Medical practices can measure success in many ways, but when it comes to revenue, an upward trend is always a positive sign. Whether you’re looking to boost your current income or reverse a downward trend, implementing effective strategies can make a significant difference. Here are seven proven approaches to help you increase your medical practice revenue.

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1. Provider Credentialing

Credentialing is a crucial step in establishing contracts with payers, ensuring you get reimbursed at the appropriate rates. Being an in-network provider increases patient referrals and reduces out-of-pocket costs for patients, directly impacting your revenue.

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Steps to Effective Credentialing:

1. Evaluate local payers to determine which contracts are worth pursuing. Although carriers will not disclose their fee schedule upfront, you can determine if that relationship will be beneficial based on the demand of your patient base. Read more about provider credentialing.
2. Ensure applications are accurate and complete to avoid delays or denials. Without proper credentialing, your practice risks losing thousands to hundreds of thousands of dollars in revenue per year due to denied claims or delays in adjudication.
3. Regularly update and maintain your credentials to stay competitive. This will also put your practice at an advantage, allowing you to stay competitive across multiple avenues. Growing practices will attract physicians more likely to join a group with a larger network because of the benefits of credentialing.

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2. Physician Fee Schedule Negotiation

Negotiating reimbursement rates with payers can significantly boost your revenue. Many physicians overlook this step, but it’s a vital part of maintaining a healthy financial practice.

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Tips for Successful Negotiation:

• Analyze financial reports to identify your top-paying carriers and procedures. Your financial reporting should identify your top-paying carriers as well as your top-billed procedure codes.
• Research customary rates in your region to set benchmarks. You’ll need to demonstrate the value that your practice can bring to the insurance network, such as cost savings due to your clinical outcomes.
• Highlight your practice’s value, such as cost savings due to clinical outcomes and unique specialties in high demand. Is there a shortage of your specialty in the area? Will you continue to grow your practice consistently to offer a larger network for their patient base?

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3. Eligibility Verification

Ensuring patients are eligible for coverage before their appointments can prevent costly claim denials. Implementing an electronic eligibility verification system can save time and reduce errors.

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Benefits of Electronic Verification:

• Identify the patient’s specific health plan and out-of-pocket expenses beforehand. This enables you to leverage these responses to collect the patient's co-pay or deductible at the time of the appointment.
• Collect co-pays or deductibles at the time of the appointment to avoid payment delays. This reduces the lag time in patient collections and prevents denials.
• Reduce the risk of denials due to inaccurate insurance information. Running eligibility prior to a visit ensures that your practice will be reimbursed for the services you’ve rendered.

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Challenges with Manual Verification:

• The alternative to electronic verification requires your staff to spend countless hours calling various payers, resulting in missed eligibility checks, inaccurate responses, or limitations to the data provided.

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4. Patient Outreach

Engaging with patients effectively can lead to higher retention rates and on-time payments. One study found that one in five adults delayed seeking medical care due to the pandemic. There are multiple factors that could have contributed to this: apprehension from being exposed to the virus, financial challenges, and difficulties in accessing care. The COVID-19 pandemic has made it evident that patient communication is more important than ever to ensure patients know they are your practice's top priority.

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Effective Patient Outreach Strategies:

• Keep patients informed about safety measures and available appointments. Establish an open line of communication with your patients and keep them informed of their care options.
• Utilize telehealth options to provide flexible care. Make patients aware of any available appointment openings and how they can utilize telehealth.
• Offer financial counseling to address concerns and facilitate payments. Discuss their current financial situation and what they can expect if they choose to resume care.

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5. Claims Investigation

Timely and accurate claims submission is essential for maintaining a steady revenue stream. Regularly follow up on denied claims and ensure your billing team is proactive.

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Claims Management Best Practices:

• Delegate claims investigation to experienced staff members. Experts recommend having staff members take ownership of outreach with insurance carriers they have experience working with.
• Confirm requirements with carriers before re-submitting rejected claims. Don't just resubmit a rejected claim to an automated system; confirm what the carrier needs to ensure acceptance.
• Avoid passing high bills to patients, as this can damage trust and reduce payment likelihood. Studies have shown that unreasonably high bills can cause patients to distrust their medical professionals.

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6. Online Collection Systems

Modern patients prefer convenience, including when paying their medical bills. Offering online payment options can lead to faster and more reliable revenue collection.

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Advantages of Online Payment Systems:

• Instant payment processing and verification. Patients want the ability to make payments quickly and in a format they trust.
• Simplified payment plans and automated reminders. Setting up payment plans becomes simpler and easily automated.
• Increased patient satisfaction due to convenience and transparency. Patients can confirm their current balance and receive immediate verification that their payment has been processed.

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7. Expertise and Services

Sometimes, the best way to enhance your practice's revenue is to enlist the help of experts. Services like pMD's revenue cycle management can streamline billing and payment workflows, ensuring you maximize your income.

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How pMD Can Help:

• Comprehensive billing services that enhance workflow efficiency. pMD’s billing service has found ways to streamline and enhance the billing and payment workflow.
• Tools and expertise to navigate credentialing, fee negotiations, and eligibility processes. The expert team at pMD provides the revenue cycle management services, tools, and experience you need.
• Free consultations to evaluate and improve your practice’s financial health. Contact pMD today and learn how we can help you improve practice revenue!

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By implementing these seven strategies, you can effectively increase your medical practice revenue. Whether through improved credentialing, better patient outreach, or leveraging modern payment systems, each step contributes to a healthier bottom line. For personalized assistance, consider partnering with experts like pMD to further optimize your revenue cycle management.

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