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Payor Recoupments - What Leverage Do You Have? 

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…

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Payor Underpayments Part 1: How to Identify This Sneaky Tactic!

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…

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How to Make the New Year Spectacular in Your Life and Your Practice

We all know that New Years Resolutions are over-rated. We know that people set them and then don’t follow through. So, what’s the answer? Just don’t set any? I don’t think so. I think the problem isn’t having them, it’s the way we do it. Let me help you to create a way that will make you excited about having new goals, accomplishing them, and creating a spectacular year. First don’t be short-sighted. Going to the gym every day is a goal, but it’s not very long range. Go to the gym to do what? For how long? How will you know when you are…

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Poor Financial Performance in your Urgent Care? Pt. 4

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…

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Poor Financial Performance in Your Urgent Care Pt. 3

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…

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Poor Financial Performance in Your Urgent Care? Pt. 2

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…

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Poor Financial Performance in Your Urgent Care Pt. 1

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…

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What are You Committed to?

“Grow up, and that is a terribly hard thing to do. It is much easier to skip it and go from one childhood to another.” … -F. Scott Fitzgerald … Here’s a little secret: The results we achieve in our business are a direct result of what we are committed to. Crazy, right? One of the people I coach in business development spends a lot of his time struggling with his relationship with his team members. “They are difficult to get along with and so I end up spending an inordinate amount of time taking care of problems,” he said. After that statement, I asked him why he…

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The Pareto Principle in Your Practice

We live busy lives, and you run a busy medical practice. There are so many things that need doing and so many things to keep track of. How do you figure out which things to do, which things to delegate, and which to just choose not to do? That is a dilemma we all face. The bigger your practice grows, the more help you have but also the bigger the number of things that need to be done. How do we solve it? In 1896, Vilfredo Pareto noted that 80% of the land in Italy was owned by 20% of the people. Since then, it has been noted that most things in life follow a similar law and it has become…

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Accepting Feedback

“Am I flexible enough to change my mind and accept feedback?” … This was a question in my The Daily Stoic Journal that’s had me thinking. It couldn’t have come at a more crucial time in our practice. We are in the middle of making considerable changes and needing to re-think where we are and where we’re going. In the process, we’re asking a lot of questions that are uncomfortable as they point out our deficiencies in our processes and business. My initial response is to become defensive and to defend what we’ve done and why we’ve done it. As we…

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