By SONDA EUNUS, MHA, CMPE, CPB
Orlando Medical News continues this series of answers to questions from readers dealing with issues faced by practice managers in our healthcare community. We encourage readers to send questions they face in everyday practice. Use the subject Practice Management Challenges to editor@orlandomedicalnews.com Questions selected for inclusion in the September edition will receive a complimentary 300 x 600 pixel ad with animated gif on our website.
1. How can our pediatric practice improve our HEDIS Quality Measure scores?
Practice performance on quality measures is becoming increasingly important, and good performance can lead to substantial financial rewards. Additionally, Medicaid payers feel more comfortable assigning more patients to practices that have demonstrated that they can meet quality measures and provide superior medical care to their patients. Many practices have dedicated employees to work solely on meeting HEDIS measures and closing care gaps, or have contracted with outside consultants to take care of this function.
The designated HEDIS specialist can use the monthly reports generated by the Medicaid payers--which can be obtained from your Provider Relations representative for that payer--to reach out to the patients who have care gaps such as missing their last well child check (WCC), not being up-to-date on immunizations, needing nutrition or physical activity counseling, etc. Many quality measures can be met by simply keeping your patients up-to-date with the WCC schedule as well as the immunization schedule as recommended by the CDC.
Other trickier measures include ensuring that your patients have had their yearly dental visit, which may be out of your hands, but you are still responsible for educating the patients and parents on the importance of appropriate dental care. Other measures such as yearly Chlamydia screening for girls over 13 years of age require that your practice be very diligent in performing the right screenings on each patient. Still other measures focus on your documentation, such as ensuring that the child's BMI is being measured and entered in the chart, documenting counseling given by entering the appropriate codes even if they are non-covered codes, etc.
Most importantly, practices must realize that these quality measures will only become more prevalent, and that commercial payers also have similar programs. It is therefore crucial to hire and train a detail-oriented and persistent employee to stay on top of these care gap reports, reach out to the patients to schedule necessary appointments, communicate with providers and clinical staff about the importance of complete documentation, and ensure that all care gaps are being closed. After all, the main objective of the HEDIS program is to ensure that quality care is being provided to
patients--the financial incentives are simply a nice bonus for doing what we should be doing for our patients regardless.
2. How can our medical practice increase our patient payment collections?
Patient accounts are hardest to collect after the patient has already walked out the door after their visit. It is therefore important to communicate your practice's collection policies to your patients up front, and to make sure that they are aware of them when they first register as a new patient.
It is a good idea to create a document outlining all of your billing policies and to have the patient read and sign it along with your other office policies and patient registration forms. This way, the patient cannot claim that they weren't aware that co-pays and coinsurances were due at the time of visit, that they did not know that they would be responsible for the visit if their insurance plan's deductible is not met or their coverage is inactive, etc.
Some patients may try to be seen without making a necessary payment at time of service, or may avoid paying a past balance when they are at your office by claiming that they forgot their wallet, or that they are not getting paid until next week, and other such reasons. It is important to remain polite but firm in such situations, and to explain that your practice's policies were very clearly outlined in your new patient paperwork.
By setting clear expectations, it is much easier to keep such patients accountable.
Furthermore, your front office and billing employees must be trained on how to ask for payment prior to checking the patient in for their appointment, both for time of service collections as well as for previous account balances. They should be prepared to answer questions about what the payment is for, as well as explain previous balances.
With improved communication between your practice and its patients, as well as appropriate staff training on patient payment collections, your practice will be able to greatly improve your patient payment collection rates.
