South Florida Hospital News
Friday October 30, 2020

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March 2009 - Volume 5 - Issue 9


Go Back To Basics During Hard Times - Part I

If your healthcare organization/practice is like most, during this "economic down-turn" you may be experiencing declining reimbursement and uncertainty and maybe even some anxiety. After all, even paranoid people have real enemies too. Like most you are thinking, how do we ensure the organization/practice gets every dollar earned. You can begin by:

1. Assessing your market vis--vis your mission statement. Have things changed? What are the up statistics, and how can we increase them? Conversely, what are the down statistics and what can you do to mitigate them? Basically, a SWOT Chart Analysis identifying your "strengths", "weaknesses", "opportunities" and "threats".

2. Keep in mind healthcare is a "contact sport" therefore, focusing on your relationships with your payors is critical. Which agreements are "ever greening", i.e. a clause in the agreement that allows the payor to leave things as they have been because you did not take proactive steps to renegotiate more provider-friendly terms. Now is a good time to prepare for better times and develop some new disciplines. Remember the old adage: Take care of discipline in the good times and discipline will take care of you in the bad times.

Begin by gathering all your payor agreements and summarizing the essential contractual terms, e.g. make copies and place them in another safe and secure location; minimum information to inventory are: Payer name, "Notice" address, Initial effective date and Term (usually three years with an "evergreen" clause), Termination/renegotiation notice required (usually 60, 90 or 120 days), Current reimbursement summary both part A & B, and perhaps some things that are unusual like "bill-aboves", "disposables", "implantables", etc. If you cannot find agreements, write the payor and request their copy on file.

Pull 12 to 36 months of actual data from your IT system(s) for each payor for every reimbursement code (remember the 80/20 rule). If you are a practice a good place to start is with your "superbill". Dont forget applying modifiers and locations of service, when applicable. Dont forget Denial and EOB analysis. At minimum you need to determine: number of units performed, total charges, total payments; as well as, percentage of charges to payment as a good benchmark to compare payors on a percentage basis.

After completing the above-mentioned steps you should summarize your findings and develop an action plan with deliverable dates going forward based upon priorities. Keep in mind that you need to balance your cash flow needs against your desire improvements based on a "biggest bang for the buck" or put differently "the bigger the return on your efforts comes first". Once formulated, you need to be tenacious about following your action plan, as a missed "drop-dead-date" means you will be stuck with your old payor terms for another term (usually a year) until cycle comes around again.

Michael Casanova, Healthcare Executive and Consultant, can be reached at or (305) 606-3409.
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