Bradys New Healthcare Chart times two

Like I pointed out in that post, the sheer size and complexity of the plan made it even more important than before for hospitals and smaller practices to get some help navigating the murky waters of health care billing in the years to come.

But now, we’ve got even more to worry about. Maybe Double?

According to the latest numbers, Obamacare is going to cost twice as much as originally promised!  I don’t know about you, but that makes me need to sit down and take a few deep breaths.  We’re talking about 1.79 trillion dollars!

The post I’m referencing here is from The Gateway Pundit, a Republican blog.  Obviously, they’re pointing out the political side of things.  And maybe Democrats did what ever they had to get Obamacare passed and say that the facts are wrong like this Media Matters post.  But regardless of that, ”We” in Healthcare are left to deal with the results.

Like I’ve pointed out before, this thing can mean the end of a practice that isn’t willing and able to change with the times and start focusing on running their office like the business it is.  That means making the necessary adjustments to keep overhead down and profit up, without sacrificing the quality of patient care.

Adding the right follow-up staff to your team can a great start  because in the “old world” of health care in the United States, it might not have been necessary to worry about collecting old receivables or monitoring insurance claims like a hawk.  But with a 1.79 trillion dollar upheaval on the horizon, the “old world” is disappearing fast. Gross collections will be “KING” and every dollar will count!

What steps are you taking to make sure your ship stays on course to success?

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He comes from the viewpoint that doctors in smaller practices have had to shift their role in recent years from one of oversight to one of team leading.  Here’s how Bush states the adjustment:

Physicians, Umbdenstock told me, have been moving from a role “as captain of the ship to leader of the team. It’s a very different orientation, from a hierarchical relationship to more of a leader, motivator and coordinator.” This month’s cover story explores that issue in depth, looking at how physicians, nurses, pharmacists, social workers and others are building collaborative teams to better serve patients. But as clinicians begin to embrace these new relationships, what about their counterparts in the C-suite? I applaud Bush and HH&N for bringing this issue up.  It’s something I’ve been talking about for a while now and I think it’s only becoming more important as time goes on.

In today’s economic environment, health care needs to start taking a page or two out of corporate America’s playbook.  Take a look at how Apple or other similarly successful companies handle their leadership and you’ll see the future of hospital administration.

In these companies, the CEOs that survive and thrive are totally team players.  They can’t succeed by looking down on drones sent out to do their bidding.  Instead, they need to be right there in the action, interacting with – and learning from – the skilled people they hire.

And another skill the top corporate CEOs possess (which a lot of hospital administrators still need to work on,) is knowing what they don’t know.  A Steve Jobs, for example, was really smart and talented.  But he was also smart enough to know that he didn’t know everything.  So he worked hard to surround himself with people who knew better.  And to go out and find the experts who could provide the knowledge he needed.

After all, it’s about the goal, right?  With all the changes affecting health care, there’s a whole new set of rules health care organizations need to play by.  And this trend toward teamwork internally and reliance on outsourced experts externally isn’t going to slow down any time soon.  A CEO who wants to succeed needs to adjust to leverage that fact, and they need to start now.

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It feels like healthcare reform has been batted around and debated forever at this point, and medical insurance providers have always been really vocal about how bad Obamacare was going to be for everyone, especially them.

So, I found it really interesting that 18 months into it, Bloomberg Government reported that the insurance providers have made more profit since Obamacare went into effect than in the 18 months prior!

Here’s a detailed article from FierceHealthPayer newsletter called, Insurers Profit From Health Reform.

This quote really says it all:

“The average operating profit margins for the five largest insurers expanded to 8.24 percent in the six quarters since reform, compared to 6.88 percent for the 18 months before the reform law passed, reports Bloomberg.”

And it doesn’t stop there.  Check out this eye-opener:

“The insurers stand to reap even more benefits as they position themselves to gain from Medicaid’s expansion in 2014.”

After reading it, I had one big question in my mind:

They’re getting theirs.  Are you getting yours?

In other words, whether you’re an independent practitioner, a cooperative practice, or a large hospital, Obamacare has had a huge impact on how you do business.  For some, it’s been a total paradigm shift, and a lot of my clients are still working on picking up the pieces.

