MGMA In Practice blog

The most frequently asked question that Elizabeth Woodcock, MBA, FACMPE, CPC, gets from medical practice administrators is, "How can I get more money in the door?" It's the same question we recently asked the professional speaker, trainer and author specializing in medical practice management.

The environment you're dealing with in your practices isn't easy. The recession caused an increase in uninsured patients. Uninsured patients caused an increase in bad debt for practices. And insured patients are actually assuming higher financial responsibility, based on their employers' plans. Faced with all these pressures, how do you amp up your patient collections efforts?

Woodcock shared her 3-tiered strategy with us in an MGMA podcast, and we've transcribed part of it here:

This step sets up all the collection efforts to follow. Take a look at your contracts and participation agreements with insurance companies and see what you're allowed to do. For example, can you collect copayments or unmet deductibles?

Also, keep in mind whom you'll be collecting from. Woodcock says there are three types of patients: 

1. The happy patients who have their credit card ready and waiting
2. Those who need a little nudging, or maybe a compliment or two
3. Those who have no intention whatsoever of paying you

Expect your collection agency to step in and assist with the second group of patients - the nudgers.

This step combines pre-visit, time-of-service and post-visit communications. One of Woodcock's favorite time-of-service collection tips is the collection script. Instead of asking the patient if she would like to pay today, which can prompt someone to say no, ask her how she would like to pay. Changing one simple word can make a world of difference in the staff-patient interaction.

Woodcock also recommends offering a payment plan for a patient who simply cannot pay right now. "It's a great alternative to getting nothing," she says. But put parameters in place: don't extend the plan past six months and have a minimum monthly payment of $25 dollars. Ask the patient about their time frame; in general it will be a tighter time frame than you would have developed yourself.

Another step to remember is patient check-out. "Check-out is an opportunity to be a safety net for your collections process at the time of service," says Woodcock. It also offers an opportunity to recapture copayments you may not have collected at check-in. Plus, you can see if any account balances are due and possibly calculate any unmet deductibles or coinsurance based on the services rendered in the office that day.

See these 40 questions to ask yourself about patient collections to ensure you're doing all you can.

Should you hire more people? Have a financial counselor? Could a kiosk or predictive dialer employed in the business office help? How you implement your plan depends on what's best for your practice and staff.

Woodcock describes how one practice decided to use the patients' explanation of benefits (EOB) to help them collect unmet deductibles and account balances. The front office initiated the payment conversation, and when a patient would make an excuse about paying, the staff handed them the printed EOB and explained how the insurance company already took care of a portion of their bill. Staff invited the patient to call the insurance company if they had any questions, then asked again for payment.

"It is a wonderful best practice and a great success because it really allows the practice to be put in an advocacy position instead of the bad guy," says Woodcock. "Truly, a medical practice administrator and all of the front office and business office team members really are advocates for the patient. And unfortunately, they've been put into the 'bad guy' position. This was a way to turn that around and be successful in collecting as well."

For more patient collection tips from Woodcock, check out her book, The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting Paid, 2nd Edition, or meet her in person at the following upcoming MGMA specialty conferences:

• MGMA 2010 Academic Practice Management Conference
• MGMA 2010 Financial Management and Payer Contracting Conference
• MGMA 2010 Obstetrics and Gynecology Practice Management Conference

Volunteering is defined as contributing time, work and knowledge without receiving financial compensation. That definition, while accurate, fails to reflect the benefits you receive in return. So we asked MGMA and ACMPE members to tell us the benefits of volunteering for the Association. Here are their top six along with advice for getting involved.

Resoundingly, members told us this was the main benefit of volunteering. Serving alongside and interacting with a group of your peers gives you a chance to make important connections and even build lifelong friendships. This network can become a great resource for ideas, advice and laughs.

One of the best ways to get involved is to simply reach out and let someone know you're interested, says Genie Blough, MBA, FACMPE, principal of G Blough Associates LLC, Mobile, Ala. "If you have an idea of an area that's of particular interest to you, contact somebody you know who's been a mentor to you or who's involved in MGMA." Simply saying you're interested is the first step toward bringing many new opportunities and friends into your life.

Get started by filling out our volunteer form

Many volunteer positions in MGMA and ACMPE allow you to work with people across the nation and in other types of healthcare organizations. Your peers can offer ideas that help you bring a broader perspective back to your practice, giving you additional credibility with your physicians.

