You Need a Medical Practice Champion!

With the complexity of revenue cycle management you need a medical practice Champion! The process revisions and trainings can wear on staff who don’t get excited about changes in their workday. Or if your medical practice has finally accepted it needs to get new practice management and electronic medical records technology solutions, you may need a heroic effort to get the team on board. A practice Champion is an invaluable person(s) that never gives up and can motivate staff when the going gets tough.

ChampionEngaging staff to learn a new mandate or system can be a challenge. Working with staff who have not bought in and just want to keep things the way they are is not unusual. Everyone has enough chaos in their lives, now a new system to learn? It is critical to get the concept of why a change is being implemented. A practice Champion can be the person who backs up the administrator when gathering input from staff. It is easy to forget yesterdays challenges when face with new ones today. It is easy to forget the chunky system work-arounds when you have done it for years.

Who should be selected as the Champion in your practice? First, it should be someone doing the day to day work, not the administrator. Second, you need a person who has the trust and respect of their co-workers. Third, you need someone that has a track record of listening to management, and implementing policy and training effectively. You do not want a Champion who is a go-it-alone or do-it-their-way type of personality. A Champion needs to be savvy picking up new technology and seeing similarities across tools, especially if you are implementing a new system. Perhaps most importantly, Champions need to be committed to organizational mission and values!

A Champion is a voice that supports the organization at the water cooler. He or she will typically have the following values and skills:

  • Realistic
  • Collaborative
  • Resourceful
  • Proactive
  • Organized

Having project management skills and experience is also a plus:

  • Ability to schedule and hold effective meetings, formal or informal
  • Build stronger teams
  • Recruit additional champions or “believers”
  • Provide input for education and training sessions
  • Communicate questions for vendors and consultants

Industry changes like increased scrutiny of ICD-10 coding or new practice management and electronic medical records systems can be a huge benefit for practice performance. It doesn’t need to be a year long process with anxiety 10 out of the 12 months. Reach out to your Champion resources to make the transition easier:

  • Getting the right partners and vendors on board is also critical. Outsource Receivables ensures that the vendors selected as partners have the right customer service model, efficient service and ability to adapt to change.
  • Is your billing company the partner you need to drive the project forward to completion? ORI has a team of project management experts
  • Identify training needs early on. Choose appropriate training and ensure adequate time is in the schedule.
  • What are your budget resources for a transition? If the practice is not realistic about what the investment will be and potential impacts on cash flow, it can be a recipe for failure.
  • Get existing processes written down so they are easy to share and communicate with vendors.
  • Calculate direct and indirect costs such as lost productivity from the learning curve and training sessions.

Outsource Receivables, Inc. has been partnering with practice administrators and their Champions to improve  medical billing processes. We work collaboratively to implement ORI’s highest standards, technology focus and responsive culture across revenue cycle management processes. Contact us today to learn more and set up your initial consultation.

Rev-up Your Revenue Cycle

Motorcycle 2Mid size independent medical practices have been hit hard by the various trends over the last few years in insurance reimbursement. The overall reduction of Medicare and Medicaid reimbursement, third-party payers negotiating fee-for-service contracts., tightening of claims submission requirements, and the increasing need for patient facing technology portals. During this same time overall business expenses and regulation have increased.

Have strong and consistent revenue cycle management processes are key to success. This begins with sound policies, processes and technology. It also requires accurate projections and reporting. These elements are even more important when industry transitions take place, such as ICD-10.

Revenue cycle management beings with accurate patient data. Haphazard data entry and insurance verification will cost the practice big in the long run. Using a script and following a strict check-in process can ensure even new staff can gather the appropriate information once trained. Front desk policy is so important for supporting your front line staff. They have to deal with challenging patients every day. Being able consistency cite clinic policy, and better yet, point to the sign on the wall about co-pays or other rules is the first step to instituting a consistent front desk experience. Attention to detail in these processes and staff accountability are also important, such as reviewing information provided for accuracy and grading staff on the quality of their check-ins.

Eligibility must be checked prior to appointments. In this day and age most advanced practice management systems can run an eligibility check on the fly or schedule auto eligibility on a weekly or even daily basis. Do not ignore or underestimate the importance of this step in the revenue cycle management process. It will cost on the back end.

