“The AMA tells us that 20% of all claims are denied. The insurance industry says that clean claims are denied only 2-3% of the time. So what we strive for are clean claims,” says Sarah, who points out that there are three phases involved in generating a clean claim: pre-visit, visit and post-visit. Even before the visit, however, there are important issues related to clean claims that must be addressed. “Negotiate your contracts well and make sure that your physicians are credentialed properly so that they get paid when they work,” says Sarah.

Pre-visit: “A clean claim starts at the front desk, but too often the front desk staff doesn’t understand their role in the revenue cycle,” says Sarah. “The revenue cycle is everybody’s job and it all starts before the patient arrives.”

Sarah recommends looking carefully at the CMS claim form to ensure that all necessary information is gathered from patients. And, she says, copy a patient’s insurance card at every visit. “If you go to Ruby Tuesday for lunch three days in a row, you’ll give them your credit card every time,” says Sarah. That’s a great analogy, because just as people change which credit card they use from time to time, patients may change jobs, get new insurance, or lose insurance from visit to visit. Be sure, too, to get information release forms signed by patients and give them a copy of your payment policy so they understand that ultimately they are responsible for charges incurred.

Once you have all of the patient information you need, make sure it’s entered into the system accurately. One transposed number is all it takes for a claim to be kicked back. “Information should be double checked by a second person on the day of the visit,” says Sarah.

Visit: “The visit is when you create expectations with patients,” says Sarah. She recommends collecting co-insurance payments at the time of service and establishing the fact that patients are responsible for any balance due after their insurance pays or for the entire balance if their insurance does not pay.

Correct diagnosis and CPT codes are essential for clean claims, so take steps to ensure that everyone in the office involved in the revenue cycle is trained and up to date in this important area. “Codes must be accurate,” says Sarah. “Educate your staff, and remember that the front desk staff needs to be equally educated.”

Timeliness in several areas is important when it comes to the patient visit. “Make sure that the clinic portions of visits are dictated immediately,” says Sarah. “The sooner a claim is filed, the more apt is it to be paid, so you’ve got to create the expectation with physicians that claims must be filed daily. Don’t let things sit,” she says.

Post-visit: “The most important thing about the billing process is assigning duties and holding people accountable for what they’ve been assigned,” says Sarah. Having the right people in the right jobs is also a factor. According to Sarah, the ideal billing staff employee is self-reliant, responsible, reliable and a good communicator. “When you give them work to do, they should act with autonomy,” says Sarah, who is also a fan of cross-training. “Rather than have one person do all the work for one doctor or one insurance, they should be cross-trained,” she says. “Divide the work up so that everyone is getting experience across the board.”

The billing process should be streamlined so that clean claims get paid with as little hands-on staff time as possible. “Automate everything you can,” says Sarah. Doing so frees up your highly trained staff to deal with the few claims that are denied and to communicate with patients about the status of their medical bills–something your computer system cannot do.

·    Place a box, questionnaires and pens in the waiting area so that patients can complete written surveys while they are in the office.
·    Hand surveys out to patients as they leave the office and include a stamped return envelope.
·    Mail surveys to patients.
·    Conduct a telephone survey.
·    Put an online survey on your website and direct patients there with a postcard mailing, note on monthly billing statements, or in your practice e-newsletter.
·    Use SurveyMonkey, an online service where the most basic surveys are free.
·    Hire a firm that specializes in conducting surveys for medical practices.

Keep your survey short or patients won’t bother to respond. Ten to 15 questions should be enough to get a sense of how you’re doing in terms of keeping your customers satisfied. Some areas to consider asking about include access (ease in getting appointments), service (how helpful and respectful is the staff), quality (provider competence), communication (phone messages returned, test results conveyed) convenience (office hours and parking), facility (cleanliness and comfort of the office) and privacy (how patients perceive the way in which you handle their confidential information).

Write the survey carefully so that you’re not asking leading or biased questions. Use a consistent scoring method such as a 1-5 scale with 1 being “poor” and 5 being “excellent.” Depending on how you word your questions, you might also consider using a 4-point scale in which patients strongly agree, agree, disagree, or strongly disagree with statements such as “It’s easy to get an appointment to see my doctor” or “My phone calls are returned in a timely manner.” Include one open-ended question at the end of the survey such as, “What else would you like for us to know?” or “How can our office serve you better in the future?”

The response rate you achieve from your survey will depend on how you distribute it. Try to get at least 100 responses so that you’ll have statistically significant data. This might require mailing or handing out 400-500 surveys, making 200-300 phone calls, or leaving your survey box in the waiting area over a period of several weeks.

