Is Your Medical Office Current Prescription Expired? Using S.O.A.P. Could Save Your Medical Practice….

I know exactly what you are thinking, who prescribes medication to someone who is not sick. Well we both know even the most healthiest person has to have some type of regimen to stay healthy. Whether they exercise, take vitamins and or work out daily. The same way we have to nourish our bodies, we have to do the same for our medical practices. You can’t expect to go out and lease a building, hire some staff members and then open your doors for business without first doing a market and practice analysis. 

I know you are thinking that is crazy why do all those things? I am a doctor, people are going to be knocking down my door for services. Well guess what? The same day you open your medical practice, 25 other providers open their practice within a 50-mile radius of you.  Oh let me think you’ve had a tech guy to approach you about creating a website and optimizing your search engine that guarantees when someone decides to Google your service you will be the first name to pop up on the list. Okay, now you have solved the problem in getting the patients in the door; what happens when the patients start coming in by the truckload and your current staff starts to cut corners forgetting to verify insurance benefits, collect copays and their wait time increased to an hour or longer? Let me guess you will continue on doing your same routine because the patients like you and needs your services.  WRONG!!! This same mindset is why a lot of medical providers are closing their doors, have a current claim rejection rate of 33%, high patient receivables, waiting 120 days to be paid from insurance company, unable to take a vacation, spend all night charting records, and becoming physically sick themselves, etc. The problems are endless because they did not do a thorough check of their medical practice.  

The healthcare industry has changed. Specifically, the days of easy money, easy practice start-ups and easy clients are gone. To be a successful medical practice you must start completing annual check-ups of your current medical practice and making adjustments to your prescription.  Having a fancy Website, office space, and a lot of staff members cannot compete with an important tool -- S.O.A.P., which stands for Subjective, Objective, Assessment and Plan. You should complete a business assessment such as this every year. 

How to use S.O.A.P.?

Subjective: Did your current medical biller allow you to tell them what symptoms you are experiencing? Did you provide them with your current receivable records for review?

Objective: Has your current biller written down his/her observations? What tests were performed? 

Assessment: Were you given a thorough system check of why you are experiencing these problems? 

Plan:  Is your plan the same he/she gave the last 5 clients? When is your follow-up appointment? Are you happy with this plan?

Here at Triple E Medical Solutions LLC we understand the importance of revenue cycle management. Our trained, certified and licensed staff members specialize in making sure our clients are in compliance and most importantly getting paid in as little as14 days on average. If you are afraid that your current prescription has expired or it’s just time for your annual assessment, give Triple E Medical Solutions LLC a call today at 1-888-338-7293 and get your FREE Practice Analysis.

Tracie Clark, BSHIIM, HCM, RHIA, CMRM, is the Medical Billing Operations Director at Triple E Medical Solutions LLC. Contact her by telephone at 888-338-7293 ext.101 or fax 888-391-2109, email tracie.clark@tripleemedicalsolutions.com.   

9 Ways Doctors Can Generate More Revenue—Starting Today

9 Ways Doctors Can Generate More Revenue—Starting Today

by Vicki Rackner, MD

As a medical professional, how will you respond to falling fees, rising costs and higher taxes?

Here are 9 ways you can continue to enjoy the personal, professional and financial rewards that attracted you to a career in medicine.

Stop losing money.  A penny saved is a penny earned.

1. Address your billing practices. A medical billing expert remembers the day his new client showed him his “Porsche drawer” filled with rejected insurance claims.  This physician knew that if he contested the rejections, he could fund his dream car; he just never found time.

Are you doing everything you can to get paid for the services you render?  Most doctors see significant increases in cash flow when they turn their billing into the hands of the outsourced billing experts.

2. Look for found money.  A practice management expert tells me that virtually every medical organization leaks money, and he knows where to look.  He guarantees his results—putting more money in doctors’ pockets by patching the leaks.

3. Protect yourself againstfraud.  Do you have checks and balances in place to help keep your honest employees honest?  A colleague told me that she should have listened to her intuition about her “trusted office manager.”  She discovered that over the years, this person embezzled hundreds of thousands of dollars.

Get paid more. You can increase your practice revenue through ethical, professional approaches.

4. Identify profitable activities. Mine your billing data to get a handle on the revenue generated by each of your daily activities.  In a fee-for-service practice model, you exchange your time for money.  Calculate your “hourly wage” for each procedure you perform or kind of patient you see.

