Strategic Planning Begins With the Basics

Susan Schettino-Genrich, for HealthLeaders Media , April 30, 2009

The fallout from the market downturn in the last quarter of 2008 will have far-reaching effects this year, making 2009 a year of economic challenges. Practices must take appropriate measures to ensure continued success and growth while dealing with changes that are soon to come their way.

Strategic planning is usually perceived as a long-term view of practice operations. However, this year, strategic planning must be done by evaluating the basic administrative and billing procedures at the practice level.

Financial partners
When banks failed last year, credit dried up. Lines of credit that a medical office was able to tap into in the past for both short- and long-term needs may no longer be available. If a practice relied on these credit lines, administration must ensure they are still readily available for access if necessary. Make time to meet with the bank that services the practice to review the various accounts, especially if the institution has had a change in ownership. There may be a new banker assigned to the account who is unfamiliar with the needs of the practice.

The landscape of the insurance industry will also change drastically this year, and a practice must be prepared for the changes. In order to maintain or lower premium costs, many employers will be offering the medical or health savings accounts (HAS). These plans will be presented with a variety of names and acronyms to the general public, and the price will sound right. However, the public at large has a poor understanding of healthcare coverage, and a greater number of HSAs will pose an even greater problem. HSAs are coupled with high-deductible health plans, which place the financial risk on the patient and the provider. If the medical billing office is not educated concerning these plans, and proper verification is not performed, providers will be left with many thousands of dollars in unpaid patient accounts.

Point-of-service collections
Raising deductibles and copays/co-insurance represent another way to reduce premium costs for employers. A greater portion of the total cost of the service will be payable at the time of service, and not received from the insurance carrier. For example, if the cost of a service is $75 and the patient has a $50 copay, the insurance carrier responsibility is only $25. The bulk of the service will be paid from the copay. In-network deductibles will become more prevalent, so even if the practice is in the insurance network, the patient will still be responsible to pay his or her deductible. These amounts due need to be collected at the time of service for commercial carriers and submitted to the insurance companies in a timely fashion. Only then will the practice be compensated for future claims.

Tightening up the operations of the billing department, and creating a good working relationship between the front and back offices is critical.

Verification of medical insurance benefits must be performed prior to a patient visit. This information must be noted on the patient account for access by other staff members.

Copays, deductibles, and other patient monies due should be communicated to the patient at the time of appointment confirmation. If a patient has a past-due balance, this information should be relayed as well.

Money to be collected at the time of service should be communicated to the reception staff. This can be done through alerts in the software, written on charge tickets, or written on a printed patient schedule.

Reception staff should be given proper training on the appropriate method to request payment from a patient. If employees are hesitant to ask patients for money, they do not belong in that critical position.

When practice policy allows, copays and other amounts due should be collected prior to the service being rendered.

Patients should be offered all payment methods, cash, check, credit, and debit cards. Reception staff should be prepared to direct patients to the nearest automatic teller machine if necessary.

Patients with questions concerning billing should have access to a billing staff member either via telephone at the reception area, or preferably in person.

Administration needs to create tight financial controls as the money passing hands in the practice will be increasing. Expected monies versus actual over-the-counter collections should be monitored by employee to note any trends and discrepancies.

Billing department/company
The finances of a practice live (and die) in the operations of the billing department or billing vendor. Correct, compliant, and timely processing of claims will maintain a medical office through difficult financial times.

This year saw an enormous increase in the number of CPT and ICD-9 coding changes. If administration did not check their existing charge ticket against the new codes, the office may see a sharp increase in coding denials.

Explanation of benefits forms from insurance carriers are the best source of financial information for the practice. They need to evaluated line by line for codes, charges, receipts, and adjustments. Posting should be done carefully, with billers noting trends:

  • Are any carriers routinely downcoding claims?
  • Are reimbursements smaller than expected?
  • Is the timeframe for payment of claims longer than expected?
  • When was the last time (if ever) that the contracted fees were reviewed?

Utilize the financial reporting capabilities of your software to the maximum. Run your management reports (aging reports, productivity analyses, receipts and adjustments by carrier, days in receivable, system financial summary, patient breakdown). Compare the reports at regular intervals to look for trends and potential problems.

When using a billing vendor, insist on seeing the same reports as listed previously to ensure they are operating optimally.

Other areas of evaluation

Staff is the largest cost in a practice, so watch for task efficiency.

  • Are jobs overlapping, too may staff performing the same function, or not enough staff to operate efficiently?
  • Is everyone working to their maximum, or are there people who should be replaced with more efficient employees?
  • Are any long-time staff members making salaries that are "out of the ball park"? Consider other methods of compensation, including bonuses, instead of raising salaries.

Evaluate the vendors currently being used for such services as medical supplies. Many vendors had implemented "fuel surcharges" when the cost of gasoline was high, yet these charges should have been eliminated back in November.

Shop around for the needs of the practice, and negotiate with your vendors for the best prices and payment terms.

Take a hard look at provider productivity as well:

  • Are all of the providers working at an expected level?
  • Can an nonphysician practitioner be used to see additional patients?
  • Has a hospitalist been considered to better utilize physician office time?

Ask these questions regarding software:

  • Is the practice management system being utilized to its full potential?
  • Are software updates available that will allow automation of any function being performed by a staff member such as insurance verification and statement processing?

Steering a practice through a nationwide financial and healthcare crisis will take some savvy and hard work. Beginning with an evaluation of the basics and tightening the belt now will help to provide a safe financial future.

Schettino-Genrich is a consultant at Complete Management Solutions in Hauppauge, NY. Contact her via e-mail at This article originally appeared in the April 2009 issue of The Doctor's Office, a HealthLeaders Media publication.
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