"I feel like my physicians respect [my volunteering]. It gives me stature in my practice," says Shena Scott, MBA, FACMPE, executive director of Brevard Anesthesia Services, Melbourne, Fla. "What I've learned in my volunteer positions has expanded my thinking beyond my immediate practice. I am able to bring that broader thinking back to my day job."

When you volunteer for MGMA and ACMPE, you choose how you want to get involved. The volunteer opportunities throughout the organization are numerous and varied, from writing a guest post on this blog to serving on the Board of Directors. Tell us what your passions, interests and skills are and we'll find a position to fit. Have an hour a day to give? Or an hour a year? Every contribution counts.

"People are always worried about the amount of time that it takes to volunteer," says volunteer Rick E. Weymier, MBA, FACMPE, administrator, Metrocrest Orthopaedics & Sports Medicine, Carrollton, Texas. "What it comes down to is the value that you get out of it. And the value you get out of it is always greater than the time put into it."

When you volunteer, you bring your opinions (and those of your physicians) to the table. If there's a pressing issue you're dealing with, help us create solutions and resources that meet yours and your colleagues' needs. You can also share your ideas on pending healthcare legislation through our Government Affairs committee, legislative liaison program and a number of eGroups in the MGMA Member Community. 

Almost every volunteer position provides you with ways to expand your skill set. Reading professional papers, reviewing articles and grading essay exams ensure that you're constantly exposed to new ideas and new ways to solve problems. Serving as a committee chair can help hone your management and leadership skills. Overall, volunteers told us what they do for MGMA and ACMPE made them better at their "day job."

Volunteering gives you the opportunity to build a stronger profession and to use your experience to help shape its future. If you received help, advice and encouragement from other members as you began your career in healthcare administration, there are many volunteer positions that allow you to "pay it forward" and help the next generation of administrators learn and grow.

MGMA member Mona Reimers, CPC, CMPE, director of revenue services, Orthopaedics NorthEast, Fort Wayne, Ind., began volunteering when the time was right, both personally and professionally. "There's different times in our lives that we have the energy and time to spend to volunteer," she says. When you know it's your time, don't be afraid to ask how you can help. "The truth of the matter is there aren't enough volunteers for the work that needs to be done," she says. "There's a place for everybody."

Ready to raise your hand and get involved? We'll help you find the right opportunity.

When they're not busy collecting data, they're analyzing it. The MGMA Surveys department often fields queries about benchmarking from a wide range of medical practice specialties and sizes. Requests from practices that are part of an integrated delivery system (IDS) are increasing, and so is the benchmarking data MGMA captures each year.

This year, we're tailoring our surveys to capture even more IDS data. In the meantime, you can find 2.2 million IDS data points in current MGMA surveys. The fastest way to find information specific to IDS-owned practices is explore the tables indicating "ownership type."

For example, hospital-owned practices compensate physicians a greater percentage of professional collections in both primary care and specialty care categories, according to the MGMA Physician Compensation and Production Survey: 2009 Report Based on 2008 Data.

Primary care physicians in hospital-owned practices were compensated 4.5 percentage points more of their collections than those in not hospital-owned practices (53.5 percent to 49.0 percent of professional collections). This gap was even wider for specialty care physicians, who earned 77.5 percent of professional collections in hospital-owned practices but only 68.5 percent in not hospital-owned practices.

Other IDS info in MGMA surveys

In addition to physician compensation, you can find IDS data in our other major reports.

Physician Compensation CD & DataDive Report

• 51 tables
• 1,491 rows of data
• 123,753 data points
• Includes IDS data analysis, such as: In 2008, specialists reported virtually the same compensation to work RVU ratio in hospital- and not-hospital-owned practices, $51.21 and $51.08, respectively.

Management Compensation CD Report

• 52 tables
• 5,869 rows of data
• 487,127 data points
• Includes IDS analysis, such as: Physician CEO/presidents in hospital/IDS-owned practices earned 12.8 percent less in 2008 ($333,608), correcting from a near 50 percent increase in 2007.

Cost Survey CD & DataDive Report

• 1,155 tables
• 19,262 rows of data
• 1,598,746 data points
• Includes IDS analysis, such as: Total general operating costs in IDS practices, increased from 26.9 percent of total medical revenue to 40.3 percent in 2008.

