How To Keep A/R Out Of The ER

In today’s challenging economic climate, medical specialists – including those in diagnostic fields like community pathology and radiology-- increasingly find themselves working overtime to maintain even basic fiscal fitness. 

Consider the land mines that separate pathologists and radiologists from their accounts receivable (A/R): the growing complexity of the reimbursement system, their patients’ inability to remit co-payments or deductibles, reductions in third-party payer reimbursements and the competitive landscape in anatomic pathology, where community practices bump up against considerably larger labs. The difference between what a community pathologist or radiologist charges and what he or she actually collects can fluctuate wildly, due to reductions in fee for service, managed care contractual allowances and bundled payments that lower reimbursements. To compound matters, simple billing, coding or collection mistakes can delay payments for claims submitted in good faith, significantly affecting profitability. 

In both developing and nurturing their practices, medical specialists like radiologists and pathologists often find themselves running behind the hospital with which they are affiliated or to which they have contracted. Most hospitals, of course, have the business side down cold, with effective outreach programs that generate significant revenue for their institutions and boost utilization of laboratory clinical instruments, which otherwise would have remained idle. Community pathologists, although tied to many of these hospitals, are beginning to recognize the importance of applying this kind of rigor and discipline to both their business development initiatives and the fundamental business operations (e.g., accounts receivable) of their practices. 

Thankfully, there are specific, proven ways to optimize systems and processes -- and thereby generate additional revenue. It all begins with smart Revenue Cycle Management (RCM). The backbone of effective revenue cycle management is access to financial management capabilities that provide total visibility into revenue and billing systems -- from critical business metrics to account and payer details. Radiologists and community pathologists need to rely on systems that help measure and manage accounts receivable in detail (including the precise calculation of net revenue based on contractual expect price, denial rates and contract compliance), while also enabling decision makers to see the big picture. Financial reports need to detail profitability by individual payer, referring physician and/or modality are essential tools when negotiating new contracts with payers and clients or when determining which areas in which to invest. 

RCM extends to managing by measurement – establishing and tracking revenue goals that are linked to specific, detailed financial metrics. It requires billing timeliness and accuracy. It encompasses the automation of decision-making. It involves understanding the root causes of denials.

Vital as RCM is, fiscal fitness does not live by increased operational efficiency alone. Marketing plays a critical role in attracting and retaining those accounts that, in short order, convert into revenue. If RCM is in the inside play, marketing is the outside game. It starts with the creation of essential tools that might include, at minimum, a capabilities brochure, sample case reports, a functioning website, and a biography or dossier sheet about the practice.

Creating effective marketing materials is an art in itself, along with the strategic guidance that can help practitioners to determine their key strengths and offerings. An engaging website, after all, is akin to a handshake. It says “we are real and we are here for you.”

Other tools and tactics -- such as direct mail, trade show attendance, even an active social media presence – can and should reinforce that basic handshake, but at the risk of mixing a metaphor, these additional marketing techniques can’t be the tail that wags the dog. For community pathologists, as with other clinical specialists, the most important marketing assets consist of the practice partners themselves. Each partner’s personal network remains the best source of new client wins. A call, a lunch, a visit over coffee at the hospital often is all it takes to attract interest from a colleague.

Optimizing financial systems and processes is clearly an Rx for keeping a specialist practice healthy. And it’s just as much a tonic for marketing that practice.

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