But the insurance companies are making more money than before.  Are you?

You’re not going to find a better time to review your current billing procedures, accounts receivable collections and records management.  Then, figure out where you’re leaving money on the table.  Obamacare has probably removed some or all of your wiggle-room. 

But someone’s making a profit.  Are you?

I’d love to know what you’ve been able to do to keep profits up in the last 18 months.  Anything outside the box?  Let me know in the comments!

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FOR IMMEDIATE RELEASE

Focused Medical Billing Solution Adds $1.3M Annually to NY Inner-city Hospital’s Bottom Line

Through the efforts of New York Medical Billing Firm, Medical Account Solutions (MAS), NY area hospitals may be able to reduce budgets while maintaining, or even increasing, services for patients through more productive follow up of outpatient billing receivables.

Long Island, NY March 13, 2012 – For most hospitals, budget shortfalls aren’t always caused by poor reimbursement from insurers or uninsured patients. In fact, the overwhelming issue for hospitals tends to be the mismanagement of claims processing and payment, along with the inability to manage and train the proper staff to handle the sheer daily volume. These shortfalls can lead to sub-standard treatment and even the closure of hospitals for the patients who need them the most.

“The old methods of managing outpatient medical billing just don’t work anymore”, says Bill Baylis, president of Medical Account Solutions (MAS), a medical billing firm located in Merrick, NY, “the rules for billing are constantly changing and it’s become too complex of a job for the hospital to maintain. Hospitals really need to rethink how they go about pursuing accounts receivables and if it’s in their best interest to go it alone.”

Having identified the core issues regarding the closures of many inner-city hospitals, MAS created a case study over a 5 year span utilizing a hospital in an inner-city setting. “The fact is that these facilities are already running on extremely tight budgets. They can’t afford the level of staffing it would require to employ experts in each type of billing department, but allowing the receivables to build up can lead to closure,” states Baylis. Over the 5 year span in just one hospital, MAS cleaned up 87,789 aged claims that were over 60 days old which resulted in an infusion of over $5.5M. This effort was maintained despite adjustments to hospital administration, which can often derail budgeting efforts. This hospital can now rely on a steady 1.3 million annually to their bottom line through efforts of MAS.

“The volume is there,” says Baylis, “but current systems aren’t getting the money into the hospitals in a timely manner. New systems are needed to capture the money owed to them faster for services rendered. The hospital’s business is to save the patient, but our business is to save the hospital. Let the experts stick to their expertise and things will run more smoothly.”

About Medical Account Solutions (MAS):
Since 1986, MAS has been creating customized billing programs and expert consultation services to precisely fit each of our hospitals’ unique medical billing scenarios. Our over 25 years of expertise allows the hospital to secure payments, both efficiently and effectively. To everyone’s benefit, the MAS approach gets through significantly more claims faster than what our client’s office can do on their own.

Press contact:
Bill Baylis
Medical Account Solutions
(p) 516-348-7282
(f) 516-348-7283
(e) info@yourmedicalbillingoffice.com
www.yourmedicalbillingoffice.com

# # #

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FOR IMMEDIATE RELEASE

Focused Medical Billing Solution Adds $1.3M Annually to NY Inner-city Hospital’s Bottom Line

Through the efforts of New York Medical Billing Firm, Medical Account Solutions (MAS), NY area hospitals may be able to reduce budgets while maintaining, or even increasing, services for patients through more productive follow up of outpatient billing receivables.

Press Release is available at PRweb http://www.prweb.com/ at: http://www.prweb.com/releases/2012/3/prweb9307766.htm

MAS-

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This economy isn’t easy on any organization.  And even in the best of times, a hospital or private practice could end up in bankruptcy if they failed to handle their billing effectively.  So, without a doubt, effective and efficient medical billing needs to be a priority for any healthcare organization today.

But how can you tell if your practice needs help with your medical billing?

We’ve identified seven tell-tale signs that this is the case:

1.   You have a lack of cash flow momentum.

If you’re having difficulty keeping up with payroll, following up with insurance carriers, confirming you’ve received the full payment you deserve through insurance, or getting due bills out in a timely way, you’re going to run into serious cash flow problems in a hurry.  Once that momentum slows down, it’s going to start snowballing very quickly.

