How an independent practice grew through optimizations and consolidation Current revenue cycle management (RCM) processes in some practices may be well established, but there is always room for improvement and optimizations. At MGMA’s virtual Medical Practice Excellence Conference, Lawrence Jones, MD, partner and physician of One Pediatrics; and Daniel Pope, senior vice president and general manager at R1 RCM, presented “Thriving Financially through Better Claims and Collections”. One Pediatrics, Dr. Jones’ practice, started out as an independent practice founded in 2014. Now a total of seven integrated practices all operate independently across nine locations, comprised of over 40 providers. In 2019, the practice group recorded 179,000 visits, roughly 35% of which came from the Lousiville market. During the time from establishment through the present day, Jones says that his practice was increasingly challenged by hospital groups that purchased ...

  The rapid decline of in-person visitation in early 2020 due to the COVID-19 pandemic revealed the unstable reality of fee-for-service payments, which should be replaced by population-based payments, authors of an article recently published in JAMA suggest. Suhas Gondi, BA, and Dave A. Chokshi, MD, MSc , suggest that financial clearance should be a new goal for payment reform . Though CMS designed and implemented various value-based are programs through alternative payment models to simultaneously improve the quality of care and reduce costs, the authors say these efforts have only had modest effects on health outcomes and spending. Furthermore, the authors write that the pandemic’s effect on in-person visitation reveals that fee-for-service payments are “exceptionally vulnerable to shocks that reduce demand for in-person care.” On the contrary, the authors suggest that population-based payments are more resilient in the face of shocks like COVID-19 a...

Consistent cash flow is essential to the health of any business. This holds true for medical practices, as well. Maintaining an adequate level of revenue while minimizing the number of claim denials can be a struggle. Unfortunately, claim disputes have a number of associated costs beyond the denied payment. Estimates show that the average medical practice could loose between $30,000 and $80,000 yearly in denied claims and the staffing expense associated with resolving them. Appealing denied claims can be a huge time drain on your staff. In some cases, the process is purposefully designed to discourage the provider. It is for this reason that some 50 to 65 percent of denied claims are never disputed. Bottom line and staffing costs can be exacerbated by deteriorating patient relations. When a patient is receiving bills months after service, they are likely to believe the medical practice is mishandling the billing. Ignore the issue and the same denials are likely to repeat. Staff trainin...

  As healthcare payment liability continues to shift to patients, it has become increasingly important for healthcare organizations to offer convenient and accessible patient payment options. Prior to COVID-19, the exponential growth of high deductible health plans along with rising consumerism drove the need for more flexible payment vehicles. While those drivers are still valid, the current public health crisis has made payment programs even more essential. The cost of treating the virus is significant, and rising unemployment means more people are coming to the hospital without insurance. A key component in a patient-centered payment experience is a patient lending program, which allows patients to spread payments over time with little to no interest. These types of programs empower patients to meet their responsibilities while respecting the burden the obligations represent. A well-administered payment plan can also foster a lasting relationship with pat...