Physicians Practice - January 2008 - (Page 26)

GETTING PAID reimbursements to physicians — bundle procedures, and put protocols in place as barriers to care (e.g., preauthorization). “If it takes 30 to 45 days for physicians to catch on, you’re saving millions,” says Madden, who even worked for UnitedHealth for nine months. It’s these little erosions that add up to big, big losses for physicians, she says. “There are initiatives put into place that target small-dollar areas.” WHADDAYA KNOW? A WIDENING GAP Primary Care Hit by Declining Reimbursements $110 Average Reimbursement for All E&M Codes I I I Medical Specialty Primary Care Surgical Specialty $100 $90 $80 and cost of delivery of services,” says director of outreach programs for the American Academy of Professional Coders Barbara Cobuzzi. “If I were making widgets, I would know the cost.” Not so with medical practices; there are just too many variables. Costs include overhead, ancillary personnel, rent, and supplies, to name a few. Hence, the birth of the volume-based practice. “Physicians think they’ll make it up in volume,” she says. “But doing more just means it’s costing you $70 $60 2004 2005 2006 2007 its stockholders. Sound wrong? To many people it does, “unless you put your business hat on,” says Nick Fabrizio, a Medical Group Management Association senior consultant. “They’re taking advantage of the market.” Juliet Breeze, a part-time family practitioner and CEO of Partners in Practice, a Richmond, Texas-based practice management consulting ﬁrm, concurs. She even admits a grudging respect: “Insurance companies are worthy adversaries. They have very good strategies.” Insurance companies employ many ways to increase their proﬁt margins by playing around with operating income. They lower their “medical loss ratios” — industry-speak for what an insurance company pays out in Prevailing foggy perceptions by physicians also frustrate Madden: “Most physicians are not business people. They want to take care of their patients. I can’t tell you how many ask why they need to know about [payers’] policy changes.” You do need to know about policy changes, and more, if you’re truly interested in bettering your situation. Speciﬁcally, you should know: Your data. Pop quiz: Say you were promised $99 for a 99213 by a payer. Are you actually getting that? Fabrizio says that many physicians would have no idea if asked. Shaving just a couple dollars off this one very common code can cost you tens of thousands of dollars. You should know your top 20 codes in this intimate fashion. Make yourself an Excel spreadsheet with one row for each payer and your top 20 codes across the top. Track timeliness, denial rate, and whatever else makes sense to you. “Trend each payer. When you do that you can really see what’s happening,” says Breeze. Leverage is being able to jab your ﬁnger at some indisputable facts and say, ‘Did you know you deny 20 percent more claims than other payers?’ Breeze also points out that, “A new trend with insurers is to pull out a ‘report card’ on you. … If you know your own data, then if those report cards don’t seem accurate, you’ve got your own data to refute it — a little bit of turning the tables.” Your costs. This is admittedly easier SURVEY STATS Responses Gross total Online Count 762 701 61 760 Percent* 100% 92% 8% 99% • Fax/Mail • Usable total Region Southeast/ South Central 267 Middle Atlantic 151 North Central Paciﬁc Mountain New England Group Size Solo 2-10 11-50 51+ Area Type Suburban Urban Rural Specialty Family/General practice Allergy Internal medicine Pediatrics Dermatology Gastroenterology OB/GYN Orthopedics Otolaryngology Surgery Endocrinology Psychiatry Neurology Ophthalmology Urology Other specialty 121 109 69 58 55 50 37 30 20 19 18 17 15 14 12 116 16% 14% 9% 8% 7% 7% 5% 4% 3% 3% 2% 2% 2% 2% 2% 16% 341 229 133 45% 30% 18% 280 376 74 30 37% 49% 10% 4% 135 76 68 27 35% 20% 18% 10% 9% 4% READ MORE ABOUT IT! Visit this article online at PhysiciansPractice.com to: • View additional data and charts from the 2007 Fee Schedule Survey. survey to our 2006 survey results by typing “Power to the Payers” in our Search Articles box. • Compare the results of the current * Percentages may not equal 100 due to rounding and/or unreported data. Survey distribution/advertisement via: • Physicians Practice issues May to September, 2007 • Eight issues of PEARLS e-newsletter • One issue of PEARLS on Coding e-newsletter • Get the inside scoop on individual payer performance by typing “PayerView” in our Search Articles box. 26 | PHYSICIANS PRACTICE | JANUARY 2008 said than done. “There’s no real relation between reimbursements NOTE: We publish CPT code information reported by three or more respondents only. WWW.PHYSICIANSPRACTICE.COM http://PhysiciansPractice.com http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - January 2008

Physicians Practice - January 2008 Contents The Bigger Picture: Fixing Medicaid Letters Physicians Practice Pearls: You Can Teach an Old Dog New Tricks Noteworthy Cover Story: Fee Schedule Survey: 2007 Results Adding Ancillaries: Bucking the Practice Ask the Experts Idealab: 'How I Got Over My EMR Excuses' Technology: Don't Be Denied The Tech Doctor: Blessing or Curse? The Administrator's Desk: Learning From the Best Coding Career: To Partner, or Not? Management: Controlling Your Inventory Human Resources: How to Fire an Enployee Finance: Beyond Reimbursment - How to Fix Your Mix Classifieds Advertiser Index

Physicians Practice - January 2008

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