Increasing Revenue and Reimbursements

Medical practices have always had difficulty establishing usual, customary and reasonable fees (UCR) for procedures they perform. The changing landscape of the healthcare industry puts a premium on fees. For example, reimbursements are too low, malpractice premiums are too high, A/R collections are being unraveled by high deductibles and uninsured patients, and managing expenses requires a high level of creativity.

The best indication of a healthy practice is a solid bottom line. Increasingly, the job of administrators is making sure revenue and reimbursements remain high enough to combat expenses. A remedy for correcting fees is available. A Comprehensive Medical Practice Analysis (CMPA) can be utilized.

The CMPA is more of a tool than a means to an end. A primary focus is establishing correct fees for procedures performed and collecting those fees. Insurance carriers (commercial, HMO, PPO and Workers Compensation plans) generally do not disclose maximum allowable payments. A CMPA analyzes a practice.s fee schedule and compares it to the reimbursements received. The practice.s fees are compared against national and state fees as well as insurance carrier reimbursements. Fees for services below state, national and insurance carrier reimbursements are then identified. Fee changes can be made at this point. Sound statistical and mathematical information enables practices to defend changes. This can help practices increase fees that are too low and maximize their revenues.

Changes can also be made to E&M utilization. E&M codes make up approximately 80% of a typical practice's service base. Improper E&M coding can do one of two things. Under coding will cost a practice earned revenue. Over coding makes the practice vulnerable to third party reviews.

Thousands of changes have been made to the coding system over the past few years. There are over 80,000 combinations of comprehensive and component procedure codes. Common errors practices encounter are using invalid or deleted procedure codes, improperly billing for surgical services, and inaccurately coding for service descriptions. The CMPA provides a solid starting point for incorporating coding changes into a practice.s coding and billing process.

The benefits of using a CMPA to analyze a practice are immeasurable; there are so many tools available. It is impossible to give an all inclusive explanation of the benefits. Overall, practices will be better equipped to optimize revenue and reimbursements.