Few physicians entered their chosen profession because they wanted to run a business. In fact, if they were being honest, many would prefer never to have to think about the daily tide of incoming and outgoing bills and invoices that keep the practice afloat financially. In general, even the most business-savvy physicians prefer to spend their time concentrating on their passion: medicine. Nonetheless, most physicians also expect that their practice will easily generate sufficient cash to maintain a profit each year.
But in these days of shrinking reimbursements and dwindling health care insurance coverage, profitability of a medical practice is not the sure thing that it used to be. Today’s medical practice billing department needs to know much more than how to submit insurance claims. And as the responsibility for payments is increasingly shifting from insurance companies to patients themselves, the whole process has become more confusing, complex and precarious.
“Patient confusion and cost-shifting is likely to make cash flow much more erratic for physicians in the future,” predicts Frank Nuck, Esq., President of Financial Control Solutions (FCS), a Milwaukee-based firm that was born over 40 years ago as a third-party collection agency, but now is so much more. The company originally opened its doors by serving physicians. Today, over half of its client base are doctors’ offices, which gives it a leg up in understanding the challenges facing doctors when it comes to managing, by providing RecoveryAssist™ a unique offering in the region.
“We believe in investing time and energy on the front end to help our clients,” says Nuck. “There are many things that we can do to help make their lives easier.” Helping clients to reduce the number of accounts that are past due may seem counterintuitive for a collection agency, but Nuck says it is all about relationship building. FCS recognizes that growing practices are always going to have some need for collection services and that, if they prove themselves to be a worthy and committed partner, they will be entrusted with those collections.
“RecoveryAssist™ is really just a simplistic way to increase account recovery and reduce the need for collection,” explains FCS Vice President Suzanne Gizella, who has worked with hundred of medical offices during her 16 years with the company. “Basically, I start by going into an office and auditing their accounts receivables. We look at everything and we help them do a complete cleanup. We make sure that everything that needs to be submitted to insurance has been submitted. A lot of agencies won’t even bother to work with insurance companies, but we will work with them. We will even submit new HCFA forms if necessary.”
Initially, Gizella will work intensely with an office for the first three months, helping them to review their processes and set up a system that works. The entire audit and Gizella’s consultation and advice are free to clients. “I’ve never heard of anybody else who even comes close to offering a service like this,” says Nuck. “You’ll find accounting firms who will go into your office for $250 an hour with the goal of helping you increase cash flow and improve collection. FCS acts as a consultant and we do not charge for it. It is unique. It is a differentiator.”
Milwaukee family physician Gojko Stula of Health Guard Medical Group thought the concept had merit when his office began working with FCS 16 years ago. At the time, their billing system was in a state of chaos. Current billing manager Ann Heding says FCS’ hands-on, personal approach allowed the practice to regain control of its A/R and get back on track. “Our last collection agency did not even bother to come to our office. They did nothing to help us identify problems or clear our books,” recalls Heding. “But FCS not only came out and spent time with our books and helped us to set up our own system, they are still there for me any time I have a question or need assistance. And we recovered over 80% of what was outstanding.”
Gizella and the team at FCS are skilled at quickly and efficiently identifying the red flags and helping the practice take action in the form of a “bridge letter” or “option letter and the labor costs are absorbed by FCS.” Sent out to delinquent accounts on practice letterhead (but on pink paper), the letter is a gentler way to collect a debt by offering the patient some options for repayment, such as setting up a monthly payment plan. “Quite often patients don’t even know that their account is seriously past due,” says Heding. “They’re just assuming that their insurance is going to pay. The bridge letter has been a very positive method for us.” Now, when a patient’s account reaches 45 days, Heding’s billing department automatically sends a bridge letter. Accounts that remain delinquent can be turned over to FCS for collection. Because the letter comes from their doctor and not a collection agency, and is even hand-addressed, patients are more likely to respond positively, a fact that not only means a better rate of recovery but also the preservation of the important doctor / patient relationship.
Due to the success of this program for Health Guard Medical Group, Dr. Stula, Medical Director, and his administrative staff have implemented this same system for his new practice, LifeSteps Health and Wellness Clinic, specializing in the areas of hormone imbalance, weight loss, adrenal fatigue and thyroid disorders, along with anti-aging aesthetics and supplements.
