Maximizing Office Revenue: What You Should Know

Author(s): 
Anthony Poggio, DPM

Given the challenges of ensuring sound profitability for your practice in a difficult economic climate, this author reviews key principles to ensure proper billing and reimbursement, and how to minimize expenses. He also discusses key considerations when debating whether to offer additional services or purchase new diagnostic equipment.

   There are two components for the financial success of a practice: maximizing income and minimizing expenses. Being able to achieve both of these components is essential, especially in these difficult economic times.

   Although this may sound very simple, be careful that your billing communicates to the front office staff exactly what you are doing. Oftentimes, podiatrists simply leave the chart with office personnel to try to decipher what services you rendered and what the staff should bill. The only person who truly knows what services were rendered is the provider of those services.

   Make sure there is a clear form of communication between yourself and the front office to make sure your staff bills every legitimate service that you have performed. Many services may occur in a podiatric office since we deal with bilateral conditions and multiple digits. It is easier than you think to leave a procedure or two off the bill. There is no reason to give away any services for free.

Clearing Up Misperceptions About Under-Billing

   Some doctors are concerned that if they bill too many services, it may somehow trigger an audit. As a result of this fear, they tend to under-bill in an attempt to fly under the radar. There are many reasons why you may be audited. A common cause is based upon a review of your practice statistics. It is obvious when a practice bills for only high level codes as those are easy targets for auditors. Conversely, a practice that bills only extremely low level codes may also catch the attention of an auditor as either extremes of the billing spectrum are suspect.

   Unless you have a very specialized practice, it would be reasonable to assume there is a mixture of services rendered and complexities of those services. Under-billing can trigger an audit as the auditor may consider that even the low-level billings are suspect and the doctor is trying to pass off non-covered services as a low level evaluation and management (E/M). Alternately, the auditor may have a perception that the physician is misrepresenting services in the hope that nobody will bother to investigate because the dollar volume is low.

   Periodically audit your own super bills to ensure that what the front office staff actually submits to each insurance company is what you checked off on the super bill. If the office is not billing all services, then investigate where the problem is occurring. It could be poor training or sloppiness on the part of the front office … or you.

   Also familiarize yourself with proper billing protocols, the use of modifiers and what services are generally bundled into other services. Even though you should bill for what you do, excessive billing of services or supplies can result in further analysis of your claims by the insurance carrier. This will slow down the payment time and likely facilitate a request for records (which costs you money to do and further slows down reimbursement time). This could also put you on the insurance company’s “watch” list, potentially leading to reviews of all your claims with that insurer.

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