Once you have the survey results in hand, analyze it carefully and make action plans based on the findings. Keep in mind that perception is just as important as reality. If your office scores poorly in, for example, ease in scheduling appointments, but your front desk staff insists that everyone who calls the office is accommodated, don’t ignore the survey findings. Dig a little deeper to try to determine what might have generated the low score and then address the issue. If your practice scores exceptionally well in every area you survey on, celebrate your success, but don’t take this as permission to “coast” when it comes to providing quality care and service. There is always more you can do to continually improve patient satisfaction scores.

Analyze your workload. Set aside as much time as it takes to capture–in writing–everything that you typically do on a daily, weekly, monthly and annual basis. Write everything down on four separate sheets of paper or in four separate pages in a document. Examples:

Daily: Review appointment schedules; conduct walk through of front office and clinical areas; bank deposit.

Weekly: Review accounts receivable; review staff schedule; prepare payroll; pay bills; order supplies.

Monthly: Staff meeting; balance bank statement; review monthly reports.

Annual: Staff performance reviews; prepare tax information for accountant; staff retreat.

On a fifth list, write down all of the non-routine projects you currently have pending. This might include things like updating your staff training manual, redecorating the reception area, upgrading your accounting software, writing a practice marketing plan, or implementing a cross-training program for the staff.

Identify what you can delegate. Go over your lists carefully and determine which tasks and projects you can turn over to someone else in the office. Who could competently handle preparing and distributing staff meeting agendas each month? Is there someone in the office who would like to learn how to analyze accounts receivable on a weekly basis and report the bottom line results to you once a month? How about assigning ordering supplies and managing inventory to one or two individuals in the office? Could you outsource marketing activities to a local practice management consultant? Try to come up with a few items that you are willing to delegate from each of your five lists.

Set expectations. When you delegate a one-off project or an ongoing task to a staff member, take time on the front end to be very clear about what you expect in terms of the outcome you’re looking for and what kind of communication you’d like to have throughout the process.

Monitor progress. Keep track of what you assign to whom and check in periodically to make sure that the work is being accomplished. That said, resist the urge to micromanage a project that you’ve turned over to someone else to take the lead on. Doing so undermines that person’s confidence and defeats the purpose of delegating, which is to free you up to focus on other work.

Communicate. Once you’ve successfully delegated an ongoing project to a staff member, make sure that the rest of the team, including providers, knows that that individual is now the person in charge. If employees and doctors continue to come to you with questions related to the task or project you’ve delegated, gently steer them in the direction of the responsible person.

Delegating is an essential skill that can be mastered, but it might take a little practice. If you find that you have trouble letting go of responsibilities, start by delegating small or low-risk tasks and then build from there. As you experience success, you’ll find that turning work over to capable employees becomes easier each time you do it.

File 2011 taxes away. Once your returns are complete, box up and store all of your tax records from last year to make room for this year’s paperwork. Ask your accountant how long to keep prior year records. Seven years is a rule of thumb, but there are exceptions, and some tax professionals recommend keeping old records for much longer.

Put your filing system in order. Keeping all of your income and expense paperwork organized throughout the year will, quite obviously, make your life easier as you get ready to prepare for tax time. If your system needs a makeover, ask practice mangers at other offices what methods and tools they use to keep everything in order. Staying more organized may be as simple as highlighting dates on documents before your file them, using color-coded folders, or purchasing an additional file cabinet for storage.

Upgrade accounting software. Have you been limping along with an old version of QuickBooks® or another software program for a few years too many at this point? Go ahead and invest in the tools you need to make your job easier. You’ll be glad you did, and the cost of the upgrade is tax-deductible.

Enter data as it becomes available. If you’re anxiously eyeing a big stack of bank deposit records and receipts that need to be entered into your system (although this is less of an issue than is used to be since accounting software has become more efficient), this may be an indicator that you need to develop a routine of inputting data in a more timely manner.

Make an appointment with your accountant. CPAs and other tax professionals often disappear for vacation in late April, but as soon as it’s reasonably possible, schedule an appointment with your accountant to see what advice he or she has about making the process easier for next year. Choose a date now for when you’ll commit to having records to your accountant in early 2013 for 2012 tax preparation.

Tax time may never be pleasant, but by staying organized throughout the year, you can create a situation in which you’re not scrambling around at the last minute to meet filing deadlines.

Note: It might be helpful to print out the following exercises, or copy/paste the text into a document to print so that you can do the exercises several times over the next year. 

Exercise #1

Rank in 1-10 order (1 being the most important) the following areas of your life that you feel are critical to your overall well-being and happiness.