And such stories are not uncommon for FCS. Often, Gizella finds, a practice is its own worst enemy when it comes to facilitating on-time payments, and the A/R department may not even be aware of it. In such cases, the suggestions she makes and the experience she brings can be invaluable. “Many practices don’t bill the patient at all until after the insurance pays, which is a big mistake. Others assume that because a particular case is in litigation, they should not bother to send statements. Another big problem is just failing to review your A/R on a regular basis so that you miss those red flags that would be prompted you to take action.”
“The approach to medical collections is considered qualitatively different than collecting in most other markets,” explains Nuck. “We tell prospective practices that our approach is to assume we will both collect monies owed while protecting the practice-patient relationship. Conversations with insured patients invariably turn to insurance issues, meaning more of the collection effort is pure problem solving in nature.
“Since FCS was born in the medical market, our culture and reflexive agent orientation is toward a highly professional approach to debtor interaction.” During agent training, FCS emphasizes tone, vocal control and pace as well as content. The company regularly audits agent-debtor discussions to make sure they are practicing what FCS preaches.
Over time, approximately 7% to 12% of patients make payment to the practice upon receipt of the bridge letter. Because calls to the office typically increase after bridge letters are sent out, FCS will work with the office to space mailings so as not to overwhelm the staff with incoming calls. Monies collected by the bridge letter flow directly to the practice, with no commission paid to FCS.
“The key to the whole thing is they aren’t spending any money for my time and to get those letters out,” says Gizella. “And we are getting those accounts into the office within 90 days. We can run the numbers at the end of any month and show the practice that more money is coming in to the office. The result is a cleaned up A/R, virtually no accounts more than 90 days old and a system in place that they can use forever.”
For their part, FCS not only builds a solid, trusting partnership with RecoveryAssist™ but, with a system in place, they can also be ensured of some consistency in the turnover of accounts. Even if there is a change in the billing staff, a client office using RecoveryAssist™ is going to consistently move past-due accounts over to FCS for collection. And if FCS receives accounts in a timely manner, they are more likely to be able to collect.
“One of the few truisms in the collections industry is that the older the account becomes (age of the account), the less likely that you are going to collect,” says Nuck. “If we can move the time that we receive the account to not older than 90 days, the rate of recovery is going to go up and the client is going to make more money.”
Their approach may be unconventional, but FCS and the RecoveryAssist™ program have been well received by the medical community. Gizella says a full 95% of her new clients now come from word-of-mouth referrals. And, as they reduce their outstanding A/Rs and recover more of the money they are owed, new client practices become long-term clients.
“Bill people will say that life has just gotten so different because now they can enjoy their job,” says Gizella. “It takes so much of the stress out of billing. We shrink their accounts receivable down until it’s very, very manageable. With this system that we set up internally, they can go back to the physician and show exactly what steps have been taken to collect the outstanding balance in-house. The physician can then clearly justify moving it to the next step.”
Contact Financial Control Solutions for more information about their full service accounts receivable management solutions.
“Working with Suzanne and Financial Control Solutions with RecoveryAssist™ has proved to be a great benefit for our business. They have assisted us in getting better control of overdue accounts and helped us increase the capture of these accounts, thus increasing our revenue. It is a pleasure working with them.”
-Peg Vick, Office Coordinator, Surgical Specialists of Dodge County
“We started our association [with FCS] at a critical time in our practice, taking the billing away from a large corporation and brining it in house. We are now in very strong control of our accounts receivables due in part to the support and structure of RecoveryAssist™. It is comforting to know that, when needed, FCS will help collect our outstanding balances with the same courtesy and respect we give our patients in the office.”
-Tari Schulte, Office Manager, Medved ENT, S.C.
Suzanne has made a positive impact for our clinic. She is extremely knowledgeable in this area and presented the product to our physicians in a professional manner. The process works and we have already seen results. We only expect to continue to decrease our AR and hear responses from our patients due t this “pink letter.”
-Nancy Rabideau, Administrator, NeuroSpine Center of WI, S.C.
After reviewing the accounts that have been worked on since [Suzanne’s] initial visit, it has been determined that we have collected $15,346.78 from the patient aging. Your input and guidance helped us implement a ‘tighter’ collection policy and has empowered the billing staff. I appreciate their determination and high-energy style.
-Gail Oninski, Office Administrator, Shoreview Pediatrics, S.C.
In the short amount of time we have been with FCS we have already collected over $1,500. At first when I heard how they do their collections, I was skeptical. It sounded too easy. But it is working wonderfully and we are getting our AR cleaned up very quickly. Suzanne is wonderful to work with and very, very helpful.
– Rhonda Davis, Bone & Joint Surgeons, Ltd./Mokena Family Physicians, LLC