News & Events

Archive for Medical Claims Processing

Medical Claims Processing: Recession Proof Your Practice

By JoAnne Tanner
Many practices are still feeling the pinch of the recession, but with a few simple tactics you can boost business and recession proof your practice. Below is just part of what JoAnne Tanner, a leading dental practice consultant, shared with us to help your practice continue to find success. Although JoAnne focuses on dental practices, these principles apply to all healthcare practices.

Maximize Your Current Patient Base

Develop and implement a system to follow up on patients who need treatment that have not scheduled an appointment. I strongly believe that each patient should be contacted three times for follow up before being retired back to the shelf. Allow your scheduling coordinator or treatment coordinator to decide their best method to keep track of these patients. Such options may be to keep a list of patients needing followups, create a “memo” in the computer if available, or create a calendar and place the patients name and treatment needed on a day. Then follow up as needed. Additionally, assign a team member to print a report of the previous month's treatment plans (or pull up written records) and review to see who has not scheduled and make sure they have received their follow up calls.

Provide An Ongoing Call List To Assist You When Filling The Schedule

When scheduling a patient, ask your scheduling coordinator to let patients know she will call them with any openings that become available sooner. A list should be created for treatment patients and hygiene patients with patients' preferred day and time, provider they prefer to see, and how many contacts have been made.

Additionally, if you have a patient who has had to re-schedule an appointment more than twice it would be advisable to offer to place them on a call list instead of reappointing.

Provide A Caring Form Of Follow-Up For Our Patients That Shows We Care

If your scheduling coordinator has attempted to contact a patient three times by phone and has not received a response have her send a reactivation letter informing the patient that you miss seeing them and to contact your office. A treatment reminder letter may also be appropriate to send to patients who need necessary treatment outlining the benefits of having work done. On a lighter note, birthday cards and referral appreciation gifts are a great way to show you truly appreciate your patients.

Have The Entire Team Involved In Increasing Patient Flow

Review appropriate wording with your team on how to ask for referrals. Encourage everyone to come up with a great way to discuss this with patients so they feel comfortable. Some offices create team competitions or individual competitions for asking for referrals, or you may opt to reward the group as a whole for reaching a set goal of new patient referrals per month. Always remember to thank existing patients who refer new patients to your practice.

Offer Affordable Payment Options

Patients appreciate knowing that they have many options. In order to be perceived as affordable and flexible by your patient, you need to offer payment options. These options must be beneficial to the practice, as well as the patient. The patient will then select the option that meets their needs. It's important to have something visually to show the patient, and not just the treatment, it needs to have the payment options. Without the payment options, the patient is only going to remember the big number and not what the monthly payment plan with all of the attractive options.

JoAnne Tanner, MBA, brings compelling insights to dental practice management from her more than twenty-five years of experience in the dental profession. Her ability to provide dental professionals with management skills needed to maintain control, create an environment for achievement, and instill enthusiasm in the entire dental team has made her a strong asset to the dental profession. JoAnne holds a Master in Business Administration with an emphasis on Strategic Planning and a BS in Marketing Management. For more information, contact JoAnne Tanner, MBA at
(916) 791-2720 or visit her website at www.joannetanner.com.

About Apex EDI

Apex EDI is a leading healthcare claims clearinghouse for medical and dental professionals. Apex EDI serves thousands of physicians, dentists, and other medical providers nationwide with its Apex OneTouch® solution. The OneTouch® solution is a Web-based electronic claims reimbursement system that increases productivity and profitability while facilitating fast payment of insurance claims and providing additional reporting and analysis. Founded in 1995, Apex EDI is based in American Fork, Utah.

Posted in: Medical Claims Processing

Leave a Comment (0) →

Medical Claims Processing: Setting Prices for Your Practice

by Tom Limoli
LIMOLI.com

As the New Year gets going it may be time to reevaluate your practices pricing structure. In updating your fees for 2011, take care and please do not trap yourself by attempting to establish your office fee schedule based on what some third-party payer reimburses at 65% of the 85th percentile. And don't establish your fees based on the provider down the hall or across the street. Your fees should be based on your overhead, expenses, patient base, and your individual level of professional expertise.

