Physiatry Practice Management Resources

If extracting payment from third-party payers has tried your patience and usurped time better spent practicing medicine, take heart. We are on the cusp of an era when payers' desire to save money is meshing with advances in technology to ease administrative burdens on physicians. Experts say that exercising vigilance over the payment process and taking advantage of electronic options offered by payers are steps you can take right now to reduce payment hassles and improve cash flow.

But even the most sophisticated technology is useless without human oversight. Some experts think doctors are too far removed from their practices' finances. "The office manager will come to the physician when things look really bad, and by then it's too late," says Dan Bernick, and attorney-consultant with the Health Care Group in Plymouth Meeting, Pa.

Practice management consultants encourage doctors to guard the financial health of their practices through constant vigilance, starting with selecting the payers you contract with carefully, managing those contracts by analyzing payments regularly and staying on top of problems, and preventing cash-flow roadblocks.

Mr. Bernick believes vigilance starts with being selective about the payers you contract with. If you're looking at a new contract, he says, find out what the experiences of other physicians in your area have been with that payer.

"Word tends to get out if a payer is really difficult, down-coding claims or denying payment or just holding back, dragging their feet. That's an inexpensive and very effective way to head off a problem before it arises," he says.

Don't Rely on Payers
But foot dragging, denial and down-coding seem to be the name of the game some payers are playing. "You can't count on a payer to simply pay what [claims] you send them," says Mr. Bernick. He believes that problem payers are relying on practices to take the initiative and chase them down and demand payment from them.
To cope with that reality, he says, "You need to monitor how much you have out there in terms of receivables for each payer," he says. "Develop a system for tracking a claim that has not been paid within 30 days."

Rosemarie Nelson, a practice management consultant with WelchAllyn in Syracuse, N.Y., and a member of the Medical Group Management Association, says that many practices still make sure they are getting paid the right amount manually, by "eyeballing" the explanation of medical benefits (EOMB) from the insurance company.

She suggests using the technology available -- perhaps even a system the practice may have in place -- to automate the process. An up-to-date system can store the information about the rates the practice has contracted for with various insurance plans, she says, and at the end of a month, spit out a report detailing payments that have not been made or payments that vary from the contracted amount. "The idea is to truly manage those contracts they've created by doing a little check and balance," she says.

When it comes to dealing with providers to resolve discrepancies or find out what is holding up late payments, Mr. Bernick believes the squeaky wheel gets the grease. "If the staff at the payer knows you are monitoring them closely, they will tend to respond to that," he says. "It's only human."

Ideally, Mr. Bernick would like to see physicians meet weekly with their managers to monitor billing. Ms. Nelson thinks monthly reviews are optimal, and says quarterly reviews should be the minimum. If that's still too onerous, she says, hire someone to analyze the data.

It's not just sloppy monitoring and collection after a service is performed that robs practices of cash flow. Part of the problem is at the front end, before the service is rendered.

"[Doctors] don't have the information up front about what's covered and not covered, or who is eligible or not eligible, so they are operating in a vacuum," says John Du Moulin, director of managed care and regulatory affairs for the American Academy of Physicians-American Society of Internal Medicine (ACP-ASIM). The specialty society monitors its members' complaints about insurers and frequently meets with payers to make suggestions and resolve problems.

"It's important to get that information in a real time format, as opposed to having to submit the paperwork and wait a couple of months to get it back. The doctor's office is out of pocket [for the amount] for however long it takes the insurance company to make their determination," he says, "and that creates cash flow problems."

Some of the areas ACP-ASIM is working on, Mr. Du Moulin says, are trying to get private payers to release their coverage policies to help doctors determine beforehand whether a service is covered or not covered, and to provide doctors with a means to get patient eligibility information up front.