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}

I’m sure you remember when you were 10 years old and your friend forgot his lunch money. You trustingly lent him money expecting to be repaid promptly only to realize that you had to ask him for repayment. In fact, sometimes you had to pester the borrower until you downright embarrassed him before you were repaid. You were eventually repaid, but realized the relationship would never be the same.

Fast-forward a few decades and that lesson is as relevant as ever.

Human nature hasn’t changed. Add an uncertain economy and stress to the equation and it is simply easier for a lot of people to ignore challenging situations, particularly those involving financial stress. It is definitely something we can all relate to. We all want to do the right thing, and sometimes a small nudge is all we need to help us – this is particularly true when it comes to patient A/R.

Your patients really want to do the right thing, but the right thing can be very confusing. Patients are mystified by HMOs, PPOs or other insurance carrier decisions and constant coverage changes.

In 2010 alone providers wrote off over $65 billion in bad patient debt.*
This is a result of healthcare reform, rising patient responsibility and the increase of consumer directed health care (CDH). On the other hand claims processing costs payers an estimated $15-20 billion annually.† These two dynamics account for a substantial portion of the total revenues flowing through the US healthcare system every year.

The bottom line:
Practices need to adopt a patient friendly process and with fewer payment processing delays. Practices will also have to implement more patient-friendly information than ever before. Even so, at best, practices should be prepared to devote at least twice the amount of time with patient A/R as they are currently spending on claims with insurance payers.

While this may sound like a daunting task with the looming mandatory requirements for meaningful use and transitions to 5010 by 2012, CRT Medical Systems can help ease the pressure you’re feeling. We have helped practices like yours succeed for over 30 years.

CRT developed PAR to help you manage patient confusion and delinquent accounts. It’s a new service that employs expert patient management. CRT is capable of dealing with delinquent patients in an intimate and caring manner. Our experts have the personal skills to empathize with the patient as well as intimate knowledge of their medical file. There are no gray areas regarding patient responsibility and no hard feelings because the patient felt pressured into paying.

Our experts know the medical billing industry inside-out, so they can definitely eliminate the confusion and mystery your patients experience by constant changes in their insurance coverage. You could say that these patients have been waiting for the right answers so they could do the right thing. Some have even been waiting as long as five years. As a matter of fact, since CRT has implemented the PAR program we have settled receivables from over 5 years ago and have a success rate of over 90%.

PAR has been a homerun for practices that have signed on with CRT Medical Systems.
Give us a call @ 248.679.1700 to see what we can do to minimize your patient A/R.
We guarantee the days of patients eating your lunch are over. 

 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.

* – Mckinsey Quarterly (2010)
† – Mckinsey Quarterly (2007)

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.

For the past 5 years medicine has seen an attack on its business model from all fronts. From falling reimbursements, higher labor costs, higher patient deductibles, more non-covered services have brought many if not ALL practices to a cross road, that’s demanding their full attention as business owners. All of us in business have been subjected to relentless attack over the past 15 years. First it was the need to invest in technology, then it was the need to get on the internet or be a part of the internet in order to remain competitive, then it was the outsourcing of work to countries with lower cost metrics. Last but not least we faced the “Real Global Economy” whereby we truly were competing with businesses in Vietnam, China, Phillipines, Eastern Europe not to forget India and others who started 10 years ago.

All these changes have forced all business verticals to reexamine how they conduct business in order to stay profitable. Look at what is happening to Blockbuster, once the most dominant company in the pre-recorded video business has been forced into bankruptcy… by what? A new business model called NetFlix. But now there are signs that even Netflix are facing new threats to their business model.

So what needs to be done in the medical field to avoid those fates? Throw out the old rules and bring in the new. Take a moment to review the following which were published in a recent blog about the “status” of health care and the business side of it. They listed out the “old” and “New” rules for practices today. Do any of these apply to how you think about your practice?

• OLD RULE: Physicians could make a good living without having much business experience; just being a “good doctor” was enough for practice success.
• NEW RULE: Those days are gone. Change is the “new normal”. Physicians will need to be astute observers of healthcare and business economic conditions and determine how they need to respond to change from a business practice standpoint.

• OLD RULE: Enough healthcare dollars were available to allow physicians to make their fair share of the pie.
• NEW RULE: The per-patient healthcare dollar available will decline for the remainder of today’s physicians’ careers. Smart physicians will find ways to gain more control of the healthcare dollar they produce and in particular go after the patient portion of the health care dollar.

• OLD RULE: Managing a medical practice could be handled by administrative people with general administrative skills.
• NEW RULE: The complexity and risk of managing a medical practice has skyrocketed, requiring highly specialized expertise. 4,000 new regulations per year are created that affect physicians. Physicians cannot find the required level of expertise in one or two administrative persons. Outsourcing to specialized firms will become the norm.

• OLD RULE: Doctors could get away with being “low-tech”.
• NEW RULE: Patients, insurance carriers and the government will expect physicians to be high-tech. Physicians who are not high-tech will be limiting their income and value to patients AND become employees of systems that are.

• OLD RULE: The billing function of a medical practice could be performed by regular administrative staff.
• NEW RULE: With unintentional billing fraud* on the increase, identity theft running rampant and regulatory fines on the increase, physicians must ensure that their billing is done professionally by certified coders with multiple layers of protection in place.

• OLD RULE: A healthcare practice was not considered a “business”.
• NEW RULE: Structuring a practice around sound business principles and an understanding of healthcare economics will become increasingly important in order to survive. Those physicians who run their practice on business principles will survive. Those who don’t will be absorbed by those who do.

In summary, the administration of healthcare practices has become increasingly sophisticated. The post-healthcare reform system will increase in complexity. Success of physician practices will depend largely on the talent managing it. Embracing and deploying the right business process and technology will enable doctors to stay INDEPENDENT as oppose to becoming employees of a larger organization. Medical practices can MAKE money and can deliver world class health care. The paradigm needs to change in order to do that.

To see how we can improve your medical billing services please visit www.crtmedical.com or call me, David Doyle @ 248-679-1700

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.

* – The “New Rules” for Survival for Physicians in Private Practice Part 2 in a 4 part Series (December 07, 2010)