More Requirements by UHC
by Cheryl Nash and AJ Riviezo
Over the past few weeks we have obtained further clarification from Dr. Jeff Mason, Senior Medical Director for United Healthcare (UHC). One of the key questions needing clarification was "pictures of what exactly?". UHC, per Dr. Mason, would like to receive the following from the diagnostic duplex ultrasound:
1) Images (black and white, or color) that show the anatomy and size of the vein at sections relevant to the case. These images can be submitted in hard-copy prints, or, preferably, in a digital file. We do not need a record of the entire exam --- several "snapshots' are enough.
2) We need speed and direction of blood flow information, either from a color doppler print(the colors represent direction and speed of flow) or locations (denoted by cursors) where flow readings were taken.
3) We need a report of the exam including results of the above size of vein and degree and timing of reflux, that is signed, hard copy or electronically, by a physician.
UHC has also already modified their policy regarding the surface skin photos. They now want a ruler showing size next to the problem area(s) as well as the patient name. One group is taping the patient name as a flag on the ruler. Another group has the patient stand in front of a white board and the patient name is written on the white board.
If you or your team have questions regarding any of the new UHC processes, do feel free to call us. We are happy to try and explain the processes as we understand them. No charge. We are all in this boat together! Please ask for Cheryl at 719.955.9128 ext. 203.
Monday, August 30, 2010
Marketing to Males
Or... How to Herd Cats
by AJ Riviezzo, MBA
As the data above shows, very few men are coming in for phlebology services. The reasons are fairly evident and are not unique to phlebology. The question then becomes: "How do we capture a few more of these reticent males?" Below are some ideas for your consideration.
1. Pain and Performance: The bulk of the phlebology marketing tri-folds and brochures are geared towards women in both their look and language. Understandably so. I recommend creating a separate brochure specifically for men. This will typically cause a re-write of your brochure as men will not respond to the aesthetic elements most marketing pieces contain. The men will respond to two elements.
The first is pain. Your services can reduce the pain and swelling in their legs. The information should contain a bit of clinical information describing how that happens. Very straight forward information. Stress that this is an ailment and not a cosmetic procedure. The second element is performance. By having healthier, pain free legs the gentleman will be able to golf, walk their dog, hike, lift weights, bike, and other activities at a higher performance level.
2. Pictures: Consider adding some more male pictures to your website and especially your 'male' brochure. Again, have them focus on performance by showing pictures of healthy legs climbing a cliff, biking, dog walking, and the like. You may want a separate page on your website stylized 'For Men' or similar heading that contains your more male oriented information.
3. Build It and They Will NOT Come: Your male patient is not typically looking for your service. You need to determine how best to go to them. If you have had a few patients that work for a male dominated industry with a union (electrical, pipe fitters, carpenters, meat cutters, etc.) and the patient is happy with their outcome; ask them who you should contact in the union. Many unions have a preferred provider book. They may allow you to do a Lunch and Learn or other speaking engagement at one of their meetings. You may be able to place brochures in the commons areas.
Another possibility is to get your brochures out to various activity venues. Bicycle shops may be willing to keep your information on a brochure rack or on the counter. High end running shoe stores may also be a possibility. Gyms that cater primarily to men may be willing to have you place your brochures. You may even be able to meet with the trainers. A quick review of signs and symptoms with the trainers and you now have three or four people looking at legs for you! Work a reciprocity agreement so to speak by carrying their brochures in your office.
A third possibility is health fairs. Yes, they are sometimes boring and not always much fun. Having information that caters specifically to men will help you at the health fair. The man may or may not be there to meet with you or your team... but their spouse is. Their wife then has something they can take back to them for their review.
by AJ Riviezzo, MBA
As the data above shows, very few men are coming in for phlebology services. The reasons are fairly evident and are not unique to phlebology. The question then becomes: "How do we capture a few more of these reticent males?" Below are some ideas for your consideration.
