Frequently Asked Questions

Navigating the complexities of healthcare organizational management can be challenging. Get answers on practice optimization, management, mergers, compliance, and more with our FAQs.

Revenue Cycle Assessment

A revenue cycle assessment is a comprehensive analysis of the entire process that a business follows to generate revenue, from initial customer interaction to the collection of payments. When CHCBC conducts an assessment, we evaluate the efficiency and effectiveness of each stage in the revenue cycle. This assessment is crucial for your business to identify bottlenecks, streamline processes, and optimize financial performance. It helps in maximizing revenue, reducing operational costs, and enhancing overall financial health. Learn more about the benefits of a revenue cycle assessment in our blog, How Revenue Cycle Assessments Maximize Profits. 

The duration of a revenue cycle assessment can vary depending on the size and complexity of the business. On average, it may take a few weeks to a couple of months. The process generally involves several key steps, including data collection, analysis of current processes, identification of key performance indicators (KPIs), interviews with stakeholders, and the development of recommendations for improvement. When CHCBC works with your practice, the goal is to provide a thorough understanding of the existing revenue cycle and propose actionable strategies to enhance its efficiency. Learn more here. 

Implementing recommendations from a Revenue Cycle Assessment can yield numerous benefits for a business. These may include: 

Improved cash flow: Streamlining processes can accelerate the collection of payments, reducing delays and improving cash flow. 

Enhanced operational efficiency and employee satisfaction: Identifying and eliminating bottlenecks and inefficiencies can lead to a more streamlined and cost-effective revenue cycle. 

Increased revenue capture: Optimizing billing processes and reducing errors can result in higher revenue capture and minimize revenue leakage. 

Better compliance: Ensuring that the revenue cycle aligns with relevant regulations and industry standards can mitigate compliance risks. 

Payor Contract Negotiations

Payor contract negotiations are critical for healthcare providers as they directly impact the financial health of the organization. These negotiations involve discussions with insurance companies or payors to establish reimbursement rates and terms for medical services. The outcome of these negotiations can influence the revenue generated by the provider, affecting profitability and sustainability. Working with a consulting team such as CHCBC can identify ways to reduce liability, point out hidden obligations that have gone unnoticed, and optimize revenue. Learn more. 

The frequency of payor contract negotiations can vary, but it is generally advisable for healthcare providers to review and negotiate contracts regularly. Factors influencing the negotiation frequency include changes in market conditions, shifts in payer strategies, updates to healthcare regulations, and the provider’s own strategic objectives. Additionally, you may consider renegotiating contracts when significant changes occur in your service offerings, patient demographics, or when existing contracts are due for renewal. CHCBC contract review and negotiation services can help you reduce administrative burdens, increase reimbursement/revenue, and leverage your services. 

Successful payor contract negotiations require careful consideration of various elements that providers should focus on, such as: 

Reimbursement rates: Negotiating competitive reimbursement rates that reflect the value of the services provided. 

Contract terms: Ensuring favorable contract terms, such as timely payment schedules, clear definitions of covered services, and transparent reporting requirements. 

Performance/Utilization metrics: Capture billing transaction data to determine services billed by payor, by provider, and by place of service. This data is critical to contract negotiations. Establishing meaningful performance metrics measuring the provider’s goals and compliance with their quality of care. 

Compliance and regulations: Staying informed about healthcare regulations and compliance requirements to negotiate contracts that align with legal and regulatory standards. 

Working with the experts at CHCBC consulting can ensure nothing is missed, get in touch today to learn more. 

Practice Startups

The timing and sequence of tasks in a medical practice startup are crucial because they set the foundation for success. Properly timing tasks ensures a smooth and efficient launch, preventing unnecessary delays and complications. The sequence of tasks, from hiring staff to establishing organizational structure, contributes to the overall effectiveness of the startup. A well-orchestrated timeline helps optimize resources, meet regulatory requirements, and reach the intended clientele strategically. Get started with our blog on 8 Keys To Starting A Successful Private Medical Practice.

