Getting the red out: A focused, strategic approach will keep you 'in the black'

September 1, 2009

Neither being on the brink of major health reform nor living through the tumultuous economy will give you any relief from the challenges to your dermatology practice's bottom line. As employers continue to push more financial responsibility to employees, the ranks of the uninsured surge daily,

Key Points

Scour for missing charges

Handing in an encounter form at the end of each visit doesn't mean you've captured every charge. First, list every step involved in capturing charges for office visits, aesthetic services, excisions, etc. As you audit each process, look for ways to improve the timeliness, accuracy and completeness of your charge-capture process.

Next, set up a process to run missing charge reports daily. It will help detect missing encounter forms from the previous day.

Finally, stay up-to-date on annual coding changes for dermatology.

Getting paid

Coach staff in how to ask for money and correctly determine owed amounts. Front desk employees are still heard to ask patients, "Would you like to pay today?" Teach them to ask instead, "How would you like to take care of your charges today, Ms. Jones?"

Everyone who collects payments from patients in your practice should know how to determine and request co-payments, look up and collect unmet deductibles, and calculate and ask for coinsurance amounts. The fact that 20 percent of $86.25 equals $17.25, for example, may seem obvious to you, but many front desk employees aren't trained to perform these simple calculations.

Reimbursement

Your dermatology practice's revenue cycle can never truly get up to speed if you don't know what you are owed - a sad, but common, situation. Demand that your payers reveal the allowables for your most frequently performed procedures. (Note that many states have established laws to force payers to disclose their fee schedules upon request.)

When you get the allowable, set up a query in your practice management system to automatically track the payers' allowables for each claim. Setting up and maintaining the database does take time, but your efforts will pay off when you catch lower-than-contracted reimbursements, which happens more often than you might suspect.

The next time your contract with a payer comes up, insist on defining the allowables for the procedure codes you use most often, to include the specifics regarding reimbursement when you code with a modifier.

Remember, a contract is a relationship between two parties, so take steps to negotiate more of your concerns into future contracts with payers.

Collections

Give your entire collections cycle a makeover. Forget thinking of your collections cycle as exclusively a post-encounter process; collections begin before your patient even walks in the door.

Add collection scripts to your appointment scheduling and reminder processes; set patients' expectations about their time-of-service payment responsibility and, when making telephone contacts with patients who have outstanding balances, request a credit card payment by phone.

Offer internal or vendor-administered payment plans to those who can't afford to pay in full, but require a minimum deposit. Set up a secure portal on your practice Web site for patients to access account statements and make online payments.

Reduce your collections cycle to 75 days or less, with an effective statement letter and, if resources allow, telephone campaign.

Dismiss patients for nonpayment, allowing them to return to your practice if they pay off their balance.