Prioritizing regular evaluations of your surgical practice is essential for maintaining profitability. It’s also crucial to increase surgical capacity, including expanding specialties. On the administrative side, practices should review processes such as reimbursement, procedure codes and fee schedules to ensure they remain relevant as the practice grows. NexGen partners with surgical facilities to help improve these factors to achieve our client’s financial goals without compromising patient care.
OR Utilization
Surgeons are often the highest-paid medical professionals in a hospital, and surgeries usually account for most of their revenue. At the same time, operating rooms (ORs) routinely require the coordinated efforts of many specialists, including physicians, nurses and assistants, making them one of the most costly areas of a healthcare facility. As a result, even slight improvements in OR efficiency can generate enormous savings that improve a practice’s bottom line.
One of NexGen’s first steps to improve OR efficiency is defining the key metrics to track, which can be particularly challenging given the many choices available. Achieving real gains in OR utilization requires comparing relevant metrics to identify problems and develop the appropriate process improvements. Metrics commonly used to measure OR performance include the following:
- Case times
- Turnover times
- Cancellation rates
- Staffing costs
- Patient outcomes
Reimbursement Review
The most significant single benefit of NexGen’s surgical practice analysis is often identifying problems in the billing process that prevent a practice from capturing all the revenue to which it is entitled. Maximizing the number of claims paid on the first submission is particularly important for improving profit. Reimbursement analysis should include an examination of payers and modifiers by procedure code. This process helps identify areas for improvement in managing pre-authorizations, coding and claim denials. It also shows codes with reimbursements that fail to align with similar procedures and opportunities to re-negotiate fees based on high volume.
Coding Audits
Coding audits should be a core component of any surgical practice analysis due to the wide variety and complexity of coding rules. It’s particularly important to examine surgical procedure codes since they often require multiple modifiers, resulting in greater reimbursement for a practice. A coding audit focusing on surgical codes provides the highest return on investment (ROI) in most cases. Optimizing the use of modifiers allows practices to submit clean invoices the first time, resulting in faster payment. Spending more time investigating rebilling and denials significantly slows down the payment process, reducing cash flow.
Periodic assessments by an independent third party like NexGen can identify an unbiased set of opportunities for improvement that allow a medical group to proactively protect its revenue by eliminating costs. These assessments also serve as valuable methods for comparing external equity valuations.
Fee Schedule Maintenance
A practice analysis can also identify problems with fee schedules, which typically occur when the schedule becomes obsolete. An outdated schedule often results in a practice filing claims with third-party payers for less than the allowed amount, greatly reducing revenue. Fee schedule maintenance should play a key role in managing the reimbursement of all surgical specialties.
This is primarily because payers usually pay the billed charge or the amount on the reimbursement schedule, whichever is lower. Medical groups typically lack the market power to demand rates above this minimum. Furthermore, setting even slightly higher fees than contractually required obligates payers to pay the contracted rates.
NexGen’s practice analysis focuses on fee schedules concerning consistency and transparency by ensuring charges are reasonable. The development of a consistent plan for setting procedure fees is also a common benefit of fee schedule maintenance.
How NexGen Can Benefit Your Practice
NexGen Surgical creates environments that are attractive to surgeons for various reasons. For example, we help practices focus on bringing in patients, allowing surgeons to focus on patient care. We also relieve our clients from worrying about OR utilization and surgeon shortages. NexGen ensures our surgeons are high performers with experience leading a patient care team because they are our most valuable asset. We also provide practices with other clinical and business professionals who deliver prompt, exceptional service to their practices each day.
Contact us online or call 844-592-0802 to learn more about how we can help expand your practice.
