happens Discovery

how well your business is doing.”

The solution is a new layer to the review process. “Someone on staff needs to go through and match the electronic payments with the explanation of benefits to make sure the payer is covering all they should be,” Cockrell says.

Use the adjusted collections rate to assess the efficacy of collected reimbursements. Divide payments (the net of credits) by charges (net of approved contractual agreements) during a specific time frame. Then multiply by 100 to get the percentage. That number reflects how much of every fee allowable is being collected.

“Typically, you should be collecting 97 percent,” Cockrell says, leaving 3 percent bad debt, which allows for things such as patients not paying. “If that number is 100 percent, I know from the start they have problems, because the only way to do that is to write off everything—what the insurance didn’t pay and what the patient did not pay you.”

The amount of revenue lost can be staggering. “It’s not unusual to cover our fees in what we’re able to do to help groups by doing a better job on followup,” Cockrell says. For one group, the follow-ups improved their gross collections by 5 percent. Even increasing gross collections by 2 percent in a million-dol- lar-a-month practice would add another $240,000 revenue a year.

Yet physicians usually balk at hiring additional office staff or outsource the billing in order to right the reimbursement process to generate the most revenue. “They see it as costing them money, rather than looking at it as this is going to improve my bottom line,” Cockrell says.

They also tend to not fire those staff responsible for the ongoing and often notable loss of revenue over significant time. “They don’t chop off people’s heads. They say, we gotta fix that and not let it happen again,” Cockrell says.

“You don’t know you lost it, if you never see it,” Cockrell says. But once that lost revenue comes to light, move quickly to realign the claims-handling processes. Because time results in actual money, when it comes to refiling claims.

When physicians, scientists and researchers with extraordinary talent and passion are given the technology, the facilities, and the support, they achieve great things. The discoveries, innovations and clinical trials happening today will help shape the future of treatments and lead to cures.