KLA Healthcare Consultants

Website    About Us     Service    Resources   BLOG    Contact
Join Our Mailing List
Practice Rx 
Is Your Practice Fiscally Fix?
Top Ten Ways to Improve Your Bottom Line in 2012


Happy 2012! 

It's going to be a great year. 

Here's our top ten list of what you can do to make your bottom line great too:


10.  Get to know your insurance representatives.

Do you know the names of your insurance representatives for your top five private insurance companies?  You should have them on your speed dial.  They are an invaluable resource.

Early this year, schedule a luncheon meeting with each top representative and your staff to review the year's changes.  The representative will be able to tell you about changes in referral and precertification requirements; and to tell you about services the insurance company pays for that may be beyond the norm.  The insurance company will have marketed these to their subscribers and will want you to provide the service.

 For example, most insurance companies now pay 100% for well-patient physicals.  Your insurance representative will provide you with details on what you should document and what codes to bill.

Also, many insurance companies now offer nurses that can answer questions after hours.  This may help YOU or your staff get a better night's sleep.

Making friends with your insurance representatives sometimes helps you cut through the red tape too.  We have seen an insurance representative push over twenty claims through for a favored client despite the client failing to get proper precertifications.

Sometimes it is all about who you know.


9.  Avoid getting dinged with non compliance fines.

Providers live in fear of the Medicare audit; and they should.  Medicare auditors are being paid a commission on what they collect back from you!  Most will no longer give you the benefit of the doubt when auditing your charts. 

Be sure that your Medicare compliance plan is up to date and followed. If you don't have a compliance plan, get one! 

Review the documentation guidelines and try to find time to attend a class on documentation. 

There's more to documentation than following the evaluation and management guidelines. 

Do your charts include orders for lab work and x-rays?  Have you signed and dated your reports?  An electronic printout from your equipment is not sufficient.  CMS and other payors want to know the results have been reviewed by the doctor and communicated to the patient.

Most malpractice carriers are now offering auditing services.  KLA also maintains a list of some good auditors that can review several charts for a reasonable fee and give you a report.

Remember to keep CLIA and OSHA requirements up to date too.

8.  Get your electronic prescribing done early.

Unfortunately, many providers are being paid less than they could be this year because they didn't get their electronic prescribing done early in 2011. 

Beginning January 1, we entered another measuring period for Medicare.  For details, visit:  http://www.cms.gov/ERxIncentive/06_E-Prescribing_Measure.asp#TopOfPage.  Penalties for 2013 will increase to 1.5% on every Medicare dollar.  For 2012, successful eRx prescribers still will receive a .5% bonus.

Note that for 2012, eRx is being measured by EIN and by NPI.  Thus, every provider in your practice must comply to avoid next year's penalties.  If you aren't already on an EMR, Practice Fusion offers a free eRx program.  To sign up, go to:  http://www.practicefusion.com/ccn/kla. 


7.  Understand quantity limitations on services.

Most providers have become sophisticated in understanding what diagnoses are needed to support the services they render. 

What we are seeing now are denials for providing services too often. 

Because Medicare uses the same denial code for diagnosis-related and frequency-related denials, providers are frequently frustrated refiling diagnoses codes again and again when the issue isn't diagnosis but frequency.

Avoid this problem by learning the frequency limitations for your most common services.  Print out Coverage Determinations for Medicare and your primary insurers and have them readily available for reference. 

Also, remember to ask your patients if they have had the procedure performed at another facility.  Payors don't care who rendered the service, just how frequently it has been performed.

Medicare's National Coverage Determinations can be found at:  http://www.cms.gov/medicare-coverage-database/indexes/ncd-alphabetical-index.aspx?bc=BAAAAAAAAAAA.

Be sure to check your local Medicare Carrier or MAC and major insurance carriers too.


6.  Save some open appointment slots for new patients and emergency walk-ins.

There's an axiom:  "If you aren't growing, you're dying." 

Even full practices need new patients.  New patients allow you to replace patients that move away, change providers or whose insurance no longer uses your preferred hospital(s).

Those with the best-paying insurance have the most options as to which doctor they will see.  Save room for them in your calendar.  You don't want to lose them because they have to wait a month for an appointment.

Also save room for a patient with an emergency need.  If you can't see them, someone else will.

Remember, your patients are critical to your bottom line. 


5.  Watch for overuse and under monitoring of voicemail. 

I call doctors' offices several times a day.  It always surprises me how hard it is to get a living person on the phone when I call the main number.

Imagine you are a patient looking for a new physician.  Which practice are you more likely to visit: (A) one that sends your call to a full voicemail or (B) one whose phone is answered by a pleasant and helpful person?

A resource we are fond of for training those that answer phones is telephonedoctor.com. 

At least a few times a month call your office through the main line to monitor how it is being answered.  You may even want to have a "mystery patient" to call a be a little annoying.

To protect from potential legal liability, be sure each recorded message instructs the patient what to do in cases of emergency and where to call if their message is not promptly handled.  Tell the patient how long they should expect to wait for an answer.

Be sure that prescription refills are handled promptly. This does not necessarily mean filling the prescriptions; it does mean communicating with the patient if you are not for any reason.

We at KLA found voicemail to be such a problem, we completely eliminated it from our office several years ago.


4.  Read specialty and insurance newsletters.

Many offices think that reviewing the changes in a CPT manual each year alerts them to new codes.  Unfortunately, that's only part of the story. 

