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Independent medical practices gain better data to facilitate improvement with HK’s Payer Gap Analysis

October 10, 2019

Managing an independent medical practice is an increasingly time-consuming responsibility requiring you to do more, often with less. You are managing human resources, benefits, office operations, patient relations, supplier and drug representative relations, marketing, referral generation, licensing and credentialing, continuing education, scheduling, phone calls and emails; the list goes on and on. What gets priority and what gets pushed aside due to the day-to-day demands of running a practice? Where is the gap in your practice management?

With all of this responsibility, when was the last time you took stock of how your practice was really performing? You may be measuring performance by comparing your data to industry trends, if you have the time. At a high level this is important, but it likely does not provide the granular results needed to help turn your practice into a high performer and, in turn, get you paid for your performance. So how is this accomplished, and what data should you be using?

Honkamp Krueger’s independent medical group team works with practices to take a deeper data dive into their business’s performance by analyzing the practice’s contracts and fee schedules and reviewing collections policies and practices to help fill in the payer gap. By outsourcing this heavy lifting, practices gain the edge to succeed and improve their bottom line.

Let us crunch the numbers
Your patient management system is full of a tremendous amount of data that can be used to develop benchmarks and formulate what success looks like for your practice. Using the Honkamp Krueger Payer Gap Analysis, we dig into that existing data to find your top revenue sources in a variety of ways: Revenue by CPT/J code, by third party payer, by provider, and then stratify the revenue sources. Our analysis identifies those payers and codes that make up the top 90-95 percent of revenues, so you can focus your contract negotiations on those items that matter the most to maximize your efforts.

Know what to charge
Are your fee schedules set appropriately and updated frequently enough to ensure the services you bill are covering the allowable amounts set by your contracts? We will compare your fee schedule to current fees customarily charged for your type of practice, compare it to current Medicare reimbursement rates and reimbursement amounts outlined in your contracts, and evaluate whether or not you are receiving the full value for your services. Too often we see outdated contract information that demonstrates lost revenue to your practice. This is preventable and easily remedied.

Know what you should be getting
Reimbursement rates are tied to a reimbursement schedule that is established and updated at the discretion of the insurance companies. Often, these contracts have an evergreen clause, not requiring regular revision or renegotiation for payment of fees. Additionally, this is rarely printed and frequently not easily accessible. Through our Payer Gap Analysis, we locate the reimbursement schedule in effect for your contracts and compare it to the reimbursement rates populated in your billing system.
Know what you’re worth and negotiate better.

How many insurance networks does your practice have contracts with? Who are your high payers and low payers? Have you performed a comparison of the reimbursement of your various procedure codes side-by-side? If you understand your position in your local marketplace, both in terms of volume and quality, you can negotiate from a stronger position with payers. Honkamp Krueger’s data analysis will help give you the tools necessary to be more effective at the negotiating table during contract renewals.

Know your patients’ responsibilities
With the rising popularity of HDHPs, HSAs and rising deductibles for traditional insurance plans, the burden of payment is shifting. Collectively, your patients are quickly becoming your top payers. We can review your collections procedures and policies to maximize results at intake to reduce the expense of post-care collections.

Know what’s in there
The potential for errors and lost revenue happens at the chart level before claims are ever sent out the door. Is there sufficient documentation to support the claim? Does the documentation support a higher-level claim? How often does your practice perform internal chart audits? Have you considered engaging an outside consultant with a fresh set of eyes to review your documentation for compliance errors and opportunities? Top performing practices do frequent internal audits and regularly hire an external audit to review both methodology and accuracy. Honkamp Krueger has resources available to connect you with trusted and knowledgeable experts in billing and coding, so you can rest assured you’re properly billing for every dollar.

Know we have your back
Because no two practices’ needs are the same, the scope of a Payer Gap Analysis can be easily tailored for an extremely detailed, in-depth analysis or a big picture overview. Talk to your trusted advisor at Honkamp Krueger. Let’s have a discussion to discover your concerns, opportunities and goals. An initial Payer Gap Analysis is complimentary. This high-level review will help to scope out if there is an opportunity to engage in a detailed analysis. With opportunities identified, we will work with you to build an analysis and an action plan that meets your specific needs to improve your revenue cycle.

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