In my last report (Capturing all your money matters. Here’s why) I explained why it matters to capture as much revenue as possible. Let’s recap some of the major reasons for doing this.
- You make more money: No matter what the economic environment, you could always use more.
- Improved hospital relationships: This may help minimize the subsidy a hospital may pay, thus strengthening the relationship between the radiology practice and the hospital.
- Less government control: More revenue mitigates the continuous threat of changes in government and commercial insurance reimbursements, thus allowing you to pay your physicians a consistent annual compensation.
- Less conflict: Having more money on hand avoids conflicts among practice, hospitals, and imaging centers due to inaccurate or bad data.
- Growth: Having cash in reserve creates space for you to develop projects that protect and increase your compensation for the future. You can take advantage now while others are just panicking.
Now, how do you get there? Several relatively simple strategies can put you on the path to better capturing all of your revenue.
- First make sure that your partners all agree. Of course, everyone will say, “Yes, find me more me more money.” But you need agreement that there is an empowering body (one person or all; however your group dynamics work) that will champion this project. This means that if employees or vendors are not aligned, you agree to have consequences. You should have positive consequences for those who help, too.
- Second, assess the incentives within each of your work relationships. A classic disconnect is a case where there is an activity that increases your overall revenue capture but implementing it means less in profits for your billing/collection department or vendor. For example, you figure that going after patient overdue balances can increase your collections by $20,000 a month, but doing so costs another $3000 and you are already paying 5% ($1000) for billing and collections. Your vendor will be threatened.
Many times we see practices go to collections, pay more than 30% on the dollar, and end up with a bad stigma for their brand. Collect earlier in a customer-friendly way. There is new software that is inexpensive; leverages existing technology, such as dialers; and can maximize your returns.
- Third, break-up your revenue cycle capture program into specific workflows and assess the incentives and performance of each function. These workflows should include:
- Patient access-front-end protocols. On average, about 13% of your collections should happen at the front desk. This leads to less collection work on the back end. Also, best practices can significantly reduce denials and no-pay patients. In order to do this, you must check for benefit eligibility, load fee schedules and calculate patient due balances before arrival, produce financial counseling worksheets that help your patients understand their benefits and what is due, and have easy access for patients to make payment.
- Patient information capture and billing. Elements include demographic and insurance capture, coding, and submitting claims (including secondary claim submission).
- Accounts receivable follow-up. Elements include collecting patient due balances (use an early-out program), ensuring proper payments from payers, and assessing denials and improving front desk services.
- Strategic initiatives. Elements include compliance, reporting and practice management, payer negotiations, and improved communications between hospital and practice to capture better data
Note that many billing companies are incentivized only to perform basic information capture and billing. Make sure there is someone either internally or externally who is accountable to measure each activity for you.
- Design a solution that involves multiple parties, including your own employees, and rewards collaboration with a more effective outcome. Make change with knowledge of what will work, and do not experiment. I have made mistakes in the past and have learned. I would hate to see others go through the same.
Don’t be scared. The longer you wait, the more frustrated you will become with your current process and the less confident you will be in other aspects of your business.
Mr. Jethani is CEO of Medical Imaging Specialists. He can be reached by e-mail at email@example.com.