecting, doctors can improve their bottom line significantly."
Learn more about Healthcare Watchdog.
Read more coverage on orthopedic practice efficiency:
-13 Strategic Thoughts and Concepts for Orthopedic Practices: Developing a Strategic Plan and Allocating Practice Resources
- 3 Steps to Improve Spine Efficiency and Cut Costs
- 8 Best Practices to Make Orthopedics Profitable in Surgery Centers
1. Delegation. Though physicians are capable of tackling practice management and billing responsibilities, it is inefficient use of the physician's time to deal with these types of issues. Physicians should entrust a capable individual(s) with practice management responsibilities or outsource these tasks in order to focus on providing the best treatment for their patients. "The trick is to make sure you're delegating to the right people. The policy of forcing everything to run through a central authority makes the company stagnate because it just isn't efficient," says Mr. Nussbaum. "The doctor needs to learn to delegate both internally and externally. The doctor should be focused on medicine."
2. Establish checks and balances. Split tasks among practice staff with some overlap in order to establish redundancy and ensure the tasks are completed accurately. This means staff members should establish a system of checking each other's work for mistakes. If tasks, such as billing, are done correctly, the practice saves money.
At Watchdog, Mr. Nussbaum says there are several checks and balances among the employees. "We always need to make sure that no one instance of human error will cost a client of ours a dime."
3. Keep coders updated. Incorrectly filed claims and faulty coding can incur heavy costs on orthopedic practices, especially in today's rapidly changing medical environment. If the practice keeps in-house billing, the coders should receive consistent recertification in order to remain informed on the latest coding techniques. Practices that outsource billing responsibilities need confidence in the billing company's knowledge and certification requirements. "In 2012, ICD-10 will contain some 15,000 additional codes. That’s why keeping our coders on the cutting edge of knowledge is essential to our business."
4. Simultaneous reporting. Physicians should document each procedure immediately after the procedure. When a physician waits until the end of the week to document their procedures, they risk forgetting the details of the procedure or writing an insufficient report for the coders to create a claim. Detailed reporting is crucial for the coders to accurately bill for correct reimbursement. "Coding is an art, it's not an exact science," says Mr. Nussbaum. "A lot of times, what you're going to code depends on what the doctors write in the documentation"
Additionally, if a claim is denied because the payor found a procedure unnecessary, detailed notes help physicians defend their choice to follow through with the procedure. "If the physician has taken good notes, they can make a good claim as to why the procedure was necessary to the insurance companies. Making that strong case really can turn a lot of denials into approvals," says Mr. Nussbaum.
5. Outsource denied claims. When claims are denied at practices with in-house billing, physicians can outsource the claims so outside organizations can work on them for further approval on a case-by-case bases. Outsourcing companies work on contingent fees, which mean the employees work at no cost until the physician has collected on the claim. "Because companies like Healthcare Watchdog work on a contingent fee — whether they’re providing comprehensive billing services or just advocacy work on previously denied claims — they have more motivation to collect every dollar that’s due."
At a billing company, if employees take sick days or vacation time, their claims are processed by another one of the company's employees. This means there will always be an employee available to complete the practice's billing responsibilities.
7. Maintain up-to-date payor patient information. Before performing a procedure, ensure the patient's payor information is current and the patient is still paying for his or her insurance. Additionally, make sure the payor will cover some of the procedure and the patient understands his or her copay in order to ensure complete reimbursement. "In orthopedics, if you don't check the payor information you stand the chance of spending four hours in the operating room you aren't going to be paid for," says Mr. Nussbaum. "Just by collecting the information you should be collecting, doctors can improve their bottom line significantly."
Learn more about Healthcare Watchdog.
Read more coverage on orthopedic practice efficiency:
-13 Strategic Thoughts and Concepts for Orthopedic Practices: Developing a Strategic Plan and Allocating Practice Resources
- 3 Steps to Improve Spine Efficiency and Cut Costs
- 8 Best Practices to Make Orthopedics Profitable in Surgery Centers