Then consider the level of personal and professional rewards you get with each activity.

From that you can gain clarity about what your ideal day looks like.  You may decide to narrow your scope of services. You may find a “sweet spot” like the dentist who discovered he likes working with phobic patients. There are any number of ways you can attract more of those best-fit patients.

5. Add services.  If you run a busy practice, it might make sense to set up an in-house formulary that could increase your patients’ medication compliance as well as generate more revenue. 

Maybe you consider adding a cosmetic service for which patients pay out-of-pocket.

Maybe you decide to hire physician assistants or nurse practitioners so that you can spend more of your time  engaged in sweet-spot activities.

6. Sell products.  Consider offering products that help patients achieve the desired medical outcomes. A veterinarian could sell pet food, toys and educational materials.  A dermatologist could sell skin care products.  I met a pulmonologist who created an effective smoking cessation program, which he sells nationally through his practice.

Earn outside of your clinical practice.  Your value transcends your ability to diagnose and treat individual patients.  You can help many people in many different ways, and get paid for it.

7. Moonlight.  You could serve as an expert in medical malpractice lawsuits.  The benefits include your ability to review cases on your own schedule, generate a high hourly wage and gain insights that made me a better doctor.

You could take locums positions, serve as a director in medically-supervised weight loss programs,or get on staff at assisted living facilities.

8. Shift to a non-clinical career. You could offer leadership to medical organizations, launch a business venture or work in companies that sell medical products and services.

You might consider generating revenue through speaking or writing or coaching.

9. Make investments.  You can make your money work for you.  Be sure to vet any business opportunity with an expert who can evaluate the level of risk and impact on your bigger financial picture.

You can help people across the globe, educate people whom you never personally met and deliver value in unique ways.  This offers unprecedented opportunities for you.

I do not believe the golden age of medicine is over; I think it’s just beginning.

© 2015. Vicki Rackner MD.  All rights reserved.


Vicki Rackner MD, President of www.MedicalBridges.com, helps doctors enjoy the personal, professional and financial rewards that attracted them to a career in medicine.  She leverages her experiences as a surgeon, clinical faculty at the University of Washington School of Medicine and entrepreneur to help physicians and dentists thrive in the era of ObamaCare.

BENEFITS OF OUTSOURCED MEDICAL BILLING & REVENUE CYCLE MANAGEMENT

If you find it more difficult to manage the entirety of your medical practice while maintaining the complexity and efficiency of your revenue cycle management, you should consider outsourcing.

Saves Time and Resources
It takes a great deal of time to hire, train, and maintain a revenue cycle management (RCM) staff. With the ever-changing regulations and protocols in the healthcare industry, outsourcing relieves your business of these burdens and allows you to focus on the core of your medical practice.

Enhances Revenue Generation
An RCM service will be able to generate a higher practice income through efficiencies
of scale, broader experience with payors, resources dedicated to denial management, and self-pay follow-up, even after calculating the fees.

Decrease Days in A/R
Lack of follow up is a major contributor in lost revenue. Contributing factors such as timely filing issues, contractual allowances and write offs result in an increase in days in A/R.

Monthly Reporting
A contemporary RCM service will provide customized monthly reports and analysis's that offer a deeper look at key metrics, allowing the organization to make better strategic decisions. This should include provider productivity, coding methods, resource management, enhanced patient care and myriad other practice specific ones.

Detailed Information (Cost/Utilization Patterns to Assist in Contract Negotiations)
Negotiating with payors in today’s environment is not only a tedious process, but puts a tremendous strain on providers and their management team. Having detailed, empirical historical information on an ongoing basis is a competitively enabling foundation when negotiating contracts.

Designated Team
A RCM should be your “Business Partner”, not your “Billing Company”. Clients should have dedicated personnel to handle your account almost as if they were your own employees.

Single Point of Accountability
When outsourcing, you have an accredited organization focused on the highest level of performance while providing checks and balances, making sure there are no inconsistencies. This allows for a more efficient billing process that offers a one stop solution.

Cost of Building an Internal Billing Operation
The costs and personnel complexities associated with implementing and running an internal billing operation is very high. A billing administrator is required to hire, train, certify and carry out a compliance plan. The average cost of recruiting, hiring and training a new employee is $3,500 (that does not include the decreased production caused by turnover). Technology, (hardware/software) resources, salary, benefits and office space are just a few contributing factors to the overwhelming expense of inhouse billing.

