Will Cash Pay Models Disrupt the Current Health Care Compensation Conundrum?
Some doctors are tired of waiting around for insurance companies to pay them, and many patients can’t find insurance anyway. This has prompted many physicians to attempt to create 100% cash-based practices in order to compensate for these issues.
The thinking is that such a practice will make health care more accessible to more people while sidestepping the kinds of billing issues which can tank the average medical practice. Unfortunately, health care is just too complex to support such models.
One doctor passed on our services, opting instead to create a sort of “members-based” practice. He opened his offices just down the hall from ours so we got a chance to see how his alternative strategy might play out in the real world. The idea was that members would pay $250 per month, per person and could then theoretically see this doctor for any and every medical concern.
There were several problems with this business model.
First, it continued to put his services out of the average family’s reach. A family of four would have had to pay $1000 each month to obtain medical care for every member of the family. Even the worst insurance plans don’t typically cost so much, and a bad, cheap insurance plan will still get most patients through the door. Anyone wealthy enough to pay such prices probably already had or could pay for an insurance plan—and this physician was no longer accepting any insurance plans at all.
Furthermore, such a model was only cost-effective for the physician so long as patients were only coming to him to treat minor illnesses. When the issue wasn’t bronchitis or the flu but rather something catastrophic and long-term the $250 in monthly compensation was now far too little to cover the expenses the doctor incurred while addressing these chronic concerns.
It didn’t take long for this experimental practice to go out of business.
It would be nice if there were some good way to side-step insurance companies. They’re the only winners in the current health care model. They’re bragging about their record profits while doctors and patients get the short end of the stick. Unfortunately, viable alternatives have not presented themselves, and these alternatives seem unlikely to present themselves any time soon.
Instead, medical practices should focus on doing everything they can do to recoup money from insurance companies. Our services help practices eradicate some of the most common excuses used by insurance companies when they deny a claim. This means doctors get paid for the services they have rendered fairly and in good faith, and they’re able to keep their doors open without having to experiment with new models of healthcare delivery which may prove to be financially devastating to them in the long run.
Keep Your Practice Open by Avoiding These Major Mistakes
As claims resolution specialist’s we see medical care facilities and doctor’s offices making a lot of mistakes which threaten their practices. Helping doctors rectify these mistakes is one of the services we provide to our customers.
Many of these mistakes are quite complex. Others are simple issues which the average practice can address right away. Here are four of the simplest ways you can ensure your practice continues to remain financially viable.
1. Never allow yourself to forget your medical practice is a business.
Most doctors get into health care because they want to serve others. Healing is a noble profession, and doctors in general tend to have a great deal of compassion.
Unfortunately, nobility and compassion can threaten a medical practice when they are misapplied. We’ve seen doctors worrying about patient bills to the point where they are refunding patient co-pays after the insurance company cuts a check, which is a form of insurance fraud. We’ve also seen doctors shy away from using medical collections agencies to recoup the patient portion of bills.
You must get paid if your practice is to survive, which means you must do everything you can to recover the money you are owed from all sources. If you can’t turn a profit your practice will not be around next year to offer help and healing to the next patient who comes along.
2. Make sure you are getting copies of patient ID cards and insurance cards.
Member numbers are usually 13-15 characters long and contain both numbers and letters. Transcription errors happen, no matter how careful staff members are about typing these numbers correctly.
What’s the easiest claim for an insurance company to deny? Why, “We can’t find that member number,” of course. An insurance company doesn’t even have to worry about PR problems if they can deny a claim by pretending they don’t know that patient is their customer. Keeping copies gives the staff something to go back to so this common billing issue can be resolved very quickly.
People change insurance policies all the time, so make sure your intake staff is routinely asking if there have been any changes in insurance coverage lately, too.
3. Make sure you’re using modifiers correctly.
Desperate medical practices often misuse modifiers in an attempt to generate some revenue. Unfortunately, they often wind up committing fraud when they do. Modifier 25 is the biggest culprit.
Remember, when you’re billing you can usually bill for a procedure or for the office visit, but for the most part you cannot bill for both.
