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Tom’s Top Ten (Weaknesses in the Physician Revenue Cycle) Tom Ealey, an experienced practice administrator and practice management consultant, is an associate professor of business administration at ALMA College in Alma Michigan.

HCCA Physician Compliance Conference

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Page 1: HCCA Physician Compliance Conference

Tom’s Top Ten(Weaknesses in the Physician Revenue Cycle)

Tom Ealey, an experienced practice administrator and practice management consultant, is an associate professor of business

administration at ALMA College in Alma Michigan.

Page 2: HCCA Physician Compliance Conference

Disclaimer:

Any opinions expressed are those of the seminar leader and not those of the Health Care Compliance Association or Alma College.

This seminar is not an attempt to provide legal or consulting advice. Such advice should always be obtained from professionals with the proper licensing and qualifications.

Page 3: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

At least we agree on the date for theChristmas party!

Page 4: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

#1

Weak governance in the physician group creates many problems, and is likely to leave the group unable to develop and implement an effective compliance plan.

Page 5: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

The rules do not apply to Me, the rules apply to staff.

I am a physician, after all.

Page 6: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

#2

Some physicians do not believe the rules apply to them. Several are likely mopping the dining hall in a federal prison this very moment.

Page 7: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

Which Bob Smith? We have ten of them!

Page 8: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

#3

Weaknesses in gathering and maintaining demographics and insurance information plague physician office revenue cycles.

Page 9: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

We are too busy to get organized!

Page 10: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

#4 The Busyness Syndrome

The pace in a physician practice is fast and relentless. Being behind becomes par for the course. Niceties such as organizing and training get left behind.

Page 11: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

What management should be:

plan > organize > direct > control> feedback> plan……….

What management becomes:

hang on for dear life!

Page 12: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

There are about 7800 CPT codes, how am I supposed to understand all this??!!

Page 13: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

#5

Accurate coding requires constant training, monitoring, auditing, and feedback.

Page 14: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

Stark, doesn’t he play cornerback for the Steelers?

Page 15: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

#6

Keeping up with the regulations requires a constant effort and lots of reading, plus regular training efforts for physicians and staff.

Page 16: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

We are collecting a lot of money so everything must be ok, right?

Page 17: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

#7

Missing the details – denial follow up, hold accounts, write offs, co-pays, bad checks, payer correspondence, etc.

Page 18: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

We have a compliance plan, I have a copy of it here somewhere, ah, I know I can find it, ah, maybe this drawer.

Page 19: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

#8

No compliance plan, a cook book plan or a plan that no one pays much attention to.

Page 20: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

I like young doctors, they have all sorts of interesting coding ideas!

Page 21: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

#9

Failure to watch trouble spots; new doctors, impaired doctors, doctors who are obsessed with the bonus plan, etc.

Page 22: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

The vendor said this thing would work miracles for us. It’s got a lot of gigabytes and RAM and stuff.

Page 23: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

#10

Bought the wrong system, or did a poor job of installation and/or training, or failed to use all of the components, or otherwise failed to control the practice management software.

Page 24: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

So what is the cure for the physician revenue cycle?•Relentless attention to detail•Constant monitoring and auditing - data•Follow the flow – front desk to bank deposit•Constant Quality Improvement (CQI)

Page 25: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

Contact Tom at: [email protected] or (989) 463-7135

Also read his work at:http://practicemanagementnews.blogspot.com/

http://healthcarethinktank.blogspot.com/

Page 26: HCCA Physician Compliance Conference

Weaknesses in the Physician Revenue Cycle

THANK YOU!