Government Protocols
With the complex regulatory environment in the healthcare industry, the demands for billing knowledge and experience have become overwhelming for healthcare providers. Full service billing services are in demand partly because of their efficient administrative processes, HIPAA compliance, and their ability to stay contemporary with regulations and requirements.

Technology
End to End Management of IT includes the ability to meet the demand for skilled IT personnel, continuous assessment of your application (Industry Standards, HIPAA), hardware, network, heating, ventilation, HVAC, power, security, staffing, policies, procedures, upgrades, backups, monthly maintenance fees and the ability to integrate various systems and deploy new technologies. Offsite backups are required by HIPAA. And, an internal data backup plan is also required. You must establish and implement procedures to create and maintain retrievable exact copies of electronic protected health information.

Billing Business is Different From Your Core Business
Medical Billing is complex and requires 100% of your staff members time. Practices are looking to full service billing partners to allow the practice to focus on quality patient care.

Continuous Change in Healthcare Regulations
With the constant change in health regulations, providers no longer have the time and resources to dedicate to reading material, checking websites, interacting with payers and attending industry seminars. A quality RCM service staff will stay current on all of the aforementioned disciplines.

Don't wait until its to late and you find yourself in a predicament to have to close your practice because your revenue has dwindled away to nothing because you did not make a change. Whether we like it or not the healthcare industry is changing and if you don't jump on-board
then you will be left in the past and out of your money. Don't lose your practice and your revenue. Get in the loop and get in compliance and allow dedicated personnel to take care of your business financial needs while you focus on the patients.

Top 5 Advantages of Cloud Based EHR Systems

With the new health reform also known as "Obama-care" its has become more evident that the government is enforcing that medical providers especially those who bill Medicare have an EHR system. One may ask why should they have an EHR system and what is the benefits that are to be had or gained by implementing an EHR system? Well, for starters a certified EHR system will allow for providers to cash in on the federal incentives that ate available for them, through systems that are certified as meaningful use. Of course with the meaningful use incentive there are milestones that must be met in order to qualify for the incentive and providers must ensure that they report the proper paperwork in order to collect on the money that is out there.  So you do a little to gain a lot. A medical provider stands to reduce his/her costs, decrease claim denials and also boost his/her patient retention by reducing the amount of time it takes to effectively check-in a patient and also check their eligibility for care.

Now that that is out of the way lets look at a comparison of the 2 most prominent forms of EHR/EMR systems. The two we will be discussing today are Client based servers and Cloud based EHR/EMR systems. Many providers are scared to go digital with their records because they feel that it may be a complicated process, but it doesn't have to be. This is the reason for this message is to show that by using a cloud based EHR/EMR system you can cut out the complication and get down to business.

Okay, so lets look at Client server systems. Client-server systems store data in house, requiring a server, hardware and software that has to be installed in the medical providers office. Traditionally in -house servers have been deemed the nor, practices are finding themselves switching to the cloud for numerous reasons. Just for instance, say you have an office and you are using hard drives, or servers that are located on the property, and a bad storm, or fire breaks out, what happens to all of your files? Well, I'll tell you they are lost, and now one has to start from scratch. Who wants to have to start all over from scratch? I certainly would not want to deal with that hassle. So look at the cloud based system and this alone should be a reason why medical providers would look to transition from client servers to the cloud.  The cloud can be accessed from any computer, or tablet device and data will be encrypted multiple times and then backed up in redundancy. Which means for medical providers that they will never lose their documents on their patients and it is secure and offers HIPAA compliance. 

So cloud based systems are able to be accessed via the web and the data form the practice is stored in an external servers and you only have to have an internet connection to be in touch with the important records you need. The cloud can save your practice and provide you with the simple security that if your office burns down, is broken into and records and hard drives are stolen that you still have control and will not have to start over from scratch. Some of the benefits that to be had by using/implementing a cloud based system will be covered in the next few paragraphs so keep reading to find out.

1. Implementing a cloud based EHR system is simple. Cloud Based EHR software is powered by the internet and not by a hard drive on a computer, meaning that no hardware or software needs to be installed on your server/hard drive. Practices are able to prevent the interruption of their cash flow and receive a faster return on their investment with an implementation process that will not take the medical providers staff out of the office. It is also a quicker implementation process than the traditional client based server systems.

