How Much Money is Your Practice Losing?


How is your practice doing with collections? Many times when physicians are asked this question they will tell you their office is doing a great job with collections. Sometimes they are correct but most often they are not doing as well as they think. Many are shocked to see what they are not collecting.

Missed Copays – Patient copays have increased significantly in the last several years. Let’s assume your office fails to collect 10 copays a week that average $40 each. That is over $20,000 a year.

Missed Office Charges – Charge tickets that don’t make it to the poster or that simply slip through the cracks and don’t get posted. Tickets with only E&M visits that would be reimbursed at only $50 each add up. Only 2 a week results in a yearly loss of over $5,000. That number goes up considerably if the ticket included x-rays, medications, braces or procedures. This doesn’t account for the fact that these additional items may have associated costs that you have already paid for.

Missed Hospital/Surgery Charges – These missed charges can kill a practice. One missed surgery per month with a reimbursement of $2,000 results in an annual loss of $24,000.

With just the 3 examples above, that is a loss of almost $50,000 a year.

Precerts/Preauthorizations - Failure to get authorizations for office visits and precertifications for surgery increase the loss substantially. Some carriers require that precerts be amended. For instance, your staff obtains a precert but once you are in the OR it is decided a different or additional procedure is required. These procedure codes were not on the original precert and may be denied if the carrier is not contacted to have these added.

Follow Up – Ask almost any biller what task they most often do not have time for and they will tell you "follow up" and yet, it is one of the most important aspects of the billing process.

AppealsYour charges were posted, the claim was submitted and the carrier processed it but they denied all or part of your charges. That’s it right? You have to write off those charges? Not always. Often times a missing modifier is the culprit. Other claims may require an actual appeal. Understanding the appeals process and how to put together an effective appeal is essential.

RecoupsJust because the carrier says they overpaid you and are now taking the money back doesn’t mean they are right. Research the claim and understand why they feel they overpaid. Appeal the decision if you disagree.

With a few relatively simple changes in your processes, your practice could increase revenue by 20% or more each year without increasing the number of patients seen.

More money without increasing your workload – who doesn’t want that?

Robin Jackson is an Independent Practice Management Consultant with over 30 years of experience in the healthcare industry.