Why is this important?
According to a recent survey, 46% of physicians said they faced a burnout from practicing medicine. Unable to bear the pressures of inane insurance requirements, expanding government regulations, time consuming technology mandates and challenges of managing a business, several doctors are quitting medicine to get their life back. Business of medicine has become overtly complicated. However, there are ways to bring balance and find your space to do what you love without being overwhelmed. Over the last twelve years, we’ve used these methods to help several doctors practice medicine profitably. These ten ways will help you keep your medical practice sustainable and profitable.
1. Submit claims within 48 hours
When you designate a day of the week to submit claims, you reduce the chances of getting paid correctly and in time from insurance companies.
Use integrated billing and EHR systems to submit claims the same day or at best the next day of seeing the patients. Ensure that billing staff performs quality checks before submitting claims or even better automate quality processes. Cloud-based systems can help you complete your work even outside of the office.
Develop cheat-sheets for most commonly used CPT, ICD-10 codes and modifiers to make sure your claims aren’t held up for billing. Have your billing team create a “missing information” log that you must clear out before the end of every business week.
2. Apply Pareto’s Principle for billing
Apply Pareto’s Principle (also called the 80-20 rule) to identify top 20% insurances, procedures and denials – these typically contribute to 80% of your gains and pains.
For example, you may bill an EGD (an upper gastroenterology procedure) to BlueCrossBlueShield (BCBS) insurance most of the time. If your billing team does not go on high alert to ensure clean billing of EGDs for BCBS then your profitability is at risk.
Your entire operations can be optimized to submit top 20% claims quickly and cleanly. Fix the sources of your top 20% denials that contribute to 80% of your losses. Negotiate with insurances on your top 20% procedures to see an uptick in revenues. Applying the 80-20 rule to everything in your practice will help you identify what you need to focus on.
3. Aim for zero denials
Denials occur because practices miss playing the game according to changing insurance rules. Collecting accurate payments when you submit claims the first time is far more profitable than dealing with denials. Consider the time you will spend in following up on claims, collating accurate information, writing appeal letters and so on.
Practices fail to get prior authorizations and referrals on procedures they are about to perform. Missing to verify patient benefits and eligibility prove extremely costly. They even fail to submit claims in time.
Develop rules to fix the sources of denials. For example, get prior authorizations at least two days in advance. Rigorously implement performing eligibility checks on all patients you are about to see. Use online insurance eligibility tools to verify walk-in patients.
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Over the last twelve years, we’ve used these methods to help several doctors practice medicine profitably. These ten ways will help you keep your medical practice sustainable and profitable.