RESOURCES
The Library
Since 1992, PMRG has helped and guided ophthalmologists to navigate the sometimes difficult waters of running a physician owned medical practice. Over those years, we have written and published many articles in support of that work. This library of offerings is updated and added to regularly and is here as a resource to assist you in the operations and management of your practice.
Please come back often and don’t hesitate to let us know if there is something you would like us to write on that is not listed here!
To contact us to find out more or to suggest a topic, please click here.
Social Determinants of Health (SDoH) are economic or social conditions in the environment that can affect individuals’ health and quality-of-life outcomes.
Consolidated billing was established by the Centers for Medicare & Medicare Services (CMS) in 1998 to help eliminate duplicate billings for services rendered to SNF residents by multiple providers. With consolidated billing, an SNF receives a basic per diem rate per level of care for each resident.
There are times when care is not covered by Medicare because they deem the service not medically necessary. In these circumstances, it is vital to make sure that you communicate the likelihood that the service will not be paid for by Medicare and give your patient the option to receive these services but pay for them out-of-pocket.
This communication is called an Advanced Beneficiary Notice of Non-Coverage, or ABN.
National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) are created by the Centers for Medicare & Medicaid Services (CMS.) They apply to all Medicare providers to establish how a service will be covered; what criteria is required to establish medical necessity; and what documentation requirements there are for the service.
Time management is the organization of one’s time and activities. Time-management skills are important for health care professionals who must perform a multitude of different tasks throughout the day.
Collecting patient balances at the time of service is a key step in your revenue cycle. If your office does not currently have policies and procedures in place for collecting from your patient at the time of the visit, it can be a challenge to implement.
Although it may seem the easiest way to be “compliant, if your compliance plan is not personalized for your practice, you could face scrutiny from the OIG.
Patients with vision plans will sign a form at the time of service that explains that medical insurance may also be billed when necessary (Regarding Vision & Medical Insurance.)
Building, updating, and maintaining your contracted allowables for the major insurance carriers you are contracted with is a crucial aspect of managing a well-run practice.
It can be difficult to know what data your practice should be tracking. Most current practice management systems have such in depth reporting capabilities, it can be challenging to find a report or reports to quickly summarize your practice’s data to analyze your metrics and ensure business goals are being met.
Patients with vision plans will sign a form at the time of service that explains that medical insurance may also be billed when necessary (Regarding Vision & Medical Insurance.)
Comparative Billing Reports (CBRs) summarize Medicare claims data and distribute it to providers to provide insight into billing trends. Each CBR is unique to a single provider and is only available to that individual provider. CBRs are not punitive and will not be publicly available.
The August/September 1999 issue of Watching Your Bottom Line discussed evaluation of your practice’s fee schedule based on the use of the Resource-Based Relative Value Scale (RBRVS).
We’ve looked at charge capture, at productivity and product-line analyses, and at payor mix. We’ve also looked at how our computer systems handle and report data to ensure that we’re getting an accurate picture of our clinical activity translated into financial information. In this issue of the newsletter, we’ll put all of the income data together to calculate a collection target.
Usually a computerized billing system captures and reports information differently from the way you manage your practice’s business. Unless you build a customized program, you will have to understand your computer’s thinking in order to maximize its use as a management tool for your business.
Transforming a clinical service into income requires managing tens of thousands of transactions with hundreds of thousands of data elements. In order to make the difference between mediocre and outstanding collection performance, an effective and efficient billing process is required.
As the practice owner (or manager), one of the most powerful points of leverage you have for having your practice be effective and successful is your staff.
Implement systems to assure that an appropriate charge is entered for each clinical service. Use your computer system’s appointment scheduling to compare appointments with charge tickets, identifying missing tickets.
In the last issue we laid the groundwork for a monthly reporting package. We showed how to prepare reports of clinical activity and patient type. In this issue we’ll use the data from those reports in describing the reporting of collection performance, accounts receivable (AR), and practice expense.
One of the most challenging tasks for ophthalmology practices is the business process of sending thousands of fee-for-service claims (for both medical and surgical services) to third-party payors and of ensuring proper payment.
In past issues of this newsletter, we’ve worked through the methodology to use in the analysis of your practice’s financial performance. In the next two issues, we’ll look at a set of regular management reports formatted for review by you and the physicians in your practice.
Hiring the right number of staff and paying staff at the right level are both key factors in managing staff costs and office overhead.
We will make the assertion that PHYSICIANS DO HAVE TRAINING IN THE TOOLS REQUIRED TO MASTER THEIR BUSINESS.
Are you dreading going through a computer installation in your practice? Complying with HIPAA regulations, phasing out an obsolete system, and making functional upgrades to keep pace with your business needs are but a few of the reasons you may be facing installation of a new practice management software system.
It’s the end of the year and time to review every aspect of the business of your practice in order to plan for the upcoming year.
Many ophthalmology practices use optometrists and opticians to expand the practices’ productivity, income, and profitability. Your ability to obtain and retain the services of these professionals, as well as to improve their performance and productivity, is enhanced by offering compensation incentives.
Many ophthalmology practices find themselves functioning as a finance company for patients’ unpaid balances and co-payments.
Certain functions obviously require expertise beyond the capabilities of the ophthalmologist and the practice staff, such as accounting, legal, and equipment maintenance services.
What is the best way to acquire capital equipment? Purchase with cash? Finance purchase? Lease? Although this newsletter provides solid guidelines to help you evaluate purchase choices, it is not a substitute for consultation with your professional financial advisors (e.g., accountant, tax attorney).