Managing Your Practice's Revenue Cycle in 2015

It's 2009 and you are looking at your key performance indicators (KPIs) from 2008. It was a difficult year due to the recession, but your practice made it through OK. Your payment mix was positive - the percentage of major insurance carriers was consistent with the previous year.

It's now 2015: You are again looking at your KPIs and realize the payment environment has changed radically. Patients are now responsible for a much larger portion of their medical bill, and there has been a significant increase in the size of outstanding patient balances. This is in spite of the increase in insurance coverage due to the healthcare exchanges.

Several questions come to your mind: What is happening when patients check in at the front desk? Are staff letting patients know what their outstanding balance is? What is happening on the back end with patient collection efforts after the visit is concluded?

So you look and ask:

1. Does your practice's financial policy (that statement given to patients and posted on the website) state that payments are due prior to seeing the provider?

2. What does your daily collections report show? This simply states, based on today's schedule of patients, how much was collected in terms of dollars, how many patients were collected from, and if there was no collection posted, why that occurred.

3. Does the front desk get accurate information on the copay, deductible, and past due balances for all patients? Are there inaccuracies, preventing them from asking for or collecting the amount due? Is that information provided in a timely manner?

4. Do automated/staff generated appointment-reminder phone calls suggest that there will be a payment required prior to seeing the provider?

5. Do you have adequate guidelines for staff concerning patients who don't pay prior to seeing the provider? Does your staff have the authority to reschedule a patient if payment is not made? When is this clinically acceptable?

6. Does your malpractice carrier provide guidance in terms of not seeing a scheduled patient due to lack of payment?

7. Is there adequate training for front-desk staff in how to ask for payment at the time of visit?

8. Have staff members have been assigned to identify and collect outstanding patient balances?

9. Are there options through the patient portal to collect outstanding patient balances?

10. What is the practice position on collecting from a new patient with a high deductible plan? Do you make sure you see the patient after the visit to ensure that the level of services and all services provided are documented and can be collected at check out? Is there an estimate of cost provided to the new patient at intake - on the initial call, as well as at check in?

11. Is there guidance for staff on the occasional patient who is private pay and requests a discount - e.g., offer a 25 percent discount (or even 50 percent if you have a fee schedule strategy of 200 percent of Medicare, which means that the patient payment would be equal to that of Medicare)?

There is no time like the present to review your patient payment strategy.

One more thing - there was a slight adjustment in the Medicare conversion factor from $35.80 to $35.75 as of Jan. 1 (which was a technical change and not an SGR revision); but remember too, that Medicare allowances will change as of April 1, 2015. There could be a significant hit, but more likely there will be a small change in the allowable amount at that time. Just be aware of it.