Strategies for Successful Medical Practices

FROM THE PAGES OF MEDICAL ECONOMICS

Only 11% of medical practice owners said they did better in 2020 than in 2019, whereas 46% said they were doing worse, according to the Medical Economics® 2021 Physician Report. The top reason listed was lost revenue and increased expenses because of COVID-19. Here are some strategies to boost your practice’s bottom line.

Look at Performance Indicators

Successful practices track performance indicators to identify opportunities for improvement, said Andrew Hajde, assistant director of association content for the Medical Group Management Association. These indicators include accounts receivable, insurance claims, reimbursement, denials, and patient satisfaction.

With those data, practices can not only track their own performance over time, Hajde explained, but also benchmark themselves against data from similar providers. He added, “It gives them [praactices] a bar to see if they’re doing well or if they have some opportunities for improvement in any of those areas.”

Similarly, it is also important to find out what other practices are doing to get positive patient engagement and quality ratings, Hajde told Medical Economics. “That’s where it is critical to work with your peers across the country that are achieving those best practices via conferences [and] member communities with associations and [by] researching, reading articles, [listening to] podcasts, or any way you can get in front of how people are achieving those things to bring to your practice.”

Denials and Accounts Receivable

Additionally, thriving practices analyze their claims denials and take action to reduce them. It’s crucial to track which payers are denying claims and why they are doing so, Hajde said.

Likewise, Hajde suggested checking accounts receivable for possible causes. “Is it because you are not getting paid in a timely manner or that a lot of claims are being denied?” Hajde asked. To reduce denials, ensure information is entered correctly by office employees.

Claims should also be filed in a timely manner, and all denials that are deemed inappropriate should be appealed within the payers’ established deadlines. “Sometimes you only have 30 or 60 days, so make sure you are on top of that,” Hajde explained.

Regularly Review Payer Contracts

Every contract has unique details such as requirements for prior authorizations, medical necessity, and timely filing, in addition to the reimbursement agreement. Hajde recommended regularly reviewing contracts and payment rates. “I’ve talked to some practices that haven’t renegotiated with an insurance payer for 5 or 10 years,” he said, “and they are underperforming in terms of their payment rates.”

Also, verify payment compliance and do not assume the payer is always accurate. “Confirm the payment is actually for what your contracted rate is, because sometimes you are inadvertently underpaid,” he added.

Communicate Patient Expectations

Patients should be aware of which part of the payment is their responsibility and, if they cannot pay, how that will be handled, Hajde said. All payment policies and procedures also need to be clearly communicated to staff.

Rick Gundling, senior vice president of health care financial practices at Healthcare Financial Management Association, recommended surveying patients on how they wish to be contacted: text, phone, portal, or app. Different patient populations have different expectations, but knowing their preferred communication type can help with billing- and care-related messages. An online payment portal is vital because patients expect the convenience, and it can speed up payment, Gundling added.

Nurture a Positive Office Culture

“You really need to…commit to customer service training to really create a high morale and great patient experience,” Hajde noted. “Patients really pick up on it, and anyone who’s been in a medical practice or other health care facility can tell when employees are dissatisfied. It doesn’t lead to a great experience. It won’t make patients want to tell their friends and family to go to this practice or organization.”

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