Office visit fees are typically quite high because it is expected that the patient might need to talk to you about multiple issues. Make sure you are only using Modifier 25 when there is a significant difference between the procedure and the activities that would normally take place during a routine office visit. Simply writing a second prescription for an unrelated issue doesn’t count!
Every time doctors misuse Modifier 25 they invite the insurance companies to give their bills even more scrutiny, which can delay legitimate payments. Make sure the entire staff is trained on when Modifier 25 use is appropriate, and when it isn’t.
4. Failing to get help when you need it.
If a significant number of insurance claims are being denied to the point where your practice is facing financial ruin then it is time to reach for outside aid. Chances are, there are pervasive problems which can benefit from external evaluation by a qualified claims resolution service. Such a service can often help doctors recoup significant monies before the practice goes under.
In fact, practices which have committed every other major mistake have managed to stay in the game by taking advantage of our claims resolution services. We truly care about doctors and their practices, and we know every trick insurance companies use to get out of paying claims. This means money in the bank for you and the chance to keep on treating patients for another day.
How to Get More Out of Your Medical Support Staff
Whenever a medical practice is in trouble doctors will often tell us it’s because their office staff members aren’t doing a good job. Unfortunately, doctors themselves often contribute to office staff inefficiencies by failing to take the steps which would create a stronger, more efficient working environment.
Most of these steps are simple and cost-effective, though they do take some time and effort to implement.
Write a job description for every employee.
Believe it or not, your office staff may not be entirely clear on what you need from them or how they can provide value to your practice. They know they need to make patients feel welcome, set appointments, and enter information into the computer, but they might not know that their adherence to policies, accuracy, and know-how can make a huge difference on the practice’s bottom line.
They also don’t necessarily understand who is responsible for what or how they can accomplish what you need them to accomplish. So make sure every staffer has a job description with a clearly defined list of duties. You might even take a few moments to explain why each of their duties matters to the practice as a whole. Make sure this job description is on paper, signed by each employee, and stored in an accessible place.
Boil everything you can down to a process.
Often, the routine little things the office staff forgets about when there are a lot of patients in the waiting room can become the issues that prevent your practice from getting paid. The easiest way to ensure that staffers don’t forget vital steps when they are overwhelmed is to boil everything down to a series of steps. Those steps should be written out and posted somewhere visible.
You can make almost anything into a process. You can have a process for what staff members should say when they greet a patient. “Good morning, Mrs. Jones, here for your ten o’clock? Great. Has your insurance changed at all since your last visit? Oh it has? May I get a photocopy of your new card, please?” When these phrases are “the way we do things” instead of optional pleasantries you increase your chances of creating a staff which will get everything you need to get paid each and every time. You can print these phrases out and post them on the wall next to the service window.
You can create a process for anything that gets problematic in your office. We once worked with a doctor who was fuming because his staff was having trouble working the fax machine. It took thirty seconds for us to type a “how to send a fax” document, to print it out, trim it, and paste it to the side of the fax machine. This 30 second fix put an end to the problem and made sure every fax got sent out correctly in the future.
Conduct regular training and review sessions.
Your staffers may have worked in medical offices before. They may have gone to school for medical billing and coding. That does not mean they know everything they need to know to be a successful member of your practice.
In addition, there are a lot of reasons why medical training is a must. Workers are human and get complacent, so procedures slip and then are forgotten. New legislation requires new procedures at the office level. Targets shift. Staying on top of training ensures your staff members always know what they need to do in order to protect your interests. It also helps them connect the dots between the work that they’re performing and the survival of the practice.
These sessions offer an ancillary benefit as well. They give staff members a chance to reach out to you with questions and concerns while solidifying the group as a team with a greater mission, not just a disparate group of men and women working jobs to pay the bills.
Remember, managing employees at a medical practice is just like managing them everywhere else. Staff members aren’t magically going to perform if there is a leadership vacuum. But in general, staffers want to succeed and they want to do a good job for you. Give these team members what they need to do in order to do just that, and they will reward you by doing whatever they can to support your practice and help it thrive.