Are you experiencing payor recoupments or refund demands? Did you know that the Department of Insurance for your state actually has guidelines on how far back a payor can go to recoup a payment that they paid in error? Some payors call these "Adverse Benefit Determinations (ABD)." The good news is that you have some rights! My first suggestion is to know what your state's guidelines are regarding payor recoupments/refund requests. Second, you should immediately reply back to all recoupment and/or refund requests in writing asking for an appeal and that the payor provides you with a complete…

You’ve seen it before. A payment comes in. Your staff manually posts the payment and the corresponding contractual allowance. Without a detailed understanding of contracted rates, terms, and conditions, the staff member who posts the payment may or may not get it right. It’s never audited … but it works its way through the system. You end up with a zero balance on the procedure. It falls off everyone’s workload. Without you knowing, it’s written off. A recent review performed by our office found that on one particular plan, our new client was underpaid an…

This is it! We’re going to learn the final piece of the puzzle to fix the poor financial performance of your practice. Last time, we discussed the billing and collections process, but this week we’re going to talk about managing receivables. Managing Receivables … The next area for improving the revenue cycle is accounts receivable management. We recommend that an organization segregate its aged trial balance by major third-party payers to determine the number of delinquent accounts over forty-five days old. It is easier to contact one insurer regarding twenty accounts, for…

Last week, we learned how our reimbursement systems affect our practice's financial performance. This week, we’re going to take a long, hard look at our billing and collections process. Billing and Collections … A second key area of importance involves the processes used for billing and collections. Physicians/owners should think of this area as being akin to an assembly line that begins with patient registration and continues through insurance verification and eligibility, over-the-counter collections of copayments and deductibles, charge entry, initial billing and follow-up…

Last week, we discussed how you can spot weakness in your revenue cycle management. This week, we’re going to evaluate our reimbursement systems and see how they can be hurting the financial performance of your practice. Reimbursement Systems … As you saw last week, three of the five areas listed in the previous blog focus on revenue cycle management. Under the area of reimbursement systems, appropriate coding has been determined to be the single most important element for practice improvement, given that the majority of all providers under code. Therefore, implementing a coding…

If you have poor financial performance, then it could be due to your inattentive practices concerning your organization’s revenue cycle management process. Coding, EMR and PM software systems flaws, reimbursement methodologies, billing and collection processes, all have an adverse effect on your organization’s overall accounts receivable health. Since many urgent care center physicians/owners are not aware of this problem, they often cannot “stop the bleeding” prior to disaster striking. When there is a lack of appropriate oversight in your accounts receivable process…

Did you know the average person is exposed to the equivalent of 174 newspapers full of information daily? Even more interestingly, the average person receives 35 text messages a day, and the average office worker spends 28% of their time answering emails. It’s no wonder medical practice marketers are finding it more and more difficult to get their message into the mind of the consumers, but with “top of mind awareness” crucial to success in medical practice marketing, it’s imperative marketers find a way to cut through the marketing clutter. Enter the Infographic. Why…

Nearly 3.6 million occupational injuries and illnesses are treated each year in the United States. Those injured workers need somewhere to go for treatment, and many companies are irritated with the long wait times their employees face at the local emergency rooms. Additionally, most employers want a one-stop shopping-clinic model for all their occupational medicine needs. Your Medical Practice has the potential to fill this niche in your community. If your clinic is already offering drug screens, physicals, and pre-employment testing, adding workers’ compensation care to your practice…

When you decided to open your Medical Practice you probably had one thing in mind – a desire to help the people in your community get access to quality medical care in a quick and convenient setting. Somewhere along the way, however, you realized you also had to make money. Unlike selling food in a restaurant where you know what you make on each customer, collecting money for your services in the medical field can be puzzling. 1. Keep It Simple & Updated One of the first things you have to understand is fee schedules. Simply put, fee schedules are a specific dollar amount that will…

Your Medical Practice’s success depends ultimately on one very important thing: The way you treat your customers. Perhaps, the most critical point for your success to shine comes in how you treat your customers when they make a complaint. There are a variety of reasons one of your patients may make a complaint. Maybe they’re unhappy with the cost of the visit. Maybe their prescription did not get faxed to the correct pharmacy. They may not agree with the plan of treatment they have been given. No matter what the complaint is, each complaint can be canopied under: “Unmet…