1. Pain and Performance: The bulk of the phlebology marketing tri-folds and brochures are geared towards women in both their look and language. Understandably so. I recommend creating a separate brochure specifically for men. This will typically cause a re-write of your brochure as men will not respond to the aesthetic elements most marketing pieces contain. The men will respond to two elements.
The first is pain. Your services can reduce the pain and swelling in their legs. The information should contain a bit of clinical information describing how that happens. Very straight forward information. Stress that this is an ailment and not a cosmetic procedure. The second element is performance. By having healthier, pain free legs the gentleman will be able to golf, walk their dog, hike, lift weights, bike, and other activities at a higher performance level.
2. Pictures: Consider adding some more male pictures to your website and especially your 'male' brochure. Again, have them focus on performance by showing pictures of healthy legs climbing a cliff, biking, dog walking, and the like. You may want a separate page on your website stylized 'For Men' or similar heading that contains your more male oriented information.
3. Build It and They Will NOT Come: Your male patient is not typically looking for your service. You need to determine how best to go to them. If you have had a few patients that work for a male dominated industry with a union (electrical, pipe fitters, carpenters, meat cutters, etc.) and the patient is happy with their outcome; ask them who you should contact in the union. Many unions have a preferred provider book. They may allow you to do a Lunch and Learn or other speaking engagement at one of their meetings. You may be able to place brochures in the commons areas.
Another possibility is to get your brochures out to various activity venues. Bicycle shops may be willing to keep your information on a brochure rack or on the counter. High end running shoe stores may also be a possibility. Gyms that cater primarily to men may be willing to have you place your brochures. You may even be able to meet with the trainers. A quick review of signs and symptoms with the trainers and you now have three or four people looking at legs for you! Work a reciprocity agreement so to speak by carrying their brochures in your office.
A third possibility is health fairs. Yes, they are sometimes boring and not always much fun. Having information that caters specifically to men will help you at the health fair. The man may or may not be there to meet with you or your team... but their spouse is. Their wife then has something they can take back to them for their review.
Who Are Your Patients
A Quick Demographic Study
by AJ Riviezo, MBA
A new practice was asking for some information about patient demographics. To that end, I combined the demographic data of three large phlebology practices. None of these practices specifically target Medicare members as their primary market. All of them have primarily commercial payers with some (less than 20%) Medicare in the mix. Total patient sample size is 2,306 patients. The results are interesting and give you some comparison information you can use after reviewing your own practice's experience.
Under 30 - 4%, 30 to 39 - 15%, 40 to 49 - 23%, 50 to 59 - 27%, 60 - 69 - 19%, 71 to 79 - 9%, 80+ - 3%
Almost 70% of the business was 40 to 70 years of age. This age banding was skewed a bit older than what I had expected when reviewing practices that primarily see commercial payer patients.
The male/female ratios were even more significant. Males constituted only 16% of the patient population for these practices.
I recommend giving this data and your own age/sex patient data to your marketing person or company. Armed with this, they should be able to rifle in on a more targeted marketing campaign rather than a shotgun approach.
by AJ Riviezo, MBA
A new practice was asking for some information about patient demographics. To that end, I combined the demographic data of three large phlebology practices. None of these practices specifically target Medicare members as their primary market. All of them have primarily commercial payers with some (less than 20%) Medicare in the mix. Total patient sample size is 2,306 patients. The results are interesting and give you some comparison information you can use after reviewing your own practice's experience.
Under 30 - 4%, 30 to 39 - 15%, 40 to 49 - 23%, 50 to 59 - 27%, 60 - 69 - 19%, 71 to 79 - 9%, 80+ - 3%
Almost 70% of the business was 40 to 70 years of age. This age banding was skewed a bit older than what I had expected when reviewing practices that primarily see commercial payer patients.
The male/female ratios were even more significant. Males constituted only 16% of the patient population for these practices.
I recommend giving this data and your own age/sex patient data to your marketing person or company. Armed with this, they should be able to rifle in on a more targeted marketing campaign rather than a shotgun approach.