Medical Directorship and On-Call Compensation Report

• More than 200 data points related to medical directorship duties and on-call compensation
• Includes colored IDS graphs, snapshots and analysis, such as: In 2008, in both hospital- and not-hospital-owned practices, general surgeons reported $500 per day in compensation for on-call coverage, while neurosurgeons earned more than $2,000 per day in hospital-owned practices vs. $2,125 per day in nonhospital-owned practices.

Physician Placement Starting Salary Report

• Nearly 250 data points related to the starting salary
• Includes colored IDS graphs and analysis, such as: In 2008, there appeared to be a widening gap between hospital/IDS-owned general surgery ($300,000) and physician-owned general surgery practices ($245,000) in first-year compensation of physicians in a new practice.

Performance and Practices of Successful Medical Groups Report

• Sets the "gold standard" for medical practice performance by illustrating the activities of high-performing groups
• Includes three performance categories:
• o Profitability and Cost Management
• o Productivity, Capacity, and Staffing
• o Accounts Receivable and Collections

New IDS and hospital medicine data in 2010 MGMA surveys

This year, MGMA is offering the expanded Hospital Medicine Supplement, in collaboration with the Society of Hospital Medicine, with the MGMA Physician Compensation and Production Survey Report. This supplemental survey will collect additional data regarding financial support for hospital medicine groups.

The Cost Survey, which launches March 1, will have an expanded IDS survey supplement this year, as well. This includes additional questions related to the Joint Commission on the Accreditation of Healthcare Organizations, electronic health record systems, the Physician Quality Reporting Initiative and clinical integration, to name a few.

MGMA analysts will provide you with three complimentary data points, even if you have not purchased or participated in the survey reports and need an IDS benchmark. (Survey participants receive the results for free.) Call us today at 877.275.6462 ext. 1895 or e-mail us.

Despite the economy, last year the American College of Medical Practice Executives (ACMPE) – the certification body of MGMA – saw an increase in membership and a record-breaking addition of 240 certified members. Even in trying times, competition pushes motivated people to differentiate themselves and prove their worth. What better way to demonstrate your knowledge and dedication to your medical practice management profession than by attaining ACMPE certification?

It's a great investment in your future that provides many rewards, including:

• Professional respect from physicians, peers and colleagues
• Increased earning and career potential
• Knowing that what you learn and implement measurably benefits your practice

Make this year your year to earn your credentials as a Certified Medical Practice Executive (CMPE) or Fellow in ACMPE. After all, CMPEs and Fellows earn, on average, 24 percent more than their non-certified colleagues.

To get started, check out these seven (mostly free!) resources for ACMPE members pursuing board certification and Fellowship.

1. Take the Body of Knowledge Quiz
   Passing the ACMPE objective exam is one of the certification requirements. This quiz has 100 questions weighted by domain in the same manner as the objective exam. In addition to helping Nominees prepare for the exam, all ACMPE members earn continuing education credit hours for completing it. MGMA members are free to take it, too.
   
2. Earn continuing education with MGMA Connexion article assessments
   New last year, ACMPE members can earn ACMPE continuing education by reading and completing assessments about MGMA Connexion magazine articles. Each assessment provides 1 hour of continuing education – perfect for earning credit without leaving your office.
   
3. Download the Board Certification Progress Report & Planning Tool
   Chart your path to certification with this easy-to-use worksheet that walks you through each step of the certification process. The tool allows you to note your progress and contains helpful ACMPE resources for achieving your goal.
   
4. Attend a workshop to plan your certification process
   Prefer to have someone guide you through certification? Attend an upcoming, online board-certification course to get an in-depth understanding of the four ACMPE board-certification requirements: objective examination, essay examination, presentation requirement and continuing education requirement.
   
   An ACMPE Fellow and ACMPE staff member will guide you through the process, and you'll be connected instantly with other ACMPE members pursuing certification. Think of this workshop like your own personal cheerleader.
   
