Diary of a broken revenue cycle

‘Today’s entry: I need help with billing!’

We’ve heard how it happens to the best of them — managers and administrators in all kinds of practices, all sizes … One day they reach an ‘aha’ moment in billing: They realize they need help.

“We were always falling behind,” says Joel Link, billing manager at Affiliated Medical Associates, as he recalls his own moment of sudden insight. “There was a lot of pressure on us. The doctors were not happy because money wasn’t coming in the way that it should in the time that it should.”

Brittany Clark remembers her aha moment too, as the Practice Administrator at Peoria Surgical Group: “When you have $2.5 million in A/R, and it’s because insurances aren’t paying, you know you have to find a way. How can we get insurance to pay these claims?”

Positioning your practice for value-based care while staying financially healthy in a challenging regulatory environment means knowing how to get paid for your services — from handling claim denials and underpayments to following up on outstanding payments. But that’s not always easy.

When those daily billing pains start mounting, and office managers and practice administrators finally realize they’re losing money they shouldn’t be, they often feel they have no choice but to seek help. Many of them are partnering with teams of revenue cycle management experts bent on collecting every dollar they can.

Matching revenue to care delivery

It’s a match that makes sense, they say, especially in today’s regulatory healthcare environment.

“I got a letter from Medicare saying I was going to get a 2% deduction for not meeting Meaningful Use,” said Dr. Mark Godiksen, physician and practice owner. “I was pretty frustrated, and I just thought, ‘You know what? No matter what I do, they’re just going to ding me.’ At that point, I felt like I had given up.

“I don’t have a lot of time to oversee billing,” Godiksen added “And I don’t really have any expertise as far as how all of that should go.”

According to Is Your practice positioned for long-term financial health? 5 questions that let you know, a Greenway Health infographic, as high as 96% of practice leaders report inefficient billing processes. And almost 90% of small practices are unprepared financially and technologically for implementing value-driven care.

Value-based care programs, changing payer fee schedules, employee attrition, government regulations, lackluster training and oversight, high deductible health plans — there are many reasons your practice might not be bringing in the revenue that it’s truly earning.

Joel says a big part of his struggle was dealing with days in accounts receivable (A/R). “Obviously the longer it takes to get the money, the less money you’re going to get. Once it hits 120 days, you’re getting 10 cents on the dollar, on average. Keeping the majority of claims under 60 days is essential.”

Partnering for success

Once you’ve hit the breaking point and you know you need additional help, it’s time to weigh your options. Whether your goal is to remain independent, grow your practice, or simply improve your cash flow, it usually comes down to deciding whether you hire additional employees or bring on a revenue services partner.

There are many factors to consider, of course. For example, when hiring additional or new billers, will the monetary investment (wages, benefits, vacation) be worth the return? Who will train staff, and when? Who will complete billing tasks when employees are sick or on vacation, or quit a job?

If adding additional billers doesn’t sound like the right solution, partnering with a team of experts might be the answer. But hiring a partner doesn’t mean you have to let go of your dedicated staff. Their knowledge can be transferred to revenue-producing roles within your practice.

“The results are amazing,” says Joel, who now partners with Greenway Revenue Services. His practice started seeing results almost immediately. “The turnaround time is much quicker. The follow-up is fantastic. The communication between them and us is constant.”

Mark and Brittany also decided to partner with Greenway Revenue Services. “I’ve been doing this for 30 years, and this is a step above anything I’ve had before,” Mark said. “It’s cost-effective, and there’s expertise there. And then there’s a lower stress level knowing this stuff is off your plate.”

To learn more about what the Greenway Revenue Services team can do for you, request a call from a Greenway Health representative.