In the same vein, services that require referrals or pre-authorization are a huge area for denied claims. This is also the case for work comp claims. Having a check-in process that reviews patient coverage and the associated authorization requirements can reduce the risk of unpaid services. Moreover, having a system that can track service units and flag patients that are nearing their limits will prevent patients from exceeding their authorizations.

Once the patient has been seen another dynamic often occurs. The provider is just too busy to do their notes and enter their charges. Worse yet, a provider simple forgets about an appointment all together and the service is not billed out and timely filing kicks in and the reimbursement is lost. Having a written policy for providers that addresses timeliness for completion of charts and coding. The next step is to perform a regular audit of all appointments and associated charges. A big area for missed appointments is off hours or out of office services, such as weekend surgeries or hospital deliveries. Just identifying 25 missing visits a month at an average of $150 can make a big difference in your practice revenue.

Once you have confidence that you are capturing all the charges then reviewing charting and coding for maximization of reimbursement is the next step to successful RCM. Those responsible for coding should be engaged in regular professional development to stay on top of best practices. Ensuring your practice management system is setup for coding workflow, such as the ability to categorize visit types and integrated coding search tools, will ensure efficient and accurate coding. Clear communication channels between providers and coders is also key to facilitating feedback, getting questions resolved, and improving documentation.

Having a high-end clearinghouse to send your claims is the next element of technology in the RCM process. A quality clearinghouse will provide rejections with actionable detail, the ability to sort and categories rejections and produce reports to see consistent issues. More importantly, a robust clearinghouse will allow edits to continuously fine tune your claims and ensure the correct payer specific modifiers are being added. Having your files sent and received electronically as Electronic Remittance Advice or ERA is absolutely necessary. Lastly, getting your check delivered EFT will create quicker turn-around times and less opportunities for errors.

Once claims have gone out and rejections worked a separate and thorough process of posting payments and working denials begins. Following the steps laid out above will reduce your overall denial volume. Having a organized denial management and follow-up process is a subject for another article.

Managing the revenue cycle in an independent mid-size medical practice is critical to success. Timing and workflow must be incorporated into every step. Running a tight ship will help the practice navigate the negative trends or bumps in the road as they occur. Outsource Receivables is in the business of revenue cycle management so clinics can focus on what they do best – provide care for their patients. Give us a call or fill out the contact form to take the first step and complete ORI’s practice assessment.

Promoting Listening Skills and Techniques for Medical Billing Customer Service

Lunch-n-Learn appleAs day-to-day representatives of the organizations we serve, how do we recognize if we are really listening to, understanding, and connecting with our patient, vendor and client needs? How are we checking our understanding and ensuring satisfaction when providing medical billing customer service? Internally, when we need help, how can each of us listen to our team members to understand the strengths and challenges to see an issue through to resolve?

At one of Outsource Receivables Lunch & Learn sessions we asked just these questions. Our goal was to provide listening skills and techniques that create real understanding, and hopefully better connections for our medical billing customer service. When an employee creates a successful connection with a co-worker or customer, it can have profound implications for company productivity and even profitability. But how do we accomplish this? The Lunch & Learn focused on specific listening skills and how these help us connect with our clients, business collaborators and our co-workers.

Our Lunch & Learn employed a short presentation, a tip sheet, and interactive exercises – and don’t forget the pizza! We provided points on observation skills to help staff learn to look and identify when disagreement or miscommunication is happening. A review of emotional skills and the ability to recognize when something has been taken the wrong way or misunderstood was provided. Skills were provided to refrain from quick judgments and how to keep an open mind. Furthermore, recognizing internally when we are becoming emotionally engaged and need to step back for a self-check.

Even with the best techniques and intentions, conversations can still go awry. If you feel a misunderstanding has taken place a contrasting statement helps to articulate specifically what you do mean, and just as important – what you don’t mean. Moreover, describing what you expected in comparison to what you heard or received can help others take a moment to reflect on their own understanding and expectations.