2. There are tremendous savings to be had from Cloud Based EHR systems. This can be one of the greatest obstacles fro small medical practices to overcome, which is the initial cost of EHR installation and implementation. Many of the client-server based systems can cost practices upward of $40,000 to just setup and install the equipment, not to mention providers will have to pay for update patches, licensing fees, maintenance costs and also training for the staff which can cost up to $1500 a person depending on the company one is using.  With the cloud based system providers will pay a fraction of the upfront cost associated with client-server based systems and most cloud based EHR companies offer free upgrades and training when things change and many times it is virtually seamless.

3. The IT requirements are reduced when medical providers and their practice decide to move their medical records to a cloud based system. Instead of having to coordinate with IT experts to configure, test, run and update hardware and software all of that is already done for the provider by the Company that hosts the EHR system for the medical provider choosing to use them which means that the headaches are diminished. Updates are also done automatically in web-based systems, so practices are running on the most current systems available. 4. Growth is simplified with EHR systems that are cloud based. Small practices are able to grow without IT hassles. Web-based EHR systems make it easy increase the number of new users, doctors and locations. Web-based software allows flexibility for small practices to think outside the box without breaking the bank. 5. Web-based software provides better accessibility over client-server systems because users are able to securely log in to the system from anywhere they have an Internet connection. By giving medical providers the ability to access the system outside of the office allows them, their staff and patients to collaborate more effectively in a secure environment in order to provide better continuity of care.

4. Growth is simplified with cloud based EHR systems. Small practices are able to grow without IT hassles and headaches. Web-based EHR systems make it easy increase the number of new users, doctors, and locations. Web-based software allows for small practices to have a greater flexibility and not break the bank.

5. Web-based software provides better accessibility over client-server systems. The cloud gives medical providers ease of use from any computer with an internet connection that will allow them to log on to a secure system. Having the ability to access their system outside of the office gives doctors, their staff and patients an effective system that will boost the continuity of care.

With these truths about the cloud based EHR system why are many doctors still very skeptical about about them? Well some may feel that security is a problem or there is a lack there of, this is simply not true. When going into any endeavor it is understandable there is going to be some uncertainty, but when dealing with web-based or cloud based services they are actually more secure than client-servers and paper.

See, cloud based/ web-based systems achieve HIPAA compliance because the information that is stored in them has goes through data centers that with bank level security and such a high level of encryption that the data is deemed to be unreadable even if a security breech happens the data will not be able to be retrieved except for those who have a log on. It is definitely safer than paper because paper can be lost, stolen, burned, blown away or simply just misplaced, but when dealing with a cloud you don't have to worry about theft, or natural disasters.

The future is upon us and we are moving into the digital age and soon most of the day to business will be done via the internet and storage will be the cloud. So stop procrastinating and losing out on time and money look at the benefits that the cloud offers and look how your operation is running now and make a decision for your future.

For more information contact Triple E Medical Solutions LLC
Phone: (888) 338-7293
Email: info@tripleemedicalsolutions.com
Website: Triple E Medical Solutions LLC

The Truth Behind Why Doctors Lose Money.

Alright, so you read the title of this post and are super interested as to why doctors are really losing money, right? Well I hope so because the truth may hurt some people and their feelings, but it is none the less the truth. First, before we go into depth about the subject at hand I would like to give you a little background and premise for this truth I have found. My wife an I have been in business for the past 18 months and we have encountered many different office managers and observed medical office workflows and have been able to conclude that some of the people running medical practices just don't know what they are doing. I have encountered many office managers and receptionists that just don't have a clue of whats going on in the practice they work in. Partially because they are getting paid and really just don't have to know and now one is really holding their feet to the fire sort to speak.

Incompetent staff members make businesses and medical practices lose tons of money as well as patients and clients. Look, its simple if you have a staff that is fluent, and well versed in the daily operations and customer service than you can save yourself headaches in the long run. I got it sometimes your staff may be comprised of friends and family,honestly who cares if they know what they are doing, but its when they don't that it hurts your pockets and your business. All in all it is safe to say that members of your staff should be trained and have some type of credentialing in order to ensure that you are producing quality work and ensuring that everything is done right the first time around. We, are all human and can make mistakes, but when mistakes become the standard there is an obvious problem that needs to be fixed.