If you see this happening in your billing office, it’s time to get some outsourced help from people who specialize in handling these functions.  This allows you to get back to doing what you do best.

2.   You are experiencing increased days in accounts receivable.

This is a sure-fire way to get into the problem we just discussed in #1: a lack of cash flow momentum.

Accounts receivable has to be running like a well-oiled machine in order to make up for the inevitable paperwork delays you’re going to get from Medicare, Medicaid and other huge insurance carriers.  If you’re delaying the process on your end, you’re shooting yourself in the foot.

Outsourcing your A/R functions takes the pressure off your billing team and puts it on the shoulders of a team who can focus completely on their core expertise: collecting your money for you.

3.   You and your staff are working harder without noticeable results.

This is frustrating.  It increases stress and hurts morale in what is already an inherently stressful environment.

If you find you and your staff are working harder, but no more is being accomplished, you can be sure there are inefficiencies and procedural snafus getting in the way.  Maybe it’s unnecessary or poorly formatted paperwork.  Maybe it’s a software or hardware issue.  It could be a leadership problem.

Whatever it is, outsourcing a key function can lighten the load on everyone, allowing your team to regroup and refocus on what they’re all really there to do: serve the patient.  And a team of experts handling your medical billing for you can and should review the current processes and procedures to note and help you eliminate inefficiencies as well.  Bonus!

4.   Your superiors are becoming more involved with your everyday business in an attempt to improve cash collections.

Similar to the #3 sign above, having management breathing down your neck can increase stress and harm morale as well.  Their concern is legitimate: they’re looking at the bottom line.  But all too often, they might be overlooking the root causes of the issue.

A medical billing organization like MAS will work directly with leadership, as well as the folks who work with the systems and with the patients day in and day out, to make sure the billing process is being improved from the ground up.  That way, everybody’s happy: the patients receive better service, the staff is able to focus more fully on their core expertise, and leadership is able to see a healthy, and improving, bottom line.

5.   Your overtime costs are exceeding your budget.

This is another sign that something is wrong internally with the current processes, procedures or staffing functions.  But, it comes down to billing too.

If you need additional staff, or need staff to work additional hours, but the budget is not there to support it, there’s a very good possibility money is being left on the table at some point in the process.  If the billing functions are not running efficiently, if billable work is being missed or not properly documented, or if outstanding bills and A/R are not being followed up on quickly and effectively, you’re not going to have the money available to pay the staff you need.

But, if these issues were resolved through outsourcing the billing functions to a team of experts, the money would be there.

6.   You are being asked to increase collections with less staff or more staff turnover.

This is a classic “cost-savings” effort by management that, unfortunately, tends to have the opposite effect.  By trying to force a team to do more with less, they create a breeding ground for inefficiencies and sloppy work.

A far more effective solution is to allow an outside team of billing experts to increase collections for you.  That allows a small but efficient internal team of billing staff to handle an even greater volume of work, with greater cash flow and speedier resolution of claims as the result.

7.   Your third party payers are becoming more difficult in processing and paying your accounts.

This is an unfortunate situation, but it happens all the time: many insurers, including organizations working with Workers’ Compensation and No-fault auto claims, take advantage of complex state insurance regulations and other legal maneuvering to delay or renege on paying claims. 

As a large healthcare facility with a high volume of claims, it’s difficult for you to keep up with the constant back and forth, and they’re counting on your giving up on collecting.

But, an outsourced team of billing experts is going to go after these payments like a bulldog after a bone.  It’s what we do, and we have the legal expertise and realistic motivation to stick with it until the money is in your hands.

Although it’s becoming more and more difficult to maintain a profitable practice in this economy without sacrificing patient care, here at MAS we strongly believe that outsourcing your medical billing is a huge step in the right direction. 

We encourage you to get a hold of us and let us help you find out how much value we can add to your organization!

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Over the years, working with hospitals and other healthcare organizations, we’ve had the opportunity to help some really great people and hospitals turn things around so they can keep serving their communities while turning a reasonable profit.