5. Bookmark the Body of Knowledge Web pages
   Accompanying the Body of Knowledge for Medical Practice Management, 2nd Edition, are eight Web pages dedicated to each of the eight knowledge domains. These pages contain free domain quizzes and are continually updated with articles and products that can help you manage your practice in the areas of:

• Business Operations
• Financial Management
• Human Resource Management
• Information Management
• Organizational Governance
• Patient Care Systems
• Quality Management
• Risk Management
  

6. Use the ACMPE Knowledge Assessment
   Earn continuing education credit, and prepare for the exams, with this self-scored, objective evaluation containing 175 multiple-choice questions from material in the Body of Knowledge. The assessment is a great way to determine your strengths and areas for improvement. Plus, explore five sample essay questions and a sample essay exam grading form.
   
7. Check out ACMPE Fellowship resources
   Already a CMPE? If you're thinking about Fellowship this year, be sure to visit the ACMPE Fellowship page for everything you need to achieve the highest level of distinction in the medical practice profession. This year's Fellows class will be officially recognized (and will celebrate!) at the MGMA 2010 Annual Conference in New Orleans.

Great customer service provides a strong foundation for any business, especially medical practices whose patients often decide whether they'll return based on their last experience. That experience can include a physician, a nurse or the employee who booked the appointment and collected the copay.

Unfortunately, it takes only one person to create a negative experience. Recently in our MGMA LinkedIn Group, a group member posed a simple question that turned into a hot topic, with 21 comments to date: "Can anyone offer specific areas or situations where you think front office staff could use some customer service re-training assistance?"

Here's advice from our group's members:

• "Hospitality training is the first thing everyone receives when newly employed and [it] is a topic at each staff meeting. Patients are our customers and are treated as we would like to be. Although we are not Disney, I'd like to think we do our best every day. With direct eye contact, a warm greeting and attention to wait times, our patients are treated as the reason for our existence. One angry patient can do more harm to your business than the good a happy patient can do!"
  
  - Barbara Bernal, practice manager at Bucks Rehabilitation Specialists
  
• Some patients become frustrated when they are treated as if their telephone calls or their questions are an imposition upon staff. Staff should never give patients that impression.
  
  Be patient with senior citizens when gathering insurance information. Medicare HMOs and Medicare supplement policies are not as simple as the commercials claim and not easily understood by everyone.
  
  - Jim Grigsby, CPAM, CDIA, president/CEO at Jim Grigsby Consulting
  
• "Pay attention to the tone of the office. It starts with the first point of contact, even before the patient goes to the exam room."
  
  - Quentin Mitchum, business analyst at HCA Physician Services
  
• "I recently had a discussion with a health system that is now training its physicians to apologize when a mistake in care is made. This might seem counterintuitive in relation to risk management, but apparently studies have shown that patients are more apt to accept mistakes in care if the physician/practice/health system 'owns' it rather than ignores or refuses to acknowledge it in a forthright manner."
  
  - Aaron Boatin, Ambs Call Center, 24-Hour Telephone Answering
  
• "One of the keys to maintaining momentum after delivering the service protocols is to hold staff accountable for the service standards (integrating them with employee job descriptions, including them in performance evaluations) and conducting ongoing satisfaction measurement (patient surveys, mystery patient assessments, etc.)."
  
  - Mari Bacon, director, Sales & Client Service at SullivanLuallin Inc.
  
• "Training should be seen as a reinforcement tool. My experience bears out that insufficient attention to what the business culture is and says and does only results in any training having a short life span ... and so having to be reinvented continually."
  
  - Tim Wright, owner of Wright Results Inc.
  
• "The receptionist sets the tone for the entire visit experience. The medical profession is behind in this area. We don't do it as well as hotels, restaurants and other service industries. What's more ironic is that customers get more TLC ordering a burger than our ailing patients in our offices."
  
  - Ciro Attardo, physician at Horizon Family Medical Group

Guest blog by Lucien Roberts, MHA, FACMPE, MGMA member, executive director, Neuropsychological Services of Virginia, Richmond, Va.

After a long wait, "meaningful use" has been defined, and the electronic health record (EHR) certification guidelines are within days of publication. Now is the time for many medical practices to finally make the migration to EHR.

I have a confession, though. I'm not ready for ARRAgeddon.  My practice doesn't have an EHR, and thinking about moving forward with one gives me chills. Sure, there's the $44,000 per physician incentive in stimulus money, and I know the longer I wait the more that number will shrink. But I also know that EHRs can cost a lot more than $44,000 per physician in upfront expenditures, training, implementation, downtime and ongoing maintenance.

