After reading "Sweet relief: Pay raise will help with malpractice costs in Penn." in your July 2001 issue (page 14), I could not help but wonder if the author of the article had been sprinkled with Tinkerbell dust.
Does Modern Physician honestly believe a 10% pay raise on subpar RBRVS rates will help with malpractice costs? Does Modern Physician actually suggest that a 4% increase in a reimbursement rate will begin to match the Blues' double-digit premium rate hikes they charge to patients and doctors? Does Modern Physicianactually think these hikes will offset three $49 million malpractice verdicts?
The take-home message from this drivel you published is that the physicians should refuse to participate in any plan that does not match practice revenues with practice expenses. Only then will physicians take back control of medicine from the bean counters.
If Modern Physician is truly interested in the welfare of the physician, perhaps you might want to report on the abuses of insurance companies and their failure to pay legitimate claims on time.
John Braun, M.D.
The article "Panning for profits" in the June 2001 issue (page 22) asserted that "there is not much docs can do to get more money out of HMOs," recommending that medical groups begin offering new services to generate additional revenue.
Medical groups that do not work to improve their rate of denied claims, resolve no-response claims, manage referrals, examine high adjustments and improve their accounts receivable are missing a big opportunity to collect more of the money they're leaving behind. And if they launch new practice areas without analyzing their billing practices, they are likely to continue making the same mistakes when billing for their new services.
The key to improving denied claims begins with analyzing the financials to find ways to get paid right the first time. In our experience, the key is to identify patterns in how claims are paid or denied and how procedures are reimbursed.
From this analysis, groups can improve how claims are submitted and how self-pays are collected.
For example, many groups fail to identify self-pays (e.g. deductible not met; patient ineligible, procedure not covered). By flagging these issues using online, real-time analysis, reports and efficient procedures, physicians can collect fees directly from the patients and not lose them amid unreconciled denials.
Chief Executive Officer
The September 2001 article "Call waiting: ER staffing problem moves into cities nationwide" (page 2), concerning ER responses by specialists, is right on target.
A plumber's service call for arriving on any given day is more than the reimbursement an otolaryngologist receives for an anterior nasal packing and the privilege of disrupting his life and having blood spit in his face.
Then for his office to try to get reimbursed is near impossible, especially if he is not on the patient's "panel" or if the emergency room physician's bill hits the computer first. ("We only pay once for any given procedure.")
Until such injustices, which are an insult to our profession, are rectified, I am afraid all physicians will opt for a better quality of life and abandon emergency room call.
Raymond Votypka, M.D.