Benchmarking is a great way to evaluate how your practice is performing. Various methodologies range from singular internal practice benchmarking (such as one physician to another’s collections year over year) to external benchmarking (comparing one practice to the best performing practices in a specific region).

The key to actionable, effective benchmarking is to ask the right questions of your practice in the benchmarking process. It is a bit more challenging than it might seem and requires an astute understanding of the care-providing business (not simply care providing!).

To start you‘ll need to understand a few of the integral categories for consideration (as outlined by MGMA) including Leadership, governance and equity, Productivity, Compensation, Clinic/Practice operations, Facilities and capital improvement, Staffing, Accounts receivable management, Coding and compliance, Information systems, and Utilization management. This is the basis for a holistic perspective that will shed insights on opportunities for practice improvement.

While all of the categories named above play a role in the vitality of your practice, we will focus on two primary areas that seem to give practices the most challenges:

1 – Accounts receivable management
2 – Coding and compliance

Analysis of these two areas will clearly indicate the practice’s financial health and help you forecast the impact of patient A/R and coding variables in the future.

Accounts Receivable Management
These days we are seeing a trend of practices gravitating to affiliations with hospitals to help ensure stability. While this may seem like a great alternative to the current business climate and its challenges, it does have some underlying drawbacks. When independent practices are immersed in a new health system, there are generally a number of billing and collection systems performing at a range of different levels, all required to interface and coexist with the larger health systems’ infrastructures. It can be a laborious and costly transition. The tedious nature of the transition is impacted even more substantially by virtue of payers’ increasingly rigid claims management.

Here are a few questions to ask yourself that will provide a strong basis for actionable learning:

• Have sufficient staff and a realistic time line been dedicated to standardizing billing practices and minimizing operational redundancy?
• Have systems been implemented to minimize patient A/R delinquencies (days and amount owed)?
• Has one person been designated to provide insights and guidance on individual payer requirements for co-pays, deductibles, pre-authorizations and referrals?
• Is there a system in place to deal effectively with delinquent accounts after they have been written off by the hospital or health system?

These astute questions will help you become keenly aware of your practice’s financial potential. These are also questions you may not know the answers to. That’s where CRT Medical Systems’ 30 years of experience can help get you on the right track. We can answer these questions because we have over 30 years of aggregated data from practices of all sizes. We know the best processes to improve practice performance at any size.

Coding and Compliance.

A famous architect once said, “God is in the details.” When it comes to coding and compliance he was wise beyond his drawing board. Consider coding and compliance the superhighway infrastructure of the healthcare system. Now think of that superhighway being regulated by signals that change at random intervals at new locations on a daily basis. It requires a sharp and nimble intellect that can identify change, react to it quickly and implement new information seamlessly in order to be reimbursed in a timely manner and to maintain compliance. Detailed documentation is critical to reimbursement and to maintaining compliance.

Is your head spinning yet?

We know that physicians generally make minimal investments in practice management systems, typically only to handle billing.¹  As government scrutiny of integrated systems and compliance increases, it’s paramount that a practice understand changes in regulation (such as meaningful use and transition to 5010). Physicians and staff are solely responsible for optimizing reimbursement and minimizing denials and compliance risks. As payers pay less and patients pay more, practices are moving to a threshold of greater risk.

Is your practice prepared for this increased risk?

Here are some questions to help you determine how well prepared you are:

• Does your practice maintain up-to-date and proper coding procedures?
• Does this training account for individual specialties within your practice?
• Have all of your practice’s providers been audited annually?
• Is your practice (organization and process) in compliance with relevant rules and regulations?
• Does your practice perpetually implement and observe compliance throughout the system?

While these questions will give you a solid foundation to begin implementing the best processes for your practice, we humbly believe the best question is “Have you called CRT Medical Systems yet?”

If the answer to this question is yes, then an affirmative domino effect is in place for any remaining questions. CRT handles it all.

Process and performance benchmarking help practice leaders understand their organization’s performance year to year and how it compares to similar medical practices in their region. Please call me, David Doyle, CRT CEO @ 248-679-1700 or visit www.crtmedical.com. We can answer these questions and many more, freeing your mind, helping you be a better doctor.

 CRT Medical is the largest medical billing company in Michigan. It has also flourished in the industry for over 30 years.