Friday, July 23, 2010
How to Make Life More Complicated/United Health Care Changes
by Cheryl Nash
Many of you may have received a letter from United Healthcare recently detailing some significant modifications to their coverage guidelines. With the main topic of discussion being documentation this month, I feel this is an opportune time to review these changes.
The most dramatic change by United is the addition of digital photos and the color flow Doppler results in addition to the interpretation by a physician. This digital media will be requested at the time of notification/pre-authorization. A standard 10 megapixel camera (cost is between $100 and $ 300) should be sufficient. The preferred way of submitting this information will be by digital upload through a secured email. Contact your local United Healthcare provider representative to obtain your personal secured email address. The documentation can also be sent hard-copy, but they freely acknowledge that this will delay processing. We recommend securing a comprehensive way of storing this data in an easily accessible electronic file to make communication with the insurance company as smooth as possible.
Some other significant changes to the clinical requirements is the detail to be documented in the Doppler study as well as in the patient History and Physical. United will require the vein diameter with strict guidelines as to what the diameter must be for different venous issues (including perforators). They will also be requiring the duration of reflux to be written in the report. This is all in addition to the previous requirements of reflux without evidence of DVT/PAD. For patients who exhibit only signs and symptoms they have added a questionnaire to be filled out completely and sent along with a dictated H&P from the provider. This H&P will need to have a complete treatment plan and proposed outcome. As always, a trial of conservative treatment to include compression stockings will be included.
The complete clinical guidelines can be found at unitedhealthcareonline.com under the tools and resources/policies and protocols/coverage determination guidelines. The header has changed and is now listed as Ablative Procedures for Venous Insufficiency and Varicose Veins (this was formerly under Surgical and Minimally Invasive Treatment for Varicose Veins of the Leg).
Unfortunately, practices that treat varicose veins will only have a couple of weeks to get these changes into place as the new guidelines go into effect on August First, 2010.
Many of you may have received a letter from United Healthcare recently detailing some significant modifications to their coverage guidelines. With the main topic of discussion being documentation this month, I feel this is an opportune time to review these changes.
The most dramatic change by United is the addition of digital photos and the color flow Doppler results in addition to the interpretation by a physician. This digital media will be requested at the time of notification/pre-authorization. A standard 10 megapixel camera (cost is between $100 and $ 300) should be sufficient. The preferred way of submitting this information will be by digital upload through a secured email. Contact your local United Healthcare provider representative to obtain your personal secured email address. The documentation can also be sent hard-copy, but they freely acknowledge that this will delay processing. We recommend securing a comprehensive way of storing this data in an easily accessible electronic file to make communication with the insurance company as smooth as possible.
Some other significant changes to the clinical requirements is the detail to be documented in the Doppler study as well as in the patient History and Physical. United will require the vein diameter with strict guidelines as to what the diameter must be for different venous issues (including perforators). They will also be requiring the duration of reflux to be written in the report. This is all in addition to the previous requirements of reflux without evidence of DVT/PAD. For patients who exhibit only signs and symptoms they have added a questionnaire to be filled out completely and sent along with a dictated H&P from the provider. This H&P will need to have a complete treatment plan and proposed outcome. As always, a trial of conservative treatment to include compression stockings will be included.
The complete clinical guidelines can be found at unitedhealthcareonline.com under the tools and resources/policies and protocols/coverage determination guidelines. The header has changed and is now listed as Ablative Procedures for Venous Insufficiency and Varicose Veins (this was formerly under Surgical and Minimally Invasive Treatment for Varicose Veins of the Leg).
Unfortunately, practices that treat varicose veins will only have a couple of weeks to get these changes into place as the new guidelines go into effect on August First, 2010.
The Impact of Documentation on Your Practice
by Cheryl Nash
We've all heard it and we all have to do it. Documentation: The necessary evil. For a phlebology practice, each new year seems to bring more lengthy requirements and requests for records. From Ultrasound Reports to History and Physicals; Operative reports to Letters of Medical Necessity; it seems that today's phlebology specialist spends more and more time dictating, and the requirements keep changing. How does anyone keep up?!
