Billing, Cash Flow, & ICD-10, continued from page 9 11. EXTRA EXPENDITURES: Plan for unforeseen expenses in time and resources such as training of staff, IT upgrade costs, business process analysis of health plan contracts and documentation, and cash flow disruptions due to the ICD-10 transition. 12. OUTSOURCING VS. IN-HOUSE BILLING: If billing is handled in-house, the cost of keeping employees on staff may be higher than the cost of hiring a third-party biller. Here are some questions to consider in making the decision: What are some of the financial benefits in hiring a third-party biller that your practice currently does not get? How will your practice pay for the third-party biller and what hidden expenses will come up (postage or processing fees)? Also, ask yourself how will billing services be affected as your practice continues to grow, given that many revenue cycle management firms are paid a percentage of collections? 13. TURNOVER: Ask yourself if your billing department has a high turnover rate. If the answer is 20% or more, you may have inefficiencies that either need to be addressed in-house or may lead you to consider outsourcing. 14. HIRE COUNSEL: Because payment disputes are possible, providers should proactively address ICD-10 issues in their current negotiations. The attorneys at Epstein Becker & Green suggest that any provisions addressing group changes that address ICD-10, and those referencing “revenue neutral” requirements and provisions dealing with policy and manual compliance, should be carefully considered in contract reviews. Finally, the attorneys also recommend a clear, fair dispute resolution provision for ICD-10 conversion.
INCREASING YOUR CASH FLOW EARLY
While some organizations continue to wait to see if the compliance date of October 1 will truly stand, some experts caution that waiting for the final date could put your revenue at risk. Robert Wergin, MD, president of the American Academy of Family Physicians, expressed confidence that the October 1 deadline will stick. “This time, it looks like the real thing,” Dr. Wergin told Medscape. He agrees that doctors’ anxiety remains high over what it will take to implement the new coding system and what it will mean for doctors in terms of income. “There is concern that the technology won’t work when the systems start up,” he said. He also noted that providers might not get paid right away. The best way to prepare for any delays, the experts say, is to increase your cash flow early.
FIVE WAYS TO INCREASE CASH FLOW NOW:
1. CLEAR EXISTING BLOCKAGES: With the move by health plans to increase deductibles, more patients face higher outof-pocket costs. Rather than waiting to be reimbursed, by tapping into the payers’ systems, practices can assess the status of a patient’s deductible and accurately predict out-ofpocket expenses at the time of their visit. They then can obtain authorization right away to charge a patient’s credit card once the insurance claim is settled.
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2. USE NEW TECHNOLOGIES: Using new technologies such as lockbox services, remote deposit, electronic funds transfer, sweep accounts, and online bill payments for all expenses allows practices to get payments into their accounts faster. Combining claims into one outsourcing solution and a single electronic database rather than tracking them separately also helps improve cash flow. 3. COORDINATE CARE IN YOUR PRACTICE: In the old days, long wait times were seen as a sign of a physician’s popularity, but today any obstructions in a practice’s scheduling process will likely leave patients to seek care elsewhere. To keep your clients coming back and keep your reputation as an efficient and effective practice intact, you want to optimize care, which will ultimately translate into optimized cash flow. 4. IDENTIFY ERRORS EARLY: Post-service revenue cycle management opportunities abound, giving you tools to identify and correct errors before you submit a claim to your insurer. Also, training your staff to monitor claim denials to spot trends and fix problems at their source is key. Common preventable causes of claim denials include lack of insurance company-required referrals or prior authorization, inaccurate demographic or insurance information, claims that weren’t filed in a timely manner, and incorrect modifier, procedure, and diagnosis codes. 5. RULE OUT FRAUD: With large sums of cash coming in, it’s critical that you hire honest employees. It takes only one dishonest worker to disrupt your cash flow. Consider paying vendors with a business credit card instead of checks. Banks offer business credit cards to medical practices for internal use as well as credit card merchant processing for payments. Segregate banking duties among staff so no one person has access to all bank accounts. Ask your bank to send account statements directly to your accountant and limit online banking access. Put strong cash controls in place and log all funds collected on site and total them at the end of each work shift. Invest in periodic audits of internal controls performed by an accountant or an auditor who specializes in detecting fraud. Consultants advise doctors to keep three months of cash flow in reserve to prepare for any delays in pay as ICD-10 implementation gets closer. While some groups continue to push for additional delays, saying the mandate comes at a time when physicians are already dealing with several other technology requirements and risk penalties, several experts recommend that physicians who aren’t ready to comply put themselves at a financial risk.