Medical Practice Management

The following article was posted on www.mgma.com by Caren Baginski on Wed, Jan 13, 2010

Streamlining your medical practice’s patient collections goes beyond simply collecting from patients at the time of service. In fact, there are many ways to improve patient collections, from performing a monthly charge-capture audit to having your front desk adequately staffed. Are you as a practice administrator doing all you can to maximize revenue? Answer these questions, compiled with help from the MGMA Health Care Consulting Group, to find out.

1. When scheduling the patient’s appointment, is staff mentioning the fees/copays required during the visit?
2. Do you offer flexible payments plans for patients who cannot pay in full?
3. Do you accept credit and debit cards?
4. Do you use kiosks in your practice?
5. Are signs about copays clearly displayed at the front desk?
6. Are employees consistently asking for copays?
7. Do you provide appointments for your patients when they want them? Deliver a valuable service, and it’s easy to ask for payment.
8. Do you use your automated appointment reminder system to also remind patients of past-due balances and/or expected copays at the time of their appointments?
9. Does your checkout employee look up as soon as the patient arrives at the checkout station to greet them promptly and start the checkout process?
10. Do you have a countertop with a pen and calendar readily available so that the patient can easily write a check or set their things down while reaching for their wallet?
11. Does your cashier/checkout person say “thank you” when the patient makes a payment?
12. Do you have cash on hand to provide change to patients who pay using a large bill ($50 or $100)?
13. Do automated receipts print from your system to link the patient’s payment to their account, assuring the patient that posting mistakes are eliminated?
14. Are you checking for patient insurance eligibility and benefits at least two days before a scheduled visit?
15. Does your practice have a clear written policy regarding patient financial responsibility (collecting copayments and prior balances)? If yes, is it followed?
16. What are your lag times? Identify the times between date of service and
        a. Date of charge entry
        b. Date of claim submission
17. Do you collect and monitor data regarding reasons for denials and use the results to train your employees?
18. Do you perform a monthly charge-capture audit to ensure that all types of charges and place-of-service information is accurate?
19. Does your practice base its fee schedule on a quantifiable process or is it determined in an indiscriminate manner?
20. Are you using all the services offered by your clearinghouse?
21. Does your business office share the reasons for electronic charge rejections so staff can be trained, or does the business office employee correct the errors himself because it’s easier and faster?
22. Do you monitor both categories of write-offs: contractual and non-contractual?
23. How often is a credit balance report run?
24. Does your practice comply with state and federal laws regarding credit balances?
25. 25. Do you prioritize your outstanding accounts receivable by balance due (high to low), account type, payer type, date claim submitted, date of service and age of account?
26. Have you developed and do you follow a policy concerning patients that cannot pay co-pays on the day of service? Will you tell them they need to reschedule?
27. Do you use a tiered approach to patient collections and match the collection effort not with the patient balance but with the expected payment? 
28. Do you use a monthly bonus system for employees who collect patient payments in the office?
29. Have you implemented online billing and payment tools?
30. Have you recently assessed your current billing statement effectiveness?
31. Does your practice assign accounts receivable by alphabet or by payer type?
32. Is your billing staff cross-trained so that when one person is out the entire process can continue seamlessly?
33. Do you establish performance targets for the staff and trend them over time?
34. Is patient collections performance benchmarked to practice results and to MGMA survey data?
35. Is your practice maximizing features and capabilities of your practice management software?
36. Does your practice have a super-user on site for the practice management software, or do you have to rely on tech support for every question needing an answer?
37. Has the front desk staff been trained in the proper way to ask for payment?
38. Is there adequate privacy at the front desk area so that staff may speak with patients regarding outstanding balances without everybody in the reception area hearing?
39. For patients with outstanding balances greater than the acceptable age (60-90 days), do you ask the patient to sign an agreement for settling the previous balance and require either a deposit on the current visit or payment in full?
40. Do you ask patients to sign a promissory note?

Sources
1-6 from MGMA resources
7-14 provided by Rosemarie Nelson, MS, MGMA principal consultant
14-25 provided by Cindy Dunn, RN, FACMPE, MGMA senior consultant
26-30 provided by John Emerson, MGMA consultant
31-38 provided by Ken Hertz, CMPE, MGMA principal consultant
38-40 provided by Trip Kinmon, FACMPE, MGMA consultant

The Following Post was taken from www.mgma.com

Guest blog by Elizabeth W. Woodcock, MBA, FACMPE, CPC, healthcare speaker and author of Front Office Success: How to Satisfy Patients and Boost the Bottom Line.

It takes a few seconds to form a first impression, but that impression lasts a long time.

Your medical practice’s front office staff maintains patient flow, collects cash and verifies insurance coverage and patient demographics while also answering phones and sending faxes. But there’s another critical responsibility you entrust them with: Being directors of first impressions.