My inbox has been deluged with e-mails offering guarantees of stimulus dollars from vendors. Every healthcare organization out there is offering me a Webinar on the "meaningful use" guidelines. Some are free, others are not. Even my 77-year-old mother, who learned about "meaningful use" during a recent visit to her doctor, may offer her own Webinar. At least Mom's will offer a great recipe or two.

While "meaningful use" and EHR certification are critical, they don't keep me up at night. I want to understand "meaningful use," after all, it's the benchmark for capturing stimulus incentives. I also want to understand the certification guidelines but decided months ago the only EHRs we'd evaluate in our practice must be CCHIT-certified. Vendor promises of future CCHIT will not cut it.

Contracting, training and implementation are my primary concerns.

These three areas are where I can save a lot of money for my practice, or make EHR a big, ugly money pit. And these concerns seem to be but footnotes in most of the offerings out there.   

One exception, I hope, is MGMA's three-part Webinar series that starts Jan. 26. I've signed up for it because it's the only Webinar series that addresses what I feel are the key issues of EHR migration. And by doing the series, I get a CD of different tools to help with the migration and a copy of speaker Margret Amatayakul's book, Electronic Health Records: Transforming Your Medical Practice, 2nd edition, that I almost bought at the MGMA 2009 Annual Conference. 

• The first Webinar in the series is an overview: What's "meaningful use" and certification, and what are the hoops we must jump through to qualify for stimulus dollars? One highlight: There will be discussion on preparing practices for migration to EHRs.
• The second Webinar will address EHR evaluation and selection. More importantly, it promises to address two of my three big concerns: contracting and training. I'm thinking this Webinar is where I will more than recoup my investment in the series. The speakers have helped lots of practices select and purchase EHRs, and I want to glean their contracting/negotiation tips. I want to know how best to use my training dollars and how to prepare my staff and doctors so these dollars are not wasted. (I've wasted training dollars before with practice management system conversions and need to be wiser this time around.)
• The final Webinar holds similar promise in addressing my third concern: implementation. How can I go from paper to electronic records without costing the practice an arm and a leg and me a pretty good marriage? How do I plan for the conversion? How do I avoid the weeks of unproductive downtime we so often hear about?

Will I still attend some of the free "meaningful use" Webinars from other vendors? At least one or two of them, I guess, though I don't think they'll help with what concerns me most. They won't help me prepare for my upcoming ARRAgeddon. For that, I am hopeful – even optimistic – that MGMA's series will be just what I need to cure my ARRAphobia and begin my migration to EHR.

By Matthew Vuletich, MGMA senior writer/editor

Two plotlines dominated healthcare news in 2009: healthcare reform efforts and the outbreak of the first flu pandemic, H1N1, in 40 years. Here's a look at how the Medical Group Management Association was involved, with a couple other notable events tossed in.  

Jan. 6 - Democrats take control of Congress

The 111th Congress is sworn in and convenes. Democrats hold 256 House seats compared with the Republicans' 178. With the Minnesota Senate race still too close to call, Democrats have 56 seats and the Republicans have 41. Two seats belong to Independents who caucus with the Democrats.

Jan. 20 - Obama sworn in

Inaugurated as the 44th and first African-American president, Barak Obama vows to enact sweeping healthcare reform legislation

Feb. 3 - Daschle is dashed

Health and Human Services secretary, Tom Daschle, who some viewed as critical to Obama's efforts to pass healthcare reform, withdraws his nomination for Health and Human Services secretary after revelations that he failed to pay approximately $128,000 in taxes for using a friend's car service.

April 24 - Rise of a pandemic?

The World Health Organization expresses concern about the spread of influenza from Mexico and the United States to other countries. International cases and deaths are confirmed. 

April 26 - It's an emergency

The United States declares a public health emergency over the swine flu outbreak after confirming 20 cases. The strain is milder than the one in Mexico.

April 27 - A word from MGMA

MGMA and other healthcare organizations outline healthcare reform goals in a letter to congressional leaders. This was just one in a yearlong series of intense lobbying activities by the Association related to reform. 

April 28 - The specter switch

Sen. Arlen Specter, R-Pa., announces that he's switching to the Democratic Party, bringing the Democrats within one vote of a filibuster-proof majority. 

April 29 - Swine flu claims first victim in the United States

The swine flu kills a 22-month-old from Mexico visiting Texas with family. 

