Why quote?

Why quote?

The answer is simple; improve compliance, reduce outstanding accounts, and reduce the stress on your staff when claims are rejected by the Health Fund.
The changes to government tier structure for health fund are a timely opportunity for specialist medical practices to review their informed financial consent and quoting processes.
Do you provide an estimate of fees for every procedure you perform?
What is your debt recovery process if you perform the procedure only to discover that the patient’s level of cover does not cover the items used in the procedure?
Generating a quote or estimate of fees from your software:

  • provides you with a copy of the information given to the patient prior to the surgery,
  • provides the patient the opportunity to check with their fund for the anticipated item numbers,
  • provides the patient the opportunity to reschedule the procedure if they are not covered,
  • provides the practice with the opportunity to request a signed acknowledgement of responsibility for the FULL fee in the event that they are not covered,
  • helps dispel the misinformation often provided to patients that the procedure “will not cost anything” or “it will only cost $200”
  • reduces the debt accrued when health fund cover is inadequate
  • streamlines the process with clear, transparent information
  • ensures compliance with the expectations around informed financial consent (https://ama.com.au/article/ama-informed-financial-consent)

At Practice Management Plus, we thrive on streamlining your workflow processes to improve compliance, profit, and workplace satisfaction in Australian Medical Specialist Practices.
Contact Fiona or Veronica to discuss how we can help your practice.

Make Your Medical Practice Good Business

Make Your Medical Practice Good Business

“I just want to practise medicine”. Sound familiar? Being a great doctor doesn’t automatically translate into being a great businessperson, however, many doctors end up as business owners. To be successful, make your medical practice a good business.

So, here are our top five tips to turn your medical practice into a successful business:

  1. Keep your finger on the pulse

Practising medicine means taking care of patients first; this is where your training, skills and interests lie. After all, if you had been interested in business you would have opened a shop, right? Remember that your business enables you to practise medicine, so you need to have a plan and pay attention to what goes on in the Practice. Nobody cares about the success of your business as much as you do.

  1. Get your setup right the first time

Doctors study for longer than any other profession yet many of your business skills are learned by trial and error after you have already set up practice. Practising medicine is what they trained you to do and you aren’t expected to be the expert in every aspect.  Hire good staff or use agencies to take on the Accounting (Billing, and interpreting financial reports), HR (hiring and managing staff), IT (computers and software) and reception. Invest in training for the right people by the right people.

  1. Have a Business Plan

Medicine is a fee for service industry, i.e. a doctor must see patients in order to charge a fee. For a solo doctor practice, you are entirely responsible for the business income, and this puts the focus on clinics, appointments, and surgeries to earn an income and pay staff, leaving business activities a poor second. A good business plan is essential to map out what you can afford to do and when, and what your targets are. Review how many patients you are currently seeing multiplied by your average fees, less your costs. Determine whether your current fees will cover the costs associated with running your practice. Predict your income.

  1. Be proactive rather than reactive

Waiting lists can be months long. When patients are piling up to see you, you work harder and longer to meet the demand. And this can leave even less time for family and sleep, let alone business tasks. Be proactive rather than reactive. You can only be in one place at a time, so your schedule is simple maths. Review how long it takes to perform your appointments, including any dictation of letters. Look for efficiencies your practice software can offer to enable you to work smarter rather than harder, and then determine how many patients can realistically be seen in one day. Utilise your practice software waiting list feature where available and monitor your ‘next available’ appointment date. It will tell you whether you might need to share the load with a colleague (session rent your consult room) or put on an extra half day clinic once a month.

  1. Manage Patient Expectations

Medicine is a “caring” profession. In patient-speak, this roughly translates into “why do I have to pay for that?”. No specialist wants to haggle over fees for surgery or turn away pensioners who ask to be bulk-billed. Since services are not something you can take back if the patient refuses to pay, doctors will often take a financial hit in order to do what they were trained to do – practise medicine. The solution is accurate quotes, accepting deposits prior to surgery, and staff, well trained in managing patient expectations.

What is good business?

Practice Managers commonly ask, “what reports should I be providing?”

I answer, “What does the doctor or business want to know?”

