A Reminder: Opportunities to Expand and Keep Your Business

by Steven Peltz, from the Jan/Feb issue of HBMA Billing

As a medical practice consultant, one the first areas of a medical practice that I evaluate is the billing department or billing company of a practice that has hired me. In my capacity as the president-elect of the National Society of Certified Healthcare Business Consultants (NSCHBC), I have had informal discussions with HBMA President Don Rodden, CHBME, about the consulting services that billing companies provide to practices, sometimes without understanding how important their role is to the practice.

I was introduced to HBMA by Government Relations Committee Chairman, Barry Reiter, CHBME. He and I have discussed the constant chaos that the healthcare delivery system is in and identified some of the opportunities that arise from that state. You may not know it, but many of you are already consulting, and if you have not set up your engagement contracts wisely, you are missing out both on revenue and having your client understand and appreciate all the value you bring to the practice. As practices merge and are acquired by hospitals, it is a good idea for your company to offer more than one line of service. Here are a few examples of what I do; you may want to consider adding these services to your company if you do not already offer them.

Over the years, I have established a benchmark of what a practice's accounts receivable (A/R) should look like. It is not cast in stone and is not fail proof, but it is a simple measuring tool that I use. I take the A/R temperature of all new clients and put it on a bar graph, then compare it to my benchmarks (see page 24). I then demonstrate to the potential client that by using the graph, their money is worth less the longer it is owed to the practice. I point out that either their billing company or billing department is not meeting the standard. I also break down the front end of the billing process and identify disconnects in the data collection process, such as: poorly trained staff, lack of reconciliation, monitoring, and the final decision with respect to collections.

Reducing the lifetime of debts that your company must collect begins at the point of service. Collecting co-pays at the time of each practice visit reduces postage, cuts billing staff time, and increases cash flow. Increasing the consistency of this front end collection means training the practice's staff to train the patients. For example, the front end staff may say to the patient, "Your co-pay today is $20" and then stop and wait. A more effective script for collecting co-pays may be, "Your co-pay today is $20, and we accept cash, checks, and credit cards. How would you like to pay?" A subtle but important difference, and while it will not work 100% of the time, it will result in increased revenue. Then, tell your client that you will monitor the success of their front office staff in collecting co-pays and refresh the front staff's training a few times a year. Finally, track the front staff collections on a monthly (or less frequent, but consistent) schedule and meet with your client enough times for your client to develop trust in you as a part of the management team.

When patients call to schedule appointments, do the front desk staff members ask for enough information to check insurance eligibility and acquire authorizations, when appropriate, before the visit?

Is there a daily, weekly, or monthly close that reconciles the cash, personal checks, credit card receipts, and insurance checks with the end-of day and end-of-week computer report and the bank statement? This is a simple way to make sure all the funds go into the bank and not into someone's pocket.

Does the office manager or billing department / company supervisor produce a monthly report that compares the charges and collections of the past month with the same month last year and two months before? This will spot and identify trends before they become problems.
During the first few meetings with your client, be prepared to bring something to the discussion that demonstrates the depth and scope of your knowledge and how your expertise will add to the success of the practice. For example, each year Medicare changes their codes; you could explain which, if any, impact the practice. If it is a primary care practice, establish a referral-based report. Identify how many dollars are sent out of the practice and to what specialties. Are there ways to recapture some of those dollars? Is the PCP or the specialist asking enough questions and documenting enough to code one level higher, if appropriate? I usually tell the owners(s) that the practice needs a preventative audit at least once every year and especially after a new provider is hired. When they ask why, I give them examples of other practices that have had to write checks back to payers.

When your client brings in a new provider, do you offer to credential the provider or bring in someone who can? Do you discuss ancillary sources of revenue that other practitioners use that can also be applied to that practice?

You probably already do between 80% and 100% of the above suggestions, but does the client understand how these services impact their practice? The point is whether your client knows that you provide these services. Yes, I know that they do not want to pay more for services that they think should be included, but that is not a reason to forgo informing them of all you do. Enhancing the services that you offer discourages clients from shopping for competing providers – it is much less expensive to keep a client than it is to get a client. Also importantly, by enhancing your services, you become more appealing to potential new clients when you make sales calls and offer to analyze their operational efficiency.

As a consultant, I either know the answer to the question or where to get it. You should be no different. With the constant change in the healthcare delivery system, you need to be constantly enhancing your product and empowering your clients with more opportunities.