Few physicians and practice managers enjoy the dreaded task of budgeting for the upcoming year. There never seems to be enough money to accomplish everything, and with the growing list of regulatory requirements, this probably won’t change anytime soon.
However, setting a budget—and sticking to it—is one of the most important steps that practices can take toward ensuring financial viability, says Heather Greene, MBA, RHIA, CPC, CPMA, vice president of compliance at Kraft Healthcare Consulting, LLC in Nashville, TN. Regardless of your practice’s size, specialty, or location, there are several important areas in which physicians should invest in 2015.
Greene provides a summary of the top seven investment opportunities.
#1: ICD-10 education and training. The best way to mitigate denials and revenue loss in ICD-10 is to provide comprehensive training for all staff members. This includes administrative staff, clinical staff, and coders. According to a February 2014 report published by the American Medical Association and Nachimson Advisors, LLC, approximate practice expenses related to training could include the following:
- $300 for an ICD-10 coding manual
- $600 per coder for attendance at an ICD-10 coding boot camp with additional costs (25%-50% more) for specialty training
- $500 per coder for large on-site group training
- $1,000 per coder for online boot camps/training courses
- $300 per clinician for three-hour specialty-specific ICD-10 training
- $700 per administrative staff member for attendance at a two-day ICD-10 boot camp
Practices should also budget for travel expenses, material costs for trainings, practice time for coding in ICD-10, as well as ongoing refresher training leading up to the October 1, 2015 implementation date.
2. Compliance plan. When practices operate using what Greene refers to as a “skeleton budget,” the compliance plan is often one of the first items to be forgotten. However, practices that don’t develop a formal, written compliance plan put themselves at risk for audits and recoupments. Don’t have enough money to hire a consultant or develop one internally from scratch? Physicians on a strict budget may be able to team up with other local practices of similar size and specialty to compile a list of vulnerabilities and then create a plan to address those vulnerabilities. Also consider contacting local hospitals to determine whether the practice can tailor the hospital plan to fit its own needs. Many hospitals are willing to share this information with practices when they ask, says Greene. The OIG Work Plan, which is updated annually, is another great resource on which practices can base their plans. The OIG also provides other guidance for how practices can develop compliance plans.
3. Meaningful Use. Though it may seem labor intensive, it’s worth it for practices to attest to Meaningful Use. 2014 is the last year in which eligible professionals can begin participation and receive an incentive payment. Beginning in 2015, eligible professionals who do not successfully demonstrate meaningful use will be subject to a payment adjustment. The payment reduction starts at 1% and increases each year that an eligible professional does not demonstrate meaningful use. The maximum penalty is 5%.
Greene says it’s important to evaluate whether your EHR is meeting your expectations, including whether it is enabling your progress toward Meaningful Use attestation. Don’t continue to invest in a vendor that isn’t working for you, she says. You may need to cut your losses and move on.
4. Internal audits. Heading into ICD-10, it will be paramount for physician practices to perform proactive audits regarding coding and documentation quality. Working with a consultant to perform these audits may be most effective. Some consultants can also provide audits to make your practice more efficient. This will be particularly important heading into ICD-10 when both coder and physician productivity are expected to decrease.
5. Certified coders. Some practices may rely on individuals who don’t have formal coding training or credentials to perform the coding function. Although this may have been acceptable, the practice of hiring non-credentialed coders may become obsolete as physicians continue to undergo billing and documentation scrutiny by external auditors. Consider investing in a seasoned, certified coder or at least providing formal coding certification training for existing staff members. The American Academy of Professional Coders provides many resources on coder salaries, including an annual salary survey. Keep in mind that one certified coder would likely pay for him or herself annually by preventing denials and costly recoupments.
6. Non-physician practitioners. As patients continue to flood the healthcare system due to the Affordable Care Act, it may be worthwhile for physicians to invest in non-physician practitioners. The Medical Group Management Association published a report in March titled “NPP utilization in the future of US Healthcare” that can help practices determine how an NPP might benefit them. The report also answers other questions, such as how to recruit and retain an NPP, whether a full-time or part-time contract is appropriate, and more.
7. Marketing. Although the Affordable Care Act may continue to bring in new business for your practice, it’s important to think strategically for long-term success. Marketing the practice via a Website or social media can help establish a brand, highlight areas of expertise, and more, according to amednews.com.
Keep budgets for each initiative separate, says Greene. For example, keep one budget for Meaningful Use and another separate budget for ICD-10 training. This helps practices track spending and assess the impact of changes to each budget.
Practices should also think about creating a “rainy day” fund to minimize the impact of payment delays related to ICD-10. The Healthcare Information and Management Systems Society (HIMSS) provides an ICD-10 preparation and contingency planning resource for large practices as well as one for small to medium practices.