Poor cash controls are still one of the most common risks we discover during our consultations.
Poor cash controls are still one of the most common risks we discover during our consultations. Make sure the practice’s “daily close procedure” balances charges and collected amounts with the totals shown on computer reports. Reconcile patient encounter forms and electronic numbers daily to be sure each has been “closed out.” Make sure the month-end bank balance matches the practice-management system report of total collections. Don’t allow the person who opens the mail to post payments or write refund checks. And no one but physician owners should sign checks. Period.
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Reduce your risk by conducting background checks for all final candidates. Trusted Employees is one company that provides this service at reasonable rates.
Do front-desk staff members keep their computer and clearinghouse login credentials on a Post-It Note stuck to their desk? Do some employees know each other’s passwords because they’ve been set up using the names of children or pets? Is your practice still using email instead of secure messaging to communicate with patients? If you can answer “yes” to any of these questions, you are not alone. A lackadaisical attitude about Internet safety is a common risk in physician practices. But with the number of healthcare data breaches increasing, it’s more important than ever to practice good cyber-hygiene.
Start with simple steps, such as insisting that staff use strong passwords and not share them. Hire an IT consultant to conduct a data security assessment.
Consistently under-coding E&M services
This is a revenue risk that can double as an audit risk if you under-code consistently.
Coding a level below the service you actually deliver and document is a financial faux pas. You may think that under-coding one established visit weekday is no big deal. But, for example, $25 less reimbursement each time you under-code, multiplied by 48 weeks per year, adds up to $6,000 annually. And assuming you under-code new patients at this same rate, you’re up to $12,000.
Consistent under-coding can also draw unwanted payer attention to the practice. For example, CMS analyzes coding patterns of physicians in the same specialty and state, as well as national averages. Falling outside the norm of your peers’ coding patterns can make you a potential audit target.
If you haven’t reviewed E&M usage in recent memory, generate a report from your computer system of all E&M codes used by each physician during a one-year time frame. Create bar graphs that show each physician’s usage pattern, and request your specialty and state data from CMS to compare it against the coding patterns of your physician colleagues.
Although physicians and administrators don’t need to know every last software feature or operational protocol, the practice could be at risk if physician leaders don’t understand essential business functions and review vital reports. For example, If you take the time to review the adjustments report at least quarterly, you’ll be more apt to ask questions about why so much is being written off to categories you don’t recognize.
Karen Zupko is president of practice management consulting and training firm KarenZupko & Associates, Inc., working for and with physicians for more than 30 years. Send your practice management questions to firstname.lastname@example.org.