What Makes a Practice Successful?
Medical Claims ProcessCrush your billing and collection operations to achieve maximum results
- Obtain and enter correct data into your electronic system the first time. The old adage “garbage in garbage out” still applies. Correcting data is time consuming and expensive
- Preauthorize all appropriate services. Don’t wait to retro-authorize
- Collect all cash copays upfront and don’t wait to bill the patient. No excuses!
- Send the bill to the insurance company electronically and within 48 hours of service
- Know your contracts and appeal every claim paid incorrectly
- Your total accounts receivable should be well below 2 months of charges
- Total cost to collect should range between 2.5% and 7% of all collections, depending on your services
FinancialThink about your assets which are employees, medical equipment, space, and reputation. How are you using each to maximize revenue?
- Every employee should be providing you leverage and the ability to perform as a physician at a higher level of productivity. Within a successful practice, each employee is an extension of your services as a physician and makes a contribution to the practice’s efficiency and services. Each person plays a dual role, ie, nurse and sales, front desk and marketing, medical assistant and sales.
- Each piece of medical equipment should be making money for the practice. Ensure it does
- Maximize the revenue versus nonrevenue space within your practice. If you have space that is not utilized, consider other options, including whether restructuring your current services and adding services to use the space or subletting the space to other providers
- Know your specialty’s financial benchmark’s and understand where and how you are relative to them. What can you do to surpass them? One word of caution: place higher value on leveraging your assets than cutting expenses. Successful practices may have higher expenses than average, but also higher revenues and higher physician income!
- Protect your reputation, period. Lowering your reputation’s value has long-term negative financial consequences to you and your practice
MarketingPlan your marketing carefully, making sure you have determined how you will measure results. Don’t spend practice marketing money blindly; always know the effort’s value so you can repeat those efforts with the highest returns.
- Every patient/referring physician/payor/employer contact by the physician and the office staff is a marketing event. Know how you handle each one and the marketing impressions made with each contact
- Know who your customer is: patient, payor, referring provider, employer, etc
- The bottom-line goal is new patients. Track new patients carefully, as they are the leading indicator of the practice’s health
- Walk through the practice using the patient’s eyes of the patient. What do they see? Does your facility, telephone and systems, physical access, location, furniture, fixtures, staff appearance, and professionalism match the marketing image you want? If not, do something about it now
While not everyone is satisfied, successful practices have a very high percentage of satisfied patients. Satisfied patients tell their friends about the practice; dissatisfied patients tell everyone about the practice.
You need to know how your patients feel about:
- Access to your services
- Clinical quality
- Your physicians
Physician SkillsSuccessful practices have physicians who know that their clinical skills are assumed, and that patients perceive value based on other key criteria. Successful practices are rarely sued, since conflicts and problems are addressed openly and timely. These criteria include:
- The office staff interaction with the physician to care for the patient
- If the physician appears to listen to their problem
- If the physician appears to understand their problem
- If the physician appears to care about their problem
ReferralsSuccessful practices are careful about whom they refer patients to. Their reputation is related to the referral quality for specialty care, diagnostics, or treatment. Demand timely reports and ongoing communication about patients referred. Expect the patient to be returned when appropriate.
EducationSuccessful practices continually educate all employees about their services, the industry, and the standard of care in their community. All employees know services provided and why their services and their physicians are as good as or better than other providers. All employees know why the practice performs certain services and feel very good about referring people to the practice.
- Hold monthly clinical education meetings for all employees
- Undergo monthly case conferences for the clinical team which may include invited referring- or referred-to physicians
- The practices’ providers maintain and advance their skills and education
- The practice adds at least 1 new service every year
Location and LifestyleEverything about your geography is relative. What may appear successful in La Jolla, California, may be below average in your community. Except for completely subprime markets with high government payor mix and low incomes, most cities and markets allow for a successful practice. You can find success even in “subprime” locations, whether rural or major city, as every physician’s definition of success, altruism, and personal mission is different. Since every market has wealthy and poor and every region has attributes that make it nice to live there, establish yourself in an area you like to live in, one in which you can become a contributor, and choose a location within that region/city that matches the expectations and image you desire to build.
By following these criteria, we hope to provide you with an arsenal of ideas and tools to help make your practice as successful as possible.