To Swipe or NOT to Swipe?

Sherry L. Krueger Executieve Director

I have come across an interesting program that I need your input on. Verifying benefits has always been excruciating and I have learned that there is a low cost way to cut this large time drain down to size. Rather than sitting on hold there is a way to swipe the patients healthcare card through your credit card terminal and get instantaneous results including current status, deductible amount, copay, coverage and co-insurance amount and much more. Have any of you utilized this service? What have you experienced? It is always helpful to hear the features / services that you like or don’t like from the people that live it everyday.

Practice Revenue Down?

Sherry L. Krueger
Executive Director

With the economy on the decline practice revenues are sure to follow.
Did you know that healthcare is 1 of the top 5 things people cut first when trimming their budget? We have heard some creative ways to trim the budget as well as add money to the bottom line. Please post your ideas here to share with your fellow HNA providers. Healthcare Networks of America will be utilizing these ideas to put together a free white paper for our providers. Please indicate if we may contact you and quote you in an article that will be published and syndicated.

I’m Losing Money but I’ll Make it up in Volume

By Sherry L. Krueger Skrueger@hna-net.com

Do you have the right patient mix?

Patient Mix is a tricky road to navigate. Many practices just assume the more patients it sees the more money it makes! Well, what if you could see different patients and make more? What is patient Mix? Patient Mix is the equation that leads to all the patients you see in your practice. Simply put: How many PPO patients, HMO patients, cash patients, and Medicare patients do I have? For example a typical General Practitioner runs about 85-90% on the large HMO patient mix structure. Meaning you are contracted with the top 5-10 HMO/PPO in your area because they control a large patient base. You contract with them and they fill your waiting room with patients. But are the reimbursements what you want? Usually not. You may think you make up for less money with more volume but this approach is a formula for disaster.

Do I really want Work Comp patients?

Many practices are so hungry for patients that they sign up on patient contracts that are not as much of a benefit as they should be. One of the contract types is Workers Compensation. Most doctors will see a work comp patient if they come into their office, but many practices and specialties actually look for these types of patients. But should YOU look for these patients? Do you know if your state is directed or non-directed? Does your state have a state mandated fee schedule or not? If so, what is the fee schedule? After extensive research HNA put together a work comp grid specifically to assist our doctors in making this decision. Keep in mind that if you are in a directed state, this means that an employer tells the employee what doctor they must go see for an injury. Whereas a non- directed state the employee chooses what doctor to go see. Of course a state mandated fee schedule is a fee schedule the state has produced as to the charges you will be reimbursed for these services. This seems easy enough but what to do with this information? Well, if you are contracting with a private carrier your fee schedule may be a cpt code fee schedule or a percentage of a mandated fee schedule.
For example:

Here's a little riddle?

Arizona is a non-Directed state with a state mandated work comp fee schedule

You live in Phoenix, AZ and you have been approached to contract with a work comp carrier for 70% of your billed charges OR 10% off the state mandated fee schedule if applicable whichever is less.

How do you do the math? Lets say the Arizona state mandated fee schedule pays $50 for an office visit and your office’s billed charges for this office visit is $60. What would your fee be?
70% of your billed charges is $42, and 10% off the fee schedule would equate to $45 dollars. So they will use the $42 reimbursement because it is lower.

OK, Riddle time: Should you contract with this carrier?

Probably not. Why? Because you are in a non-directed state and the patient was came to you because they wanted to see YOU not because they have to. You would have seen this patient if you weren’t contracted AND would have received $50 or %100 of the state fee schedule.

Sherry L. Krueger
Executive Director

Decline in Physician Revenues?

Your fellow Healthcare Networks of America physicians need your help. It is no surprise that numerous physicians are experiencing a significant decline in revenues due to the economic troubles in our country. To respond to this need, HNA is starting a section in our online Resource Center at http://www.hna-net.com/ where physicians can share income producing strategies and programs that have been proven to work.

Here how this will work: If you have a proven strategy, send us your solutions or ideas by posting these solutions in our blog. If interested in launching a new idea you may have, we are also equipped to help you package and market your idea to other physicians if you are interested.

This is a work in progress and will take time to populate with good ideas. In tough economic times we are eager to build a community of physicians and office managers to turn this recession into an opportunity to grow.

HNA is in search of great tools, forms and articles

Members Helping Members: If your practice has a great tool or resource you would like to see posted send a copy in JPG or DOC format to service@hna-net.com and we will consider posting it on the site for members use.

Want to see some specific tools or articles posted? Let us know what information you need and we will attempt to find it for you.