Poor listening skills will get you in difficult situations much quicker, especially in medical billing customer service. Sometimes conscious or unconsciously, we contribute to poor listening by:

        • Giving advice, making suggestions, or providing solutions
        • Persuading with logic, arguing, or lecturing
        • Moralizing, or telling clients what they “should” do
        • Disagreeing, judging, criticizing, or blaming
        • Agreeing, approving, or praising
        • Reassuring, sympathizing, or consoling
        • Questioning or probing, interpreting or analyzing

However, sometimes giving advice, making suggestions or providing solutions falls into our professional responsibility. We can only be effective after we have really listened, understood, and checked our understanding with the patient or client.

Outsource Receivables mission is to lessen the complexity of healthcare reimbursement and that includes medical billing customer service. Having strong listening skills is critical to achieving this mission. By understanding how others interpret the complexities of healthcare, bridging understanding, and providing meaningful solutions we can achieve mutually beneficial results.

Kit Welchlin is a Minneapolis area professional that ORI has worked with in the past for employee development. Check out his fun (and educational) video on the topic of listening skills: Aren’t Hearing and Listening the Same Thing?

Customer Service and Saying What We Mean

Lunch & Learn’s are a good opportunity to target skill sets and techniques that we may already have, but don’t always remember to use day to day. An example is our day to day communication and focusing on the messages we send, intentionally or unintentionally, to our patients, clients and vendors. When on the phone we are communicating without visual cues, but we are still sending many signals to the listener. How can pauses, breathing, tone, and even gestures or smiling improve your success in effectively communicating what you mean, and not just what you say?

Saying what we meanWhen you are working in customer service and calling patients to let them know they need to pay their $1000 deductible on the day of service, to give them news about their test results, or to let them know their appointment will have to be rescheduled, saying what you mean is critical. It doesn’t take long after a customer hears the tone of your voice to pick up on how you feel or your attitude. Your customers will know within ten seconds of initiating the call what kind of day you are having. That’s why developing excellent telephone customer service (in both tone and words) is one of the more valuable skills you and your staff can acquire.

First, take a moment to think about what “friendly” sounds like to you. While there are qualities that send a message that a person can be relied upon, is calm and reassuring, and can be trusted, these qualities can be hard to define. Speaking with a natural tone, with confidence, clearly and without tension in your voice are key to building a friendly impression. In the reverse, anyone shouting, yelling, speaking quickly, mumbling or sounding irritated are not conducive to being friendly.

One way to increase your ability to perceive voices is to listen to the radio for how tone and pronunciation are manipulated to send a specific meaning to the listener. You can even watch your favorite actors on TV to learn how to say what you mean. At first, you may think that watching TV and speaking on the phone are two different things, but how you are physically on the phone can impact how you are perceived on the other end. One of the most basic tricks is to have a mirror at your desk. Before you pick-up the phone check yourself and make sure you are ready for the call. Secondly, take a drink of water to lubricate your voice and put your body at ease. Take a deep breath and correct your posture to ensure that you are relaxed and your voice does not sound constricted from not enough air.

Most people reading this article are thinking “I sound just fine, it’s my co-worker or employees who need the help.” It is often difficult to really hear how we sound. The easiest way is to record yourself while on the phone. This can be a little intimidating at first, but it’s a lot better to embarrass yourself little than to learn about your mistakes from a customer. Another way is to grab your smart phone or other recording device and find a paragraph in a book or newspaper to read. Speak as naturally and normal as possible for the recording.

Another way to get a reading on your own voice patterns is to pick a partner and practice using tone to say the same words with different meaning. For example:

  •  Say it defensively (emphasizing the words “would you”)
  • “What would you like us to do about it?”
  • Say it with apathy (not emphasizing any of the words)
  • “What would you like us to do about it?”
  • Say it with curiosity (emphasizing the words “like us”)
  • “What would you like us to do about it?”

