The Right Questions to Diagnose Physician Practice Financial Pains

Insights from Forum Sponsor Greenway Health

Physician practices should seek operational answers to their revenue challenges.

If you could treat your practice’s shrinking profitability the same way as you treat your patients’ ailments, how would you improve its financial health?

At first glance, you may attribute the symptoms to repercussions of the Affordable Care Act and other increasing regulations or the overall decline in reimbursements from payers. But by assuming your financial issues are out of your control, you could be ignoring a significant underlying issue.

The true answer to the cause of your financial pains might be your revenue cycle processes. However, you may just not be asking the right questions to uncover those faulty processes.

Do You Know What Your Payers Are Paying?

For example, I once talked to an orthopedic group that was being underpaid for a common injection they billed for quite often, which resulted in a loss of hundreds of thousands of dollars each year, all because of a processing error.

To bill accurately and collect what they’re owed, practices must frequently research changing payer rules, update fee schedules, and ensure payers are paying the correct amounts.

Are You Collecting from Your Patients?

As unpredictable as insurance payers may be, patient payments can be a much more unreliable source of revenue.

With the rise of high-deductible health plans, patients will more often be responsible for payments, but physician practices that are used to traditional billing don’t always successfully collect what they’re owed. And once patients leave the office, they’re much less likely to pay—which isn’t all that surprising, considering only 32 percent of patients who owe money receive a collection letter.

When Is the Last Time You Tackled Your Claims Denial Backlog?

Some practices have a backlog of denials that has been sitting out there for 90-plus days. And it’s likely they’ll never get to them. Almost 20 percent of claims are denied annually—and 65 percent of those denials are never worked.

These questions can reveal a problem common in physician practices. Historically, billing has always been a back-office function. Physicians and other practice administrators don’t have insight into any errors that the coding staff is making, and they’re not always alerted to cash flow problems.

Improving revenue cycle processes might require evaluating your payment and denials processes on your own, or working with a revenue cycle management services vendor to do so. Either way you choose, an analysis of your revenue cycle processes can encourage timely payer and patient payments and result in improved billing and payment experiences for your patients.

Leighton Noel is revenue cycle management specialist, Greenway Health, Birmingham, Ala.