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Reimbursement and Practice Management

Performance Tips for Challenging Times

Managing a specialty practice is more challenging today than ever.

In this Pulse article, review tips from better performers to help manage your specialty practice in challenging times by:

  • Listing key factors to look for in prospective employees
  • Identifying revenue cycle focus for improvement
  • Describing ways to re-engineer workflow with technology

View related pearls

With reimbursement plunging and the future of health care financing uncertain, successful practices focus on refining practice management results, instead of allowing the chaos of the external market to reign. Although success can be defined in many ways, maintaining quality medical care for patients in your community – and staying well-positioned to do so for many years to come – requires a solid bottom line.

Recently I was able to spend some time with three seasoned administrators who shared their insights on the best practices for steering a medical practice to success during these turbulent times.


Managing the flow of patients is vital to maximize revenue – just as important, you must optimize the patient's experience. Process improvement in a normal business is an annual undertaking – in a successful practice, however, it's an ongoing process. Recognizing that every minute is precious, high performers focus on scheduling optimization, a supportive infrastructure and ensuring that patient flow is streamlined each and every day.


Let's face it; a human being can look busy eight hours a day. Successful practices realize that having a topnotch staff is the key to rendering quality care in a highly productive environment. Expectations are so high – and the value that each person brings so important – that successful practices innately know that hiring the right person is the first step to ensuring a highly productive workforce. Hiring for “fit” as well as “function” is how successful practices approach recruitment of all employees, not just physicians. They recognize that it takes a team to produce at the levels needed in today's busy, service-oriented medical practice.

Patient Management

Practices managing neurological issues often have challenging patients. Sometimes overmedicated, often frustrated by the failure of other physicians to manage their care, these patients can be difficult. Fighting fire with fire – talking back at a patient who is yelling at you, for example – is no path to success. High performing practices realize that managing difficult patients is a fact of life in their environment. And they don't leave the process to chance. Indeed, they spend time and effort in creating a patient-friendly office – recliner chairs, for example, in exam rooms – and training providers and staff to manage difficult situations.


Controlling costs is at the top of the list for successful practices. Better performers constantly evaluate – and often outsource – the services and processes that underlie their expenses. High cost items like health insurance for employees have come under scrutiny, but even smaller discretionary items, such as holiday parties, are being scaled back. From printers to medical supplies, every dollar spent is scrutinized.


With the EHR craze sweeping the country, it's easy to get swept up in the movement to purchase technology. Planning for an EHR or other technology purchase is the recipe for a successful technology implementation. Instead of shifting staff from the medical records room to the records scanning area when an EHR purchase is under consideration, for example, high performers first consider – and reengineer – the workflow to gain value from the technology. This approach may help save money while improving service to patients. For example, to reduce the amount of paper handed to patients – and improve patient knowledge – direct patients to the practice's web portal to retrieve after-visit summaries in lieu of printing them. Encouraging patients to visit the practice's YouTube channel to watch a video of you describing proper post-procedure instructions is another example of the smart use of technology. Other opportunities may lie in gaining new efficiencies, such as automating the charge capture and entry functions. High performers focus first on working smarter, they seek out the hardware and software to support or make possible those efficiencies.


As fee schedules decline, it is more important than ever to determine and improve relationships with payers, as well as, other practices. Successful practices analyze and negotiate contracts with payers, and explore opportunities to solidify relationships with employers and Worker's Compensation carriers, including direct contracting. Evaluating the market, better performers also recognize and seek out opportunities to partner with other health care providers, when appropriate.

Practice Manager

A practice is a complex business, and ensuring that it runs well every minute of every day is a necessity in today's challenging times. When hiring a manager, seek out candidates who show a knack for multi-tasking and have a proven potential for leading and managing people. Instead of solely reviewing a candidate's years of experience in practice management, look for the individuals who have the vision and management skills to lead continuous performance improvement, as well as enhancing the finances of the practice.

Revenue Cycle

From coding to final payment, optimizing the revenue cycle is critical. Successful practices focus on the inputs to the revenue cycle – accurate insurance and demographic data, full accounting of all charges, upfront collections where applicable, and a timely and accurate pre-certification process. Payments are scrutinized at the line item level in recognition that payers have an economic incentive to deny or reject payment for claims. Measuring and monitoring denials allows the practice not only to hold payers accountable for timely and accurate reimbursement, but also to initiate performance improvement related to internal revenue cycle processes. If someone disregards the insurance verification process, for example, monitoring denials will swiftly identify this problem, and management can correct it. Most of all, successful practices recognize that the revenue cycle is no longer the exclusive domain of the business office – indeed, pursuing all deserved payments is a core function in which all members of the practice staff must actively participate.


A physician's time is limited, so successful practices determine whether ancillary services can add value to patients – and the bottom line. Although surgery centers have long been an investment of choice, practices today are scrutinizing every opportunity at hand. For example, a pain practice performing a large volume of laboratory work or medication management might find value in bringing those services in-house if the reimbursement environment supports it. Adding alternative medicine, such as acupuncture, might even be under consideration if the value can be achieved. Medical technology, such as ultrasound equipment for deploying ultrasound guidance during procedures, also is an ancillary under consideration by many of today's high performers. Investing in ancillaries focused on improving patient care, when the volume of cases and reimbursement levels support doing so, also a characteristic of better performing practice.

While some technologies come and go and our medical reimbursement seems to be in a continued state of flux, the successful practices outperform others by keeping a laser-like focus on the pursuit of clinical and business excellence. They do so by hiring talented managers who combine leadership qualities with their technical and business skills, by recruiting providers and staff carefully to create a team-based, productive workforce, and by measuring their success in terms of patient care and service results, in addition to financial outcomes.

Pearls 03/2012

1. Be Prepared
Create detailed checklists for staff to make sure every clinic session starts with all charts previewed, clean rooms, computers on, equipment placed, supplies stocked, forms prepared, patient education materials ready, and any special items the physician may need for that day's clinic on hand – within arms' reach.

2. Stay on Time
Become a wizard about time management. Place clear signs and labels on shelves, drawers and cabinets. Use color coding of labels to prioritize storage locations. Standardize everything possible, especially exam room layouts. Develop an inventory system that will tell you at a glance when it's time to order supplies or stock more forms.

3. De-Stress the Phone
Reception staff cannot do justice to good phone service and accurate patient registration when the phones are jammed and the front counter is overwhelmed with arriving patients. Staff registration adequately and move phone duties into a quieter area near, but not in, your busy reception area.

4. Hire for Attitude
Most practices limit practice hires to persons with experience in their specialty, but this might be re-cycling less-than-average employees. Instead of looking for hires solely based on experience, hire a person from the hospitality industry for an administrative duty, or a topnotch nurse whose experience has been limited to the emergency room. Schedule a three-hour “working interview” with your top candidate to see if they will fit in the team. Even if it takes longer to find the right person, it will be well worth it.

5. Benchmark the Numbers
Measuring and monitoring the revenue cycle allows you to compare key indicators of billing and collections performance from month to month, year to year and, importantly, in relation to industry standards for your specialty. Keeping key performance indicators at your fingertips also helps you find opportunities to improve your business performance or spot problems with payers. Indicators include aged trial balance, days in receivables outstanding, adjusted collection rate, and last, and certainly not least, cash.

6. Payment Expectations
Create a uniform financial policy, like a minimum deposit for procedures paid before the service is rendered. Reinforce your policy by posting it on your website, in written patient ‘welcome' packages, into scripts for schedulers and those making appointment reminder calls. Teach your staff the most effective ways to politely and directly ask for payment, including citing the patient's insurance company's requirements for payment of copayments at the time of service.

United States