The most important point of any of these exercises is identify the areas you need to improve and create a plan of action. Pay attention to these common problems:

  • Inflection and varying pitch: Avoid having a monotone voice. Raise and lower your voice to emphasize or de-emphasize the points you are a trying to make. Put a little feeling into your words. Pitch and inflection vary by region and can be a significant challenge to communication.
  • Volume: It is important to have a strong voice, but not a loud voice. Speaking from your core, with a good breath beforehand will be equated with confidence and being firm. A voice without enough air can sound sqeaky or soft and impact your message significantly.
  • Tone: Relaxing your body in the neck, shoulders and abdominal will ensure your voice is pleasant, not forced and tense. Always smile, or just consciously think about a smile, when you speak as it impacts how you sound. The wider you open your mouth and the more teeth you show, the better tone you get. The same applies on the telephone. Smiling helps your voice to sound friendly, warm, and receptive.
  • Using gaps: Someone who speaks continuously or interrupts sounds impatient and uncomfortable. Using pauses with a medium pace will help with the delivery and pronunciation of words, thus drawing the listener in and making them calmer.
  • Clear mind and message: Lastly, always watch your thoughts and language. Using thoughtful, courteous and caring language can go a long way. A genuine belief in “I will do my best to listen and help this person with their deductible” will come across in your voice as well.

People working in the medical industry must be there for people who are in need, and this can be a stressful job. Saying what you mean and using a friendly voice can make the job you and your staff are faced with just that much easier. It can also improve your ability to collect payments, help those in need, retain patients, and ultimately grow your business.

Read about another recent ORI Lunch & Learn


Clinic planning for holidays, vacations and time off

As summer nears many families will be enjoying time together, parades and barbecues. At the same time, many in the medical care field continue to serve families in need across the U.S. Some staff take advantage of summer holidays to schedule an extended weekend. Practice administrators know it is not uncommon for staff and physicians to add a few days before or after a holiday weekend in addition to the holiday itself. For staff managers it is important to ensure that coverage is provided around major holidays and staff vacations. This means clinic planning and effectively coordinating staff and physicians to balance time off with the needs of the practice.

In addition to time off, practices must contend with employee turnover. MGMA (Medical Group Management Association) cited annual average rate of employee turnover at 20% for receptionist and medical records staff. Moreover, one out of three employees will leave their job within the first year of employment. This finding was consistent with large and small practices. Both of these situations can impact your practice revenue and productivity. This is especially true when you have staff holidays and turnover in the billing office.Now Hiring

When a staff person does leave there are many additional tasks to fill the role temporarily and to advertise and hire a new employee. Hiring specialty skills may require a recruiter which can add an additional $10-$20k to the process. Once the employee is on-board the work begins with HR and training. Even if other members are able to help do the job the additional responsibility can tax overloaded schedules and remove leadership from revenue producing activities. Add on the cost of morale, institutional knowledge and consistency of culture in your organization and you may just want to throw in the towel!

An alternative strategy for many clinics is outsourcing the revenue cycle management. The advantages of outsourcing are many and having a scalable business partner for regular or short term needs is key. Outsourcing with ORI provides an “entourage” of expertise, resources and staffing that help maintain a consistency for staff time off and staff resignations.

Your clinic business flow and seasonal fluctuations can also be a big consideration for outsourcing. Factors such as seasonal sickness, flu outbreaks and end of year insurance benefits expiration all impact patient counts. When a practice relies on their internal team it can take weeks to get caught up. Making your have coverage is critical to maintaining a high level of service during these periods.

Outsourcing brings the bandwidth that allows shifting of resources to accommodate seasonal fluctuations and growth spurts. ORI relies heavily on workflow technology to ensure staff are efficient, accurate and productive. Without the proprietary workflow tools the reliance is on staffing.

ORI will conduct a staffing productivity evaluation and comparison as part of an outsource assessment. Contact ORI to make and appointment and have your clinic assessed and learn about options for outsourcing.

ICD-10 Updates for 2016: Upcoding and Downcoding

Whether upcoding or downcoding, both can potentially put you at risk and both are undesirable for a well managed practice. Upcoding claims will get the attention of payers and instigate an audit. This can lead to takebacks, and a compliance risk for the practice. Downcoding is a common occurrence when providers don’t have a properly setup EHR or are documenting with traditional methods and not gathering the required information.

Coders are left to base their decisions off of what has been provided and if the content and detail is lack downcoding will likely result. Both downcoding and upcoding can be unintentional and a lack of education and understanding of the service, procedure, or diagnosis and how it relates to the optimal level of specificity may result.