May 22 - SGR must go!

MGMA and 59 healthcare organizations make recommendations to Congress and the Obama administration regarding healthcare quality appropriateness and the need to eliminate the sustainable growth rate (SGR). 

June 2 - Obama's wish list

The president outlines healthcare reform principles in a letter to Senate committee chairmen. 

June 30 - The votes are in

The Minnesota Supreme Court declares former Saturday Night Live comedian Al Franken the winner of the Minnesota Senate race. Including two independent senators, the Democrats gain what appears to be a filibuster-proof, 60-seat majority in the chamber. Despite reaching the "magic number," Democrats will struggle to corral that 60-vote threshold and keep healthcare reform legislation alive. 

June 11 - It's now a pandemic

The H1N1 influenza strain, commonly called swine flu, achieves pandemic status - the first since the Hong Kong flu of 1967-68. 

July 16 - Time for tort reform

MGMA and other healthcare organizations urge Congress to include meaningful medical malpractice liability reform in healthcare reform legislation. 

Aug. 25 Senate healthcare-reform advocate succumbs

Sen. Ted Kennedy, D-Mass., dies after a bout with brain cancer. 

Sept. 13 - Help is on the way (not so fast)

Health and Human Services Secretary Kathleen Sebelius announces that the H1N1 vaccine will be available a week earlier than originally scheduled. However, because the vaccine takes longer than expected to develop, the campaign against swine flu suffers numerous delays over the next couple of months. 

Sept. 18 - A reminder: SGR must go

MGMA and 120 national and state medical associations send a letter to senators urging them to repeal the SGR. 

Oct. 29 - One day, two proposals

House Democrats release the Medicare Physician Reform Act, which would eliminate the SGR, and a healthcare reform bill. 

Nov. 3 - Here's an alternative

House Republicans unsuccessfully attempt to introduce alternative healthcare reform legislation. 

Nov. 6 - You have support as long as ...

MGMA announces qualified support for the House healthcare reform bill and legislation that would repeal the SGR. 

Nov. 7 - Alternative rejected, reform bill passes in close vote

The House defeats the Republican substitute healthcare reform bill and then approves the Democrats' bill 220-215. 

Nov. 12 - Support for payment reform

MGMA and 127 physician organizations urge the House to approve the Medicare Physician Reform Act. 

Nov. 18 - Now it's our turn

Senate Democrats introduce their version of healthcare reform. 

Dec. 1 - MGMA weighs in

The Association sends comments on the Senate healthcare reform bill to the entire chamber. 

Dec. 15 - Don't forget the SGR

MGMA and 117 physician organizations stress in a letter to senators the urgency of eliminating the SGR. 

Dec. 22 - More pain than gain

MGMA continues to voice concern about the Senate's failure to repeal the SGR and seeks additional changes to ensure that any final legislation reflects the Association's principles. In another "not so sure about this" moment, Rep. Parker Griffith from Alabama declares that he's switching to the Republican Party. 

Dec. 24 - Surprise! It's 60 to (almost) 40

The Senate approves a healthcare reform bill by a vote of 60-39.

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. 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

Last month we wrote about a somewhat controversial subject – outsourcing the billing and collections department. Lots of you weighed in with your two cents in the comments: some for and some against. Here's what you had to say.

Should a medical group ever outsource billing and collections?

"I'm confident that with any practice of three or more physicians outsourcing is a mistake. If you are having problems with your billing, you need to either get new billing people or a better practice administrator to oversee it.

"The simple 'gross collections' charge that is associated with outsourced billing is much higher as a cost than it is to run an effective in-house billing department, even including salaries, health insurance, payroll taxes, computer/software costs and everything else associated with billing.

"The practice I currently did an evaluation for was paying a flat 6 percent gross collections to its outsourced billing, which culminated in about $270,000. That same practice could have its own in-house billing department with three employees for no more than $125,000. Plus, as the practice grows, the billing costs grow at a much slower rate than with an outsourced company.

"In the end, if a practice has an effective administrator and brings in the right people, no outsourced billing company can compete with it because an in-house billing department doesn't need a profit margin that is separate from the practice's profits. 

"For my part, I want to disclose that I have no affiliation to any billing company or professional management company. I work as a practice administrator and consultant to help practices be top-level efficient. Outsourcing, time after time, has been the biggest drag on many practice's bottom line."  