^{1 – 2011 Q2 HBMA Survey}

As long as we seem to be on the best-in-class business band wagon, I thought it might be interesting to take a look at how Apple does business. I’m not talking about the cool products or the seamless software (which makes people wonder how they did it) but rather a more fundamental aspect, the brand/customer interface.

Apple has become synonymous with easy when it comes to technology. Their first question in product development or customer service seems to be, How can we make (insert buying music, making movies, etc.) easier than it has ever been? That philosophy starts from the top down with its chairman and leader.

 Wait a minute, isn’t that what all consumer based products or services should do, make things easier for their customers? So why does Apple seem to get all of the credit for such an “easy” business premise?

What did Apple do so effectively that no one else has?

It created a desire through transparency.

Apple made the help desk a destination and an incredibly positive experience. Not only can a customer come in and be enlightened by one of the geniuses behind the Genius Bar, but other customers with the same question can be similarly enlightened and engaged. The bottom line is that people accept and understand that everyone has techie problems and they aren’t alone (…so lose the self-consciousness!). Better yet, they feel good about being a part of this group of newly empowered Apple users.

A convenient byproduct for Apple retail stores is that they always seem to be busy. Beyond that, with every new product there seems to be a line of enthusiastic zealots starting 24-48 hours prior to the product even being released at the store. They happily pay a super premium to be the first to own the newest “Apple.” And all while the country has been wallowing in the great recession, and as numerous other electronics and computer stores have fallen by the wayside. (Does Apple know how to do business or what?)

All of this activity and positive energy accomplishes two very important objectives:

1 – It strips away the “behind the curtain” mystique of technology and makes it a user-friendly encounter.

2 – These educated customers comprise the crowds in the store casting the pebbles creating the ripple effect Apple sends throughout society. They create buzz.

The first objective is met by virtue of operations, and the other forms an undeniable marketing tool.

While Apple does make it look easy, make no mistake it is a consistently evolving and tedious task of refinement. It is a philosophy that permeates every aspect of the company.

Apple has empowered the once hapless computer neophyte and made them feel like they can take on the world. Apple has given them hope and better yet, a reasonable understanding of what they might achieve.

That very same mystique exists now in Healthcare (and it is a huge opportunity). How can we bring the primary patient issues out from “behind the curtain”? How can you empower your patients to become confident and trusting, singing your praises, returning again and again while minimizing patient A/R?

Start by asking how can we make everything easy – a simple black and white proposition?

Apple does this very elegantly when it comes to in-store service and support. The make it all available online with a sophisticated scheduling system broken down geographically. They offer you the closest location, at the most convenient date and time. They even do a little recon, or pre-op, so they can have a basis from which to explore the challenges the customer is facing. Again, it is all about the customer.

How can this be literally parlayed to your practice?

1. Start by offering patients their choice of appointment schedules online

A. be transparent – allow them to see your schedule openings

B. allow them to have a second choice if their first may not be available

2. Offer your patients numerous payment options

A. most practices now accept credit cards – be sure your practice accepts the major three (Visa, MasterCard, Amex)

3. Offer your patients individualized payment plans

4. Offer your patients informed help

A. designate one of your staff to become a Patient Service expert

B. offer a help line staffed by people familiar with the patient records as well as insurance procedures and approvals

C. you might even offer a public forum for your patients to help one another out – many of your patients already trust you with their lives and they would be happy to help out a confused or uncertain patient

5. Above all find a way to let your patients know what to expect with all of the known variables

A. get pre-approvals on any expected procedures

B. follow up on those approvals to ensure the percentage of payment  expected

C. let your patient know what their responsibility is as soon as possible

Finally you can visit www.crtmedical.com or call me, John O’Green, directly @ 248-679-1606. We have some new ideas for healthcare that will improve your practice performance and help make your life being a Doctor as easy as being a Doctor again!

CRT Medical is the largest medical billing company in Michigan. It is also one of the oldest, having flourished in the industry for over 30 years.

Apple logo is a registered trade mark of Apple Computer.

What can your practice learn from Starbucks?

You’ve got to be thinking, “How does he get to Starbucks from medical billing?” – He’s out of his mind!

Please hang with me here for a moment, I promise it will be worth your while.

Starbucks recently launched an application that lets customers purchase goods with their Android smartphones. The company already has similar applications for BlackBerry, iPhone and iPod touch.

