Five Critical Strategies for Physician Practices for 2014

January 20, 2014 9:02 pm Published by Leave your thoughts

This year is expected to bring more challenges as physicians continue to work harder and harder to run a successful practice. Below you will find five critical strategies to help better manage patients and your profits.

 1.      Educate Patients on Health Insurance

How often are providers confronted with a situation where the patient is unhappy to learn that their insurance coverage is limiting the services the provider recommends and/or the treatment path the patient desires?

Here are a few points you can pass along to your patient base:

  • Patients need to be more involved in the road blocks presented by insurance plans. Many non-urgent services are going to be limited in the future.
  • Patients must understand their financial obligations under their insurance plan.
  • Patients must become more educated consumers and understand their responsibilities to fight the bureaucratic fight will be greater in the future.

2.     Prepare for Referral and Prior Authorization Expansion

The changes in the health insurance industry are going to force the insurance providers to implement more authorization processes. This restriction of care is one of few protections the insurer has in a fixed premium, unlimited benefit environment. Any non-urgent service provided by your practice will become a potential target for insurance company prior authorization.

What can you do to prepare?

  •  Chart the services your practice provides that require prior authorization with various insurance providers in your market.
  • Don’t assume all insurance companies follow the same standards.
  • Set reasonable expectation with patients on how far your staff will chase authorizations. You may not be able to chase all of these authorizations for every patient in every case. Know when to ask patients to get involved and when the responsibility for gathering authorization becomes the patient’s obligation.
  • Be sure your staff is prepared, they understand the process but they need to expect a growing quantity of authorizations will be required and those will move beyond high dollar diagnostic testing.

3.     Inform Obamacare Patients of Deductibles & Out of Pocket Maximums

All the current press on Obamacare focuses on registration issues and monthly premium amounts. Price is not the only factor in any purchase. Lower premiums come at the expense of higher deductibles, co-insurance percentages and out of pocket maximum amounts. These may be new terms to many of your patients.

The Bronze plans offered, featuring the lowest monthly premiums include 40% co-insurance – without regard to the government premium subsidy. That co-insurance amount is likely to cause great sticker shock for many of your patients. Many new entrants into the market are going to believe having insurance means they pay nothing – this will cause your uncollectable account percentage to grow significantly.

Our firm recommends clients develop a written description of the ‘Obamacare’ plan co-insurance, deductibles and out of pocket maximum amounts for each plan to provide patients. This will be critical to setting reasonable expectations of payment with patients and minimizing the potential uncollectable balances in the future.

4.     Collect at Time of Service

Be sure your practice has policies in place and staff educated to collect balances at the time of service.  Even on plans with modest deductible amounts, practices need to accelerate collection by securing payment at the time of service. Collect today, save the expense of sending statements and quantify your collection risk as soon as possible.

The cost of sending a single statement is likely as much as $10-$12 when you include personnel cost, materials cost, postage and all other related costs.  If your practice can eliminate just 10% of your statement volume, the benefit is significant.

Collecting at the time of service is even more critical in the first quarter of the year as more responsibility for payment is placed upon the patient and improvements can dramatically improve cash flow of the practice. Coach your staff on asking for outstanding balances – be polite, don’t argue, just ask.

You pay for the pizza when you eat the pizza – why is the doctor’s office any different?

5.     Don’t Forget Your Medicare Advantage Patients

 Many of the Medicare Advantage plans your patients select have similar referral and authorization requirements to those commercial plans. Very few patients understand this difference as they were sold the insurance products as same as ‘Medicare’. And in the next few years, we can expect the traditional Medicare plan to include some level of these processes as well.

Are there any new strategies you hope to implement this year?


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This post was written by Brian White

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