As insurance giants continue to grow, physicians in private practices are routinely used as a cost-saving measure as they are forced to accept ever-decreasing fee schedules. Every player and participant in the healthcare system agrees that the costs are spiraling out of control faster each day, with higher costs and increased deductibles. The misnomer is that private practices are a part of the problem when really they should be one of the most important elements in decreasing costs. Private Practices provide better care and outcomes that save money in the long run, so it’s essential that they are properly compensated so they can avoid being absorbed by vastly overpaid payer owned and hospital-owned systems. Yet, Physicians are having to jump more hurdles than ever just to get paid.
Revenue Cycle Management is the financial process that helps to bridge the ever-growing gap that divides business and healthcare. The revenue cycle itself encompasses all the administrative tasks and processes that take place from the scheduling of a patient to the collection of revenue. This may include patient registration, coding, collecting payments, and submitting or collecting claims from insurance providers.
We all know that the need to maximize profits and volume has depersonalized the healthcare industry. Effective and thoughtful medical care can’t thrive in an environment overrun by payer politics and a business model built to push physicians to their breaking point. When the number of obstacles facing the modern physician seems to grow every day, how do we adapt? Here are some of the major challenges private practices are facing and how to overcome them:
Owning a medical business is like being a C.E.O., patient advocate, accountant, human resources manager, medical healer and office manager all rolled into one. One job title that most physicians put last in their ever-growing list of roles is that of retirement planner. Ensuring that you have your long term financial house in order is often neglected in favor of dealing with all the short term problems that a medical business faces. The mere act of thinking about early retirement forces physicians to look at all of their business practices and make the hard decisions that always seem to be put off in favor of the daily practice needs. Planning for the future can seem daunting, but forcing this personal and professional review is the best thing physicians and owners can do to ensure all their hard work, education, and patient care pays off.
I am often told by clients that they don’t feel that they have any leverage when dealing with insurance payers to get better rates. The reality is that every practice has a certain amount of leverage when dealing with the insurance payers at the negotiation table. Even a smaller practice can certainly find ways to argue for better rates. In fact, small groups have an even better opportunity than they realize simply due to the fact that insurance payers don’t want to see consolidation or see you join another group.
Can you negotiate your reimbursement rates as a physician? Absolutely. A physician’s reimbursement rates can determine the difference between profitability and breaking-even — or going out of business. Rates need to be carefully negotiated for a practice to remain profitable.
Get our free guide: How to negotiate your reimbursement rates