These applications allow customers to load their Starbucks loyalty card accounts, check card balances and find stores nearby, and it also notifies customers of promotions and other discounts.

In addition to these conveniences, they are also launching mobile payment options for customers frequenting over 1,000 Starbucks within Safeway Supermarkets nationwide.
They already offer similar programs in over 1,000 Target store locations as well as 6,800 of their own locations.

Wow, talk about giving the customer some easy payment options.

“The expansion of our mobile payment footprint has been driven by customer interest and input. With the addition of Starbucks for Android to the Starbucks app line-up, a Starbucks mobile payment app may now be used on approximately 90 percent of smartphones currently in use,” said Adam Brotman, VP, general manager, digital ventures at Starbucks Coffee Co.*

To think all of this started over 25 years ago, when a cup of coffee generally cost $.75 and Starbucks was charging $1.50! Suffice it to say they had to change “product” expectations.
They did it by providing an effortless and unique experience.

Granted buying a latte is a bit different from buying medical services – one is a leisure purchase and one could be termed a “maintenance” purchase. The purchase mind set is very different.

Surprisingly, the payment experience doesn’t have to be.

As we have considered the practice payment “logjams” over the past 30 years we see definite patterns that, in this day and age of increased patient responsibility, can adversely affect patient A/R.

Patient responsibility is increasing at a rate of 10% annually meaning that insurance payer responsibility is decreasing by 10% annually. It would seem that the simple solution is to notify patients that they are responsible for payment and everything will continue “business as usual”.

Not so fast. Statistics show that collecting from patients is two and a half times more work intensive than collecting from payers! I’ll repeat that one more time as it appears on your staffs’ timesheets, for every hour your practice spends collecting from insurance or health plan networks they will spend on average 2.5 hours collecting from patients. (Something you may have already experienced.)

Now just think what that additional time against does to your practice overhead not to mention how the interim patient A/R is affected. The cost is a double hit before any money is even in the door. It becomes painfully clear that this is not a singular issue but rather a domino effect, zero-sum game.

Enter the Starbucks customer convenience model. It is the pivotal point of any successful business – getting the money in the door!

When we adjust our business perspective and think of practices as retailers (from a financial aspect) we can begin to manage customer (patient) expectation in a very different way.

As Adam Brotman, Starbucks VP, General Manager, cited earlier their actions were taken directly as a result of customer interest and input. Intel! It’s a great place for every practice to get a clear picture of its strong points as well as areas it can improve.

I would recommend that every practice develop a financial survey for every patient to fill out at the office or on-line at the practice website. From patient answers you will be able to develop actionable and empathetic payment options for your patients. You will likely receive an answer for every conceivable payment option possible. The great thing about these options is that they are easily sorted and categorized into finite actionable solutions.

Actionable solutions are where CRT Medical Systems excels. We are launching comprehensive services ranging from new patient payment options for your practice, to reducing denials and improving claims efficiencies, to increasing collections rates. While all of these services are available a la carte they are most effective when employed in concert. This is another area that CRT Medical Systems provides your practice with many great options. We have three models to offer your practice:

• First and most comprehensive is our Full Management solution, CRT Medical Systems becomes your complete billing department solution.
Please click here for more information.

• Second is our Hybrid Management solution is a combination of our Full Management solution services and giving our clients access to the system so they can perform certain billing functions themselves.
Please click here for more information.

• Third is our ASP (Application Service Provider) or Online Billing Solution CRT Medical Systems offers the Online Billing solution as the first line of improving productivity and profitability. While this is exactly like having your own computer billing system in-house, it offers many more advantages. Please click here for more information.

All of these options have an inherent 30 years of billing expertise and even offer a patient call center staffed by professionals who understand how to deal with financially stressed patients.
These professionals establish patient and practice dialogues that can specifically address any patient concerns when it comes to payment responsibility.

In the end the patient is educated and well informed and the doctor can minimize the affect of new patient financial responsibility on the practice. The net result is a happy patient and a happy doctor.

CRT also offers the InstaMed system allowing your practice to verify patient coverage prior to the visit. It also allows patients the opportunity to use customized payment plans eliminating the angst, and reluctance at the root of patient A/R issues. Taking steps to make the insurance coverage status transparent eliminates surprises and helps manage patient expectations. While patients in general may not like paying, making payment easier is a game-changing asset reducing the pain patients feel in their bank accounts.