Coins On See-Saw --- Image by ©

There are multiple factors that can necessitate a higher level of coding for evaluation and management coding for example the subspecialties, practice demographics, patient acuity statistics, administrative adjustments and denied claims analysis

Periodic chart and coding audits can help prevent upcoding and downcoding. Typically a provider will have 10-20 charts audited at least one to two times per year. An internal reviewer or external reviewer can be utilized. The information is valuable only when it is shared with coding staff and providers.

Documentation and coding audits should follow a structured methodology to identify existing coding and documentation issues that may affect practice revenues and/or compliance risks. The review should encompass documentation, coding, and billing. Methodology should also be mapped out and consistent to identify over-coded or under-coded Evaluation and Management Services. Missing or incomplete information can significantly impact an audit. Having all of the information gathered for each visit is critical to ensuring a fair audit.

Audit outcomes should be organized in an easy to read chart form for provider review as well and feedback on the documentation review findings. Including the copies of the charts reviewed allow a deeper look when deemed necessary. Providing this level of detail will create opportunities for change rather than additional confusion about how to chart and code claims.

Through this process a reduction in overcoding and undercoding can also be realized. With ICD-10 relatively recent many providers, coders and billers are settling in to new habits, good or bad.  Conducting a coding review can reduce the chances of payer audits and takebacks while increasing the overall compliance for the practice in 2016.

Why Get an Outsourcing Assessment?

Managing a large medical practice comes with a long list of responsibilities. A strong administrator knows when they need outside help. Reality dictates that a clinic’s A/R will never be 0% over 90 days, but what does good look like?  With patient self-pay becoming more and more prevalent in medical billing and the complexities of insurance payments, most clinics will always carry some percent of past due accounts on their books over 90 days.  However, the difference between good A/R and bad A/R is stark.

What does good A/R look like as a benchmark for your clinic?  A good rule of thumb is to keep your 90+ accounts receivables at or below 10%.  Many of our new clients come to us with A/R in the 20% range.  In cold hard cash terms that can means thousands of dollars for a clinic.

Why does A/R get out of control when you know it means thousands of dollars?  It happens because it’s difficult to allocate staff resources to the follow up required to get paid in a timely way.  It happens for the most part because the processes are not in place within most clinics to adequately manage unpaid self-pay, insurance rejections, and insurance denials.

You know your billing office is working at capacity.  You also know that leaving thousands of dollars on the table every year is not favorable for your clinic.  So what is a good solution?  The first step is to set up an initial, free consultation with Outsource Receivables to begin the process and to learn more about what options you have available.

ORI is a revenue cycle management company that assists medical practice administrators with identifying the key performance indicators and benchmarks for their business. ORI compares these  against comparable clinics using industry standards. Outsourcing revenue cycle management services can be effectively evaluated once these KPIs and comparisons are in hand. Along with the assessment, ORI provides the cost comparison and advantages of outsourcing.

Outsource GraphicThe assessment begins with a short consultation or discovery call to layout the goals of the assessment and practice priorities. If both parties are in agreement, a confidentiality agreement is signed. From this point a short assessment questionnaire is completed that covers current policies, procedures, coding, technology and more. In addition, a practice financial overview is generated which shows current staffing and overhead costs, insurance receivables, patient receivables, practice lag times and more. Using this data, Outsource Receivables can generate a base proposal of recommended services and fees.

Complete the contact form and get the process started today to learn what outsourcing can do for your practice.


Join ORI at the Minnesota Medical Group Management Association (MMGMA) Winter Conference

Join Outsource Receivables on March 1-2, 2016 at the Minnesota Medical Group Management Association Winter Conference 2016! ORI will be displaying at booth 309 in the vendors hall as part of this great educational opportunity for medical practice administrators. The event is hosted at the RiverCentre in St. Paul and will provide keynote sessions, seminars, and plenty of time to stop by ORI’s booth.

One topic of discussion at the booth is medical practice assessments for outsourcing your practices’ revenue cycle management. ORI offers a practice assessment which provides a clear picture of what a collaboration with ORI will look like from a financial, technology and staffing perspective.MMGMA Winter Conference

Managing a large medical practice comes with a long list of responsibilities. A strong administrator knows when they need outside help. ORI is a revenue cycle management company that assists medical practice administrators with identifying the key performance indicators and benchmarks for their business. ORI then tracks these  against comparable clinics using industry benchmarks. Outsourcing revenue cycle management services can be effectively evaluated once these KPIs and comparisons are in hand. Along with the assessment, ORI provides the cost comparison and advantages of outsourcing.