Unfortunately, incomplete documentation is one of the most-common reasons for a phlebology claim to be denied. Many factors must be addressed for surgical treatment of varicose veins to be considered medically necessary. This is standard for all payers nationwide. Some factors are common to all payers, and while there are some variants, most have the same basic requirements. They include evidence of reflux, showing incompetence of the lesser or greater saphenous veins conservative treatment tried and failed, compressive therapy for a variable amount of time and an absence of PAD and DVT. Insurance companies review their guidelines each year and make changes as they see fit. These changes need to be monitored closely to ensure requirements are followed to the letter. Missing even one factor can cause a claim to be denied at all levels of appeal, and ultimately cause a lack of payment for the practice.
Another reason to maintain correct documentation is to protect against audit. RAC audits are being conducted by Medicare and various commercial payers, most commonly Medicare Advantage plans. The importance of protecting yourself against these audits has taken center stage. Audits are no longer a case of "if, they are a case of "when", and no one wants to be caught unprepared. In addition to auditing, there have been an increasing amount of whistleblower cases that have sparked a wave of record requests from all payers, including Medicare, to verify that the level of service billed is indeed what was performed. More, not less, documentation is the only recourse to survive an audit.
The best defense really is a good offense. Having a comprehensive knowledge of what is needed, and ensuring your standard reports to meet these requirements are key to smooth and timely reimbursement. Presenting a quick and thorough response when an insurance company requests those records will result in faster payment. One of the best ways to accomplish this is to keep a file, whether physical or electronic, of your most common payers' clinical policies on hand. It is also helpful to note when the next review date will occur. When recommending a course of treatment, have a staff member that is well-versed on these policies review the patient's insurance and the chart records to ensure each element has been met. This holds true for both follow-up services and primary surgeries.
TMI (too much information) is the rule in this specialty and a brief report that only the doctor can read is not sufficient. If the insurance company cannot read it, they will not pay it. They do not employ staff that specialize in phlebology to review records, and if they are not clear, the claim will get denied. We have all heard the cliché' "if it isn't documented, it didn't happen". This is so very true with Phlebology. The insurance company is not there to help you and does not want to pay you, so it is up to healthcare providers to actively participate in their own reimbursement. Ensuring that the claim is not denied on a documentation technicality is one of the major ways to achieve this payment goal.
We've all heard it and we all have to do it. Documentation: The necessary evil. For a phlebology practice, each new year seems to bring more lengthy requirements and requests for records. From Ultrasound Reports to History and Physicals; Operative reports to Letters of Medical Necessity; it seems that today's phlebology specialist spends more and more time dictating, and the requirements keep changing. How does anyone keep up?!
Unfortunately, incomplete documentation is one of the most-common reasons for a phlebology claim to be denied. Many factors must be addressed for surgical treatment of varicose veins to be considered medically necessary. This is standard for all payers nationwide. Some factors are common to all payers, and while there are some variants, most have the same basic requirements. They include evidence of reflux, showing incompetence of the lesser or greater saphenous veins conservative treatment tried and failed, compressive therapy for a variable amount of time and an absence of PAD and DVT. Insurance companies review their guidelines each year and make changes as they see fit. These changes need to be monitored closely to ensure requirements are followed to the letter. Missing even one factor can cause a claim to be denied at all levels of appeal, and ultimately cause a lack of payment for the practice.
Another reason to maintain correct documentation is to protect against audit. RAC audits are being conducted by Medicare and various commercial payers, most commonly Medicare Advantage plans. The importance of protecting yourself against these audits has taken center stage. Audits are no longer a case of "if, they are a case of "when", and no one wants to be caught unprepared. In addition to auditing, there have been an increasing amount of whistleblower cases that have sparked a wave of record requests from all payers, including Medicare, to verify that the level of service billed is indeed what was performed. More, not less, documentation is the only recourse to survive an audit.