Complete Healthcare Business Consulting can play a pivotal role in ensuring the success of medical practice startups. During consultations, we explore your business’s goals, location, and target demographic, developing a comprehensive understanding of its unique needs. We cover various areas, including organizational structure, financial planning, contracting, PM/EMR selection, compliance, marketing, and personnel management just to name a few. By providing expertise and guidance in these critical areas, the CHCBC team can help establish a solid foundation for your medical practice, contributing to long-term success. Learn more here.

Medical practice startups involve complex processes and regulations that require expertise for successful implementation. Seeking guidance from experienced startup professionals such as CHCBC is advisable to avoid costly pitfalls and ensure a streamlined launch. Our medical practice startup professionals at CHCBC are well-versed in the processes and sequences involved in establishing a healthcare entity. We’ll work closely with your team to help you strategize your startup launch and ensure you can reach your intended clientele. Schedule your consultation to start your journey today. 

Benchmarking and Compensation & Production Analysis

Benchmarking is crucial for healthcare providers as it provides valuable metrics for assessing performance and compensation strategies. By comparing key metrics such as compensation, patient volume, and benefits to industry standards and regional benchmarks, you can gain insights into your position in the market. Understanding these benchmarks allows for informed decision-making, enabling adjustments to compensation, goal setting, and overall healthcare business strategies. Benchmarking helps identify areas of strength and areas for improvement, facilitating more effective changes that drive performance, our method complies with the OIG requirements, and enhances profitability. Ready to get benchmarking? Contact CHCBC for a consultation.

The Compensation & Production Analysis process involves analyzing various essential metrics to assess the performance of a healthcare business. These metrics include compensation, patient volume, encounters, benefits, conversion factor, collection ratio, net collection, gross charges, and overhead matrix. Each metric provides specific information about your healthcare business’s financial health, efficiency, and productivity. For instance, analyzing the compensation-to-collection ratio helps gauge the effectiveness of compensation structures. This comprehensive analysis can guide the development of a plan to rebalance different aspects of your health business for improved performance, compensation, and profits.  

The frequency of benchmarking and compensation & production analysis can vary based on industry trends, market dynamics, and changes in the healthcare landscape. However, CHCBC generally advises healthcare providers to conduct these analyses regularly, or at least every two years but annually preferred. Regular assessments ensure that you stay informed about shifts in compensation trends, market benchmarks, and performance metrics. By staying proactive and conducting these analyses periodically, you can make timely adjustments to your practice, ensuring it remains competitive, financially sound, and responsive to evolving healthcare industry standards. Work with CHCBC consulting for a complete health business analysis. 

Patient Estimator

A patient estimator is a tool or system that provides an estimate of the financial responsibilities patients may have for their healthcare services at your practice. It helps give patients a clear understanding of the expected costs associated with medical procedures or services. Contact CHCBC to learn more about a patient estimator for your healthcare practice.

Your healthcare practice needs a patient estimator for several reasons. With the increasing demand for transparency in medical costs, patients now have the right to access pricing information. A patient estimator allows your practice to meet this demand by providing clear financial expectations to patients. This aligns with the 2022 No Surprise Act and helps in building trust and satisfaction with your patients. Additionally, it enables your practice to inform out-of-network patients about the scope of their financial obligations. Learn more about patient estimators here.

A patient estimator will help your healthcare practice in several ways: 

  • Give patients clear financial expectations 
  • Increase practice revenue 
  • Reduce high collection costs 
  • Reduce ARs (Accounts Receivable) 
  • Build patient trust and loyalty
     

Find out more about how CHCBC and a patient estimator can help your healthcare practice.

Fee Schedule Analysis

Establishing and regularly updating a fee schedule is crucial for healthcare providers due to the unexpected reductions in reimbursement and the growing trend of patients “shopping” for services. A fee schedule provides a clear framework for setting gross charges to maximize reimbursement. You’ve earned it, let’s ensure you capture it.  Regular updates help providers adapt to changes in the industry and negotiate effectively with payors.