At the same time CRT never rests when it comes to improving billing and claims efficiencies.
In this never ending evolution we are continually searching for the most expedient and informative method of filing or re-filing claims. We have seen dramatic reduction in denials with our newest process over the past 60 days and when there is a denial we immediately know why. It may not sound like big news but this intelligence eliminates generations of redundancy with the insurance claims maze of information technology.

Armed with the time sensitive denial intel we can then take action to correct the information and resubmit claims immediately – or we can contact the practice and advise accordingly.
Either way the processing time is dramatically reduced. The net learnings on each case are applied to the CRT/Practice relationship to further increase efficiency and increase payment.

The benefit is a much shorter payment cycle.

Finally we go even deeper when it comes to collections; CRT Medical Systems has a new service called PAR. Designed to help minimize rapidly accumulating patient A/R. With all of the intelligence aggregated from our initial steps in the process including insurance validation, payer contributions and claims rejections CRT can approach the patient in a manner that helps inform and educate them when it comes to their financial responsibilities. We all know that an educated and relaxed patient is easier to deal with than an uneducated and emotionally charged patient – particularly when it comes to financial operations.

What could be better for your practice than decreased payment cycles, happy patients and most important an incredibly improved collections rates? If we work together and continue to apply our learnings, we might all be able to afford more lattes!

Please start by visiting www.crtmedical.com or calling me, David Doyle @ 248.679.1700. We’ve been in this business for over 30 years and we can help you develop a great practice all while helping you do what you always wanted to do – be a great doctor.

CRT Medical Systems is the largest medical billing company in Michigan. It is also one of the oldest having flourished in the industry for over 30 years.

Starbucks logo is a registered trade mark of the Starbucks Coffee Corporation.

Let’s face it no one likes surprises. Why then do most medical practices wait until the patient has been treated and left the practice before informing them that the insurance has rejected their claim and they (the patient) are now responsible for the financial obligation?

Nothing could be more backwards.

There is a recent practice that doctors have been employing to ensure that they are paid no matter what and frankly it is irritating to patients. It begins with the desk attendant asking the patient to update their file and at the same time to sign a form accepting full responsibility for complete payment. The doctor’s form states something like “Insurance coverage is a contract between the patient and the insurance company – not the insurance company and the doctor. We (the doctor) provide you (the patient) with the convenience of using your insurance”.

The patient doesn’t get an estimate – they are simply called in and for all they know it could cost hundreds or thousands of dollars. The patient is blindsided!

A patient has been given the impression that by joining a specific Healthcare or Insurance network their doctor belongs to, that they are covered with the exception of the deductible. Does your practice want to add to patient angst and an already tenuous patient/insurance relationship by saying “hey that’s your business, you figure it out”.

It is at this point that things can get real sideways. A patient shows up for an appointment made weeks in advance for a specific treatment or consultation. Between the time of the appointment and when the patient arrives for the appointment insurance coverage can change. Posting a sign on the wall mentioning that practice policy is to expect payment at the time of service may not be the best way to handle unexpected patient financial responsibilities.

Can you imagine if most service business/customer relationships were run this way?

Avoiding the pitfalls of such a situation is easy if you look at it from the patient’s perspective, deal them with respectfully, and with a full service approach. Make it easy for them and they will be your patient forever and better yet refer patients by the dozens.

Here are a few easy and immediate processes your practice can implement to improve patient satisfaction and practice profitability.

1 – Provide the patient with a document clearly explaining the process your practice employs to process a claim to insurance carriers. Detail how responsibility is determined, process time cycles, as well as the payment process for denials. Transparency helps the patient understand that your practice is looking out for their well-being eliminating frustration.

2 – Educate the practice personnel on the best ways to handle the “patient unknowns”. If you don’t know where to start, use customer surveys. This act alone conveys a sense of concern for the patient’s well being.

3 –Keep appointments on schedule. Nothing is more important than letting patients know that you value their time as much as they do. And if you are running behind keep patients informed by developing a calling and/or social media (text or tweet) plan to contact them in advance. Remember no one likes surprises.

4 – Pre-certification follow-up is important. A pre-certification isn’t a guaranteed payment.

5 – Offer patients an on-line alternative to filling out forms in the office. Let them visit your website, download and print out forms to complete at home prior to an appointment.