The best defense really is a good offense. Having a comprehensive knowledge of what is needed, and ensuring your standard reports to meet these requirements are key to smooth and timely reimbursement. Presenting a quick and thorough response when an insurance company requests those records will result in faster payment. One of the best ways to accomplish this is to keep a file, whether physical or electronic, of your most common payers' clinical policies on hand. It is also helpful to note when the next review date will occur. When recommending a course of treatment, have a staff member that is well-versed on these policies review the patient's insurance and the chart records to ensure each element has been met. This holds true for both follow-up services and primary surgeries.
TMI (too much information) is the rule in this specialty and a brief report that only the doctor can read is not sufficient. If the insurance company cannot read it, they will not pay it. They do not employ staff that specialize in phlebology to review records, and if they are not clear, the claim will get denied. We have all heard the cliché' "if it isn't documented, it didn't happen". This is so very true with Phlebology. The insurance company is not there to help you and does not want to pay you, so it is up to healthcare providers to actively participate in their own reimbursement. Ensuring that the claim is not denied on a documentation technicality is one of the major ways to achieve this payment goal.
Thursday, July 22, 2010
Shooting While Blindfolded
Effective February 15, 2010, Blue Cross and Blue Shield of Florida will no longer pay for ultrasound guidance when performed with sclerotherapy. Their medical director seems to believe that there is no clinical reason for using ultrasound guidance. They appear to be confused between being able to treat visual veins and those deeper system perforators, anterior accessories, and the like.
While many of you are not in Florida we thought you should be aware. We are advocating for the ACP to become involved in this issue. Once one Blues program gets an idea in their head, it sometimes migrates to other Blues in the same region.
Some smaller plans have gone down this road already. We have had some success in working with the nurse case manager on these claims. When we ask them if they personally would really want a physician injecting a sclerosing solution into their leg without ultrasound guidance... we receive some assistance and then payment.
While many of you are not in Florida we thought you should be aware. We are advocating for the ACP to become involved in this issue. Once one Blues program gets an idea in their head, it sometimes migrates to other Blues in the same region.
Some smaller plans have gone down this road already. We have had some success in working with the nurse case manager on these claims. When we ask them if they personally would really want a physician injecting a sclerosing solution into their leg without ultrasound guidance... we receive some assistance and then payment.
Benefit Mis-quotes and Predetermination
Our friends at CIGNA have developed a few interesting nuances over the past year. Most of these new issues create denied claims and can leave you and the patient scrambling for a resolution.
Self-funded riders. We have seen a number of patients that have a self-funded CIGNA plan. These plans contain a rider that disallows any phlebology services. Unfortunately, if you (or the patient!) call and ask about the patient's benefits you will be assured there is no problem. If you then obtain a predetermination review on the services, you will be informed that there is no phlebology coverage. This places you and your practice in a bit of jam as the patient is being told one thing and you now know you will not be paid.
For any CIGNA patients, we now strongly recommend obtaining a predetermination prior to providing treatment. While not required, it is very difficult to determine who has a phlebology rider without this step. You can also have the patient bring this information back to their Human Resources (HR) department at their employer. Quite frequently the HR manager has no idea there is a limit on this benefit. Occasionally the HR manager will override their own plan provisions and agree to have phlebology services covered.
CIGNA is now limiting the length of sclerotherapy that can be performed. You may need to provide new proof (e.g. a new diagnostic ultrasound showing open segments) and obtain a new authorization. It is now critical to know when the authorization will expire and what services were originally approved.
Self-funded riders. We have seen a number of patients that have a self-funded CIGNA plan. These plans contain a rider that disallows any phlebology services. Unfortunately, if you (or the patient!) call and ask about the patient's benefits you will be assured there is no problem. If you then obtain a predetermination review on the services, you will be informed that there is no phlebology coverage. This places you and your practice in a bit of jam as the patient is being told one thing and you now know you will not be paid.