Unfortunately, we’ve all seen some other institutions slide down that slippery slope into bankruptcy.

This is not a forgiving economy, and healthcare is in a difficult position right now, so it takes committed action to keep things afloat and to stay focused on providing the best care available for patients.

With that in mind, I wanted to share three key strategies that I’ve seen work when a hospital uses some solid business practices to turn things around.

Here are 3 Steps for Healthcare to Restart the Engines 

1.     Choose your new team wisely:  “You’re the average of the five people you spend the most time with.” – Jim Rohn

This quote, made famous by motivational speaker Jim Rohn, could serve as the basis of building your new team. In challenging times sometimes it’s best to start with the basics. For me this philosophy suggests when creating a winning team simply work with those who are playing at the highest levels. 

This could translate to hiring, but could just as easily involve training, grooming and promoting from within.  More often than not, there’s a lot of hidden talent inside an organization: folks who care a lot about the institution’s success, but aren’t yet in a position to drive that success.

2.     Stay on task:  “Beware of paralysis by analysis.”

Now that your core team is in place and the new vision is clear, it’s time to get to work. I will say it again “Beware of paralysis by analysis!” Inaction may be the biggest killer of all in healthcare. A turnaround situation is a constant action mode.  Go out and get busy. There are patients to see and claims to be paid.

And, while we’re on this subject, don’t get sucked into spending time, money and effort on tasks that don’t matter in the long run.  If you’re looking to turn things around so you can better serve your patients, redesigning the doctor’s lounge is probably not a top priority. 

3.     Bring in the best: “Do what you do best and hire out the rest.”

The quickest way to build your working staff is through outsourcing. Successful businesses make a point of concentrating on their own core expertise, then hiring out experts to do the rest.

As a healthcare organization, serving your patients and your community by providing top-quality medical care is your core expertise.  Allow outside experts to focus on marketing, billing, logistics and any other support functions that draw your team away from caring for your patients.

Like I said before, these are just a few strategies that have become clear in my own experience.  But I’m sure there are plenty more I haven’t listed. What is your own favorite? Why not share a few in the comments?

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When I read this article by

Hospitals Demand Payment Upfront From ER Patients With Routine Problems

The gist of the article is that nearly half of the emergency rooms in the nation are now forcing patients who come in with non-emergency complaints to pay a fee upfront or else they are turned away.  $150 and $350 are both noted in the article, so the charges probably range pretty far.

I was amazed by this primarily because I agree with it!  In one way, it seems to go against the grain of what an ER is “supposed to do,” or at least what hospital emergency rooms have always historically done.  But as a medical billing specialist, I can’t argue with the logic behind the policy.

The article notes some startling statistics from HCA (the nation’s largest chain of for-profit hospitals):

 “Last year, about 80,000 emergency-room patients at hospitals owned by HCA left without treatment after being told they would have to first pay $150 because they did not have a true emergency.”

In other words, the upfront fee served as a deterrent to patients who didn’t really require emergency care.  Considering the fact that ER visits by uninsured patients often end up not getting paid, and that many people have actually become experts at “working the system” to use the emergency room to obtain free health care, this can translate to millions of dollars in savings over the course of a year.

It makes great business sense!

Of course, some doctors and patient care advocates are concerned, as the article also notes:

“Physicians worry that sick people will forgo treatment. There is no data on how many who leave the ER without treatment follow up with visits to doctors’ offices or clinics.”

While I understand their concerns, it seems to me that combining this policy with some other measures may work better for everyone.  After all, when hospitals incur bad debt because of things like unnecessary and unpaid ER visits, all of us end up paying for it through higher healthcare costs.

So, here are a few ideas that might work:

• Hospitals could make available a 24-hour walk-in clinic for routine complaints so that anyone showing up at the emergency room without a true emergency can receive the proper care (at the proper price) right on the premesis.
• Maybe the price some of these ER’s are charging is a little high.  Maybe $50 is more reasonable. It could still work to deter those scam artists who are only out to receive services for free, while staying within reach of most patients with legitimate concerns.
• Or, maybe educating patients about what they should expect from the emergency room is sufficient.  The Midland Memorial Hospital in Midland, Texas, has set up a 24-hour hotline where patients can call and speak to a nurse to help determine if they should come into the emergency room or visit a local clinic.  This, in conjunction with a $150 fee for non-emergency complaints resulted in a 10% drop in ER visits and a huge drop in bad debt as well.

