Get off to a good start in 2016

Is your practice prepared for financial success in 2016?  With the holidays over, it’s time to settle back in to regular full time work and it’s worthwhile to take a moment to plan for 2016.  Here are a few ways to make sure your practice is off to a good start in the new year.

1. Know your major payers.  Be aware of the payers who represent 80% of your practice collections.
   • Review your contract terms considering your high volume codes to ensure you are receiving fair reimbursement
   • Identify any contracts that renew in 2016 and plan for rate negotiations
   • Make sure your providers are participating in all available plans for each payor that meet your reimbursement guidelines
2. Review your Accounts Receivable.  Make sure your billing staff is contacting past due accounts and establishing payment plans or referring accounts to external collection agencies.
   • Identify accounts over 120 days old that are not setup on a payment plan and find out why
   • Report on the average turnaround time for claim payment for your major payors (look for 14 – 21 days for EFT payments)
   • Review your collections policy to ensure statements and notices are going out timely
3. Review your contract inventory.  Know who you are contracted with and which practice providers are connected to the contract.  Ensure all providers are connected and participating with the plans that the practice is contracted with.
4. Be prepared for revalidation.  Make certain that your staff responsible for insurance credentialing has complete files on your practice providers and can quickly turnaround any revalidation requests from Medicare, Medicaid, or commercial insurance networks.
5. Identify expiring credentials.  Have a list of all provider expiring credentials and schedule renewal of licenses, DEA, CSR, insurance, and other credentials.  This will help to ensure that there is no lapse in health plan participation, facility privileges, or other situations that may disrupt cash flow.
6. Assign credentialing staff.  If your practice is not large enough to have a dedicated credentialing coordinator, then assign someone in your office with the responsibility.  Know who should handle the important insurance credentialing and hospital privileging applications that must be maintained.
7. Update CAQH.  If you or any practice providers have had changes such as a new malpractice case or sanctions, be sure to update your CAQH profile with the information.  An incomplete CAQH profile can cause problems during revalidation by health plans because all such incidents are reported to the National Practitioner Data Bank and if your CAQH profile does not reflect information in the NPDB, then this may cause a problem with your re-credentialing.
8. Obtain a NPDB self query report.  Make certain that you know what is reported to the National Practitioner Data Bank for your providers.
9. Review your CME’s.  CME’s will need to be reported for your license renewal, hospital re-credentialing, and in some cases insurance re-credentialing.  Make certain that you have all your CME credits documented and ready for submission when needed.
10. Review your CV.  Make sure that your CV is current with employer and that all education and work history have mm/yyyy formats for beginning and ending dates