Medical practices with inexperienced, unmotivated and underpaid staff on these front lines often suffer the consequences: poor staff morale and eroding patient loyalty – the slow, quiet killers of many practice’s bottom lines.

No matter how carefully you hire, today’s multigenerational workforce brings with it multiple outlooks about good manners and good customer service. Some employees want to make every patient feel like a pampered guest of the finest first-class hotel; others, while competent in every other aspect of the job, seem to think that looking up after a minute or two to acknowledge the patient waiting at the counter is good enough. The gulf might not be that dramatic in your practice, but I’ve seen both sides in practices where I’ve consulted.

Make sure everyone is on the same page when it comes to the service quality your patients demand. Here are “10 Commandments of Good Service” for staff to follow – an MGMA blog-exclusive supplement to my new Front Office Success book.

1. Greet patients warmly and sincerely.
   Teach staff to personalize each encounter by greeting and acknowledging each patient. The patient’s first impression – whether walking in the door or calling – should be, “I feel wanted here.”
2. Listen to patients.
   Coach staff on the importance of  giving patients a chance to express their thoughts and feelings. Whether a simple request or a complaint, patients want to be treated as individuals and to know you care.
3. Use names.
   Encourage staff to always introduce themselves and call patients by their desired address (Mr., Ms., or Mrs.) and name. It makes the encounter memorable and personal.
4. Be prepared to help.
   Front office staff should act as the patient’s guide and advocate through the administrative details.
5. Go the extra mile.
   Helping patients navigate the unfamiliar check-in process, a long wait or other events can make a lasting, positive impression. Encourage and reward employees who look for opportunities to show empathy and understanding.
6. Show respect.
   Staff members who keep patients informed about delays and apologize for them show respect for patients’ time. Also, employees who speak to each other with civility help defuse the inevitable tensions of a busy medical practice. The same goes for administrators, supervisors, clinical personnel and physicians.
7. De-stress.
   Don’t let staff skip lunch breaks or any other opportunities for short breaks that you offer during the day. Stress on the job without any let-up leads to lower performance, fatigue and a host of other problems that won’t put people at their best.
8. Defuse office politics and gossip.
   Administrators and supervisors can’t directly enforce this, but they can set the example. Steer clear of gossiping about patients, other staff and physicians. Keep an eye out for squabbles and mini power struggles between staff. Gossip and office politics destroy morale. An atmosphere of trust and respect makes the day run much smoother and everyone wins – patients, the physicians, your coworkers and, most of all, you as the successful administrator.
9. Teamwork works.
   Praise workers who jump in to help others. Provide opportunities for training and elicit employees’ suggestions for improvements. This isn’t just about being a nice boss; it’s about getting people to give their best, which most will do when it is appreciated.
10. Communicate.
    Show employees that every interaction they have with patients, workers and physicians is an opportunity to get things done – and done right. Communication makes all types of businesses, including medical practices, run and serve their customers (patients) better.

Training and motivation are critical factors in getting workers to give their best every day. Patient loyalty is built on good first impressions, which is why there’s no letting down for those who manage front office staff.

Chicago, IL — On October 1^st the Certification Commission for Health Information Technology (CCHIT^®) announced that it has tested and certified 33 Electronic Health Record (EHR) products under the Commission’s ONC-ATCB program, which certifies that the EHRs are capable of meeting the 2011/2012 criteria supporting Stage 1 meaningful use as approved by the Secretary of Health and Human Services (HHS). Certification is required to qualify eligible providers and hospitals for funding under the American Recovery and Reinvestment Act (ARRA).

CCHIT was among the first organizations to be recognized by the Office of the National Coordinator for Health Information Technology (ONC) as an Authorized Testing and Certification Body (ONC-ATCB).

EMB provides you with a fully integrated billing and EHR solution by leveraging SuccessEHS, which is one of the first EHR products that have been certified.  Based on this certification we are proud to say that the EHR technology we provide will allow qualifying eligible providers for funding under the American Recovery and Reinvestment Act.   EMB is committed to continuing to meet all HHS requirements for Meaningful Use that may be announced in subsequent stages to provide our clients with functionality needed to achieve Meaningful Use during each year of the incentive program.  EMB continually strives to maintain the highest standard of excellence in the software solutions we provide, as demonstrated by CCHIT Comprehensive 2011 certification (with a 5-star usability rating) of its 5.3 release, including the additional certification for Child Health.

Click here for the CCHIT article. 

CCHIT is Authorized by HHS as Testing and Certification Body for Electronic Health Records

CHICAGO – August 30, 2010 – Certification Commission for Health Information Technology (CCHIT®) announced today that it has been recognized by the Office of the National Coordinator for Health Information Technology (ONC), U.S. Department of Health and Human Services (HHS) as an Authorized Testing and Certification Body (ONC-ATCB) under the initial certification program created to certify that electronic health records (EHRs) are capable of meeting the criteria to support meaningful use and qualify  eligible providers and hospitals for funding under the American Recovery and Reinvestment Act (ARRA).  EMB’s CareRevolution is one of only 13 products in the country with the CCHIT 2011 certification.