Unfortunately, not all practice managers are equipped to run a business and assume that the doctor knows what they are doing. The doctor doesn’t always know what to ask for. So, here are some things to consider, just for a start:

What is your current position? 

  • How many patients are seen each week?
  • What is your current gross income?
  • What is your total expenditure (including wages)?
  • How many new referrals are received each month?
  • What is the ratio of new to review appointments?
  • How many referrers do you have? Is this number growing?
  • How do patients hear about your services?
  • Do you have any unpaid accounts building up?
  • Are your billing practices compliant with Medicare?
  • What is the timeframe for outgoing practice correspondence?

Your practice software can typically provide answers to all these questions and much more. So, it is imperative that you choose the right software to meet your needs.

Also, any agreed processes should be documented in a Practice Manual – a living instructional document that guides the staff on how to implement your business plan. This will include processes for everything from day-to-day activities to monthly and annual reporting, from financial accountability to roles and responsibilities.

Where to find help?

  1. Choose staff wisely.
    1. Decide if you need a Practice Manager with business skills or clinical skills. Multi-skilled Practice Managers are in high demand and worth every cent.
    2. Invest in staff training. Once you find the right person, you can help them build all the skills they need to support the successful growth of your business.
  2. Get a Business Coach. A business coach will help you to ask the right questions and help guide your business growth. Your business skills will grow as your business grows and your business will grow as your skills grow. That’s a win-win!
  3. Find a mentor. You aren’t the first doctor to find yourself as a business owner. Ask your colleagues, ask professional bodies – find a senior doctor with a successful practice who is willing to help you avoid early problems. You aren’t alone in this.
  4. Engage a consultant. Consultants provide short- and long-term help to setup your practice, train your staff, write a practice manual, and get you started on the road to success.
  5. Stay hands on. If you don’t know what questions to ask, find someone who does. Meet regularly with your staff. Request reports from your practice manager and monitor your billing activities. Keep up with daily activities. You need to know what is being done and why. At the end of the day, you are held responsible for the mistakes support staff make.

Need help to make your Medical Practice a good business? Contact us.

infographic

Calling for Backup!

Calling for Backup!

PulseIT today reported that Melbourne Health Group, a specialist cardiology practice located at Cabrini Health’s hospital at Malvern, was hit by a ransomware attack that encrypted their practice data. It’s not the first time we have seen this lapse in patient data security and it won’t be the last. So how is your practice data backup health?

Do you know the when, what, how, where and who of your practice backup?

When does your backup take place? Is it scheduled regularly enough that you could recover adequately if your datafile was lost?

What data is included? Does your backup include multiple copies of your practice data?

How is it collected? Do you have to run it manually? Does it warn you if it doesn’t proceed successfully?
How far back does it go? If you lost yesterday’s datafile, could you go back to an earlier copy?

Where is it stored? Is your only backup copy located on your network, where it is vulnerable to cyber-attack? Is it in the cloud – and if so, does its storage comply with the Australian Privacy laws?

Who is responsible for monitoring it? Many IT set and forget. Many practices assume the backup is working and only when disaster strikes do they realise their error.

Your backup is YOUR responsibility, but there is help available to ensure you have good processes in place to keep things safe and running smoothly. It is all part of having a good disaster recovery plan in your Practice Manual.

For a practice health check to improve your patient data security, contact Practice Management Plus for guidance and implementation support.

One single change…

One single change…

We love giving tips to help medical practices thrive with Genie software. So, what is the one single change we could make to our processes which would increase income, decrease expenses, improve efficiencies, and decrease rejections?

This is the most exciting question I have been asked in 16 years as a software trainer of Genie software and here is the answer.

Choose the correct CATEGORY in the Genie Address Book.

Now, I can feel your disbelief but read on.

The CATEGORY determines the duration of the referral.

When the CATEGORY is blank, Genie allocates a 12-month duration to the referral by default. This is the beginning of your problems.

If the referrer is a specialist, the referral expires in 3 months but your records show it as valid, so it may be another 9 months before you or your staff are alerted.

