The need for experienced medical practice managers has grown rapidly with the implementation of electronic medical records, ever-changing state and federal regulations, and incentive programs such as Meaningful Use and Physician Quality Reporting Services.
Physicians frequently make the mistake of hiring managers with no background in medical office management. As a consultant, I deal with a myriad of problems in medical practices every day; and the stark reality is that many practices border on bankruptcy due to poor medical management skills. The sad truth is that doctors simply cannot find qualified managers.
Medical Physician Practice Manager – Physician Coding
Red flags that indicate a poorly run medical practice:
• Disorganized office
• Poor co-payment and co-insurance collections
• Outstanding insurance balances over 60 days
• Unmotivated and unhappy staff
• Inaccurate medical record documentation
• High percentage of denials with payers due to invalid patient demographics, incorrect insurance company information, and missing referrals or authorizations
• Extensive wait times for patients to be seen
• Poor billing methods
• Lack of professional behavior
• Improper business attire
• Continuous audits from insurance companies
• Inability to balance out cash at the end of the day
• Lack of understanding with accounting and revenue cycle management
• Inability to work within the computerized medical practice
management software and electronic medical record software
• No understanding of health care reform
• No communication between office manager and physician
Every department in a medical practice is linked together. Communication is critical between the manager, the physician, and each employee. An office manager must oversee the operations of the entire practice. He or she must make sure that the front desk is gathering the information correctly regarding the patient’s demographics and insurance. They must monitor the workflow. Is the front desk asking the right questions when the patient calls for an appointment? Are they recording the chief complaint? Is insurance verified before the patient is seen? Are referrals in place? When the patient sees the doctor for their visit, is information verified at the front desk? Is the electronic medical record accessed to alert the medical assistant that the patient is ready to have her vital signs and history taken? Are the copayments collected at the time of service? Are old balances collected before the patient leaves? Are the medical records locked within 48 hours of the office visit? Has the documentation and coding been verified and all charges captured? Is the billing going out timely? Is follow-up of insurances being performed? The checklist is continuous but an office can flow smoothly with the right people in place and a manager understanding the flow of the medical office.
A manager does not need to fully understand coding and billing nor does she have to understand the clinical information in the documentation. However a manager must understand how all the information flows together from the initial contact with the patient to the appropriate reimbursement from the payer.
Codingcertification.org offers a comprehensive program that will train qualified individuals to become certified physician practice managers. The PPM course teaches you the business of healthcare along with the necessary tools to achieve a successfully run practice. CCO’s physician practice management online training course will prepare the student who has a background in the healthcare industry to take the next step in advancing their career as a practice manager. In addition to this, CCO’s course will prepare you for the CPPM exam offered by the American Academy of Professional Coders.
As a practice management consultant, I encourage anyone interested in this profession to acquire the proper training. Physician Practice Management is a specialized area in the healthcare industry and nothing speaks louder than the credentials CPPM after your name.