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You work hard, you have new patients along with those who make visiting you part of their lifestyle, you try to watch expenses - yet, you wonder why you’re not making the profit you expected.

From a ‘big picture’ view, everyone knows the economy has affected many areas of business and you’re probably no exception. This can actually be a positive opportunity to analyze your business and look for those little ‘drips’ that can add up to a big leak. Whether the economy looks good or bad, it doesn’t have to affect the income or the profitability of your office.

Where do you start?
Has it been awhile since you looked at your practice as a business? While your goal is to help patients, it’s critical to remember you’re a business owner too. That means all decisions must be made from a business point of view, something few people learn in school.

How are you at delegating? You can’t do it all and you also can’t just assign something and neglect to follow-up on progress. Train your staff on how you want tasks done and which position is responsible for each. Provide assignment sheets with an area for initials when the job is complete. This sheet and your follow-through create accountability in your staff reducing miscommunication, confusion and errors while it encourages time management. Delegation frees you to see more patients, network with more people and have free time for your family, friends and yourself. You don’t need to be a slave to the office.

Three easy ways to cut expenses
When you reduce expenses you increase profits.  Review your expenses for the last few months and note where the money is going. Here are three quick areas to check:

One: Electricity. Does your office have a 7-day auto, on/off thermostat set for office hours? There’s no reason to cool the office on weekends or if you close early once a week. Make sure the office temperature is comfortable, but only when you’re there. You can also put motion sensors for lights in areas that are infrequently used – such as a storeroom or bathroom – it’s easy to forget to turn those off.

Two: Supplies. Are you stocked up for the next year? There could be $100 to $1000 in cash tied up for a commodity that is very competitive. Compare prices and order as needed. Not only will your initial expense be more manageable, but there will be less time spent keeping supplies organized, throwing away ink cartridges for the printer that died and making duplicate purchases because the staff didn’t know you already had that widget.
Many practice management software packages have tracking built in so you can know, not guess, what you’re doing with supplies and more accurately forecast future expenditures.

Three: Merchant fees and discounts. These fees add up and can vary between 1% and 2%, so shop around. Ease cash flow by offering a discount if patients pay with cash.  That means you don’t pay the merchant fees and you don’t need to worry about bounced checks. Bottom line, cash payment increases your income.

Big Brother or smart business owner?
You’ve heard about misuse of the Internet.  The U.S. loses billions of dollars annually on its misuse, so monitor office Internet usage as well as personal phone calls.

Make sure there’s a written office policy signed off by each employee that outlines acceptable and non-acceptable behavior in these areas.  Utilize monitoring software and let employees know up front that personal phone use is monitored along with browsed locations on the Internet, dates and length of sessions.

Keep the cash flowing IN!
It’s interesting and true that banks want to lend to people who are in good financial shape, not those who need a loan. To ensure you have money available for that new equipment, hiring another staff member or other out-of-ordinary expenses, keep your line of credit going even when cash flow is positive.

Work closely with your billing manager or billing agency to stay on top of aged receivables. Just because the printed balance report shows zero doesn’t mean there’s not money to be collected. Check reports of dollars coming in and dollars billed out. Here’s an example: perhaps the insurance company denies a $500 claim by stating the charge was over-utilization of a service. Your accounts receivable person decides to write it off. This is not a decision to be made lightly as the denial can possibly be overturned. Create a sheet with a predetermined ceiling, perhaps $200, which requires the signature of your practice manager or you before any write-offs. Money left on the table is a prime area for lost dollars in healthcare.

Customer service – the key to longevity and success
When you hire, check the attitude along with the credentials. Don’t think you’ll change a sourpuss into a people person. Hire the people person from the start; they can be trained for the other duties. This is especially true for the person at the front desk - a very powerful position.  Answering the phone with a smile and the ability to listen and answer questions can go a long way to bringing in a new patient, keeping those you have now and getting referrals. Be sure they’re well trained; it’s time and money well spent.

You’ve worked hard to become a doctor, to set up your practice and run your business. Now it’s time to increase your profit margin and enjoy the benefits of your labor. Take the time to find the leaks. Set up systems to make your office run more efficiently. Hire friendly people, train them well and delegate. And if you need help, find a coach experienced in your profession. These few things can change your future of your practice.