“We are gratified to be among the first organizations authorized to certify EHRs by ONC,” said Karen M. Bell, M.D., M.M.S., chair of CCHIT.  “As the originator of EHR certification, CCHIT has tested and certified hundreds of EHRs. Our experience has enabled us to promptly adapt our processes to accommodate the certification and standards adopted by HHS to support the meaningful use of EHRs by healthcare providers.”

CCHIT is authorized to offer HHS certification for complete EHRs that meet all of the Stage 1, 2011/2012 HHS/ONC criteria, as well as certification for modular EHR products that meet one or more – but not all – of the criteria.

CCHIT plans to launch its authorized HHS certification program on September 20 at 1:00 PM Eastern time with a Town Call Web-cast describing its application and testing process. CCHIT will take new health IT developer applications immediately after at http://cchit.org and the first group of HHS certified complete EHRs and EHR modules will be announced within weeks of that launch. More information about the Town Call will be available at http://www.cchit.org/towncalls. The call will be recorded for later viewing.

In addition to HHS certification, CCHIT will continue to offer its CCHIT Certified® program for Ambulatory and Inpatient EHR products that exceed the HHS/ONC criteria and are designed for hospitals and physician practices that are looking for assurance of more robust, integrated EHR products to support the unique needs of its clinicians and patients.   Many of these products will also be HHS certified. 

CCHIT also offers CCHIT Certified® programs for EHRs used in Cardiovascular Medicine, Child Health, Emergency Departments, Behavioral Health, Dermatology and Long-Term and Post-Acute Care. In addition, a certification program for EHRs used in Clinical Research will be available in fall 2010, and programs in Women’s Health and Oncology are in development for launch in spring 2011.

About CCHIT
The Certification Commission for Health Information Technology (CCHIT®) is an independent, 501(c)3 nonprofit organization with the public mission of accelerating the adoption of robust, interoperable health information technology.  The Commission has been certifying electronic health record technology since 2006 and is recognized by the Office of the National Coordinator for Health Information Technology (ONC), U.S. Department of Health and Human Services (HHS) as an Authorized Testing and Certification Body (ONC-ATCB).  More information on CCHIT, CCHIT Certified® products and HHS certified electronic health record technology is available at http://cchit.org and http://ehrdecisions.com. 

“CCHIT®” and “CCHIT Certified®” are registered trademarks of the Certification Commission for Health Information Technology.

Is your staff finding it challenging to effectively communicate with difficult patients regarding copayments? Here are a few examples how the Medical Group Managers Association (MGMA) recommends handling these situations.

PATIENT: “I didn’t know I owed this.”

RESPONSE: “Your insurance company and our billing office sends statements informing you of your obligation. The doctor has performed a service and should be paid for it.”

PATIENT: “I don’t have any money with me.”

RESPONSE: “We accept all major credit and debit cards. We do require patients to pay for the services the day they receive them, and did inform you of our office financial policy. It is your responsibility to know your insurance and pay for the portion that is not covered. Would you like to go and make the payment or reschedule your appointment?”

PATIENT: “I forgot my checkbook.”

RESPONSE “We accept all major credit and debit cards. I can swipe your card today and preauthorize any future payments so you won’t have to worry.”

PATIENT: “I mailed a payment just yesterday.”

RESPONSE “Oh, you should have saved the stamp since you had a scheduled appointment and brought the payment with you. That way we would have no questions about a payment being due. I can swipe your credit card and preauthorize a payment. We won’t charge your credit card unless we don’t receive the payment.”

PATIENT: “I just lost my job.”

RESPONSE “I am so sorry. This is affecting so many people. Unfortunately, we are being affected by this economic downturn as well, and unless we collect what is owed, we can’t pay our bills here and then we are at risk of losing our jobs. I can offer you a payment plan or refer you to a subsidized clinic.”

PATIENT: “I’ll pay you after the doctor sees me.”

RESPONSE “I understand your frustration and know that this may seem unusual, but we are bound by our contracts with the insurance company to collect from patients before they are seen. We don’t make these rules but are forced to follow them and pride ourselves on running an ethical and legal practice.”

PATIENT: “I never had to do this before. No other doctor’s office does this.”

RESPONSE “I can’t speak for other offices, but we are following our contract requirements with insurance companies or our office policy. I am sure you will start seeing this more in the future. We pride ourselves on being recognized as one of the top 10 urology practices in the country for our administrative procedures since we really try to do everything to the letter of the recommended practices.”

For more information regarding how EMB can help improve your front desk collections, contact us at 508-259-7972.