You need to sell your services at a price your customers are willing to pay—and one that generates a profit for your practice.

Pricing your product or service is one of the most important functions of your business. You need to sell your services at a price your customers are willing to pay—and one that generates a profit for your practice. There are many ways to arrive at your price schedule, some rational, some not.

Here is one method for setting your fee schedule that takes into account costs, customer's willingness to pay, and the competition.

Glossary:
• Cost is the total of the fixed and variable expenses to service provider.
• Price is the selling price per unit customers pay for your service.

Evaluate Your Costs

The price you set is the cost to the customer. It should be higher than the costs of your expenses to produce the service you provide. That is office space, labor, equipment, supplies, marketing, the services you purchase from other vendors, and all the things you pay for as a small business owner.

Think of your costs as a pool of water. You must add up your costs like stacking blocks on the bottom of the pool and your prices must stack up to a point where you can stay above water. Occasionally you may set prices at or below cost for a temporary, specific purpose, such as gaining market entrance or clearing inventory. However, this is the exception and your costs should be the foundation of the price you charge.

The customer's willingness to pay

How the customer perceives the value of your service determines the maximum price customers will pay. This is sometimes described as the perceived value. Perceived value is created by an established reputation, marketing messages, packaging, and sales environments.

Once you have an idea of what is valuable to your market, besides the direct qualities of your product, you can position yourself to build additional features into your customer relationship which provide this additional perceived value. You can now make an informed decision about how to price your product or service.

Somewhere between your cost and the price the market will bear is the right price for your service—a price where you can make a profit and is fair to your customers.

Your Competition

An obvious and important component of perceived value is the comparison customers and prospects make between you and your competition.

You may find a competitor selling essentially the same product but at different price. He may even have a vastly different market share. He is probably selling on perceived value.

Inform yourself on the prices your competition charge, but base your pricing decisions on your practices costs.

Tom Limoli, Jr. is the prevailing expert on proper coding and administration of dental insurance benefit claims. He serves as president of Limoli and Associates, a company that over the past quarter century has assisted dental offices in streamlining the insurance reimbursement process. Mr. Limoli’s no-nonsense approach to the management of third-party reimbursement has been implemented in thousands of dental practices across the country. Customized fee schedule analysis for your individual office is available for a charge from Limoli and Associates / Atlanta Dental Consultants at (800) 344-2633 or www.LIMOLI.com.

About Apex EDI

Apex EDI is a leading healthcare claims clearinghouse for medical and dental professionals. Apex EDI serves thousands of physicians, dentists, and other medical providers nationwide with its Apex OneTouch® solution. The OneTouch® solution is a Web-based electronic claims reimbursement system that increases productivity and profitability while facilitating fast payment of insurance claims and providing additional reporting and analysis. Founded in 1995, Apex EDI is based in American Fork, Utah.

Posted in: Medical Claims Processing

Leave a Comment (0) →

Medical Claims Processing: 5 Steps to Retool Your Practice

Watch Your Balance Sheet

Until your practice’s business processes have proven themselves, you should be prudent about spending. Focus on your core strengths and partner with value added suppliers to enable your practice to grow and succeed.

Listen to Your Patients

Feedback, especially the kind gathered from personal conversations, is essential to figuring out how and when a practice should make a change. Physicians and administrators need to ask patients what’s working and what’s not and not rely on their gut alone.

Keep an Eye on the Stats

Track and analyze key indicators for your practice. Work with partners who can help you use your business software to monitor the success of your practice. These statistics will help you know when you need to make a change.

Experiment

If possible, you should test a new business strategy while preserving the current business model—just in case the new model turns out to be less effective than hoped for. Allow your practice to evolve and grow.