Pamela Davis is founder and CEO of Advantage Claims Recovery Group, Inc.

She has been featured on television shows such as CNN Headline News, Channel 8 News, Fox 4 Insights, Good Morning Texas and was named a “Healthcare Hero” by the Dallas Business Journal.  She is featured on the cover of the book Fearless Women Fearless Wisdom.

This line became famous thanks in part to Tom Cruise in the movie Jerry Maguire, but the mantra remains today when we talk about the Medicare EHR incentive program.  There is a lot of talk, but not a lot of clear direction, so exactly HOW do you get the money?

The Medicare program runs from 2011 through 2014 and requires that eligible providers (EP’s) demonstrate “meaningful use” of electronic health records.  There are 3 main components of “Meaningful Use” as described by the American Recovery and Reinvestment Act of 2009 (ARRA):

     1.      The use of a CERTIFIED EHR in a meaningful manner (aka Stage 1)

     2.      The use of a CERTIFIED EHR for electronic exchange of health information to improve the quality of healthcare.

     3.      The use of a CERTIFIED EHR to submit clinical quality and other measures.

To demonstrate meaningful use successfully in Stage 1, you must meet 20 of the 25 objectives.  These objectives are divided into two types: Core objectives and Menu Set objectives.  There are 15 Core elements and ALL 15 must be met to qualify.  There are 10 Menu Set objectives and an EP must select and meet 5 of the requirements.  The link below will take you to a document that outlines both the Core and Menu Set Measurements required to meet the criteria of meaningful use.

http://cms.gov/ehrincentiveprograms/downloads/ep-mu-toc.pdf

Meeting the requirements for the incentive program may seem daunting, but the monetary reward may certainly encourage eligible providers to adopt a certified EHR.   

Future stages of the program are yet-to-be-defined.  Stage 2 is expected to be implemented in 2013 and Stage 3 in 2015.  CMS will continue to expand on the requirements through future rule making.  Providers will need to meet the requirements in each stage for continued participation.  Those providers failing to meet the requirements by 2015 will see a reduction in the payment structure from Medicare.

Participation in the 2012 Physician Quality Reporting System (PQRS – formerly known as PQRI) can earn you a bonus each year as well.  Not participating in PQRS?  Want to know more?  Watch your in-box for our next “In Your Corner” edition!

Over the past few years, the healthcare field has been inundated with increased rules and regulations.  Increased enforcement of these regulations has returned billions of dollars to the government coffers.  Providers large and small have been targeted.  The Healthcare Fraud Prevention & Enforcement Action Team (HEAT) is a joint initiative between the Department of Justice and the Department of Health and Human Services. 

In 2011, HEAT has been responsible for returning $4.1 billion "stolen or improperly obtained" payments from federal health care programs.  This money was returned to the Medicare Trust Fund.  During 2011, strike force teams secured 172 guilty pleas and convicted 26 defendants at trial.  Of these 198 convictions, 175 defendants were sentenced to prison with an average sentence of more than 47 months.  The South Florida, Los Angeles, Chicago, Dallas, Houston areas are among nine “hot spots” identified by HEAT for intense focus.

Physicians, nurses, physical therapists, billing services, pharmacists, durable medical equipment and home health agencies and their staff have been included in those arrested. 

It is clear that the federal and state governments are looking to recover many of the Medicare and Medicaid dollars paid to physicians.  While some of those dollars recovered came from true fraud, many of the paybacks are a result of coding and paperwork errors.  While Medicare is making the news, other companies like BCBS, Cigna and Aetna have their own Special Investigations Unit and are also busy recovering money from providers. 

In an effort to limit exposure, identify weaknesses and build a protective compliance program, Cornerstone Medical Management offers confidential business review audits.  The outcome of these reviews will identify weaknesses in your office processes, medical charts, billing and reimbursements.

Making the investment to identify and implement practices that protect your practice is what these business reviews are all about.

For information or to schedule your confidential business review contact Terry Coy, CPC, MCS-P at 888.887.5259