5 Ways Primary Care Doctors Are Leaving Money on the Table 

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October 4, 2022

Are you leaving money on the table in your medical practice?

Chances are, the answer is yes.

If you're not doing the following, you could be missing out on millions.

1. Billing Medicare's care coordination and prevention codes

You could be leaving behind over $200,000 each year by not billing Medicare's care coordination and prevention codes as often as you can.

These codes attempt to determine which services you're frequently providing for free and losing money.

The study linked above found that in 2019, Medicare paid primary care providers $383 million for care coordination services, $1.2 billion for prevention services, and reimbursed $7.1 billion for standard evaluation and management services.

It also found that physicians were only billing a small fraction of patients that were receiving services represented by prevention codes. 

Along with that, 33% of beneficiaries were eligible for behavioral health integration services, 66% for chronic care management services, and 10.5% for cognitive assessment with care planning services. However, not even 3% of eligible patients had a claim for these services.

Essentially, if you provided and billed all coordination or preventive services to even half of your eligible patients, you could add almost $211,000 to your annual revenue.

2. Frequently and properly updating fee schedules

Fee schedules are very much still relevant, but you can't calculate a fee-for-service equivalent to assess a plan's PMPM reimbursement if your fee schedules are not accurate and up-to-date.

To make sure you're getting paid what you're owed, it's important to frequently check and update your fee schedules. They should be based on the resource-based relative value scale (RBRVS) in order to avoid fees that are set too low or too high. Simply underpricing one service may cause you to leave behind thousands every year.

3. Monitoring overtime and overstaffing

Overtime and overstaffing are two of the most common ways practices leave money on the table.

When you have too many staff members working overtime, it can quickly eat into your profits.

To avoid this, it's important to monitor your staffing levels to keep your costs down and improve your bottom line. For example, with flu season here, you may be tempted to bring in more staff to meet the demand. But will you still be able to afford this extra staff in the spring when the demand decreases?

You can prevent extra spending  due to overtime and overstaffing by pre-approving all overtime, adjusting staff schedules to minimize overtime with the use of 10-hour days or split shifts, creating a staffing budget and sticking to it, and having only one person stay with the last patient who is causing you to work after hours.

By tightly controlling your overtime and staffing levels, you can ensure that you're not leaving money on the table.

4. Having a structured budget

A budget is critical to the financial success of any business, but especially a medical practice.

Do you know what your costs of doing business are, and what these costs should be by expense category?

Take your budget and compare it to national annual surveys to determine whether you're spending too much and where. This can help you discover where you may be losing profits and decipher a plan for fixing it.

5. Hiring a fractional CMO

If you're not already using a fractional CMO, you could be leaving money on the table with your current marketing strategy.

The fractional CMOs at Bizzuka can help you optimize your practice so that you're bringing in more patients, providing them with the best possible care, and getting paid for it.

We can also help you develop new revenue streams and find ways to increase your reimbursement. 

Hiring a fractional CMO is an investment, but it's one that can pay off big time in the form of increased revenue and profitability.

In fact, you can increase your revenue by 50% with just a 17% increase in each of the following areas that we specialize in:

  1. Increasing your patient load

  2. Increasing the size of each transaction

  3. Increasing the frequency of each visit or purchase

We focus on increasing each of these areas through our proven OPTICS™ process. Schedule your free 60-minute marketing diagnostic consultation with Bizzuka today to find out what’s holding back your patient and revenue growth.