Hospital acquisitions of physician practices are on the rise. More than 5,000 physician practices were acquired by hospitals between between July 2015 and July 2016, according to a report from the Physicians Advocacy Institute. They expect this trend to continue.
While an acquisition can be positive in many ways for an independent practice, it increases the need for attention and oversight to billing processes so that revenue does not slip through the cracks.
“The number one thing to do if you’ve been acquired is make sure that the healthcare system brings on the expertise needed to integrate,” Jimmy Burnett, managing director of revenue cycle business unit for Navigant, a consulting firm that helps healthcare providers improve costs and optimize revenue cycle, says.
The importance of reconciling
Burnett says that hospitals tend to acquire practices and then “flip them to hospital based status” which can produce split bills. This sort of billing issue requires a unique expertise that a traditional practice might not be prepared for.
He stresses the importance of having a qualified person or system to make sure that these bills reconcile every month.
“We see this a lot, where we go in and find millions of dollars that nobody billed. Don’t assume somebody’s doing it. If you’re responsible, you need to make sure and validate who’s doing it, so you’re seeing those reconciliations,” he says.
Transfer contracts to track underpayments
Equally important in the process of reconciling managed care payments at the end of each month is that the payer contracts are all loaded into the practice management software. “You need to know that the payer was supposed to pay you $5 but only paid you $4.82,” Burnett points out. While 10 or 20 cents on an individual transaction isn’t much, over volume this could add up to hundreds and thousands of dollars lost.
“We highly recommend that monthly and quarterly you take those underpayments back to the payer,” he says.
He also insists that “the more automated, the better,” because it will make the process quicker and require fewer staff. However, old systems may require a manual process if a new system doesn’t allow for contracts to be easily transferred, in which case he stresses the importance of having a qualified staff member complete that task as soon as possible.
Get information up front
If the hospital system has a patient portal, Burnett insists that it’s important to get full patient registration up front to be sure that patients are insured and billing information is accurate. “We’re finding people who are not getting the authorizations, not doing the referrals, and it’s big money [lost].”
Strong coding practices
Burnett emphasizing the importance of having a well-trained, certified coding person on staff.
Coders should undergo trainings on a regular basis, he says. Additionally, the practice should engage a coding audit program to make sure the codes used are as current and correct as possible. “We’re seeing a real deterioration in coding,” he says. “We don’t know if hospitals are jut cutting back or if coders are having to pay for their own training, but he stresses that it can cost any practice money.
Optimize the EHR
Lastly, and probably most obvious, Burnett says it’s crucial to make sure that the EHR and practice management systems are optimized, running correctly and that any transfer of information between an old system and new system hasn’t resulted in lost data.
An acquisition may bring about a number of changes, but ultimately, Burnett says: “Don’t forget your basic fundamentals of physician billing. You still have to follow those.”