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Tips to Improve Upfront Collections in Urology Practices

Key elements in maintaining high efficiency in the revenue cycle and collection processes include a good dashboard reporting system, teamwork, and strong leadership, according to a presentation by Coker Group senior staff at the 2014 American Urological Association Practice Man­agement Conference.

“The office manager, administrator, or person who oversees the revenue cycle needs a real solid understanding of how the process works from upfront check-in, checkout, collection of copays, deductibles…all the way through to the end of the process,” advised Jeffrey Gorke, MBA, Senior Vice President, Coker Group, Alpharetta, GA. “They need to be able to diagram those functions out, be able to elucidate those functions to staff so that everyone understands very completely what’s going on.”

It is also important to have clear strategies in place, with involvement and education of staff and providers, such as a collection and billing timeline that is developed with staff input, a financial policy that is delineated in a patient welcome package, and regular billing audits, Mr Gorke said.

It can be very helpful to create tools to manage patient collections, he noted. Even though patients may have a contractual obligation to pay, he said, the job of the front office staff members who collect the money is extremely difficult. Jeffery Daigrepont, EFPM, who is also a Senior Vice President at Coker Group, suggested creative ways to collect money.

“For example, [the person at the front desk could say,] ‘Mrs Jones, I’m happy to schedule your appointment. We just upgraded to this new computer system, and for whatever reason it won’t allow me to make an appointment for anyone with a balance over 60 days. Having said that, I am going to put you on the list. Come in at 3:30, and I am going to have Jeff from the back office come up here and spend a few minutes with you,’” Mr Daigrepont said. “That is not threatening, it is not adversarial. In fact, it sounds like the front desk person is helping Mrs Jones out.”

Strategies for management in­clude analyzing and then updating fee schedules, and locating contracts with payers and understanding the terms, said Mr Gorke. “Most contracts with payers are evergreen, so they are just going to roll over. The unfortunate problem is, if you have them tied into Medicare, and Medicare drops your rates, then your commercial payer is going to drop their rates too,” Mr Gorke said. “This is all part and parcel of the process of managing and understanding the dollars that are coming in the door. If Blue Cross Blue Shield, for instance, is tied to Medicare, and Medicare drops 10% next year, then Blue Cross Blue Shield is going to drop, roughly speaking, 10%.”

Developing relationships with a key contact at each of the major payers is also important, he said. Managers should work with these contacts to “understand payer tactics and common denial reasons that those payers will deploy.” Fur­thermore, involving and educating providers and managing their expectations is “the lifeblood of the practice,” said Mr Gorke. “Unless you are running a 20% overhead rate and the money is good and everyone is happy, I would suggest to you it is probably key to show the physicians how the dollars are flowing in and flowing out relative to the revenue cycle collections process….These are the guys and gals who go out and actually generate the money, so they need to be involved in this process,” suggested Mr Gorke.

Mr Daigrepont said that there must also be considerable focus on front office functions. This can be aided by diagramming some of the workflows and analyzing the most common reasons for unpaid accounts.

“In study after study we have done, 90% of the reasons why doctors do not get paid is attributable to your front desk,” said Mr Daigrepont. “That is where a dashboard [comes in]. It is very inexpensive and allows for early intervention because you guys, as leaders, can see right there on your desktop where you are at any given moment of your accounts receivable cycle…. Trust me, you will find payers are shorting you a few dollars here and there, but over time that adds up to a lot of money.”

It is also a very good practice to set benchmarks in the gross collection rate, net collection rate, days in accounts receivable, and adjustment percentage (total adjustments divided by the total fee-for-service charges), advised Mr Daigrepont. “Knowing where your benchmarks are is very important, in terms of maximizing your profitability.”

Some practice managers may want to consider outsourcing the billing, or even all of the business end of the practice.

“A lot of us in leadership are somewhat overwhelmed with all of the things we have to worry about, so it is appealing sometimes to just get rid of all our IT infrastructure, our services, and just go with a straight service fee [billing company],” Mr Daigrepont said. “Having said that, they can be very expensive, especially in urology. What I would strongly encourage you to do is tie their compensation to benchmarks, so if they want that 5%, 6% of collections as their fee, they have to hit certain target levels. Also, I would tier your over-the-counter collections, cash-paying patients, to be a lesser percentage.”

Mr Daigrepont urged participants to use caution when considering outsourced billing, saying, “No one is going to care as much about your money as you do.”

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