There are numerous ways medical practices can lose revenue without noticing, sometimes until too late. Many of those leaks in the revenue can start right from the beginning – with patient information records.
A practice must first address ensuring that demographical information is accurate. Minor errors like transposing a first and last name or identifying a person by their nickname instead of their legal name that is used for insurance purposes, can lead to a denial in reimbursement or at the very least a delay while the errors are addressed. With so much information being needed to complete a patient’s record, mistakes are unavoidable. To help discourage those errors, practices should identify a limited number of staff who can change demographic information.
Healthcare reform has helped to dramatically increase the number of new patients able to access health care. But with increased access comes increased problems. As premiums on insurance climb, more patients are moving to highdeductible plans. That move often comes with potentially lower benefits. Those patients who need help for chronic conditions or an acute health problem like cancer, pose an increasingly difficult problem for medical practices. In addition, state mandates may not allow Medicaid to pay the costs for coinsurance, leaving some patients unable to pay their share for treatments.
These changes pose a serious threat to practices. At some point, every practice must decide their liability threshold.
- Will the practice treat underinsured patients? And if so, how many at a time?
- What if the patient is under a patient assistance program, and they lose their coverage in midtreatment? What will the practice do?
- Some patients will try to pay however they can, but on the rare occasion, some patients will just refuse to pay their share. What steps will the practice take?
- How much financial risk can the practice assume?
While physicians are dedicated to patient care, the issues of maintaining a viable business come into play for every medical practice. Decisions around that liability threshold will be difficult, but will also ensure that you will be there to treat other patients.
Next month: Revenue Leaks and Payer Issues
The information was taken from a webinar on Plugging Revenue Leaks, for ION Solutions on February 18, 2016.
To learn more about IntrinsiQ Specialty Solutions, visit IntrinsiQ.com.