Tuesday, September 27, 2022

5 Keys to successfully implementing strategy in your medical practice

Oftentimes physicians and administrators discuss strategies and may even devise a strategic plan, only to see nothing come of it. The most common reason for strategy failure is that they failed to build execution into their strategic planning process. We often see that budgets are not linked to strategy, staff incentives are not linked to strategy, and a very small number of employees understand the practice strategy. There are three reasons strategy fails to execute:Practice initiatives don’t aligned with strategy
Practice processes don’t align with strategy
Employees and physicians fail to engage

To ensure that your strategies are successfully implemented, you must build the execution into and across the strategy and the strategy planning process. Below are the 5 steps to successful strategy implementation.

1. Align your initiatives


A key road to failed implementation is when we create a new strategy but then continue to do the same things of old. A new strategy means new priorities and new activities across the practice. Every activity (other than the most functional) must be reviewed against its relevance to the new strategy.A good way of doing this is to create a strategic value measurement tool for existing and new initiatives. Initiatives should be analyzed against their strategic value and the impact to the practice. Measuring your initiatives as such will help highlight the priorities and ensure the right initiatives are adopted for delivery.

2. Align budgets and performance


Ideally your budgets are structured in such a manner as to protect strategic expenditure from being re-allocated to short-term requirements of operating expenditures while subjecting strategic initiatives to a rigorous review (e.g. forecasted revenue growth and productivity) much like is done for capital expenditures.



The practice’s business performance should be closely aligned to strategy. Performance measures should be placed against strategic goals across the practice and each physician and staff member. All staff members will have job functions that will impact on strategy. Most staff members will have impacts across a series of strategic goals (e.g. financial, patient experience, operational, etc.). Ensure employees are aware of their role and influence on strategy delivery and performance.

Likewise performance incentives should be directly linked to performance against strategy. They should include a combination of individual, team and practice performance measures that ensure staff recognize their direct and indirect impact on strategy performance.

3. Structure follows strategy


A transformational strategy may require a transformation to structure. Does the structure of your practice allow strategy to cascade across and down the organization in a way that meaningfully and efficiently delivers the strategy?Practices that try and force a new strategy into an outdated structure will find their strategy implementation eventually reaches a deadlock.

4. Engaging staff


The key reason strategy execution fails is because the practice doesn’t get behind it. If you’re physicians and staff members don’t understand the strategy and fail to engage, then the strategy has failed.So, how is this accomplished?

Prepare: Strategy involves change. Change is difficult and human tendency is to resist it. So not matter how enlightened and inspiring your new strategic vision, it will come up against hurdles (cognitive, resource, motivation and political). It is important to understand each of these hurdles and develop strategies to overcome them.

Include: Bring influential employees, not just managers into the planning process. Not only will they contribute meaningfully to strategy, they will also be critical in ensuring the practice engages with the strategy. Furthermore, listen across the practice during strategy formulation. Some of your best ideas will come from within your practice, not the management team.

Communicate: Ensure every staff member understands the strategic vision, the strategic themes and what their role will be in delivering the strategic vision. And enrich the communication experience. Communicate the strategy through a combination of presentations, meetings, emails, and updates. Continue strategy and performance updates throughout the year.And engage staff members emotionally in the vision. The vision needs to give people goose bumps – a vision they believe in, that they want to invest and engage with.

Clarify: It is important that all employees are aware of expectations. How are they expected to change? What and how are they expected to deliver? Each individual must understand their functions within the strategy, the expected outcomes and how they will be measured. As mentioned above performance measures and incentives should be aligned with performance against strategic key performance indicators (“KPIs”).

5. Monitor and adapt


A strategy must be a living, breathing document. As we all know: if there’s one constant in healthcare these days it’s change. So our strategies must be adaptable and flexible so they can respond to changes in both our internal and external environments. Strategy meetings should be held regularly throughout the year, where initiatives and direction are assessed for performance and strategic relevance. At least once a year we should put our strategy under full review to check it against changes in our external and competitive environments as well as our internal environments.

Strategy is not just a document written by physicians and managers and then filed away. It is a vision for the practice, owned by the practice. And to succeed the whole practice must engage with it and live and breathe it. Strategy should inform our operations, our structure, and how we go about doing what we do. It should be the pillar against which we assess our priorities, our actions and performance.When execution is brought into strategic planning you will find that your strategy is weaved throughout the practice, and it’s from here that great leaps in growth and productivity can be achieved.


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Monday, September 26, 2022

Effective AR management strategies

In-house teams at medical settings find it difficult to keep up with the mounting pressure when it comes to the Account Receivables. However, there are scores of effective AR management strategies, proven by experts of the medical billing industry, which have helped healthcare organizations to cut through the noise and manage their financial health. Let’s tackle the AR in the RCM system through these effective strategies, shall we?

Stay abreast of the trends and significant changes: In no small measure, the medical billing rules and regulations are subject to changes. Thus, it is crucial for your in-house team to stay up to date with the significant changes to avoid claim denials.

Right KPIs for the long win: Consider these account performance metrics when it comes to the streamlining of accounts receivables process:Collection 

  1. Effective Index: Ensure that the CEI is close to the mark of 100, which acts as an indicator that you are successfully collecting payments from all of your clients.
  2. Average Days Delinquent: The ADD refers to the average of the days since the client’s payment is pending. You have to try to keep this score as minimum as possible for a smooth collection process.
  3. Days Sales Outstanding: This refers to the time recorded to collect the payments. The ideal DSO should be less than 30 days so ensure to keep the scale managed by your in-house team.

