Memo From the Editor

The money you're missing out on

By Jeff Forster, Editor

This isn't a come-on for lottery tickets, or an invitation to strike it rich on "Millionaire" or "Survivor." It's a simple plea to look within your own house—rather, your own practice—and understand that you may be missing any number of opportunities to bolster your income.

The revenues I'm talking about are not undeserved windfalls, but money that flows from the basic and time-honored principle that an honest working man or woman should be paid appropriately for an honest day's work. It's bad enough that reimbursements are down and costs are up. Why widen that gap by shortchanging yourself of revenues you've rightfully earned? Consider:

• Half of all claims denied or downcoded by health plans go unchallenged by physicians—even though an estimated 25 percent of denials are overturned on first appeal and another 25 percent on second appeal. If you haven't been denied or downcoded lately, you're not in the mainstream. In a recent AMA survey, about half the physicians reported they'd had a claim retrospectively denied within the past year. Three fourths of the respondents said they'd been downcoded; in some practices, one claim in five came back that way.

• Inept coding at your end lands a direct hit on your bottom line. Kim Pollock, a practice management consultant for Chicago-based KarenZupko & Associates, cites an orthopedic practice that lost $1,500 on a single claim by not coding properly for bilateral surgeries. To make matters worse, the doctors and staff didn't read the explanation-of-benefits statements closely enough to understand that the payment was much less than it should have been.

• Inattention to accounts receivable can bleed a practice of its economic vitality. A family practice in Louisiana let its A/R age enough to sprout not only whiskers but a full-grown beard: $100,000 was outstanding for more than 150 days. When the staff aggressively attacked this mountain of unpaid bills, the profit margin jumped by 20 percent within one year.

It's time to be aggressive where missed income is concerned. Steve Coplon, a practice management consultant in Tennessee, bluntly talks about the "war room mentality" he fosters among his doctor clients—the war being one of survival, the foot soldiers the folks in the back office.

Plenty of your colleagues have answered the battle call. Some have done it by arming themselves with education. After enrolling in a Johns Hopkins "Business of Medicine" program, a pediatrician who shares an office with her husband started running the business. They saw revenues go up 30 percent in 18 months, in part because she now understands the mechanisms of billing and getting paid.

I've listed a few key articles below that might provide you with inspiration and practical guidance. Making your practice as successful as it should be requires learning how to counterpunch. You won't connect every time, but you'll feel really good when you do.

Suggested reading

Physician's Payment Update. The February 2001 edition of this subscription-based newsletter offers strategies for fighting denials and downcoding (www.ahcpub.com/online.html).

From Medical Economics:

"Show us the money!" How to make sure your fees are collected (July 27, 1998)

The biggest coding blunders—and how to avoid them (Aug. 21, 2000)

Are you being paid less than you should? (June 5, 2000)

 

Jeff Forster. Memo From the Editor: The money you're missing out on. Medical Economics 2001;4:7.