I know this subject is going to spark some lively discussion, so let me know what you think: Is charging an upfront fee at the emergency room creative or corrupt?  How would you fix the problem of bad debt at the ER? 

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What Gives?  Hospitals Hiring Broke Doctors

My main takeaway in that article was the fact that, based on the state of the economy, upcoming changes in insurance reimbursements and rising costs, hospitals need to focus not on cost containment and improved billing and collections processes to stay in the game.

I came across an article recently by Anthony Cirillo of Fast Forward Consulting that makes some great points on the other side of the story, how the individual doctors and smaller practices can adjust their outlook and processes to keep from going broke.

Check out the full article here:

How to Keep Docs From Going Broke

One of Anthony’s main points is a real key across the board in healthcare:  “What was revealed as a more systemic cause was the doctors’ lack of business acumen.”

And that is so true.  Little if any time is spent on business skills during all the years that doctors are in school.  Yet, running a successful practice, especially in tough economic times, isn’t going to be based solely on being a good doctor who knows how to treat patients.

As Anthony’s article goes on to point out, there are plenty of adjustments a practice can make to start running more like a successful business, with forward-thinking investments and partnership agreements that will allow a successful doctor to earn a solid living and a reasonable retirement.

Hand-in-hand with that kind of change, a practice can also benefit from outsourcing more of the behind-the-scenes running of the business to business professionals who specialize in handling those aspects of the medical field.

In all cases, the end goal is the same: to keep quality doctors focused on providing excellent care while staying afloat in tough times.

What kinds of changes have you had to make to stay profitable this past year?  Any mistakes you wish you could go back and change?  Let us know in the comments.

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For any private practice, larger facility or hospital, the main goal is and always should be caring for the patient.  Unfortunately, in the back office, where billing and collections take place, there seems to more of an “us and them” attitude.

In the long run, this can be damaging to the practice.  Especially in a world connected so tightly together by social media, your patients’ satisfaction can be a PR nightmare if legitimate complaints start spreading around cyberspace.

I came across an interesting article written by Sunni Patterson of Medical Bill and Claim Resolution.  I’ve pulled out a few key points, but you can read the full article here:

Hospital Business Offices and Healthcare Consumers

This statistic was an eye-opener:

“The number of consumers who gave top scores (5 on a 1 to 5 Likert scale) to hospital billing processes was just 21%.”

That means 79% of patients were dissatisfied with hospital billing processes to some extent.  That’s a huge chunk of patients, and a ton of potentially negative publicity!

It was interesting, too, that more patients were dissatisfied with their entire experience after dealing with the billing than those polled immediately after finishing treatment.  So issues with the billing process can change the minds of otherwise satisfied patients!

Obviously, billing and collecting on receivables is the lifeblood of the practice.  And, it’s not possible to make every patient delighted to pay.  That being said, there are a few things every facility should be focusing on during the billing procedure to try to mitigate negative feedback:

• Speed:  Make the billing process as efficient as possible so the patient gets the bill quickly, while they’re still in a positive frame of mind and feeling good.
• Accuracy:  The bill needs to be correct.  Coding needs to be current, with accurate insurance coverage and no erroneous, inflated charges.  Nothing makes a patient angrier than being billed for a contractual allowance that should’ve been zeroed out!
• Communication:  The patient should be able to understand the bill they’re receiving and why they’re responsible for it, and, they should be able to speak to someone if they have questions.

We’ve been shouting this from the rooftops for years now, but I think these statistics stress the point again.  You want to be certain that your entire billing and collections process is running at maximum efficiency and accuracy, while maintaining positive communication with your patients and keeping them satisfied!  If this seems like a tall order, or, you’re lacking in one of these areas, you may want to consider outsourcing it to experts.

Have you run into any surprising patient satisfaction results recently?  Any thoughts on the stats in Sunni’s article?  Let us know in the comments.

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