5 Tips for Optimizing the Orthopedic Practice Revenue Cycle

Practice Management

Here are five tips for optimizing the revenue cycle process at an orthopedic practice. 1. Send your claims out the door quickly. Make sure to get clean claims out the door as quickly as possible, says Monty Miller, president and co-founder of Momentum Billing. "Have the processes in place to ensure you are getting clean claims out the door up front and you will see the profit at the back end," he says. Having an up-front process to check a patient's insurance coverage or eligibility is an important part of moving clean claims through swiftly. When using automation technology, the practice can have a process in place to check insurance coverage prior to the visit, which will enable the office staff to handle the patient more efficiently, especially if insurance coverage has been recently discontinued. This process will ensure faster payments through fewer denials.

2. Incentivize employees to keep a close eye on accounts receivable. Not keeping track of the accounts receivable and billing process is one of the biggest mistakes orthopedic practices can make, says Nancy Moore, president of NBP, a practice management support company. "Often, the physician trusts employees to do the best job possible to manage the A/R and billing process, and sometimes it's not being handled well," she says. "Employees should be educated every year about reimbursement changes and carrier level changes. You also have to have good oversight from the management."

The trained employees who handle the revenue cycle responsibilities should be compensated appropriately because these employees are controlling the practice's cash flow. "In oversight, employees really need to be held accountable, incentivized and rewarded for good work," says Ms. Moore. "This doesn't always happen, especially now when it's tough to get reimbursement, but at the same time you can't cut corners." Orthopedic practices should set solid goals for the revenue cycle managers, such as maintaining the A/R greater than 120 days at 15 percent or lower of total A/R, a net collection ratio greater than 95 percent, and incentivize employees with compensation when goals are met.

3. Use payment tracking software. After a physician enters into a contract with a payor, he or she often assumes the contracts are met. However, payors sometimes underpay on contracts and losing this money can make a big difference to the practice. Dave Wold, CEO of Healthcare Information Services, said one of his clients recently identified over 500,000 underpayments while another discovered 100,000 instances where the payor stopped paying for a second procedure when contract guidelines stated the payor would. Payment tracking software allows the physician to enter in different negotiation schedules and then run the payments through to ensure the payor is meeting contract guidelines with each claim.

4. Don't rely only on technology to ensure correct coding. Electronic medical records (EMR) are becoming the wave of the future for many healthcare providers, and one of their functions is automating the surgeon's dictation and generating a report. While EMRs can be great tools for helping surgeons do many things efficiently, surgeons can't assume the software is able to correctly code a claim 100 percent of the time. "Not every surgical possibility is necessarily represented in the program, and surgeons need to consider that," says David Lau, managing partner of Medical Forefronts Financial Services, a management company that specializes in surgery billing for facilities featuring orthopedic and pain management physicians and practices. "People are anxiously subscribing to this new technology, which simply may not yet be ready."

For example, when surgeons do arthroscopic knee surgery, they might perform five procedures in two compartments. Using the EMR software, surgeons may be limited to pre-populated "drop-down menu" choices and thus, not be able to specify that a number of procedures were performed in one compartment and then another. In this case, the overgeneralization forced by the EMR menu would significantly change how this procedure is coded and subsequently reimbursed.  Surgeons must be familiar with how CPT codes are generated from their dictation and how that can affect the bottom line.

5. Conduct chart audits for accurate coding. Audit the medical charts to ensure the surgeons are capturing all the codes possible and correctly describing or coding the services rendered. The surgeon needs to know every different step of the treatment that is billable and how to describe the treatment accurately to receive the highest amount of compensation. "Make sure the physicians are getting paid for the amount of time they are spending with the patient," says Michael Franks of Physician Business Services in Tampa, Fla., a company that partners with physicians to handle back office and administrative responsibilities for more than 50 physician practices. "If there are any negative patterns, change them immediately. The billing and claims submissions need to be constantly monitored."

Related Articles on Orthopedic Practices:

Poised for the Future: 6 Ways for Orthopedic Practices to Overcome Today's Challenges

5 Out-of-the-Box Strategies for Increasing Orthopedic Practice Profits
6 Features of Effective Orthopedic Group Websites

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