Medical Billing for Orthopedic Practices

To facilitate communication within our departments, on a daily basis I do a walkthrough of the departments. It’s an opportunity to personalize who we are as an organization. It’s an opportunity to get to know all of our employees and help them feel that they are truly important to our objective of doing a superior job managing our client’s revenue cycle.

In doing that on a consistent basis we’re also able to notice why the pile is increasing on this individual’s desk and be able to have a dialogue with that individual or their supervisor. At a minimum of twice a month I’ll try to sit in our break room during the lunch period and I’m fascinated with some of the things I hear. This allows me to go talk to someone about, “did you hear?”, “did you know this was broken?”, or “did you realize this or that?”. Asking these questions helps you stay close with your employees.

I have yet to meet an orthopedic surgeon who likes surprises. When it comes to the revenue cycle, assure that there’s good, frequent communication with the individual responsible for doing the physician’s coding. It is important to have a free exchange of information so that the physician continues to feel comfortable. We as leaders feel comfortable that our physicians are doing everything right relative to documentation and that we’re in fact coding correctly and maximizing revenue based off the level of documentation.

Lastly, physicians’ involvement is very important. We’ve learned it’s important to have one or two physicians, depending on the size of the practice, act as a physician liaison and be committed on behalf of the practice to spend an hour a month with the appropriate people discussing what’s occurring within the business office related to the management of the revenue cycle. Help educate the physician on the whole revenue cycle process and all of the challenges involved. Educating the physician and making them aware of the complexities has been fabulous for us in terms of experiences.

Having a physician understand realistic expectations is also important. For example, a physician can talk about the revenue cycle of his or her practice and the credibility they have contrasted to Dave Wold or Dave D’Silva, having that same conversation. It does add to what we’re trying to do: Bring credibility and add to the effectiveness of what we’re creating for our physicians related to the revenue cycle.

It’s interesting, and our doctors who agree, are typically fascinated with all the little nuances. My favorite is talking to the doctors about how their collections are impacted each month based off of the number of workdays, and as importantly, the number of Mondays in a given month. For example, in October we’re looking at 22 days and 4 Mondays. December we have only 20 days but we have five Mondays. We dread January, not only do we deal with the high deductibles, etc., but we’re looking at 21 days and only three Mondays. All of those little nuances impact the revenue cycle.

One of the things we do with our physician liaisons in the fourth quarter is we start to talk about realistic expectations for the practice related to the revenue cycle for 2013. We start to talk about the payer mix. Have we seen a shift in the payer mix? Obviously, what we went through this past year in Illinois in orthopedics for our physicians who have a large worker comp book of business has been devastating. The impact was severe.

Going into 2012, our clients knew exactly how each physician was going to be impacted related to the worker comp. We try to do that by looking at Medicare and looking at the Aetna contracts. Basically, you have the conversation about if our volume is flat based off of the following changes, we anticipate seeing a decrease in your monthly reimbursement of 3.5%, or we will anticipate it being flat and/or we’ll see an increase of 4%. In setting these realistic expectations, it makes our jobs much easier come the end of the first quarter when we’re talking about the revenue cycle and the results of the first quarter.

Knowing in advance this is what Dave and Dave said was going to happen, avoids the challenge of “someone’s doing a terrible job managing my billing”. Anytime the physician’s revenue is affected it all of a sudden becomes a billing problem, and that unfortunately is not always the case.

Again, the following will lead to credibility to the initiative of managing your revenue cycle:

  • Having physician involvement
  • Setting expectations.
  • Frequent communication