1. Have physicians subspecialize. Orthopedic surgeons should learn an ultra specialization, says Craig Levitz, MD, an orthopedic surgeon and partner at Orlin & Cohen, to keep the practice profitable. Surgeons should focus on performing only a few different procedures, such as arthroscopy, instead of performing general orthopedics. Join with other surgeons who specialize in different areas to make the practice more versatile. “When you are doing the same thing every day, you can do it more efficiently, both quality- and time-wise,” says Dr. Levitz. “If you are setting up to do the same thing every day with the same team, you work quickly.” He says the average time it takes surgeons to perform an arthroscopy is 1-1.5 hours. With his ultra-specialization, he is able to perform the surgery in 10 minutes. “Regardless of the reimbursement curve, you are generating money,” he says.
2. Reassign staff responsibilities to maximize productivity. We reviewed front office job duties in both our physical therapy department and our clinic, says Penny Forbes, practice administrator at Sierra Regional Spine Institute in Reno. We noticed the support staff in PT had several hours during the day that were “down time” hours. This position requires the employee to be present throughout the day to handle calls, scheduling and billing, but this employee is efficient and was often left with little to do for various periods throughout the day.
In contrast, on the clinic side our front office supervisor often runs out of time because her duties include editing dictation, daily scanning, helping with phones, check out and supervising five other staff members. She also covers each member of the staff when one is out on vacation or sick leave. During this coverage period the dictation and scanning duties are often delayed.
So we assigned the daily scanning to the PT front office staff member to fill her down time, and freed up the clinic supervisor who could then continue to cover not only in the front office but we were able to extend her reach to the x-ray desk and even to the clinic. We have thus enabled our employees to multi-task at a greater level without hiring additional staff.
3. Simultaneous reporting from the physicians. Physicians should document each procedure immediately after the procedure. When a physician waits until the end of the week to document their procedures, they risk forgetting the details of the procedure or writing an insufficient report for the coders to create a claim. Detailed reporting is crucial for the coders to accurately bill for correct reimbursement. “Coding is an art, it’s not an exact science,” says Jay Nussbaum, CEO of Healthcare Watchdog, a medical billing and advocacy group with offices in New Jersey and California. “A lot of times, what you’re going to code depends on what the doctors write in the documentation”
Additionally, if a claim is denied because the payor found a procedure unnecessary, detailed notes help physicians defend their choice to follow through with the procedure. “If the physician has taken good notes, they can make a good claim as to why the procedure was necessary to the insurance companies. Making that strong case really can turn a lot of denials into approvals,” says Mr. Nussbaum.
4. Payment tracking software. After a physician enters into a contract with a payor, he or she often assumes the contracts are met, says Dave Wold, CEO of Healthcare Information Services. However, payors sometimes underpay on contracts and losing this money can make a big difference to the practice. Mr. Wold said one of his clients recently identified over 500,000 underpayments while another discovered 100,000 instances where the payor stopped paying for a second procedure when contract guidelines stated the payor would. Payment tracking software allows the physician to enter in different negotiation schedules and then run the payments through to ensure the payor is meeting contract guidelines with each claim.