A comprehensive fee schedule analysis involves acquiring current service utilization, payor reimbursement, analyzing payor contracts, and assessing payor distribution (payor mix). This analysis allows healthcare practices to identify unexpected reductions in reimbursement and understand their financial impact. By having a clear picture of where reductions are occurring, providers can create leverage with payors during negotiations. The analysis also helps in setting reimbursement rates that keep the practice competitive, identifying funds that were earned but not captured, and pinpointing areas for improvement, such as poor payors, coding errors, and the true cost of providing services.

A comprehensive fee schedule analysis involves several key steps, including acquiring current payor rates, analyzing payor contracts, assessing payor reimbursement and distribution, conducting a gross charge analysis, performing break-even analysis, and evaluating the financial impact. These steps collectively provide valuable insights into the financial health of the practice. The analysis helps in maximizing reimbursement, identifying cost-effective service provision, and ensuring that the practice remains financially sustainable. By continually evaluating and updating the fee schedule, healthcare practices can proactively manage their finances, adapt to industry changes, and provide better financial clarity to their patients.

Practice Assessment

Practice assessments are essential for uncovering deficiencies that may hinder performance, patient relationships, and overall profits within a medical practice. By evaluating the scope, size, and types of problems, a practice assessment aims to improve productivity, reduce patient wait times, and streamline practices for better efficiency. The benefits of a practice assessment include identifying and resolving issues such as high stress levels, staff challenges, poor patient care quality, and reimbursement issues. Ultimately, the assessment provides an ideal path to growth and success by addressing operational pains and optimizing various aspects of the practice.

A medical practice assessment focuses on various critical areas to improve practice structure and processes. These areas include strategic planning, governance and leadership, revenue expansion, cost analysis, operational improvement, total process improvement, integrated delivery systems, human resources, productivity, and quality care improvement. By delving into these aspects, the assessment helps in reviewing financial data, comparing revenue and productivity rates within the specialty, and analyzing staffing considerations. The insights gained from the assessment contribute to setting financial practice goals and correcting deficiencies to enhance overall practice performance. 

Engaging with a consulting team for a practice assessment can yield several benefits for a medical practice. The consulting teams at Complete Healthcare Business Consulting aim to assist individual physicians, private practices, or medical groups in achieving strategic goals. The benefits include the development of strategic plans, solutions for day-to-day operations, improved patient satisfaction, enhanced workflow effectiveness, optimization of office-staff functions, employee empowerment, and overall enhanced profitability. The consulting teams work to improve existing organizational systems and revamp inefficient processes tailored to the specific goals and nuances of the practice, leading to sustainable growth and success.

Mergers & Acquisitions

Mergers in the medical practice industry can be complex and involve numerous pitfalls, from blending organizational cultures to addressing staffing redundancies. It’s crucial for the existing leadership of both companies to ensure that patients, staff, and financial aspects benefit from the transition. Seeking outside assistance, such as from Complete Healthcare Business Consulting, is essential for a seamless merger. An outside company can objectively evaluate both businesses, efficiently address key functions, and provide an unbiased perspective. This external guidance helps navigate challenges, optimize insurance relationships, address financial impacts, manage redundant staffing positions, and make informed decisions crucial to the success of the merger.

Merging or acquiring medical practices involves addressing numerous considerations and challenges. Some key questions include optimizing insurance relationships, determining benefits and financial impacts, handling tax consequences, evaluating redundant staffing positions, and selecting legal and accounting representation. External assistance, particularly from a qualified consulting team, is crucial for navigating these challenges. Complete Healthcare Business Consulting provides a comprehensive review tailored to the unique circumstances of each merger or acquisition. Their experienced team members guide the process, ensuring that the merger is well-planned, executed efficiently, and establishes a solid groundwork for the new business.

