Top 4 things you might overhear at a financially unhealthy practice
Most providers think they’re doing everything they can in the value-based care environment to help their practice succeed, even when it comes to revenue cycle management. But statistics show that would be a mistake. Studies show about 95% of practice leaders report inefficient billing processes. And when providers mismanage the revenue cycle, the practice suffers.
Below we offer some clear signs of a mismanaged practice:
Four things you might overhear at a financially unhealthy practice … and what you can do about it.
1. “Do we really need someone to manage billing?”
“I don’t have a lot of time to oversee billing,” said Dr. Mark Godiksen, physician and practice owner. “And I don’t really have any expertise as far as how all of that should go.”
Dr. Godiksen didn’t go to medical school to manage revenue. Just like medicine requires unique expertise, so does revenue cycle management. To get the most out of your revenue cycle, you need a knowledgeable billing manager and a team you can trust — experienced with fee schedules, reworking claims, and regulatory changes.
And if you have an in-house billing team, there are still other questions that should be answered. What do you do when a biller goes on vacation, or leaves your practice entirely? What happens to your existing billers if your practice grows or shrinks? Do you have the people, process, and technology to make the most of both value-based and fee-for-service revenue opportunities?
Did you know that only 62% of practices review delinquent claims? By giving up on a claim once it’s been denied or rejected, you’re effectively giving up on getting the most from your revenue cycle. But this attitude is understandable, considering most practices are too worried about new claims coming in to think about fixing old mistakes or denials. That results in money being left on the table.
The best long-term fix for denied claims is attacking them at the source. With a process that can identify common mistakes and a team that proactively follows up on claims, you can ensure you’re always collecting the maximum on what you’re owed.
3. “I’m not really sure how we’re doing financially.”
Are you making more or less money than last year? Do you know why?
An increase or decrease in revenue can be an effect of many different causes. Maybe your practice is expanding, maybe your days in A/R have increased, maybe you’re seeing fewer payments from patients dealing with high deductible health plans, or maybe the new fee schedule has had an adverse effect on your getting paid in full. The only way to be sure is to review and compare key financial performance metrics.
At Greenway Health, we recommend tracking three key metrics that will give you a detailed and high-level view of your financial performance.
Days in A/R — How long it takes for you to get paid.
Net collections ratio — The money you collect compared to the amount you could have collected.
Clean claims ratio — The percent of claims that were accepted at first submission.
Financial performance can’t improve until problem areas are identified. This requires not only the knowledge and experience to understand the importance of these metrics, but also the context to compare them to your peers and past performance. This is the only way to ensure your practice is prepared for the future.
4. “Either we get the money or we don’t.”
In this modern healthcare era defined by rising patient premiums and increasing governmental oversight, it can be difficult to collect the money you need to keep your practice in good fiscal shape.
“Obviously the longer it takes to get the money, the less money you’re going to get,” said Joel Link, Billing Manager at Affiliated Medical Associates in our blog, Diary of a broken revenue cycle. “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.”
Joel Link, Billing Manager Affiliated Medical Associates
Beyond managing days in A/R, communication is an issue for some practices wanting to get paid. Per Greenway Health research, only 32% of patients who owe money receive a collection letter. That’s 68% of patients that might not even know they owe.
To make things even more challenging, many practices are already facing financial penalties in the future due to previous years of not fully complying with regulatory programs. How can you prepare for impending financial penalties while also focusing on new government programs, understanding payer fee schedules, and collecting the most from patients?
A team you can trust
When you partner with Greenway Revenue Services, you’ll have a dedicated account manager and a team of specialty-trained revenue experts knowledgeable in your region and able to understand your unique situation. Your team will attack delinquent claims, chase down denials, help you establish billing best practices, and conduct regular financial reviews that highlight areas for improvement and measure your success compared to previous months and years. And since your team will be in-house at Greenway, they’ll scale with your practice with no need for hiring or training on your end.
We have proven success at reducing days in A/R, increasing revenue, and improving employee satisfaction.
“Greenway has been great,” said Anna Bay-Moorehead, Office Manager at Mark Godiksen, MD. “My contact at Greenway, she’ll say things like ‘If this code doesn’t work, here’s another one. Let me know what codes the doctor likes to use.’ She’ll let me know. I cannot say enough about how great they’ve been. I love my Greenway team.”
Anna Bay-Moorehead, Office Manager Mark Godiksen, MD