Getting Back to Basics with Your Business Systems!

It is all about the money! After all, without it, you cannot provide the patient care services you currently do! While today’s healthcare landscape definitely presents obstacles it also presents a lot of opportunities. Internal business systems and patient care systems must work like a well-oiled machine for any practice to maximize profitability. The implementation of new patient care reporting requirements (i.e. MACRA, MIPS, APMs), new payment models, and other operational issues tend to demand everyone’s attention on a day to day basis. Unfortunately, too many practices are losing sight of maintaining sound business systems (the “foundation”) which can interfere with their ability to take advantage of the many opportunities out there. While providing top notch patient care and maintaining reporting requirements is at the top of everyone’s priority list, practices must regain focus on their internal business systems in order to maximize revenue and profitability, but more importantly avoid lost revenue.

Independent physician practices should not only survive, but thrive! It’s time to get back to basics! It’s time to work smarter, not harder!

Show Me the Money!

Revenue Cycle Management is the lifeline to any and all practices. Practices are hemorrhaging money due to the inability to properly manage the revenue cycle. Dirty claims, increased claims denials, delays in payments, subtle but increasingly important credentialing issues and other increased insurance “games” are wreaking havoc on the ability of practices to maintain consistent revenue and cash flow. Insurance companies are banking on the fact that with increased games (i.e. “lost” claims, records requests, inappropriate denials, etc.) and time, practices and providers will lose sight of unpaid claims (i.e. over 90 days) and therefore they don’t have to pay a penny. Failure to keep claims timely due to lack of resources and proper RCM processes and protocols results in tens of thousands of dollars in lost revenue per provider. How much money are you losing?

Maximize Revenue!

Don’t leave money on the table! Understand what constitutes a codeable/billable service for your organization. Coding and billing rules change quarterly and it’s important to stay up-to-date on those changes.

We have identified through tens of thousands of post-payment compliance audits that 68% of providers we audit are under-coding and under-valuing their work based on the services actually rendered. This results in substantial lost revenue! For example:

If all office visits are coded and billed as 99213 “to be safe” but 99214 should have been coded and billed, and this documentation and coding error occurred with 50 patient visits per month, this results in over $21,000 in lost revenue annually for one provider. And that’s just one coding error and one provider!
Of the 68% of the providers who we find under-code, the vast majority of those providers are under-coding in multiple E/M scenarios! Lost revenue can easily add up to over $50,000 per year per provider.

How much revenue are you losing?

Protect the Integrity of Your Revenue!

Provider credentialing management is more cumbersome, technical and time intensive than ever! New payer credentialing requirements imposed more regularly (government payer vendor changes, increased monitoring of providers, etc.) is wreaking havoc on practices. Failure to meet deadlines, lack of follow up, and allowing things to fall through the cracks will create disruptions in your revenue stream, cash flow and patient care. These are unnecessary disruptions you simply cannot afford! The days of an office manager, biller, medical assistant or receptionist being able to stay on top of provider credentialing are over – you simply don’t have time to focus on it!

Get paid for EVERYTHING you do!

The market is changing and your reimbursement models should be changing with it.

It’s no longer all about Fee for Service. Patient and population management and reporting is more demanding and time intensive than ever. You should be paid for this management! After all, you are ultimately footing the bill for it (i.e. personnel, training, risk, etc).

Managed Care contracting does include fee-for-service (FFS) payments and likely always will. But increasingly and especially for Primary Care Specialties there can be an element of Capitation (Per Member Per Month) payments in addition to the FFS. What the health plans do not talk about, as much as they should, is that your cost of doing the business of Population Health is paid for by the PMPM dollars …but very little any more. They are trying as best they can to make it a zero sum game. You saving them money on the FFS side and the Population health costs them noting – they win, you lose.

Take heart, there are lots of ways to win. It takes experience, industry knowledge and…often more than anything the willingness to ask, what may feel like, a lot of dumb questions and demand answers! Remember, payers do not provide health care, they sub-contract it to you! Believe it or not, you have all the power, you and your colleagues often times just don’t know what exactly and how to wield it.

Improve Your Bottom Line!

Accounting and financial controls are the backbone of any practice and are essential to its success. At all levels of a medical practice, risk must be managed. Proper controls and checks and balances must be in place to help protect your practice from loss or threats (yes, embezzlement still happens at an alarming rate!). Good financial reporting will enable you to make good strategic decisions and set appropriate goals. For larger, multiple providers practices, a simple Profit and Loss (P&L) report tells you nothing. You need better, more accurate, drilled-down data that enables you to make the best decisions possible for your practice.

As practice transformation continues, think well into the future to plan for significant expenses, such as new hardware or system upgrades. Being aware of large expenses down the road will help you better manage your finances now to comfortably spend on those purchases or make it through a rough patch.


Whether you are six months from opening your doors, or already in business, find out if you’ve covered all of your bases!


Featured Advisors in Practice Management

JENNIFER HEUER, CPCChief Operating Officer
RT Welter
Thomson, Esq.
G. KELLY O'DEAMarketing Strategist
Division IV
MARCA Health

Featured Partners in Practice Management

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