A Management Services Organization (MSO) provides practice management and administrative support services to individual physicians, private practices, or medical groups. MSOs play a vital role in mergers and acquisitions by offering services such as maintaining or gaining control, providing access to capital, offering expansion services, enhancing technology, leveraging relationships with payors, vendors, and hospitals, and streamlining services to avoid duplications. On the other hand, Independent Physician Associations (IPAs) are unified entities owned by a network of independent physician practices. IPAs play a role in mergers and acquisitions by providing leverage to negotiate with insurance companies and hospitals, obtain favorable pricing, and reduce overhead costs, thus enhancing the overall success. 

Market Demand Analysis

A market demand analysis is crucial for healthcare practices as it helps them determine trends for their services and make informed decisions, such as where to open new locations. This type of analysis examines the economic and healthcare market, comparing factors like patient base and competition demographics to predict future patient volume. At Complete Healthcare Business Consulting, our consulting teams conduct market demand analyses to assist medical practices in identifying markets, assessing business cycles, defining service niches, and predicting growth potential. The insights gained from this analysis contribute to strategic decision-making by providing a comprehensive understanding of the factors influencing the supply and demand of services. 

A market demand analysis conducted by our consulting teams looks at various areas influencing the supply and demand of healthcare practices or organizations. Key focus areas include: 

Service Area Definitions: Defining the geographical area of an organization’s services, considering market share factors to assess competition, patient demand, practice goals, and spatial planning. 

Population and Demographic Trends: Analyzing demographic trends and population fluctuations to determine trends within geographical areas. These trends apply to practice niches, patient preferences, and help identify higher demand for specific services. 

Future Patient Volume: Collecting data from the market demand analysis to predict patient volume projections within various scenarios. This information supports clients in the strategic planning process by providing insights into potential changes in patient numbers, technologies, and competitor landscape.

A market demand analysis conducted by our consulting teams assists healthcare practices in predicting patient volume by analyzing various factors. These include service area definitions, population and demographic trends, and other influential elements. By understanding the current market dynamics and trends, practices can anticipate changes in patient numbers and plan for the future strategically. The data collected from the analysis supports practices in making informed decisions about spatial planning, service offerings, and overall strategic direction, ensuring they are well-prepared for shifts in demand and competition in the healthcare market.

Compliance

In the constantly evolving healthcare regulatory landscape, having an effective corporate compliance program is crucial. New government guidelines, false claims acts, stark law settlements, and anti-kickback settlements add complexity to compliance requirements. An effective compliance program addresses the mandatory elements of these regulations, preparing healthcare practices to respond to challenges. At Complete Healthcare Business Consulting, our consultants can help design comprehensive corporate compliance programs that tackle new guidelines and initiatives, providing practices with the means to meet these evolving challenges and ensuring peace of mind.

Our consulting teams provide a range of services to support healthcare practices in compliance efforts, including: 

Comprehensive Risk Analysis: Identifying potential risks in areas such as procedure code utilization, modifier utilization, E/M utilization, and provider time. This analysis allows compliance teams to recommend proactive solutions. 

Regulatory Compliance & Coding Audits: Essential for reporting financial and clinical documentation to protect against scrutiny by payers and regulatory agencies. Our coding team designs accurate coding processes across relevant areas. 

HIPAA Compliance and Training: Addressing the responsibility of protecting and securing Patient Health Information (PHI) in the changing healthcare landscape. Consulting solutions help practices adhere to HIPAA regulations and security rulings, protecting against possible negligence and penalties. 

OSHA Compliance: Ensuring compliance with OSHA regulations and security by staying current with regulatory changes, CDC recommendations, and best practices. OSHA compliance consultations provide training programs and manuals on various concerns, including hazardous chemicals, electrical hazards, and bloodborne pathogens.

Quality measure enhancement in compliance efforts helps standardize the likelihood of desired health outcomes for patients. This includes improvements to clinical flow, physical capital, and technology. Our consulting teams can identify best practices and opportunities for tracking quality progress, allowing healthcare practices to enhance their overall quality measures. This proactive approach not only ensures compliance with quality standards but also contributes to better patient outcomes and overall practice performance. 

Unleash your infinite potential

Download this free audio training and get the clarity and confidence to build your dreams, on your terms.
Skip to content