Being ignorant in an area that concerns finances should not be an option for staff members, because they rely on the revenue that comes in so that they can be paid. I would hope that anyone that is working the front desk or processing the claims for a provider would be properly trained and not just "winging it". Just winging it doesn't pay the bills. Maintaining a constant and growing knowledge base is key to the success of individuals as well as companies and medical practices. When members of your staff start becoming complacent and no longer demonstrating the eagerness to excel then it may be time for you to let them go and get people on board that are hungry to see your business grow and have your best interests in mind.

Don't take this a bashing of staff members or employees but rather an education of what to look for and to be mindful in the hiring process so that you are getting the optimal candidate for the job that will provide you with the best outcome and desired results.

What is Meaningful Use and How Does It Impact My Practice?

The Medicare and Medicaid EHR Incentive Programs are unfolding in three steps:

• Stage 1 (launched in 2011): Encourages adoption of electronic health records (EHRs), focusing on data capture and sharing. All providers begin Meaningful Use participation by meeting the Stage 1 requirements.

• Stage 2 (2014): Addresses advanced clinical processes and the ability to exchange information privately and securely. CMS recently finalized the rule that specifies the Stage 2 criteria.

• Stage 3 (date to be announced): Expected to address the ability to use that information to improve quality of care, achieve better quality outcomes, simplify administrative systems, control costs and manage public health and population.

The incentives for participating in Meaningful Use are considerable: under the Medicare EHR Incentive Program, eligible professionals (EPs) can receive up to $44,000 over five years. In the Medicaid EHR Incentive Program, EPs can receive up to $63,750 over six years.

Penalties

However, if Medicare eligible professionals do not adopt and successfully demonstrate Meaningful Use of a certified EHR technology (CEHRT) by October 1st, 2015, the EP’s Medicare physician fee schedule amount for covered professional services will be adjusted down by 1% each year.

The adjustment schedule is as follows:

• 2015: 99% of Medicare physician fee schedule covered amount

• 2016: 98 % of Medicare physician fee schedule covered amount

• 2017 and each subsequent year: 97% of Medicare physician fee schedule covered amount

These penalties will add up to significant, ongoing costs—and could put some practices at risk.

Currently, the only potential relief from these adjustments is if less than 75% of EPs have become meaningful users of EHRs by 2018. In that case, the adjustment will change by 1% point each year to a maximum of 5% (95% of the Medicare covered amount).

In addition, the Recovery Act allows for hardship exception from the payment adjustment in certain instances. The exemption must be renewed each year and will not be given for more than 5 years. CMS is developing more information on payment adjustments and the requirements to qualify for a hardship exemption. Using the right EHR can help providers make better care decisions by using comprehensive patient information, reduce and prevent medical errors, and improve patient outcomes.  If you haven’t yet adopted an EHR, or are dissatisfied with your current product, it is not too late to implement the right system and plan for success with Meaningful Use and beyond.

If you are looking to be able to attest for the meaningful use incentive it is imperative that you begin now and get a certified EHR system in your practice.

Don't Be Afraid of change, It Could Save Your Practice.

 Don't let the new healthcare laws and rules get you under the weather. Look to the experts to get you where you need to be. It's simple to get in compliance and we definitely have the tools to help you boost your patient engagement, as well as boost your profits from your medical insurance reimbursements. Trust that the Evolving, Efficient, Experts in Healthcare can make your practice do a 360 and make those A/R turn from red to green. We are giving you the green light to take your practice back and make it the haven you have dreamed of. Our state of the art system is adaptive to you and your personality and not the other way around. You have full control over what you want it to look like and how you want it to work for you. No longer will you have to waste countless minutes or hours searching for paper files, we can cut it down to merely seconds with our automated system. Now, I for one am not looking to waste time because for you your time is needed to be dedicated to your patients and not to charting. See more patients and waste less time. Sounds like a win win right? Well, yes it is a win win for you, your staff and your practice as a whole.  We are in the business of helping medical providers get the money they have been losing. We can help you do a total restructuring of your practice's practices. Let Triple E Medical Solutions do the back end business and you focus on what you trained and practiced for years to do, which is take care of patients.

It is no secret that most people are really scared of change and usually don't just get up and make a drastic change at the drop of a dime. Well we are not asking you to change from your practices but improve on them and take some suggestions that will ultimately make you more profitable than ever. You may love the system that you are using and if that is the case then simply don't make the switch but look to us to run your system for you, so that you and your staff can focus on the more important things such as your incoming and outgoing patients. Simply put we are able to accommodate any type of system and we are able to do what we do effectively and without error. 

