July 12, 2024
4 Ways to Optimize Profit in a Family Practice
- by Matt Kolinski, DO, Associate Management Consultant
In the dynamic world of insurance reimbursement (Medicare, Medicaid, Private insurance) there seems to be constant change to how providers are paid and compensated for their time. In years past there were opportunities to add value to your practice by expensive capital costs investments such as bone density scanners, peripheral neuropathy testing, X-ray machines and MRI machines, however due to the rising cost of these expenses and decreasing reimbursements this is not a sustainable model. The current trends are more focused on optimizing your billing and your profit from individual patients while also optimizing the care provided to your patients. There is a range of services and enhancements you can make to your practice and they all have valid reasons to move forward with them however I’m going to focus on optimizing your billing and operations for your practice to achieve your end goals.
What Does it Mean to Optimize Your Practice’s Billing?
Providers and mid-levels have the same goal which is to provide great care to the patients they serve. Nobody is arguing the fact that when we care for our patients we only want to give them the best service possible. The utilization of electronic health records has in some ways improved our ability to document however it also does provide challenges. There is an easy win and good news involved: when you spend time optimizing your billing and correctly utilizing the CMS codes you can maximize the earned money per patient while still providing great care for them. Here are four examples of how you can optimize your billing without increasing patient load:
- Annual Wellness Exams (G0438/G0439): When used correctly this will allow you to thoroughly go through all of those checks and balances needed for a patient’s wellness while also optimizing reimbursement. By not using this code every year you will literally leave money on the table that has been allocated for the health and Wellness of Medicare patients. Documenting and scheduling the annual Wellness exam is an easy way to secure these funds and it takes minimal to know overhead to implement a strategy to ensure 100% of your Medicare patients have this service annually.
- Chronic Care Management (99487): In recent years this may be one of the few codes that actually had an increase in reimbursements from CMS. This is a code that can be used monthly for managing a chronic disease for your patients. In most practices you’re seeing the patients for a combination of acute and chronic management however by scheduling these chronic care management visits and utilizing appropriate staffing needs we can both deliver great care to the patients while also maximizing reimbursement for the carrier staffing can be anywhere from an MA or nurse who works remotely to connect with a patient and document the status of their care and the status of their health.
- Remote Patient Management: (99453-99458) This is a feature from CMS that allows you a provider to have ways to interrogate devices remotely and document them in an approved system. There are five main categories and devices that can be used: blood pressure, A1C, spirometry, pulse ox and weight checks. As long as the patient and provider connect sixteen times in a 30 day. And it is documented in terms of interrogation of this information CMS will provide up to $90.00 per month. In a calendar year, this could equate to $1,000 per patient enrolled in this program.
- G2211: The providers who consider it their responsibility to be a focal point of care the utilization of G 2211 is an add-on code that can be added to any level of service between 99202 and 99215. In 2024, CMS will pay $16.05 for this add-on code if you are considered to be a provider that has continuous care for your patient.
The key takeaway from this information is to understand that as a provider I know it’s how important it is to provide care to our patients. These examples listed above are ways to optimize the efficiencies in the practice by also providing enhanced care to the patient. There is no argument that checking blood pressure consistently at home or weight checks for congestive heart failure patients is a great way to manage chronic disease and these codes allow us as providers to simply request the reimbursement that is designated for optimization of care.
