This is going to be a pivotal year for urology practices. For starters, we know that the take-home pay for the average urologist has taken a big hit in 2005. Over the past 10 years, urologists have become accustomed to, and in some cases dependent on, the profit from administering LHRH agonists. As one office manager put it, “The Christmas candy is gone.” It’s time to re-evaluate and streamline your practice.
Hopefully, by the time you read this article, the dust has cleared, the fear is gone, and it is business as usual. The pharmaceutical companies have offered you a reasonable contract to continue to purchase drugs so that you can continue to provide your patients with complete care, without additional hassle. The profit from drugs is less, but not as bad as predicted, and the risk of losing money has been alleviated.
Nevertheless, most urologists are looking for replacement income. You can work harder and put in longer hours, but most of us are working as many hours and as hard as we can. That leaves one option: work smarter.
I have two suggestions on how to replace lost income. First and foremost, automate and streamline the business side of your practice. Second, evaluate your practice to be sure you are providing the right services and are spending your time efficiently and wisely. Good patient care should always come first, but replacing poor-paying, time-consuming services with higher-paying, more efficient services is good business.
This article will focus on the first suggestion, namely how to create a fully automated practice and the value it brings. Next month, we will explore specific options and the correct coding for alternate procedures and services to enhance income. Also, by that time we will know the final contracts pharmaceutical companies are offering.
Automation adds up The goal of every practice in the country should be to run the most efficient, patient-friendly, effective practice possible. To do that, one has to run a good business, in addition to being a good clinician.
In previous articles, we have made the very bold statement that you could increase the bottom line by 10% to 20% by complete documentation, accurate coding, payer-specific billing, and follow-up on all claims. These figures are based on our audits of hundreds of urology practices. While almost all urologists think they are running an efficient practice, we have yet to find a practice that could not improve its bottom line.
We have previously discussed implementing an electronic medical record system, practice automation and claims management services, and other software. We have also talked about automation in your practice and how implementing currently available computer and informational products and services can decrease your overhead, increase your income, obtain the information needed to be more efficient in contracting, and improve your clinical practice.
Here is how a typical practice might run if fully automated:
Wake up in the morning, turn on your computer, access the office system via the Internet, check the day’s schedule, and download it to your Tablet PC or look at the schedule your office has printed for you the night before. You head to the hospital to make rounds.
Access patient charts via the Internet for additional information.
Enter your charges into your Tablet PC. Automatically download the information to the office practice management system through the wireless system when you enter the office.
View charts of scheduled patients for the afternoon. All insurance coverage for scheduled patients has been verified and scheduled procedures electronically pre-certified automatically via the Internet. All data for each patient are organized in chart or graph form. History and other health data have been downloaded from the patients’ personal heath records into your electronic medical record. History is completed with minimum additional documentation, and physical exam, impression, and plan are documented by touch screen or voice recognition dictation. Prescriptions sent by e-mail, orders for labs, x-rays, etc. are electronically transmitted. Patient educational materials and referral letters are generated with one click for each function.
Automatic, accurate coding Coding is automatic and accurate. The codes, diagnosis, and modifiers are electronically transmitted to the practice management system. The billing is automatically checked through a web-based database for payers’ specific billing information to include specific payer rules, correct use of modifiers, mandated diagnosis, and bundling edits, among other information. The “clean” claim is electronically submitted. When the payment is received, the explanation of benefits is checked electronically for accuracy and timeliness of payment. If correct, the payment is electronically entered into the practice management system. If incorrect, it is automatically set up for appeals.
In the case of our practice, our day has been simplified. Patient charts, labs, and other data are there when needed. Time has been saved. Overhead has been cut by 10% to 15%. Income has increased by 15%. However, possibly the biggest value is in the data you obtain. The collective data and improved reports will allow you to know exactly what insurance companies are paying. The report card you receive on the payers will improve your ability to negotiate better contracts.
Yes, creating a fully automated office costs a significant amount of money and required a lot of time and hard work. For our practice, it was worth it! The return on investment has been outstanding.
Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver and is also publisher of Urology Coding and Reimbursement Sourcebook
Disclaimer:
The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.
