Year-end Resource Planning for Medical Practices

Although we have just started December, it's time to start planning your year-end reporting, insurance re-verification, staffing, and budget. On January 1, a majority of health plans start over with all new deductibles. Many plans change and patients are unaware. If you want to be paid for your services accurately and in a timely manner, you should really plan to set aside the resources in your practice to re-verify all of your patients' insurances.

Oftentimes, a group number will change, a deductible or copay increases, or a plan will terminate completely. The plan can also change what is a covered benefit, and what is not. If a patient was coming into your practice for allergy shots, and that is no longer a covered benefit under the patients plan, it's best to know this before the patient arrives on January 2 for their appointment.

Depending upon your practice size, you should be able to assign one to two people to perform these re-verifications. Each one should take four minutes to seven minutes online. Using the phone with a representative will take longer at the beginning of the year since insurance companies under staff their live, personal interaction and prefer everyone to use their website. Unfortunately, for some very specialized areas of medicine, the insurance website is not comprehensive enough to fulfill your request, and a phone call may be necessary. This could take up to two weeks depending upon how many patients you have and how busy your practice is.

Taking a look at your staffing and budget tend to be reviewed together. Are you overstaffed? Do you have some staff members milling about, chatting at the water cooler a bit too long, surfing the Internet during work hours? All of these are signs that the employee does not have enough work to do. It is also a sign of burnout, or someone else performing too many tasks and not delegating their work out. If you are understaffed, there will be a constant level of stress in your practice that can really wear people out. It is very costly to replace an employee, so consider hiring at least an additional part-time person who can come in and help answer phones, schedule patients, file, fax, scan, etc. If you can take a small amount of work away from your over stressed staff, they will thank you in the quality of the work they produce for you.

The next area that you should be ready to spend some time on is your year-end reporting. Most billing departments close previous months by the middle of the following month. So, by mid-January, you should be ready to spend about 20 hours gathering your 2012 data, reviewing it, and modifying your business plan, policies, and procedures. Again, this will depend on the size of your practice. Some areas to be looking at are:

• Days in AR

• Where your AR is within your industry's standard

• Write offs that were the result of practice errors (someone not obtaining the proper authorization, going over an insurance visit limit, not collecting co-pays / deductibles / co-insurance, etc.)

• Patient visits

• Inflow goals

There are many other areas in your business that you can review which includes overall budget that include your profit and loss statements, expenses, payroll, etc. Just make sure you review what you did last year, and make your goals for the new year based upon those results.

The most important thing to remember is to allow your staff the necessary time to get through those first few weeks, and know that as the month progresses, things will settle back down. Check in with them, often, to see where they are with their plan and ask how much more time they may need to finish these special projects.

Coming up next week: Decorating for the holidays - how not to offend your patients or even staff!