There is evidence to suggest that the first week of March is the unkindest time of year for funny fat guys. Lou Costello and William Frawley (from “I Love Lucy”) died on March 3rd, John Candy died on March 4th and John Belushi died on March 5th. If I didn’t have enough incentive to start losing weight, a look at this list during the past week would have been all I needed to move forward, as this would appear to be an unfriendly time for those with excess weight.

Historical patterns also suggest that all empires and times of excess eventually come to an abrupt end. We tend to mark the ages of man by the main national force of the time frame, chronicling the times of lapsed cultural powers, from Ancient Egypt to Greece to Rome. The modern advantage we all share is the ability to review history and learn from it. When we embrace the lessons learned, humanity has the ability to come out on the other side of lean times stronger than ever before.

Our country currently finds itself in a profound time of economic challenge, which threatens the stability of long-established institutions. With the U6 unemployment rate (which measures total unemployed, underemployed and long-term unemployed only marginally attached to the workforce) currently measuring at 17.9%, effects begin to move through parts of our economy at different rates. There is a feeling in our industry that the economy has unceremoniously arrived at the door of the healthcare delivery system. Combine our current economic morass with the double-digit premium increases foisted upon those who still have coverage from the health insurance sector (none of which is returned to healthcare providers in the form of more favorable contract terms) and it becomes of paramount importance to look for unexplored ways to increase collections.

There is a direct correlation between the reduction of workers and the increase in the self-pay population presenting for healthcare services. This burgeoning population requires increased due diligence on the part of registration and front-desk staff to minimize the impact of this group on a provider’s bottom line. The following simple steps can assure that providers protect themselves and retain full value for their services:

• Insurance Demographic Verification – When an established patient either presents for services or contacts you for an appointment for future services, verify that the patient’s coverage is still in force. This will give both parties a clear picture of the patient’s liability for services rendered.
• Know Your Fees – The self-pay population, particularly a provider’s established patients, will want to know their liability for services. Having your fees for certain services on hand will help front-end staff in designing a payment schedule for the patient.
• Compliance Awareness – Routine blanket waivers of co-payments, deductible and coinsurance are considered a violation of federal law if you see Medicare or Medicaid patients in your practice. Federal law does allow for economic relief for a patient due to financial hardship. In each case where a patient requests forgiveness of all or a portion of their outstanding balance, economic information unique to that patient should be taken into account before arriving at a dollar amount.
• Know Your Referral Rules – Specialists must be acutely aware of referral and prior authorization rules and requirements for insurances utilized in their area. Without this knowledge, the number of non-covered services for patients with active insurance coverage needlessly increases, often with no opportunity for appeal. There are some carriers that will allow for retro-authorization, but this is not such a large number that a provider should gamble with reimbursement of legitimate services.

Thin times often call for defensive measures. With the understanding that each provider’s field of practice offers with it unique considerations, internalizing and following the above steps can provide a healthy head start towards seeing a practice from current lean times to (hopefully) brighter and heavier days ahead.

11:42 am, March 5th, 2010 |