Consider the following scenarios

  • Your patient is bulk-billed: If “Referral expired” exception messages are dismissed without investigating further, you may see a patient for a year without getting paid.
  • Your patient pays the account in full: The patient will not receive the Medicare rebate. They may not contact you to alert you to the problem.

Will this discourage patients to use your services?

How will this impact your surgical billing?

Now consider this scenario:

  1. Every referring doctor in your address book has the correct Category
  2. Correct durations are allocated when referrals are added to the patient record
  3. The ‘Check Forward Referrals’ report is run each week to show each appointment in the selected date range that needs a new referral
  4. Use the ‘Show in Patient List’ option to send an SMS reminder to the patient to obtain a referral from their GP
  5. Invoices transmit with accurate details
  6. Rebates are paid correctly
    1. Bulk bill amounts pay to the Provider without error
    2. Fully paid patient claims rebates pay to the patient without error
  7. As a result, your staff have more time, and less stress
  8. The practice sees an increase of income, a decrease of expenses, an improvement of efficiencies, and a significant decrease in rejections and exceptions.

Have you enjoyed this simple tip? This is only one of the changes that Practice Management Plus can implement with Genie software at your practice. Contact us to learn how we can help you move from survive to thrive.

Interpret ECLIPSE Claims

Interpret ECLIPSE Claims

TIme to decode Medicare error code 500 and 159: This example uses screen shots from the Genie Practice Management Software, but the interpretation can be applied to any ECLIPSE transaction.

It can be difficult to know which particular item is causing a multi-item ECLIPSE Claim to fail. But here is one common thing you can look for – the Medicare Codes:

Medicare codes can be confusing, so let’s look at two very common ones – Error 500 and Error 159.

Here is a great example: This claim has three rejected items. How can we work out which one is the problem?

Genie ECLIPSE Processing Report

Look at the rejection message against each item. There we see:

1. ITEM 30490: This item was “rejected in association with another item”. This typically means that this item was rejected because another item in the claim has a problem, and therefore all items were rejected. Medicare will reject all items rather than guess at which might be correct. This error code usually suggests that this is not the problem item but merely rejected as a consequence of the real issue.

Genie ECLIPSE service-level messages

2.  ITEM 32093: This next item error is the Medicare code 159 – “Item associated with other service on which benefit payable”. This typically means that this item is in conflict with another item on the claim. When we see this error, it it time to go looking for another item which may not be billed with this one.

3. ITEM 32084: The third item has the same error code as the previous one – Error 159. This would indicate that this item and the one above are likely to be the culprits causing the rejection.

Genie ECLIPSE service-level messages

So we have narrowed the cause down to two possible items. We can check MBSOnline to investigate further. By searching MBSOnline for item 32093 we can immediately see that it is related to item 32084. Being related generally means they cannot be billed together, unless they were two entirely separate procedures, performed at different times on the same day:

MBS item 32093

As it is important not to guess with your billing, the next step is to go back to the provider, the quote or, even better, the official Operation Report, for confirmation of the correct service performed. Resubmit the correct items and credit any remaining items that were billed in error.

If in doubt – ask for help. Sometimes a little training can go a long way!

Bulk Billing Claims trick

Bulk Billing Claims trick

Here is a great little trick for your bulk billing claims in Genie. Please note that this is only for FULLY REJECTED claims.

When a claim has been fully rejected, when retrieving your reports it causes a popup that says the Payment report is not available. You end up with claims that look something like this:

Part of correcting these claims typically involves removing items from the batch and deleting the exception resulting in an empty claim, or deleting the claim altogether. This is not very useful should you need to make investigations down the track. But, since I really don’t encourage you to delete anything in Genie, you do have another option that will keep the exceptions report intact, and still deal with your claim appropriately.

Whether you intend to write off the rejected items with a credit or correct and resubmit, you will remove the item/s from the claim. When you do this, my suggestion is to NOT to delete the exception when prompted. Instead, once all the items have been removed double-click the empty claim, and tick it as finalised.

This moves it to the finalised status where the empty claim will still have full access to the Exceptions Report and the Processing and Transmission Text. This is very useful if you ever need to look back historically to see why an item was rejected.

Very nice and tidy, with all the reports preserved. Give it a try!