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Evaluate Medical Practice to Run Successfully

July 3, 2018

 Evaluate Medical Practice“The only constant in life is change,” goes the old saying. That truth is more relevant than ever, especially in the rapidly-changing healthcare industry, where amazing technological strides coupled with ever-changing governmental and insurance payer regulations and requirements call for new and more streamlined procedures in providing patient care.

Evaluate medical practice if you’ve been experiencing any of the following, such as:

  • fewer patient visits
  • increased personnel turnover
  • more claims denials, especially if from multiple payers
  • complaints from patients, especially concerning staff and office procedures
  • warnings from CMS and other payers concerning regulatory violations
  • expenses outpacing revenues

Where to begin – five steps to take:

  • Have an assessment or evaluation performed
  • Create a shared vision for the practice
  • Set workable goals
  • Assemble a designated “change team” to smooth the process within departments
  • Design and gradually implement changes

Evaluations and Assessments

First look at your organization’s workflow including all staffers from front desk to nurses and other practitioners.

Which aspects of workflow are hindering the care processes and which are helping?

How can these procedures be streamlined for more efficiency without reducing care quality?

Look at the scheduling as well for frequent gaps; are the other providers seeing enough patients to pay for their share of overhead and expenses as well as make a profit?

Check your physical inventories for excess items, whether medical or not, that are taking up space.

Perform an Audit

Making an audit part of your assessment isn’t as intimidating as it may sound: even the best-run practice or organization can benefit from having a review of its policies, procedures and how they may affect coding and billing accuracy. Think of it as “preventative medicine” for your revenue cycle and practice – knowing where your shortcomings are and how to remedy them can quickly boost your revenues while helping to avoid the penalties and other hassles caused by human or system errors.

Among the things that a well-done audit can detect:

  • Incorrect bundling procedures, coding usage errors and inappropriate billing based on documentation
  • Reimbursement shortcomings as well as identifying opportunities for improved reimbursement
  • Help reduce the chances of governmental personnel such as recovery audit contractors (RACs) or zone program integrity contractors (ZPICs) from showing up at your practice.

Sooner or later, all practices will require improvements and corrections in one or more areas; an audit helps focus on those areas in need of change and allows practitioners to plan and implement improvements and procedural changes, especially regarding training or re-training staff.

Creating a Vision and Setting Goals

No successful change can occur without developing a vision and identifying and setting goals, which should be measurable, necessary and achievable, as part of the bigger vision.

What are you trying to change, as well as accomplish?

What are your patient care, workflow, and team approaches (as opposed to the former “hero” model)?

What needs to be done to succeed with the new value approach to payment compared to the previous system that rewarded volume?

Use the “Five Whys” method to identify obstacles, in which the most obvious issue is noted, followed by asking why, then asking again to that answer and so on.

For example: 

“Your receptionist doesn’t answer the phone”


“She says that it interferes with her work and voicemail is easier to deal with.”


“She gets yelled at by patients unable to see the doctor.”


“The schedule is too full to allow last-minute visits.”


“We need another support staffer but can’t hire one.”


“Revenue in-flow is down while write-offs from clinical mistakes are high.”

What began as a behavior issue by the front office staffer evolved into a fixable staffing issue once A/R is in focus, resulting in improved communication with staff and the opportunity for making positive change.

Tips for communicating upcoming changes to your staff:

  • Show how the problem(s) as currently existing would continue to affect the practice, without implementing needed changes.
  • To stay on track with the plans, there needs to be steady, slower implementation – too many rapid changes will cause employees, including perhaps top performers, to panic and possibly leave the practice.
  • Smaller practices with just an office manager may find implementing new policies easier than larger practices with multiple departments.

Reducing employee stress while managing staff reactions to change

  • When the organization’s leadership shares its vision and reasons for change, staffers are more likely to embrace what they understand rather than fear the unknown of the coming changes.  

  • Bring employees on board from the outset – office staff, for example, are your “boots on the ground” and can offer valuable insights and suggestions for improvement in procedures and practice growth.
  • Let employees know what to expect regarding how their work processes may change and what criteria will be used to measure job performance.
  • Use visible incentives and rewards as positive reinforcement when implementing gradual changes, such as promotions, bonuses or other forms of recognition.

Getting a “second opinion” from a professional practice management service

As a physician, you wouldn’t treat a condition that fell outside of your field of expertise. At the very least, you would consult with another physician for a second opinion. For the same reasons, you will also want to engage the services of an experienced practice management company for a full professional evaluation of your practice’s management processes, revenue cycle management goals, and achievement of your unique vision for your practice’s growth.

Working with a professional billing and practice management service, such as M-Scribe, can give practices an impartial “second opinion” to identify problem areas and issues that may be hindering your vision of success. With our revenue cycle analysis and other management services, practices of all sizes and specialties have used our expertise to implement changes necessary to continue to thrive while providing optimum patient care. Contact me via email at or 770-666-0470 for a free analysis and learn how we can help your practice meet and achieve its goals.


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