Financially Surviving the Pandemic
KEVIN OMAHEN, CPA
The COVID-19 pandemic has resulted in significant decreases in the volume of patient visits since mid-March. Lack of insurance and fear of contracting the virus in a doctor’s office have led to fewer patients walking through the door. Businesses are attempting various strategies to help their bottom line. This article reviews several of the common strategies.
- Keep the Right Focus
Physicians need to rethink and reinvent their medical practices to be as comprehensive as possible. This means that physicians should focus not only on the patient’s primary complaints, but also on underlying issues the patient may not be thinking about. This increases the value that you are providing and can increase the likelihood that the patient returns.
- Find Your Quarterback
One position you may not currently have at your practice that can provide great benefits is a care coordinator. This employee acts as a liaison between patients and staff to ensure clear communication and facilitate the delivery of the best care. One of the reasons why patients fear coming to the office during a pandemic is the risk involved in the waiting room. Time spent in the waiting room can be reduced by employing an individual responsible for checking in patients, obtaining the proper insurance information and communicating when to enter the office. This can help reduce a patient’s fear of sitting in the waiting room.
- Practice Remotely When Possible
Although many procedures and visits are not possible to perform remotely, there is an opportunity here. Many practices are setting up calls or video visits to help combat the fear patients have for coming to the office.
- Utilize Your Financial Advisement Team
Whether it is discovering or applying for relief programs offered locally and federally, or taking a deep dive into your financial statements, your accountants and financial advisors can be by your side. These professionals are likely working with other businesses just like yours and can offer advice that may benefit your practice. Be sure to reach out to them for assistance if they are not reaching out to you.
- Mergers and Acquisitions
Group practices provide many benefits including minimizing the financial risk a sole practitioner faces. Prior to the pandemic, there was an increase in the number of sole practitioners merging with other practitioners or becoming part of a medical group. If your practice is struggling, this is something that may be worth considering.
Watch the Financials
Now more than ever, keeping a close eye on your financial statements is imperative. Staying on top of billing and collections, avoiding unnecessary spending and paying attention to cash flow is incredibly important right now. Ensure employees in the accounting, finance and collections are on top of this, as an oversight right now can be more damaging than ever.
Nonphysician Providers Could Enhance Your Practice
JASON FLAHIVE, CPA
In these volatile economic times, adding staff to your medical practice may not be feasible. However, if it is, hiring new staff could help grow the practice by improving patient satisfaction.
Although you may not want to bring in new physicians, you might want to consider hiring one or more nonphysician providers (NPPs) to round out your staff. Doing so may assist you in responding effectively to the changing needs of your patients.
What Do They Do?
There are two primary categories of NPPs: Physician assistants and nurse practitioners. Which category is best for your practice depends on which is licensed in your state and the range of activities that the NPP in question is licensed to perform.
An NPP may be able to function independently or work under a doctor’s supervision — again, depending on relevant state law. Typical services that an NPP of either type may provide include coordinating health education, patient counseling and patient care. They can also order and/or perform diagnostic and therapeutic procedures, arrange patient referrals, deliver on-call care, perform physical exams, take patient histories and contribute to clinical decision making.
Discuss with your physicians which services they would be willing to accept from an NPP. Also, calculate the appropriate number of NPPs to meet the practice’s needs and establish benchmarks to evaluate their performance.
How can you find them?
The most direct way to find good NPP candidates is through job listings on the websites of local and national associations for physician assistants and nurse practitioners. Another source of candidates may be local schools that train NPPs.
Once you have found and hired your NPPs, you will need to introduce them to two critical constituencies: Physicians and patients. When introducing them to doctors, clarify how the NPPs will improve patient care. Then define the roles for physicians and NPPs and document applicable standing orders, protocols, collaborative agreements and supervision agreements. Also, send letters to patients explaining the hiring of NPPs and the role they will play in their care.
What about billing?
An NPP can bill Medicare for services in two ways: 1) “Incident to” a physician’s care, using the doctor’s National Provider Identifier (NPI); or 2) directly after being credentialed by Medicare, using the NPP’s own NPI.
Under the first option, after an initial visit by a doctor, the NPP can provide services under the physician’s direct supervision or while the doctor is available in the office to give immediate assistance. To continue billing subsequent visits with the NPP as “incident to,” the physician must actively participate in and manage the patient’s treatment, with commensurate documentation in the patient’s medical record.
Unless all of an NPP’s services fall within the “incident to” definition, the NPP must use the second option — that is, to enroll in Medicare, obtain an NPI and bill directly. NPPs who bill directly receive lower reimbursements (85% of the full physician fee schedule rate) than when they bill “incident to” (100%).
Private commercial payers have their own rules about reimbursing NPP services. They usually apply separate criteria for credentialing NPPs, sometimes not allowing them to bill directly.
Plus, they typically reimburse NPPs at lower rates than for supervising physicians. Your practice must bill under the doctor’s NPI and follow the billing guidelines in the payer’s provider manual. You may need to append certain modifiers to the bill to correctly identify the NPP and supervising physician providing the care together.
Is it the right move?
NPPs can fill a niche in your practice, helping provide high-quality services to patients while relieving pressure on the physicians. It is a possibility worth considering as you seek to maintain (or increase) patient volume and meet the demands of today’s health care marketplace in an uncertain economic environment.