6 – Use your web site to help educate patients. If a patient has access to information regarding their particular case and can read it in a relaxed friendly environment at home you’re killing two birds with one stone. Befriend the patient, propagate trust and at the same time educate them. You could even offer an option for patients to email pre- appointment questions!

7 – Pay attention to details. Understand the staffing and technology issues in your practice. Improving patient relations, patient flow and patient volumes translates into a predictable environment and practice stability. Ultimately, increased patient satisfaction and increase practice profitability.

8 – If you don’t know where to start or have the staff begin by visiting www.crtmedical.com or calling me, David Doyle @ 248.679.1700. We’ve been in this business for over 30 years and we can help you develop a great practice all while helping you do what you always wanted to do – be a great doctor. 

CRT Medical Systems is the largest medical billing company in Michigan. It is also one of the oldest having flourished in the industry for over 30 years.

It’s a business! There it’s been said. Now let’s get on with the process of treating it like a business.

For 35 years I’ve been involved with the health care industry and for 34 of those 35 years I never heard the words business and medicine used in the same sentence. Understandably no one wants to deny health care because a person does not have the means to pay for it. Clearly when all else fails we must still do the right thing: provide health care to those who need it. And within the last year the government is attempting to see that fact to reality with the help of the private sector. Of course the jury is still out on how this will play out, but regardless, there are significant changes coming down the road.

But what seemingly has historically been ignored has been ensuring that medical/health care facilities make money! Yes there are non-profit and free clinic models whereby that will never happen and they are necessary. But this country’s private practices deliver 80% of our health care and they need to make sure they can sustain themselves economically. In the past 20 plus years that was not as difficult as today given that reimbursements were better, labor costs were lower and patient share of the health care cost was low or non-existent. But times have changed dramatically and therefore the practice of managing medicine needs to change, and in my opinion that has not happened.

According to Health Care Financial Experts the HCFMA (Health Care Financial Management Association) and health care consultants today medical practices are faced with the following ABSOLUTE irrefutable facts!

• Reimbursements are dropping every year and that will not change! Experts say 3-4% per year.

• Labor and benefit costs continue to climb. Experts say at least 2-3% per year.

• The share which patients are responsible for is climbing rapidly thru higher deductibles, co-pays, etc. This means collections are more complicated.

As anyone can see, the negative impact on practice revenue is significant, and continues to grow. This calls for practices to re-evaluate their business operations and put into place changes that will allow them to stay profitable, and more importantly INDEPENDENT. If we look at other industries, many faced similar problems as those facing health care today. And those companies within those industries that embraced change are the ones that survived. As unpopular as some of those decisions might have been, they allowed these companies to stay independent and, in fact, prosper and compete in the global economy.

This same mindset needs to be applied to health care with respect to change. In my opinion the changes we are talking about are not in fact that radical and they will allow doctors to remain independent and practice medicine … but they must be done soon. First whatever jobs you have in your practice that are not your CORE competency should be outsourced immediately. Frankly, all non-clinical areas should be evaluated for outsourcing so you can focus on what you do best: being a doctor! This means looking at your administrative functions such as payroll, HR, marketing, supplies, and last but not least, the billing function.

Collecting money is today by far the most critical function in a medical practice’s “business,” right BEHIND the clinical side of providing needed health care. As stated above reimbursements are declining, labor costs are going up and last, but increasingly more prevalent, patient costs are going up via higher deductibles and co-pays. Then when you consider that insurance companies have a vested interest in holding onto their money, you have the challenge of doing battle with a room full of college graduates looking at modifying the rules or adding additional conditions on how you, the doctor, get paid. Make no mistake about it, the battle of getting paid is only going to get tougher. This is why, like payroll, HR and other areas of the practice, it makes sense to consider how outsourcing your billing will benefit you. CRT has invested in substantial billing and billing follow-up technology; over a million dollars in the last 6 years alone, as well as the hiring of highly educated and experienced management to run billing operations. Our core competency is medical billing and EMR. That is all we do 24/7 and we have been doing it for over 30 years.

Please call me @ 248.679.1700 for a CRT Campus Tour or if you have any questions.
I’ll be happy to help however I can.

Kind regards.
David Doyle

CRT Medical Systems is the largest medical billing company in Michigan. It is also one of the oldest having flourished in the industry for over 30 years.