The assessment begins with a short consultation or discovery call to layout the goals of the assessment and practice priorities. If both parties are in agreement, a confidentiality agreement is signed. From this point a short assessment questionnaire is completed that covers current policies, procedures, coding, technology and more. In addition, a practice financial overview is generated which shows current staffing and overhead costs, insurance receivables, patient receivables, practice lag times and more. Using this data, Outsource Receivables can generate a base proposal of recommended services and fees.

Knowing your options is just plan good business sense. Getting an assessment from ORI on revenue cycle management services is as easy as stopping by Booth 309, or filling out our contact form or just giving us a call at 866-585-2800, Option 1.



Taking Responsibility for Patient Collections: Robust Back-end Processes Make the Difference

As you analyze your current collections strategy, it’s critical to assess collection of patient balances after insurance has processed. Consumer-driven and high-deductible health plans has necessitated other time-of-service collections strategies. While collecting copays or other payment on accounts is critical. For example, if staff misses collecting two $50 copays per day, this adds up to $25,000 annually that will need to be collected through statements and calls.

Having a thorough process of patient statements, phone calls, collections letters and formal collections will ensure you gather the most patient dollars in the shortest period of time. Having the collections process driven by account audits and deadlines will ensure the focus is on non-paying accounts. Taking responsibility for patient responsibility means having each step documented, daily monitoring, as well as technology and staff training that gets results. Call Center

ORI utilizes cycle billing that generates an even flow of statements every week which translates to an even flow of patient phone calls. All posting exceptions are reviewed and completed prior to the statements which helps avoid unanswered questions that carry over in the future months. Full color statements customized to the needs of the practice are created and include electronic payment links and the ability for patients to pay using all major credit cards as well as ACH check processing on-line. Statements are also available for viewing by customer service staff to help patients answer billing questions and walk through their balance owed.

Returned mail is a huge area for potential loss. ORI takes responsibility for patient responsibility by utilizing professional quality skip tracing tools and techniques to address return mail. First, at the clearinghouse all addresses are scanned and invalid address are added to a queue for review prior to the mail going out. Second, if mail is returned, each address and patient is scanned to acquire up-to-date billing information. The records are updated and a new statement is sent timely.

Some practices are utilizing optional e-mailed statements. Email statements are generated through the clearinghouse and require the user to sign-up for the service. Once enrolled, the patient will receive a secure e-mail and can log-in to view their statement past and present.

After two statements, ORI initiates a series of calling campaigns. Before each campaign all outstanding balances are audited and any patients who have not responded, or have not made a recent payment are contacted. After 10 days another statement is sent and then a second call is made to the patient. The combination of statements and calls generates a large volume of payments, however there are always patients that don’t respond.

Each step of the patient responsibility collections process is noted on the account to provide records for future scheduling or dispute resolution when patients insist they tried to pay their balance. A collections letter is sent which let’s the patients know that if no response is received within 10 days the account will be recommended for collections. For patients that call, the notes can be used to emphasize that time is up and the balance is past due.

This provides the opportunity to setup an approved payment plan which meets the practice guidelines. Any payment plan that does not meet the predetermined criteria is an “unapproved” plan and does not remove the patient from the collections process. A list of all unpaid accounts or those with unapproved payments plans is provided to the practice each month to approve for formal collections. Again, each account is audited to ensure the correct balance is being recommended.

The collections process does not stop at this point but continues with the collections agency in the drivers seat. ORI continues to support the collections effort by providing account ledgers to the agency and account documentation for issues like bankruptcy. The key is to stay out of the collection agencies way so they can professionally maximize recovery.

Having an end-to-end process ensures providers get paid for their efforts. For those patients that do not have the ability to pay a courtesy adjustment can always be made. However, when no documented process exists the courtesy adjustments and losses from an inconsistent and disorganized process may make providers feel like they are working for free. Don’t let this happen to your practice – give Outsource Receivables a call to have a collections process assessment as part of an overall practice analysis. Take responsibility for your patient responsibility and fill out our contact form and request a free assessment for your practice.