Most newly allowed codes do not appear in the CPT manual.  They are called temporary codes.

For Medicare, temporary codes are typically issued throughout the year with Medicare Transmittals.  Frequently these are followed up with MLN Matters publications.  These codes almost always mean new reimbursement opportunities for you.

You can spend hours each week perusing the websites of CMS and your major carriers; or you could rely on your specialty and insurance newsletters to cull down the changes to what is important to you! 

(Also refer to 10 above.)


3.  Understand NCCI edits.

One of the first things KLA looks for when we begin working with new clients is how many line items have been incorrectly adjusted off because of NCCI edits. 

NCCI edits are based on code sets.  The primary code will fall in column 1.  The secondary code in column 2.  In the far right column there will be either a 0, 1 or a 9. 

If there is a 9 in the far column, the codes will be paid together.  If there is a 0 in the column, nothing will make those codes payable together.  If, on the other hand, there is a 1 in the far column, the codes are payable together if properly modified.

Unfortunately, the explanations of benefits from most carriers do not tell you that if modified properly these codes can be paid together.  It's important to take the time to look before writing off the code.


2.  Collect patient cost share.

This is a balancing act, particularly when dealing with seniors. You do want to keep a patient with good insurance so a soft collection approach is best.

Still it's considered fraud and abuse for a provider not to attempt to collect coinsurance and deductibles from Medicare patients.  If you closely read most HMO and PPO contracts, private insurers normally expect you to collect co pays BEFORE you see the patient.

Consider the following to improve your front desk collections:

         Have professionally prepared signs prepared and posted in the waiting room that state that Medicare law requires that you collect what is due from the patient and that most private insurance requires that co pays be paid before seeing the provider.

         Train your staff to tell a patient the estimated deductible that is due with a visit, but if a patient volunteers he can't pay the deductible all at once, ask your staff to collect a portion of the deductible each visit. For example, if the patient visits on the average of four times a year, collect 25% at each visit.  This makes it more palatable to patients on fixed income.

         If a patient has secondary insurance, it normally covers coinsurance but not deductibles.  However, the cost of a secondary insurance that does cover the deductible is typically the cost of the deductible itself spread over twelve months.  Encourage your patients to buy that coverage instead. Long term, it's easier on their budget and ensures you get paid too.

         Watch out for Medicare secondary insurance plans that cover only 50% of the coinsurance.  Patients usually don't understand what they've purchased.

         If your patient is truly financially challenged, consider a hardship waiver, referring the patient to social services or recommending a Medicare Advantage plan that covers all charges.  Remember a patient's pride and do this gently.

         It costs over $2.00 to prepare and send a bill.  The return on mailing bills to patients is low vs. collecting from them at the door.


1.  Bill for everything you do. 

According to CMS, Physicians UNDER BILLED Medicare by over ONE BILLION DOLLARS in 2010! 

How much money did you leave on the table?

Medicare is transitioning from a fee for service to a preventive care model.  More and more preventive services are being paid.  Many preventive services are NOT subject to deductibles or coinsurance so you can improve your cash flow by providing these services in the early months of the year.

Medicare now pays for:

  • Initial Preventive Physical Examination (IPPE) also known as the "Welcome to Medicare" visit (includes a referral for an ultrasound screening for Abdominal Aortic Aneurysm for eligible beneficiaries)
  • Annual Wellness Visit (Including Personalized Prevention Plan Services) - Effective 1/1/11
  • Bone Mass Measurement
  • Cancer Screenings
    • Breast Cancer (mammography and clinical breast exam)
    • Cervical and Vaginal Cancer (pap test and pelvic exam (includes the clinical breast exam))
    • Colorectal Cancer
      • Fecal Occult Blood Test
      • Flexible Sigmoidoscopy
      • Colonoscopy
      • Barium Enema
    • Prostate (PSA blood test and Digital Rectal Exam)
  • Cardiovascular Disease Screening
  • Diabetes Screening
  • Diabetes Self-Management Training
  • Glaucoma Screening
  • Human Immunodeficiency Virus (HIV) Screening
  • Immunizations (Seasonal Influenza, Pneumococcal, and Hepatitis B)
  • Medical Nutrition Therapy (for beneficiaries with diabetes or renal disease)
  • Tobacco-Use Cessation Counseling
  • Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse - Effective 10/14/11
  • Screening for Depression in Adults - Effective 10/14/11
  • Intensive Behavioral Therapy for Cardiovascular Disease - Effective 11/8/11

Providers are already doing many of these services but are not billing separately for them.

In addition, there are many incentives being offered by Medicare and private insurers. 

Are you Board Certified?  Did you know that Medicare now offers a .5% incentive for maintaining your certificate?  For details visit:  https://www.cms.gov/PQRS/Downloads/2012_Maintenance_of_Certification_Requirements_2.pdf.

To get the maintaining your certificate bonus for 2012 you must sign up by the end of January.

In addition, Medicare continues to pay for reporting on three quality standards. It's too late for 2011 claims based reporting; but you can still collect in 2012 for 2012 PQRS if you report via a registry.


Please forward our email to anyone you think might be interested in improving their bottom line in 2012. 

If you want more information about any of the information above, please call 901-377-8727 or the toll-free number below.

Sharon Lusk, JD, CPA, CMC
KLA Healthcare Consultants
Contact Us
KLA Healthcare Consultants
6890 Hillshire #9
Memphis, Tennessee 38133
Phone: 888.325.1691
Fax: 888.325.1692
Follow Us On Twitter