For any CIGNA patients, we now strongly recommend obtaining a predetermination prior to providing treatment. While not required, it is very difficult to determine who has a phlebology rider without this step. You can also have the patient bring this information back to their Human Resources (HR) department at their employer. Quite frequently the HR manager has no idea there is a limit on this benefit. Occasionally the HR manager will override their own plan provisions and agree to have phlebology services covered.
CIGNA is now limiting the length of sclerotherapy that can be performed. You may need to provide new proof (e.g. a new diagnostic ultrasound showing open segments) and obtain a new authorization. It is now critical to know when the authorization will expire and what services were originally approved.
How Not to Feel like a Drug Rep
The single easiest and cheapest form of advertising available is the Lunch and Learn with primary care physicians, podiatrists, and specialty physicians. It also appears to be the most despised form of advertising by the physicians with whom I work. Below are a few ideas for overcoming some of the objections you or your physician may have regarding the Lunch and Learn marketing idea.
The physician (possibly you) does NOT want to look or feel like a drug rep. Walking in with a bag or two of food can feel unseemly. My recommendation for overcoming this obstacle is to always bring your practice manager or one of your MA's... for several reasons. Let them, the manager or MA, leave early and purchase/bring the food.
The physician does not want to feel like a drug rep. I agree. The physician should be in a teaching mode. Many primary care physicians have patients with heavy, tired, painful legs and believe there is no recourse save for painful leg stripping. The phlebology physician is now an educator. No different than teaching interns. That is something with which most every physician is comfortable. View it as an educational opportunity!
This leads me to the second reason for bringing your office manager or MA... non-physician dialogue. While the doctors are discussing treatment modalities in a peer-to-peer setting, the office manager or MA should be determining who actually fills out the referral slips, makes the referral telephone calls, and working to educate/market to this person in that office. While educating the PCP in phlebology is great, if the referral coordinator does not know to send the patients to you, the time spent was not used wisely.
The physician (possibly you) does NOT want to look or feel like a drug rep. Walking in with a bag or two of food can feel unseemly. My recommendation for overcoming this obstacle is to always bring your practice manager or one of your MA's... for several reasons. Let them, the manager or MA, leave early and purchase/bring the food.
The physician does not want to feel like a drug rep. I agree. The physician should be in a teaching mode. Many primary care physicians have patients with heavy, tired, painful legs and believe there is no recourse save for painful leg stripping. The phlebology physician is now an educator. No different than teaching interns. That is something with which most every physician is comfortable. View it as an educational opportunity!
This leads me to the second reason for bringing your office manager or MA... non-physician dialogue. While the doctors are discussing treatment modalities in a peer-to-peer setting, the office manager or MA should be determining who actually fills out the referral slips, makes the referral telephone calls, and working to educate/market to this person in that office. While educating the PCP in phlebology is great, if the referral coordinator does not know to send the patients to you, the time spent was not used wisely.
Monday, January 18, 2010
Goal Setting
Using Personal Income as the Basis
by AJ Riviezzo
The new year is a great time to review where your practice is at and where you would like it to go. One goal that is foremost in anyone's mind is their personal income. Below is one way to create some targets and goals based on the desired personal income.
Let us assume, for discussions sake, your personal income goal for 2010 is $700,000. The numbers all flow from this goal number.
The first number we need to determine is your profit margin before physician salary. Take all of your non-physician salaried expenses and add them together. Divide that number into your total collected dollars for the year. This will generate a percentage hopefully somewhere between 50% and 75% (unless you are a new practice). Using an assumed percentage of 60% in all non-physician compensation, our 'practice' will need a total income of $1,750,000.
The second number we now need is the average income per ablation (see previous article) for last year. In this example I am using $2,500 as the average income. If you divide $2,500 into the needed total income of $1,750,000 divided by 12 it shows we have to average 58 ablations per month to achieve our desired goal.
The third number we need to calculate is how many ablations were performed on each unique patient on average. For this example the number is 2 ablations per patient. In other words, we will be treating 29 to 30 individual per month over the course of the year.
