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Reimbursement and Practice Management

The Best Angle

In the busy-ness of delivering great care to patients while assuring effective business and clinical operations, difficult decisions need to be made. Sometimes we make decisions based on a single perspective in order to be nimble. However, it is often worthwhile to get multiple perspectives before finalizing the decision.

I am reminded of our family photo contest, where we competed for prizes in whimsical categories and shared a day on the road, exploring photo-ops. Often we photographed the same subject – but from quite different angles.

Consider the following scenario. Revenue has been following plan with some minor fluctuations. This month revenue is off 30% – a very significant dip. The billing manager doesn't have an answer. There has been no change in providers or contracts. No new procedures have been initiated. Referrals look the same, and charges were posted in a timely manner. So what's up? You decide to change things up and let the billing manager go. Later, the billing staff discovers a certain payer had denied a significant number of claims – reasons unknown. The revenue team digs deeper for the answer, working with the provider relations and claims staff at the payer. It turns out there had been an internal credentialing change at the payer causing some taxonomy codes to auto-deny. It was a payer change that caused the denials to go up and collections to go down. It really was not in the practice's control – yet discovery led to recovery.

Making nimble decisions regarding key business process and staffing in the medical practice is essential at times. Even when an expedited decision is necessary, make sure you get the best angle. Take shots from a variety of angles – then make the best decision for the medical group and carry on in a timely manner.

United States