06 Apr Insurance Reimbursement and Cash Flow Dilemmas for Physicians
Many physicians and medical practices are creating major partnerships and corporations in an effort to coordinate several factors for proving adequate healthcare services. These arrangements are much more efficient in treating a higher volume of patients and allowing physicians to have adequate coverage for their own vacations and free time. When several attending physicians and physician assistants can be on call for emergencies, all patients will receive the proper attention they deserve, and all medical staff will receive they proper amount of time off that they deserve.
There are several facets related to creating these business partnerships in a productive, efficient and financially sound manner. If mistakes are made in the incorporation process, they can carry over into different areas which may ultimately affect patient care and the overall sound design of the business. All parties involved should take care to consider some basic issues related to insurance reimbursement and cash flow.
One of the most important considerations, especially for existing practices that are merging into one partnership, is transferring patients. Any current patients will need to be made aware of the change well in advance. When the partnership agreement is made, all parties will have to provide an inventory of their current patient load.
By being aware of the patient load, and making necessary adjustments for this, the practice will be able to accommodate the existing schedules without interference. The inventory also supplies a good starting point for the practice to determine how many new patients can be added to the workload, so that new patients are fairly divided among available physicians.
When change occurs in a practice, or when practices merge, many of the existing staff members will be transferring to the new office space, at least temporarily. When the administrative side of the office has been established and any necessary software or scheduling programs have been merged, there may not be a need for the additional office staff. It is advisable to have at least one office manager and scheduling assistants for each medical group in the partnership or corporation.
Technicians and lab assistants may be required for any partnership that has a blood draw laboratory on the premises. The smaller offices that are merging together probably did not offer the service, so new staff members and a reputable courier service will be hired for this purpose.
In some states, there are safe harbor laws that allow a local lab to provide staffing for blood draws and courier service. However, if the lab is going to be fully in-house, that’s obviously a staffing issue for the practice itself.
Human resource management as well as training and development will be necessary to operate a larger staff and keep up with all applicable federal, state and local employment laws. Payroll and benefits concerns will need to be fashioned early and should be consistent among all members of the partnership. Differences in salary, especially among employees at the same position level and approximate tenure, create major office politics and uncomfortable situations.
Any medical office that wants to be successful must have essential business practices in place and each employee must be aware of the expectations for their role. In the case of a physician practice, profits are made from office visit fees, co-payments, and insurance reimbursements. Keeping up with these items means the administrative staff must be very knowledgeable and have experience working with different insurance companies and billing software.
Payments should be collected at the time of visit whenever possible. In the event that a patient is invoiced for services rendered, there must be two forms of follow-up: internal and external. The internal follow-up includes a note in the patient file and computer scheduling system, so staff members are aware of the outstanding balance whenever the patient comes in for a visit. The external follow-up includes billing the patient within five days of the initial visit and then every 15 to 30 days thereafter.