Physicians Practice - January 2008 - (Page 75)

stay in accounts receivable compared to Medicare? • Allowables compliance: Does the payer live up to the allowable amounts in its contract? This measure should reach close to 100 percent unless your staff members make errors on claims paperwork. • Response to appeals: Does it take a few days, a few weeks, or longer? • Credentialing: How long does it take to credential a new physician? How much paperwork is required? Do they allow a doctor undergoing credentialing to bill for services? • Referral and authorization processes: “For some payers it’s like a game of ‘gotcha’ — they just want you to miss one step to get out of paying,” says Happold-Latham. LOWER AVERAGE • Aging A/R: How long do the payer’s claims HIGHER units (RVUs) to measure physician effort, also consider using RVUs to assess payer performance. Do they measure up? ALLOWABLE AMOUNT • Revenue per RVU: If you use relative value your slowest, most complex payer that TABLE 2 causes you the most hassle (often that’s COMPARING PAYERS worker’s compensation) and a -5 to your dream payer if you have one, or Payer A (-2) Payer D (+19) perhaps the hypothetical cash-paying patient who always pays in full at the time of service. Payer C (+2) After tallying each payer’s scores using either approach, place them in the appropriate quadrants of a table (see Table 2) that takes into Payer B account both their perceived hassles (-19) and their allowable amounts based LOWER AVERAGE HIGHER on the top 10 or 20 codes your HASSLE FACTOR practice uses. You may find that Placing each payer into the proper quadrant of the high-hassle payers pay more and box above according to its average allowable amount and its hassle factor. This exercise can help low-hassle payers pay less. This clarify whether a payer’s reimbursement level justifies its adds another dimension to your degree of hassle. evaluation. Your ﬁnal step is to rate payers These exercises should not serve according to amount of hassle and as your sole method of evaluating the percentage of your practice’s your payers, but they can help paint gross charges they represent. As you a better portrait of which payers are can see in Table 3, Payer D may presworth keeping and which ones you ent a lot of hassle, but it also represhould send packing when contract sents a large part (55 percent) of the renewal time rolls around. practice’s business. • • Arbitrary decisions: Does the payer reverse PERCENTAGE OF GROSS CHARGES course after paying for certain procedures and then deny ever having done so? Happold-Latham says some payers make her staff spend time digging through records to prove otherwise. TABLE 3 ARE THEY WORTH IT? 100 90 • Overly selective labs: Practices that deal with several dozen insurance carriers may ﬁnd it a hassle if payers limit their patients’ access to only certain laboratories. “If we send it to the wrong lab, then we get stuck paying,” Happold-Latham says. 80 70 60 Payer D (+19) 50 • Third-party authorization reviews: Is the payer more likely to require outside reviews when physicians request certain services? “The payers must ﬁgure that if they make us jump through enough hoops for radiology, we’ll just order less of it,” says Happold-Latham. 40 30 Payer C (+2) 20 Payer B (-19) Medicare (0) Payer A (-2) • Confusing EOBs: Although there’s no standard explanation of beneﬁts (EOB) format, some payers’ forms make it difﬁcult for staff to determine what to post into patients’ accounts, Happold-Latham says. 10 0 • Uninformative insurance cards: Do cards display enough information for staff to determine what plan covers the patient? Or do staff have to always call and check? LOWER AVERAGE HIGHER HASSLE FACTOR Comparing each payer’s hassle factor to its percentage of your practice’s annual gross charges shows that cancelling Payer D’s contract might rid the practice of a major headache, but at the cost of a substantial amount (55 percent) of its annual gross charges. JANUARY 2008 | PHYSICIANS PRACTICE | WWW.PHYSICIANSPRACTICE.COM 75 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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