We are dedicated to providing our customers and clients with superior customer service and satisfaction. We pride ourselves as being the experts that can make a difference in your business as well as your cash flow. Don't be afraid to make a change it could save your practice. 

Contact us today and see how the difference can be made with some simple easy steps. 


Phone: (888) 338-7293 FAX: (888) 391-2109

EMAIL: info@tripleemedicalsolutions.com

WEBSITE: http://www.tripleemedicalsolutions.com

ICD-10 Transition, Do You Have A Plan?

It's no secret ICD-10 is coming and if you are not ready, it could have devastating effects on your practice. CMS has stated that they will not delay the implementation of ICD-10. Don't wait until it is to late because your medical reimbursements will go down to zero and your medical insurance claim rejection and denial rates will skyrocket; not to mention you will not generate any revenue.  Well, why would you not want that revenue? You need that revenue, in order to sustain your practice and see the people who need your services and depend on you for their health and well-being. 


As of 12 am October 1, 2014 all medical insurance claims will have to be submitted using the ICD-10 code set. Patients insurance claims that have a date of service before October 1, 2014 will still be coded using ICD-9.  It is time that you start your transition because the longer you wait the harder it will get. Making the transition now will allow you the freedom to focus on your patients and not have to worry about the financial piece when it comes down to the deadline. You will be ahead of the game. The transition to ICD-10 doesn't have to be hard, but it will take some input on your part as you pick apart the code set to identify the ICD-9 code that will correspond with the ICD-10 code in order for you to effectively generate a new superbill and properly code in order to get paid. The bottom line is that no matter how you look at it your medical practice is a business. A business has to generate capital in order to remain open. 

Here is a brief list of questions you should ask yourself or vendor when preparing your transition from ICD-9 to ICD-10. 

•  Is your practice management system ICD-10 ready?
• Can your practice management system store both code sets ICD-9 and ICD-10?
• How much will the ICD-10 upgrade cost?
• Are you aware of the revised CMS 1500 forms?
• Is your billing service prepared for ICD-10?  

 By writing down and asking these question you can really start to drill down where you need to focus and who need to focus on during your transition period. There are plenty of advantages that will come from making the switch from ICD-9 to ICD-10. The Centers for Medicare & Medicaid Services has given us nine and here they are:

•  Measuring the quality, safety and efficacy of care
•  Designing payment systems and processing claims for reimbursement
•  Conducting research, epidemiological studies, and clinical trials
•  Setting health policy
•  Operational and strategic planning and designing health care delivery systems
•  Monitoring resource utilization
•  Improving clinical, financial, and administrative performance
•  Preventing and detecting health care fraud and abuse
•  Tracking public concerns and assessing risks of adverse public health events

Change is difficult and can sometimes be intimidating to some, but you have to overcome the fear and embrace the changes that are to come within the healthcare industry.  Some doctors have stated that they will just close their doors before they comply and some will, but many won't because it is their livelihood. These changes do not have to be difficult for you. There are plenty of resources out there that have been developed to help medical providers to get in compliance and stay in compliance with the changes that will ultimately effect their entire practice. ICD-10 is just a small portion of the change but will have a huge impact if you do not make efforts to transition now. 

The time to act is now and not October 1, 2014. 

For further information regarding transitioning to ICD-10 do not hesitate to contact Triple E Medical Solutions LLC. We are here to make the transition as smooth as possible and set you up for success not only tomorrow but well into the future, so let the Evolving Efficient Experts in Healthcare give you a real time solution for the real time problem you are facing. Contact us today so you can see how our solutions are bridging the gap in the healthcare industry.

Phone: (888) 338-7293  Fax: (888) 391-2109
Email: info@tripleemedicalsolutions.com 
Website: www.tripleemedicalsolutions.com 
Facebook: Triple E Medical Solutions LLC
Twitter: @TripleEMedical

 

5 Tracking Metrics Medical Providers Can Use To Boost Profitability

Since we have been on the topic of financial concerns and ways to relieve those concerns it is only right for me to give some more ways that can contribute to the relief of those nagging financial concerns. Profitability is a major component in the business world if it wasn't then there would be no stores, manufactures or you.  Most people enjoy being able to make money and not lose it, so why should you settle when you can be earning more. You can be earning more money from various factors.