 _____ Career

_____ Relationship with spouse or significant other

_____ Family and friends; social time

_____ Financial security

_____ Faith; spirituality; religion; reflection; meditation

_____ Hobbies; activities for personal enjoyment

_____ Health and fitness

_____ Home and personal environment

_____ Learning; education

_____ Personal growth and development; emotional well-being or healing

Exercise #2

Now, for each of the 10 areas, grade yourself (A, B, C, D, F) on how well you’re doing in terms of giving each one enough time, energy and attention.

 _____ Career

_____ Relationship with spouse or significant other

_____ Family and friends; social time

_____ Financial security

_____ Faith; spirituality; religion; reflection; meditation

_____ Hobbies; activities for personal enjoyment

_____ Health and fitness

_____ Home and personal environment

_____ Learning; education

_____ Personal growth and development; emotional well-being or healing

Compare exercise #1 with exercise #2. What gaps or disconnects do you see? For example, if you rated “Health and Fitness” as your first priority in exercise #1, but graded yourself a “C” in that area, that’s something to pay attention to.

Exercise #3

List three things you want to do less of or eliminate from your life over the next 90 days.

 1. ____________________________________________

2. ____________________________________________

3. ____________________________________________

Exercise #4

List three things you want to do start doing or do more of over the next 90 days.

1. ____________________________________________

2. ____________________________________________

3. ____________________________________________

Exercise #5

Write down one primary goal that you’d like to achieve within the next 30 days.

_____________________________________________________________________

Exercise #6

Write down one primary goal that you’d like to achieve within the next 90 days.

_____________________________________________________________________

Exercise #7

List three people who can support you in accomplishing what you wrote down for exercises 3, 4, 5 and 6.

1. ____________________________________________

2. ____________________________________________

3. ____________________________________________

Exercise #8

Write down three small things that you will do this week that will likely help you move toward achieving your goal of improved work/life balance. (Examples: Tell Sue about this process and ask for her support; renew gym membership; inquire about reducing work hours from 40 to 36 hours per week).

1. ____________________________________________

2. ____________________________________________

3. ____________________________________________

Exercise #9

Take a moment to reflect on how it felt to work through this series of exercises. Write down a few words based on what you feel at this moment.

We hope that this simple, self-reflective process has been helpful to you. It never hurts to slow down and think about what’s important, what’s missing and what needs attention. Good luck with your goals, and with maintaining what you consider to be optimal work/life balance.

Do you have enough staff?  Moving patients in and out of rooms and tidying and cleaning rooms between patients requires people power. Every practice wants to keep their overhead under control, and it’s well known that staffing is a major budget line item, but adding just one additional medical assistant whose primary focus is room turnover could turn out to be the best investment your practice will make this year.

Do you have enough exam rooms?  The worst possible scenario in a practice aiming for profitability is having doctors and other providers standing around waiting to enter their next exam room. If you would benefit from an additional exam room and it’s not feasible to equip one in your existing space or move to a larger office suite, consider setting up a private area where medical assistants could, at minimum, weigh patients and take vital signs before they’re escorted into the prime real estate that is an exam room.

Are your exam rooms efficient?  Each of your exam rooms should be arranged and organized in exactly the same way. In an ideal world, doctors and other healthcare providers in your practice should be not able to tell without looking at the number on the outside of the door which room they’re in. If they’re using valuable face-to-face patient encounter time looking for commonly used supplies and equipment in a particular room, that’s a problem. Just one minute wasted during each office visit, assuming you have a doctor seeing twenty patients a day, equals 20 minutes which is enough time to see one additional patient each day.

Are your exam rooms marked for traffic control?  Proper signage in hallways and on exam room doors, coupled with a flag or light system so that everyone knows what needs to happen in each room next (patient ready for doctor, nurse needed to give discharge instructions, etc.) will help keep traffic in the back office flowing smoothly. Doctors and support staff should be able to tell at a glance where they’re needed next, and patients should be able to easily find their way to exam rooms and then back out to the front office area without a personal escort during each and every visit.

Do you have an interruption policy?  One very costly use of exam room time is having a patient sitting around waiting for a doctor who has been interrupted for a phone call to return to finish an office visit. Ask each of your doctors and other providers to come up with a short (preferably very short) list of people they’re willing to be interrupted for during direct patient care time, and then stick to that list.

If your answer is “no” to one or more of these questions, you have opportunities to improve your office efficiency, profitability, and patient satisfaction. If your answer is “yes” to every question, then congratulations, because you are already using your most valuable space wisely.