To be able to treat thirty people per month, we now have to determine how many people we have to scan. Assuming that 75% of the patients who receive an US scan show evidence of reflux, we have to scan 40 people per month to find 30 that need treatment. As not all individuals that have reflux will receive treatment, I am assuming a 10% drop rate (four people) so we actually need to scan 45 people per month to be able to treat our goal of 30.
Finally, we need to determine how many free consults actually receive a bilateral diagnostic ultrasound. If you are tracking how many free consults you are performing, you can divide this number into the number of diagnostic ultrasounds. For ease, I am assuming 80% of the free consults return for the diagnostic US. This give us another 'drop' of 11 patients per month who will not agree to have a diagnostic US performed.
Or, stated in the reverse, we now know we have to see at least 56 people in a free consultation in order to generate a sufficient number of diagnostic US's, who then go on to receive treatment. This last number is one of the keys, therefore, for ensuring you are going to meet your desired income goal for the year.
The goals and numbers for your practice will vary from the above. Do let me know if you run into any problems in calculating all the way through. I am happy to help.
Using Personal Income as the Basis
by AJ Riviezzo
The new year is a great time to review where your practice is at and where you would like it to go. One goal that is foremost in anyone's mind is their personal income. Below is one way to create some targets and goals based on the desired personal income.
Let us assume, for discussions sake, your personal income goal for 2010 is $700,000. The numbers all flow from this goal number.
The first number we need to determine is your profit margin before physician salary. Take all of your non-physician salaried expenses and add them together. Divide that number into your total collected dollars for the year. This will generate a percentage hopefully somewhere between 50% and 75% (unless you are a new practice). Using an assumed percentage of 60% in all non-physician compensation, our 'practice' will need a total income of $1,750,000.
The second number we now need is the average income per ablation (see previous article) for last year. In this example I am using $2,500 as the average income. If you divide $2,500 into the needed total income of $1,750,000 divided by 12 it shows we have to average 58 ablations per month to achieve our desired goal.
The third number we need to calculate is how many ablations were performed on each unique patient on average. For this example the number is 2 ablations per patient. In other words, we will be treating 29 to 30 individual per month over the course of the year.
To be able to treat thirty people per month, we now have to determine how many people we have to scan. Assuming that 75% of the patients who receive an US scan show evidence of reflux, we have to scan 40 people per month to find 30 that need treatment. As not all individuals that have reflux will receive treatment, I am assuming a 10% drop rate (four people) so we actually need to scan 45 people per month to be able to treat our goal of 30.
Finally, we need to determine how many free consults actually receive a bilateral diagnostic ultrasound. If you are tracking how many free consults you are performing, you can divide this number into the number of diagnostic ultrasounds. For ease, I am assuming 80% of the free consults return for the diagnostic US. This give us another 'drop' of 11 patients per month who will not agree to have a diagnostic US performed.
Or, stated in the reverse, we now know we have to see at least 56 people in a free consultation in order to generate a sufficient number of diagnostic US's, who then go on to receive treatment. This last number is one of the keys, therefore, for ensuring you are going to meet your desired income goal for the year.
The goals and numbers for your practice will vary from the above. Do let me know if you run into any problems in calculating all the way through. I am happy to help.
Billing and Collections Item
Deductibles and Plan Changes
by AJ Riviezzo
'Tis the Season for annual deductibles. Make sure your practice has a plan in place to collect at least some of the deductible amounts up front. If not, you and your billing department will be spending a lot of time and effort in chasing those dollars.
Do not forget that many employers change insurance carriers the first of the year. Be sure to ask the patient for a copy of their new card to both determine the payer and to ensure the appropriate copayment, coinsurance or deductible is collected.
Deductibles and Plan Changes
by AJ Riviezzo
'Tis the Season for annual deductibles. Make sure your practice has a plan in place to collect at least some of the deductible amounts up front. If not, you and your billing department will be spending a lot of time and effort in chasing those dollars.
Do not forget that many employers change insurance carriers the first of the year. Be sure to ask the patient for a copy of their new card to both determine the payer and to ensure the appropriate copayment, coinsurance or deductible is collected.
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