Revised invoices: To tackle the challenges of revised invoices, look up to the billing policies and meet your staffing needs, kicking out the errors for delayed payments.

Mark procedures upfront: Once you document and mark the procedures of managing the AR, it ensures immense clarity and consistency. Ensure that your procedure has mentioned all of the following: invoicing dates, necessary data inclusions, recordkeeping procedures, follow-up procedures, and collection methods for the pending payments.

Align credit and collection policies: To avoid situations of extending credits to your clients, it is important to align credit policies way ahead of time. This will ensure a streamlined process and address the issues of overdue accounts in the most systematic manner.

Insurance eligibility verification: As per the eClaim Status, insurance eligibility verification causes more than 75% of claim rejections and denials by payers. To ensure financial growth of your medical setting, it is crucial to check the patient’s eligibility and coverage. There are different ways to find out the eligibility: using third-party products to scrape data and using software on the payer’s site. It is significant to check the coverage date, identify whether it is a Co-pay amount or Deductible amount.

Identify the reasons for denial: As per Equifax, poor billing practices cause doctors in the US to lose an estimated $125 billion each year. To ensure that the billing collections are improved it is significant to identify the reasons which result in claim denials. A few of the reasons for claim denial are mentioned below:
  • Data error in registration
  • Lack of necessary information
  • Duplication of claims
  • Incorrect patient information in the records
  • Credentialing errors
  • Documentation errors

Accurate information on debtor listicle: Every medical setting has their own workflow and methods of organization thus, following any advice on a blindnote is not sound advice. It is important to access information of debtors at your medical setting. Know your organization's debtors, claim build-up and analyze critical internal processes. This ensures a streamlined process of how to approach your debtors and ensure a managed yet quick cash flow.

Investing in automation tools: A multidimensional support takes a medical setting a long way. Right from analyzing big amounts to gathering necessary timeline of claims, automation has got you covered. Digital transformations and proper infrastructures like these ensure that the AR management is highly- efficient.

Involve everyone for a smooth process: Medical institutions try to limit the AR management to the billing team however, when you involve all the other teams too, it ensures coordination. Loop in the sales team and managementteam too, avoiding redundancies and reducing piling of unnecessary costs.

The pertinent question is, whether you should outsource AR management for your medical setting

Having an in-house team to streamline the process and run software is always an option however, it comes with a lot of responsibility and stress. Thus, the best alternative is to outsource AR management. As per the BlueEHR, the Insurer AR must be maintained at 5% to 7% to mark good business performance. Who doesn’t want maximized cash flow and minimized costs, topped with healthy customer relationships? Take the right step and pick the right medical billing and coding company to streamline your AR management strategies and skyrocket results.


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Friday, September 23, 2022

Physicians, don't make this huge mistake!

A huge mistake I often see physicians make is carelessly signing up to become medical directors. Becoming a medical director of a facility, a medical device company, or some other venture could place your license and liberty in jeopardy. While on their face, medical directorship is a vehicle to make ancillary income, often these contracts are structured in ways that may be illegal. For example, the agreement:
  • pays physicians for patient referrals;
  • pays physicians for overseeing medical care, but in actuality, the provider is not overseeing anything at all;
  • allows non-clinicians to direct patient care;
  • pays physicians for fees for no work performed.

Instead, if an opportunity is presented to you to become a medical director, review the agreement and business arrangement with your attorney. Your attorney should examine rules related to your state’s licensing laws, Medicare, and the facility’s payor agreements, as well as review the organization to ensure it has not been excluded from Medicare and other federal dollars. Additionally, it wouldn’t hurt to review recent Department of Justice indictments to have a better understanding of what other medical directors have gotten into trouble for. The Office of Inspector General (OIG), states to comply as a medical director, the physicians should: actively oversee clinical care in the facility;
lead the medical staff to meet the standard of care;
ensure proper training, education, and oversight for physicians, nurses, and other staff members; and
identify and address quality problems.

Recent Dallas case—


The $27 million Novus Health Services fraud case resulted in a combined 84 years in federal prison for thirteen defendants. This conviction follows Bradley J. Harris, the former CEO of Novus and Optimum Health Services, who pleaded guilty earlier this year to fraudulent billing and a kickback scheme. According to plea papers and evidence at trial, Dallas-based Novus defrauded Medicare by making false claims about hospice services, providing kickbacks for referrals, and violating HIPAA to recruit more patients. Novus employees also gave patients Schedule II controlled substances without guidance from healthcare professionals and later transferred patients to a new hospice facility to circumvent Medicare disciplinary action.Two doctors, who helped a Novus scam Medicare, were sentenced to a combined 23 years in prison for healthcare fraud.


  1. The medical directors were found guilty of conspiracy to commit healthcare fraud and other charges.
  2. The doctors helped defraud Medicare by, among other things, illegally admitting patients who were not appropriate for hospice and submitting materially false claims for hospice services.
  3. These doctors allowed an accountant with no medical expertise – to dispense controlled substances like candy, with little to no medical oversight,” said U.S. Attorney Chad Meacham. “They claimed to have had hands-on experience with hospice patients, when in fact, they’d entrusted life-or-death medical decisions to untrained businesspeople.
  4. The government relied on the doctors to certify that they had examined these patients face-to-face when no such examinations had occurred.

There is no amount of medical director pay that is worth losing your medical license and liberty. I’m sure when these physicians took this job, they never intended to lose their liberty, but sometimes fast money prevents people from thinking clearly.


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