Be Open to Change

To allow a practice to evolve and grow, doctors must set aside their personal beliefs about the practice or its processes. There is a myth that stubbornness and raw determination are good traits for a small business owner. The truth is that tenacity and willpower are good for getting started, but then they can often get in the way of getting to the next level.

About Apex EDI

Apex EDI is a leading healthcare claims clearinghouse for medical and dental professionals. Apex EDI serves thousands of physicians, dentists, and other medical providers nationwide with its Apex OneTouch® solution. The OneTouch® solution is a Web-based electronic claims reimbursement system that increases productivity and profitability while facilitating fast payment of insurance claims and providing additional reporting and analysis. Founded in 1995, Apex EDI is based in American Fork, Utah.

Posted in: Medical Claims Processing

Leave a Comment (0) →

Medical Claims Processing: 5 Insider Tips to Get Claims Paid—Fast

For the past 15 years, we have helped many practices get paid faster and with more accuracy. We've found some best practices and insider tips to help any practice improve their insurance reimbursement. Just to clarify, we're assuming that you already send your insurance claims electronically. If you're reading this, you probably found it on the Internet. Which means you already understand the value of the Internet on your practice.

In no particular order here are 5 ways to get claims paid quickly:

Get Serious about Tracking Claims

Make sure your clearinghouse offers a simple way to track your sent claims. You should verify that:

  • Claims are received by the clearinghouse
  • Claims are successfully processed and sent to the payer
  • Additional payer requirements (like requests for more information, or attachments) are met

This may sound like a lot of work, but a good clearinghouse will automatically provide this information to you.

Ask for the EDI Department

Nothing is more maddening for a practice then to hear the words—we never received your claim. An office can see that the claim has obviously been sent and the clearinghouse has record of sending the claim, but you have to make sure you are speaking to the right people.

When you call an insurance company you usually speak with the customer service department. When they say they never received a claim, that may be true. Your claim may be held up in the payer's EDI (Electronic Data Interchange) Department where the customer service department can't even see it yet. One easy trick is to ask to speak with the EDI department. This department makes sure the data has arrived safe and sound. They control the inflow and integrity of the information.

So by simply asking to be transferred to the right department, you will avoid a lot of frustration.

Set Up Direct Deposit

You already receive your paycheck this way, but your business has to wait for funds the old fashion way? You can do better by using the direct deposit options offered by most insurance companies. Some of our clients have experienced lightning fast claims reimbursement by using eClaims to deliver, and direct deposit to receive. Amazingly some offices have seen a complete turnaround from patient to paycheck in only 4 days! Admittedly, this is still the exception, but the concept is sound. Call your insurance specialist to enroll. It is absolutely the best way to get paid fast.

Take Time to Learn the Lingo and Read the Reports

Many practices mistakenly skip over important reports that are trying to tell you what you need to know. Out of desperation and a simple lack of understanding, billing professionals may be skipping over critical data. It's the classic example of being too busy driving to pull over and get gas—at some point it will catch up with you. It is important that you read and understand the information your billing partners are sending you. If reports just aren't making sense then consider the next step.

Keep Training Fresh and Consistent

Often someone becomes the office billing expert by being thrown into the position with little or no training. A simple way to avoid the training gap is to take advantage of free trainings offered.

Quality software, clearinghouse, and insurance partners offer refresher trainings for any new or fill in employees. This is a simple add on to ask for when purchasing your software or joining a clearinghouse.

You can also make sure the billing staff has adequate continuing education. People quit, get sick, or get overwhelmed, and often someone needs to step in to learn the ropes quickly. With such a menu of webinars and online content available, you can easily find something that matches your philosophy and refer back to it as the staff changes. The local chapter of your industry association can help you.

Use these tips to see how you can speed up reimbursement in your practice.

Posted in: Medical Claims Processing

Leave a Comment (0) →
Page 4 of 4 1234