Earlier this year, we wrote a series of eight blogs, each highlighting a mistake that medical practice owners and administrators make, and as we wrap up the second weirdest year in our recent history, we thought we’d revisit them and help you develop some goals to make your 2022 financially sound.
Credentialing
In this message, we discussed the absolute no-no of the uncredentialed provider seeing patients, coupled with billing as if another (obviously credentialed) provider saw the patient. We’ll avoid the healthcare F-word and suggest that as the year winds down, you check the credentialing status of all your providers with every payor you billed this year. This will assure you start the new year knowing that you’re in the clear on this No-No.
If by chance, you discover an uncredentialed provider in your midst, immediately transition the patients to another provider and craft a short response for staff to give patients so that you retain the patient while you sort out the issue.
Last thing to do during holiday down-time… draft a new-hire provider credentialing plan that starts the process prior to the clinician’s first day of work. Use the notice time with the previous employer to submit credentialing information.
Eligibility
This message focused on one of the most crucial medical practice activities that keeps you from wasting valuable resources, rendering services without being paid. Make sure staff is conducting eligibility checks, especially in the new year when insurance coverage and patient financial responsibilities can change. Spot-check a few patients per day to assure the eligibility has been verified (you do file these checks in the chart or keep them in a section of your EMR, right?) and that the patient is authorized to see your providers. We’ve had instances where the eligibility check is filed in the chart and it specifically says the patient is not enrolled. Read carefully so you don’t see what you want to see and fail to safeguard your providers’ time.
Global fees
This blog reviewed rules for billing a global testing fee as opposed to the technical component. We have another assignment for you during the holiday lull: spot-check billing that includes testing and assure your practice used the correct modifier. If you find errors, commission a project to review a greater percentage, up to 100%, of your billings for tests; retrain staff and reprocess claims accordingly.
Fee schedule
In this installment, we suggested making sure your fee schedule tracks well with changes in provider payments. Get ahead of the curve in the next two weeks by reviewing your current fee schedule against your benchmark, which is generally Medicare allowable; be sure to use the 2022 MPFS. Revise fees as needed and remember to disseminate your new fees to all relevant staff members.
MA encounters
In this blog, we argued for having Medicare Advantage encounters reviewed and submitted by staff trained in risk adjusted payments. If you don’t have the manpower to do this just yet, work on a plan for 2022 to recruit skilled individuals who can apply their MRA expertise to preserving your funding. Depending on your volume of MA patients, it may make financial sense to outsource this function, or at least, a review of your billing, so you can operate more confidently in the coming year.
Accounts receivable
The calm before the storm of a new year is the time to dig into your A/R. First, go back over the two-part message on accounts receivables and assuming you’ve been receiving reports, make an evaluation of this past calendar year. How much did your practice bill? How much did you collect? And how much did you write off? These basic questions will provide breadcrumbs for a deeper dive into the office finances. It’s important to ask the follow-up questions once you see some patterns: Who was your largest payor? Smallest? Why were balances written off? If your practice distinguishes between adjustments for managed care payments and, say, untimely filing or billing errors, you will quickly get a sense of why some accounts were uncollectable. Then you can make a plan for retraining staff and auditing in the new year.
Billing activities
While we’re goaling together, revisiting your billing dept. staffing is key, as we suggested in this blog post. Staffing interruptions often result in neglecting certain aspects of the billing process. If you’ve had to do this in 2021, make a hiring plan to obtain the talent you need, or explore outsourcing some aspects of your billing. Give yourself every advantage in 2022 by assuring every billing activity is carried out timely and accurately.
Payment plans
In all honestly, not everything on this goal list needs to be done by the administrator. If non-billing staff has some slow time, refresh yourself with this message and ask them to perform a quick review of the status of all payment plans, their outstanding balances and the payments made this year. This will give you needed information about your billers’ activities and whether patients are living up to their commitments. You can then revisit your payment plan policy and/or institute new checks & balances (no pun intended!) to make sure those fees are collected.
We certainly don’t begrudge you some down-time before the new calendar year but we hope you will dedicate a couple of hours to the items on this list that have posed the greatest challenge for your practice this year. We promise you’ll reap the dividends in the new year!