How Do You Know If Your Practice Is On Target?

Many physicians are overwhelmed with their day-to-day activities and are not aware if their practice is doing well or is in need of some fine tuning.  Below are five key areas of concern that should be looked into and followed up on to see how the practice is flowing.

1. Overhead

Calculate your overhead rate which includes staff and general operating costs by the total revenue the practice is bringing in.  Do some research on other practices similar to yours and see if they are comparable.  If your overhead rate is higher than the average for your specialty, consider reviewing all the cost that are involved within your practice and see if there are areas where you can reduce expenses.

2.  How productive is your practice

It’s a good idea from time to time to check the amount of referrals you are getting every month.  Make a spreadsheet of all referring doctors and see where possibly there is a drop in referrals or you are seeing an increase in referrals for a specific doctor.  By a physician taking 10 minutes out of their day to call a physician to remind them of your practice and also thank them for referring patients in the past, this could generate future referrals for the practice.

3.  Access the practices financial situation

Start by calculating a net collection rate.  When you enter into a contract with an insurance company, you agree to take a contractual adjustment from your submitted charges.  The net collection rate tells you whether you are collecting the remainder of your submitted charges once the adjustment has been made.  Calculate your net collection rate.  It should be 97% or greater to ensure a healthy bottom line.

4.  Avoid unnecessary hospital admissions or ER Visits

Evaluate a one month period and calculate the number of ER visits and admissions that were avoidable or potentially avoidable.  If your practice has a high level of preventable visits and admissions, create a quality plan to expand continuity of care, transition management, and care outreach.  Track this over time by checking it on a quarterly basis, with the goal of reducing your practice’s rate to zero.

5.  Survey referring physicians and patients

Many offices now use a patient survey or referring physician survey to evaluate their practice better.  This could be something that could be e-mailed or mailed with a return postage envelope to patients and referring doctors.  It can be done unanimously to protect their privacy as well.  This is an excellent tool to use to find out what’s really going on with the practice.  This data can be analyzed and put into good use to further make changes within the practice to help it run better.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at

Click here to read testimonies regarding MariAnn Medical Billing Service

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Misconceptions About Collecting Payment From Patients

Misconception 1:  If Patients are making payments you cannot sue them to collect

Whether or not to take a patient to small claims court or send the patients account to a collection agency depends on the amount outstanding and the person’s likely ability to pay.  If a patient is making regular payments on the account that has been agreed upon in writing, then you cannot sue for payment.  If the patient is not meeting those requirements then you have the right to sue for payment.

Misconception 2:  When you mail statements makes a difference

Statements should be mailed out to insure arrival on the first of the month.  This is not a good idea.  So many companies follow that rule so what happens is the patient receives multiple bills on the same day and most likely your bill will be ignored over their car or mortgage payment.  Sending out statements the second week of the month and mid-week is a good time because most bills are sent during this time and will stand out amongst all other mail.  Sending a statement in a colored envelope such as beige or gray will also draw attention to it.

Misconception 3:  Legal restrictions make collecting harder

Most state laws prohibit unreasonably harassing debtors by calling their workplace, at night or on weekends.  With that said, the laws are not really that restrictive.  Calling people at home or at work is not harassment until they tell you to stop, and maybe not even then if you are reasonable about it.  However, if personal calls can jeopardize their jobs then that would not be ethical and will not help for you to collect money that is owed to you.

Misconception 4:  It’s so hard to reach patients at home

Good collectors try every phone number they can find.  Some offices complain and say that the patients are never home so they don’t even bother calling.  Some offices stay open after five, usually when people are coming home from work, this would be a good time to call.  Also some offices start early in the morning.  Try calling then when possibly their getting ready for work or making breakfast.  A quick brief call is all that needs to be made.  You don’t want to make the patient upset which could cause them to never pay you.

Misconception 5:  Sending patients to a collection agency is bad business

Some physicians are afraid of sending patients to collections due to them telling other potential patients or the referring doctor.  Instead, when the collection process is polite and reasonable, the doctor will gain more respect from the patient and no one will value the services you provide more that you do yourself.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at

Click here to read testimonies regarding MariAnn Medical Billing Service

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Billing Practices That Can Be Costly Part II

In part II of this article we will further discuss costly medical billing practices. In some cases, these have led to the loss of medical licenses for false reports include billing unnecessary services, double billing, upcoding or altering CPT codes, unbundling and false diagnoses. 

Unbundling is when you charge separately for a visit or a procedure that is normally part of another procedure or visit.  Double billing is when you bill for the same procedure multiple times on different dates. 

Upcoding refers to using a higher procedural code than what was performed.This includes billing for services that the patient did not receive or using codes that are at a higher level of what really took place during the visit or procedure.  Some examples of that are where a practice submitted bills for office visits for established patients on days where the office was closed, where the physician was not in the office or on vacation and on holidays and weekends when the office is closed. 

Another example is when a physician billed for office visits for parents and siblings when one child was brought into the office for a visit.  The parent had never been seen before but the physician used all the information provided for the insurance where the parent was the subscriber of the health plan, so it was easy to gain access to bill under the parent as well as the child.

Some health care providers advertise “free” services.  When the patient arrives it appears to be a “free” service but ends up being charged for the office visit and other procedural codes.

Other costly practices include failure to produce or complete medical records, which are required to back up billing codes, delegating treatment to individuals that are not qualified or it is not in their scope of practice, and performing procedures and tests that are not with valid consent from the patient.

Billing fraud leads to higher premium assessments by the insurance companies.  HIPAA prohibits billing for medical services “that a person knows or should know are not medically necessary.”  Also violating HIPAA laws and guidelines can result in monetary penalties up to $10,000 and an additional cost of 3 times the dollar amount for each claim.  These crimes are also punishable by up to 10 years in prison or even life in prison if a patient dies as a result of fraudulent activity.

Billing fraud is costly for all those involved, the practice, the doctor and their license and more importantly the patient.  Fortunately, most health care providers are honest and dedicated to helping and providing the best care for their patients and only want what’s best for them and their medical practice.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at

Click here to read testimonies regarding MariAnn Medical Billing Service

“Like” us on Facebook at