Is your A/R building a backlog? Are claims not getting out the door in a timely manner? Are your team members able to follow-up on every account at least every 30 days?
Denials are Up:
Do your denials exceed > 1% of all claims billed? Are you getting multiple rejections for billing errors? Is your Clean Claims Rate < 90%?
Reimbursements are Down:
Are your reimbursements shrinking? Could it be due to missed procedures? Could it be because patients aren’t paying their bills? Is it possibly because your denials are increasing? If your cash flow is shrinking, you need data to show you where and why.
Are you able to obtain the data you need from your system to help understand why reimbursements are down? If so, is it easily done or is it difficult to pull those reports? Is your practice rated low on Health grades quality metrics? Does the data you have tell you why?
Do you often find that, when coding, there are a lot of procedures or diagnosis codes that are missed? Do you perform audits on your coding team’s accuracy and quality? Do you have difficulty understanding why some of the payers are rejecting certain claims and code sets?
Are you finding it difficult to recruit and retain quality team members? Does the annual turnover in your billing department exceed 12-15%? Is turnover becoming more of a trend than retention? Do you feel your team is engaged or are you not sure how to engage them?
Are your quality ratings suffering and you aren’t sure why? Do other similar physicians in your market have a 4-5 star rating compared to your 2-3 stars? Do you need more insight as to what is causing your quality to suffer?
Are you finding a lot of out of network payers? Are you sure you are credentialed with the top 40-50 payers in your market? Do you know how to renew your credentialing or apply for new credentialing?
Are you finding that a lot of denials are due to Coordination of Benefits, Coverage Exhausted, or Non-Covered procedures? Is your staff checking eligibility routinely at least 2-3 business days prior to each scheduled visit?
Does your practice’s financial health sometimes feel like a sinking ship under a mound of voluminous paperwork, numerous issues, and declining cash flow? Do you feel like you need some help but aren’t sure where to turn or how to obtain it?
Are no-shows increasing? If so, are you calling the patients to find out why they didn’t show up? Are you sending recall cards to patients to remind them of the need for their next visit?
Are your visit volumes decreasing? Have they decreased by > 5-7% on a year-over-year basis?