Here are four tips for successfully managing your orthopedic practice's revenue cycle.
1. Incentivize employees to keep a close eye on revenue cycle management. Not keeping track of the accounts receivable and billing process is one of the biggest mistakes orthopedic practices can make, says Nancy Moore, president of NBP, a practice management support company. "Often, the physician trusts employees to do the best job possible to manage the A/R and billing process, and sometimes it's not being handled well," she says. "Employees should be educated every year about reimbursement changes and carrier level changes. You also have to have good oversight from the management."
The trained employees who handle the revenue cycle responsibilities should be compensated appropriately because these employees are controlling the practice's cash flow. "In oversight, employees really need to be held accountable, incentivized and rewarded for good work," says Ms. Moore. "This doesn't always happen, especially now when it's tough to get reimbursement, but at the same time you can't cut corners." Orthopedic practices should set solid goals for the revenue cycle managers, such as maintaining the A/R greater than 120 days at 15 percent or lower of total A/R, a net collection ratio greater than 95 percent, and incentivize employees with compensation when goals are met.
2. Use payment tracking software. After a physician enters into a contract with a payor, he or she often assumes the contracts are met. However, payors sometimes underpay on contracts and losing this money can make a big difference to the practice. Dave Wold, CEO of Healthcare Information Services, said one of his clients recently identified over 500,000 underpayments while another discovered 100,000 instances where the payor stopped paying for a second procedure when contract guidelines stated the payor would. Payment tracking software allows the physician to enter in different negotiation schedules and then run the payments through to ensure the payor is meeting contract guidelines with each claim.
3. 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 Michael Franks of Physician Business Services in Tampa, Fla. "If there are any negative patterns, change them immediately. The billing and claims submissions need to be constantly monitored."
4. Patch up leaks in information management. Assess practice processes and workflows for possible leaks in efficiency and develop options for fixing them, says Monty Miller, president and co-founder of Momentum Billing. If claims are often lost or denied, implement a system of checks and balances to fix these leaks in the process. One common problem in offices is the mounds of charts surgeons keep in their offices, says Mr. Miller. A standardized process should be developed to manage the flow of these charts. Another process that should be implemented in the practice is one that cross-checks and reconcile total visits and/or surgeries in a day against what was billed out. Miller has seen practices where up to 15 percent of their total encounters fell through the cracks and were not billed. It's important to delegate who is responsible for every aspect of the billing process to make sure it runs efficiently.
1. Incentivize employees to keep a close eye on revenue cycle management. Not keeping track of the accounts receivable and billing process is one of the biggest mistakes orthopedic practices can make, says Nancy Moore, president of NBP, a practice management support company. "Often, the physician trusts employees to do the best job possible to manage the A/R and billing process, and sometimes it's not being handled well," she says. "Employees should be educated every year about reimbursement changes and carrier level changes. You also have to have good oversight from the management."
The trained employees who handle the revenue cycle responsibilities should be compensated appropriately because these employees are controlling the practice's cash flow. "In oversight, employees really need to be held accountable, incentivized and rewarded for good work," says Ms. Moore. "This doesn't always happen, especially now when it's tough to get reimbursement, but at the same time you can't cut corners." Orthopedic practices should set solid goals for the revenue cycle managers, such as maintaining the A/R greater than 120 days at 15 percent or lower of total A/R, a net collection ratio greater than 95 percent, and incentivize employees with compensation when goals are met.
2. Use payment tracking software. After a physician enters into a contract with a payor, he or she often assumes the contracts are met. However, payors sometimes underpay on contracts and losing this money can make a big difference to the practice. Dave Wold, CEO of Healthcare Information Services, said one of his clients recently identified over 500,000 underpayments while another discovered 100,000 instances where the payor stopped paying for a second procedure when contract guidelines stated the payor would. Payment tracking software allows the physician to enter in different negotiation schedules and then run the payments through to ensure the payor is meeting contract guidelines with each claim.
3. 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 Michael Franks of Physician Business Services in Tampa, Fla. "If there are any negative patterns, change them immediately. The billing and claims submissions need to be constantly monitored."
4. Patch up leaks in information management. Assess practice processes and workflows for possible leaks in efficiency and develop options for fixing them, says Monty Miller, president and co-founder of Momentum Billing. If claims are often lost or denied, implement a system of checks and balances to fix these leaks in the process. One common problem in offices is the mounds of charts surgeons keep in their offices, says Mr. Miller. A standardized process should be developed to manage the flow of these charts. Another process that should be implemented in the practice is one that cross-checks and reconcile total visits and/or surgeries in a day against what was billed out. Miller has seen practices where up to 15 percent of their total encounters fell through the cracks and were not billed. It's important to delegate who is responsible for every aspect of the billing process to make sure it runs efficiently.