With the rapid growth of the healthcare technology corridor, we have seen many changes and there will many more to come.  With those changes there is a possibility if you don't change your current practices you will likely lose money instead of earn money.  Now I don't know if that is a financial concern of yours but it should be. I will discuss 5 tracking metrics that will allow you to make more profits and build your practice the way it should be.

 Metric 1. The First Pass Resolution Rate:

What is the first pass resolution rate may be the question you are asking well, the first pass resolution rate is the share of a practice's claims that get paid by insures on the first submission. This is easily calculated by taking the total number of claim charges paid divided by the total number of charges submitted. With this report you should be looking to have a rate of 90% or above. The first pass resolution rate is important because as it is a direct reflection of your revenue cycle and the processes you employ to continue to have a steady cash flow in your practice from verifying insurance eligibility, adding authorizations and inputting accurate patient demographics to  tasks like coding and billing. Ensuring these processes are right the first time is critical to maximizing both efficiency and profitability


Metric 2. Days in Accounts Receivable:

Days in Accounts Receivable is a representation of the average number of days that it takes a practice to be paid. In essence, the lower the number the faster the practice is getting paid. There are a few ways that this can be calculated but here I will give you the industry standard of the calculation, take the total current receivables also known as credits divided by the average daily gross charge amount. Your benchmark goal for Days in Accounts Receivable should stay below 50 days, but should be in the general range of 30-40 days. Your accounts receivables are very important because it provides you an insight into the efficiency of your revenue cycle management processes. By keeping a close eye on this metric you can easily find the factors that are directly effecting your finances.

Metric 3. Percentage of Accounts Receivable >120 Days:

Accounts Receivable are generally categorized into groups called aging buckets based on 30 day increments. The break down normally looks like this 30, 60, 90 and 120 days. so here again you can see from the previous metrics that the lower the age the better.  To calculate the percentage of accounts receivable >120 days you would take the Dollar value of A/R >120 days divided by the Dollar value of total A/R. This will allow you to have a reasonable benchmark goal of less than 25% of your total A/R should be in the >120 days bucket. This metric is important because it will give you clear indicators of how your practice is effectively securing reimbursements and in a timely fashion. It will also give you the red flags that will show you that the percentages are rising and now you will know that you have serious issues in your revenue cycle, and that they can be addressed promptly.


Metric 4. Net Collection Rate:

The Net Collection Rate is the percentage of the total potential reimbursement that is collected out of the total allowed amount.  The net Collection Rate is also commonly referred to as the adjusted collection rate. You can easily calculate this rate by following this formula (Payments-Credits)/ (Changes- Contractual Adjustments).  This metric allows you to assess the effectiveness of your practice. It will tell you objectively the share of the revenue your practice is due and what is essentially been left on the table. The opportunity of lost will be reflected by factors such as untimely filing and noncollectable debt. Ensure that your Net Collection Rate is not weak because if it is in cause for people to be replaced and invest in new tools.



Metric 5. Average Reimbursement Per Encounter: 

 The Average reimbursement per encounter metric is the average amount a practice collects per encounter. Simple right. So this is also a very easy metric to calculate. Take the total reimbursement divided by the # of encounters in a given time period.  There is really no way to beanchmark this metric and realisically set a goal as many factors effect each encounter as patients are different in their needs and what happens when they see the provider. But if you are able to gather lillte pieces of the data i.e with a snapshot of a given time period you are able to see the amount that has been collected per encounter. This is a very important metric to track inside of the practice as it will show you how you are performing and can be compared to historical data to show if your pratice is excelling in its revenue cycle or on the downward slope of  decline. If your practice is on a decline in its revenue than it may be time for the provider to look at diversifying the patient or payer mix.


These 5 metrics are critical performance indicators, and help to make practices see where they are losing out and where they can change to make sure that their revenue cycle does not become in jeopardy. These metrics are very insightful on their own but are at their most value when analyzed in context, over time and against relevant benchmark goals. It should become a second nature or a habit to set internal benchmark goals for you practice and let your staff know what you are looking at so they can too become more conscious of the overall state of the practice. While setting internal benchmark goals you should also set external benchmark goals to compare against the industry standards.  If your practice doesn’t have clearly defined key performance indicators, it will be difficult to gauge results and raise your practice’s profitability in the long-term.


For more information as to how you can plug the holes in your cash flow pipeline Contact us today and let the Evolving, Efficient, Experts in Healthcare get you to your bottom-line by giving you the tools to track the aforementioned metrics and bring your revenue cycle to its full potential.

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