Preparing Your Practice's Annual Business Game Plan

It's the time of year that we all start thinking about our past months and how the business is operating, and start our planning into the coming year.  It's not as big of a beast as you might think, it's important to break it down in sections and compartmentalize your process.  Even if you're new to this area, here are some simple steps to take now that will help you in the year to come:

• Assess staff skill set.  I've mentioned this in previous blogs, but staff skill set is very important in the thriving of your business.  You may have someone answering the phone who is a whiz at Excel and can manage your daily, weekly, and monthly reports.  This is also a great time to sit with each of your staff individually and ask them what they like to do and if they are currently doing it.  I found someone who has a natural talent and ability to calm irritated patients with just a few words.  Pay attention to behaviors and assess those skills.  You may be surprised.

• Observe the company culture.  What seems to be the center of the company?  Is that the message you want to spread out to your patient population?  Your company culture includes your policies, procedures, staff attitude, patient population, location, and how all of those areas come together.  Company culture typically starts at the top and trickles down.  You can, however, change areas of the company culture and with good results and happier employees.  Others start to take notice and want to be part of that positive experience. 

• Review your payer contracts. As I mentioned in my last blog, payers have a lot of rules and this is the time of year they send out those little postcard notifications that those rules are changing.  It is imperative that you understand those rules and know how to access your provider manual on the payers' website.  This is something that can be passed to another employee looking for a challenging project.

• Once you've confirmed you're following all payer rules, review your Fee Schedule.  You need to make sure you are: 1.) Charging enough for your area 2.) Know where you stand up with your colleagues, not only for pricing, but also for code usage.  CMS has comparative reports you are able to run that tell you where you are in your specialty and area.  This is important for you to know so that you can avoid unnecessary audits by CMS.

• Run your daily, weekly and monthly accounts receivable (A/R) reports.  These should include the basics like:

• Daily A/R by 0-30 days, 30-60 days, 60-90 days, 90-120 days, and 120+ days.  A good rule of thumb is to have 90 percent of your A/R in the 0-30 days category.  This allows for positive cash flow and worry-free business management.

• Payments made by date of service.  I like this one to make sure the billing staff are following up on unpaid claims.  Unpaid claims include any mistakes made on the first pass, "dropped" claims by the payer, and delays due to information being requested by the payer.

• Place of Service Summary that includes any new patients, patients seen, charges, inflow and adjustments per location.  This report allows you to see if patient chart notes are being completed on time, if separate locations are meeting their individual goals, and resource allocation.  If you have too many healthcare providers in one location and not enough in another, it's time to make some staffing moves.

• Payment audit summary is also critical in knowing what payers are paying you.  If you submit Medicare claims on a daily basis, you should be receiving them on a daily basis.  Depending on who your contractor is for Medicare (i.e., Palmetto, Meridian, etc.). they have internal issues that could very well be delaying your payments.  Medicare is required to pay you within 14 days from the date the claim was received at their clearinghouse.

• Create a game plan to gather this information.  Involve your staff that you believe have the skill set to assist in this process.  It will bring them together as a cohesive unit; help you get some much-needed information, and everyone wins.  Your game plan should include the past two-to-three years' worth of information to start.  This will give you a baseline to start with.  Know what your company's goals are and incorporate resource allocation to your game plan.  Depending on who manages the business, ask for a meeting and present your findings.

Know that most people are not terribly fond of change, so the more people you can recruit to assist you, the easier any transitions for procedure and policy updates will be.  Be sure you are following up at least monthly with the staff to keep them on-point and don't be afraid to try something new if that will help you reach your goals.