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March/April 2006

In this month's issue:

Developing a Center? The Pros and Cons of Using a Consultant
Tips for Avoiding Billing Woes

Developing a Center? The Pros and Cons of Using a Consultant

Opening an ambulatory endoscopy center is a complex, long-term undertaking requiring a unique set of skills, knowledge, and experience in areas as diverse as legal regulations, accreditation, and insurance billing. Often physicians turn to consultants as a cost-effective way to obtain the expertise required to get their center up and running.

Consultants in fact may be able to provide reasonably priced services for facility planning and set up. Based on their years of experience developing endoscopy centers, they can be a good source of information and guidance about such issues as facility requirements, accreditation, and the sources and pricing of equipment and supplies. A good consultant should be able to provide a detailed roadmap for building a state-of-the-art center.

However, the need for expert assistance doesn't end when your center opens for business. In fact, successfully managing your facility's day-to-day operations probably will be the most challenging aspect of owning a center. Unfortunately, once the center is open and the consultant is gone, the responsibilities of managing the center usually fall upon an already over-worked physician. It's a complex, thankless job that requires expertise in many areas outside a physician's training. Moreover, this work is not the best use of your time and talent. The hours you spend managing a center are not spent seeing more patients - and generating more income. After all, the reason for opening your own center was to increase the income you receive on the services you already perform, not to add to your workload.

Another issue to consider is that the continuing success of consultants often requires them to simultaneously attend to the needs of multiple current and prospective clients. If any member of the consultant's team is unavailable due to illness or commitments on other projects, your center's needs can be ignored for days or even weeks at a time. In contrast, a management team can draw upon a larger pool of experienced personnel to quickly resolve urgent matters.

When weighing the costs of teaming with a management partner versus using a consultant, it's good to keep in mind that a partner will be very interested in the success of your endoscopy center one, five, or ten years after it opens. As a result, the partner may be more motivated than the consultant to consider the short- and long-term needs of your center.

You also should consider whether or not a consultant has the bargaining power to obtain favorable pricing through contract negotiations and bulk purchasing discounts. Be sure to check out whether your consultant has a solid record of successfully negotiating fee schedules with payers to obtain the highest reimbursement rates for their clients' centers. If not, higher operating costs and lower fees may impact your center's profitability.

Opening your own endoscopy center is a wise financial decision if it increases your income stream without adding to your workload. To realize the benefit of increased passive income, you must make strategic business decisions that provide long-term solutions to the complex challenges of operating your own facility. Otherwise, your center will become a source of additional demands on your time and energy, which is the last thing that any busy physician needs. Be sure to make decisions today that will meet your needs now - and far into the future.

EndoCenter Partners can help you own a profitable, state-of-the-art endoscopy center where you can deliver high quality care to all of your patients. As our partner, you can rely on our expert staff to handle all aspects of developing and managing your center. It's the hassle-free solution to center ownership.

Tips for Avoiding Billing Woes

Maximizing reimbursement from insurance plans requires both an efficient system for collections and experience in resolving the daily problems that arise with payers. Late billing and payments can have a dramatic impact on profits, so the timely resolution of problems is critical to maintaining a healthy and predictable cash flow for your center.

Optimal system and staffing
To maximize your center's profitability from reimbursements requires a well-organized system, the best billing software, and a knowledgeable staff dedicated to productivity, service quality, and patient satisfaction. Such qualified personnel can identify and quickly resolve problems as they arise.

Outsourced or in-house
Since a bill may pass through many hands, including the physician's office staff, a unit coordinator, a billing agent, a collector, or an outside collection agency, it's important to decide whether to maintain a qualified billing and collection specialist onsite, or to outsource these functions to a company that specializes in providing these services. You will have direct control over in-house staff, but there must be sufficient work to justify recruiting and retaining qualified personnel.

Effective communication
Your endoscopy center's billing system should work independently yet in cooperation with your office. In most cases, billing will be initiated by your office because all procedures will need to be pre-authorized, and the patient informed about possible co-payments. Good communication and a positive working relationship between the office and billing staff, as well as thoroughness and efficiency, are essential to keeping the billing cycle moving and prevent holdups in payments.

Selection of billing software
Another major decision involves choosing the most appropriate billing software for your center. The best software can remove much of the guesswork in the billing process and even track staff productivity. To choose wisely, you need to know the most critical areas to track within the billing system and what you want the software to achieve. For example, does it have a contract module that can load contracts into the system? Does it do billing electronically? Does it have a collection module? Does it indicate exactly how much to expect as reimbursement? For the best fit, assess your needs before you start shopping for software.

Staff training
Ideally, the payment schedule will run without a hitch. But there are many areas where things can go awry, such as late payments, billing errors, and failure to make co-payments. Your staff must be trained to:

verify accuracy of all patient data
interpret information on insurance cards
double-check billing and claims before they are sent out
call patients and talk about payment options, when necessary
send bills to collection agencies when they are not paid after 90 days
understand the intricacies of insurance contracts
negotiate with insurance carriers.

Joining forces with a management partner that has its own billing department can offer the best of both worlds - a high level of control, along with the assurance of knowing you can leave all problems to them.