– Brock Rasmussen

"I disagree with the commenter who suggests that any practice with more than three employees should not outsource. Only a thorough evaluation of your current situation vs. competitive bids from billing companies can help you make an educated decision. I've put both large and small clients with billing services and kept billing in-house with others. As far as the cost goes, no one should negotiate a contract with fees based on gross collections. Any number of factors should be included, including performance standards with penalties."

– Retha Reeves

"Outsourcing your billing is always a better bang for your buck. All of the problems associated with in-house billing go away: no turnover, certified coders, free patient billing and invoicing, denial resubmission without contacting you or staff, especially today when you can have access to the company's EMR to check documentation. No stamp cost, invoice charges or hidden fees. Monthly meetings to discuss your account, dedicated account representatives, toll-free number for your patients to contact the billing service. And staff that work seven days a week instead of your in-house staff who work five. 
 
"I own and operate a specialized billing service for nephrology billing only, and this is why I can speak to it being a win-win situation."

– Pat Hoffman

"The need to outsource billing is the canary in the mine, it is a sign that leadership is not engaged."

– R. Daniel King

"I have experience on both sides of the fence and currently run an 11-provider cardiology practice, and we outsource our billing. I believe there is a break point where it becomes cost prohibitive to outsource billing, but I am thankful not to be at that point right now.

"Given that my background is clinical – I have worked the insurance side, the billing side, have consulted for practice operational improvement and now run a practice, – I think I have a pretty good perspective. I have an extremely competitive rate, get excellent reporting and have terrific communications with my outsourced vendor. Short of the reporting and communications – you're right – you do give up considerable control. I feel quite the opposite at this point. I have dedicated staff who work my accounts. The vendor is extremely responsive to my needs and my accounts/receivable and cash flow are in great shape. The dashboard gives me transparency to assure that activity is constant and that they are not just working the 'low-hanging fruit.'

"Outsourcing gives my practice more time for strategic planning, for growth and focusing on how to best do that given the state of healthcare today. Your geography, your specialty and your payer mix should play into your decision to outsource as well. Obviously some specialties are much more complicated. I believe it's all about how well you negotiate your outsourced contract. Your outsourced vendor can become your partner in improving your practice's financial success."

– Gina Baxter

Didn't get a chance to comment last time? Continue the discussion below.

This past year in healthcare has been a busy one. From the economic downturn to healthcare reform, we've covered a little bit of everything on the blog. The top-read stories this year included favorite topics such as physician compensation and recruitment alongside newcomers such as recommended healthcare Twitterers. Relive your favorites or discover new posts you hadn't read before.

1. Goodbye Medicare consultation codes: Your practice's next steps
   CMS' plan to eliminate consultation codes holds the potential of crushing the bottom line of many medical practices. Here's how you can prepare.
2. Key findings from MGMA's physician compensation survey
   Take a deeper look into MGMA physician compensation survey data and see why physicians in nonhospital-owned practices earn more.
3. Top billing and coding tips for any medical group practice
   In this economy, it's more important than ever to ensure a practice's medical billing and coding staff are efficient and productive.
4. How to collect from patients at the time of service
   Despite economic challenges, your medical practice can do several things to increase collections while a patient is still in your office.
5. How to get noticed by recruiters of medical group practice jobs
   Are you a jobless medical group practice administrator? Dust off the resume and land your next gig with these five medical resume writing tips.
6. Practice management 101 for physicians
   MGMA's Lessons for Financial Success free tools offer powerful resources to help physicians and practice managers improve their business operations.
7. 4 physician compensation models for your group practice or hospital
   Tune up your physician compensation model with these four ideas for your medical practice or health system.
8. 10 healthcare Twitterers you should follow
   We rounded up a few of the healthcare professionals and medical publications we like to follow. Who's on your list?
9. Integrated delivery systems: Understand and avoid the deal breakers
   Medical group practices that affiliate with hospital systems immediately begin to produce red ink. So why join an IDS? Here's how to achieve success.
10. Tips for successful physician recruitment and retention
    From finding candidates to closing the deal, try these ideas in your medical practice for physician recruitment and retention.

P.S. Last year we did a wrap up of the most popular articles on mgma.com.

What should we write about in 2010? Leave a comment and tell us.