coding strategy

Get Organized for Future Success

Five steps for a rewarding year.

JOHN RUMPAKIS, O.D., M.B.A.

We always look at the New Year as a time to make positive change. Here is a short list that can help get your practice jump-started to a healthy and profitable 2014.

1 Get your provider contracts organized and put in a format that is easy to reference.

a. Create two sections – one for refractive carriers and another for your medical carriers.

b. Find copies of your contracts and put them in the notebook in alphabetical order.

2 Request copies of your current contracts from your contracted providers. This is typically sent to the plan administrator or to the Provider Relations department.

a. It is important that you request this updated copy each and every year as your carriers typically have the ability to UNILATERALLY change your provider agreement without notification.

3 Update your CPT codes and educate you and your staff about the code definitions and characteristics — particularly things that will be changing next year.

a. Many practices are using CPT codes that are either, obsolete or improper for the care actually being delivered. Update your EHR and routing slips with the new CPT codes.

4 Create a detailed plan for learning, training, integrating and incorporating the ICD-10 diagnosis codes into your practice.

a. While we are in the middle of a “partial code freeze” with the ICD-9s and ICD-10s that doesn't mean you can take it easy. Get in touch with your EHR vendor and find out what their road map is for incorporating the ICD-10s into their systems. A few details:

i. On October 1, 2014, there will be only limited code updates to ICD-10 code sets to capture new technologies and diagnoses.

ii. There will be no updates to ICD-9-CM, as it will no longer be used for reporting.

iii. On October 1, 2015, regular updates to ICD-10 will begin.

5 Update fees and analyze how you are delivering your services.

a. While the Federal Trade Commission won't allow me to tell you how to set your fees specifically, I can advise you that most practices are leaving hard earned revenues on the table because they haven't evaluated their fee structure in an objective, dispassionate and analytical manner.

b. Increases in both gross and net income are generally realized when you pay attention to your professional service revenues. After all, it is “free money,” as you are simply increasing your reimbursements for professional services for the same work performed.

c. Understand which carriers are reducing your reimbursements. You may be surprised to find that it isn't the medical carriers, it's generally the refractive carriers. So in order to keep your profit at the level you want, you must find ways to change the number of patients you see per hour. Learn to either delegate much of your data collection or speed up the pace of what you are doing yourself.

There are only three legs of the stool, reimbursement (income), volume and profit. If income goes down, and volume stays the same, then profit will also be reduced.

Get to work

A list isn't a list just for list's sake. Execution is paramount and the true foundation for success. Make 2014 your year to realize the rewards of your planning and hard work. OM

DR. RUMPAKIS IS PRESIDENT AND CEO OF PRMI, A CONSULTING FIRM FOR THE HEALTHCARE INDUSTRY. A PROLIFIC LECTURER, HE IS ALSO THE DEVELOPER OF A CLOUD-BASED CPT/ICD DATA & INFORMATON SERVICE. SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.