Set-Up or Acquisition
Whether you're expanding into a new market or area, leaving an employed position to join someone else, starting your own practice, or merging into someone elses practice, PSB can help because we have the experience. Successful transitions require planning so let's "Plan the work, then work the Plan" months ahead of the intended change. Payer contacts can take several months to conclude. It's best to at least have deal points in place that work for you and/or or an agreement that secures your interests and that gives you the path into the deal and out of the deal, all in advance.
How and what should be spent on building or buying into a Facility, like a Surgical Center, is a multipart analysis of many parts that we can help you to decide upon and conclude, review and have prepared the necessary agreements, stay within the lines of self-referral and Stark Law requirements, and professionally approach as follows:
Preparation of budgets and proforma calculations to be clear on costs, investment, and the requirements to be profitable
Avoid legal risks and pitfalls
Source equipment, staffing, and predict start up and operating costs
Oversee Accreditation and the licensure process
Manage through to completion and get the doors open
Decide and negotiate in-network contracts when better than being out-of-network
Practice or Facility Acquisition Assistance
Business valuations are needed for many reasons and PSB has the professional relationships in place to run a CPA level valuation for the following good reasons:
You want to buy into an existing practice or facility and want to understand exactly what you’re getting and what the value really is
You want to sell an existing practice or facility and want to understand exactly what the value is to someone else
You want to gift your business to a family member and for tax purposes need a professional valuation
Business partners may be separating and need a professional valuation and for many other reasons
Billing/Collection & Improvement Opportunities
There's always something to be improved with contracting, coding, documenting, the billing process, managing and/or mitigating denials and underpayments, timeliness, performing a meaningful collection approach, and many other factors that support a crisp revenue cycle process.
Maybe your forms need a tune up, maybe new process need implementation for credit cards on file from patients for unpaid co-pays and co-insurance payment. Maybe stronger collection follow up procedures need to be implemented along with a collection agency that produces results. Maybe there are internal processes that need to be updated in order to reduce the number of denied or underpaid claims. Maybe you need to consider the billing and collections services that PSB provides?
PSB usually doesn't know what needs a tune up until we study the process, make recommendations, and then implement our recommendations. The above are all common problems that we find and fix, and there is more. Sometimes you just have a contract or two that need to be terminated and/or renegotiated.
Credentialing is the process of getting your practice and/or facility tax I.D. and NPI acknowledged as a valid entity to be paid by insurers, IPA's, claim administrators, HMO's, and the world of 3rd party payers. This starts with successful completion of the CAQH database and then submission of forms to the 3rd party payors. The process can stop here for out-of-network providers or, thereafter, go forward with the Contracting process if wanting to be in-network.
Contracting can take several months to complete, especially if looking for special carve-outs and higher reimbursement rates than the usual and predatory offers. Bottom line, this is a process that needs to start in advance of the practice being open.
Is it sometimes prudent to be out-of-network? The answer can be yes. Good contracts or the best that the 3rd party is willing to offer, will take months to negotiate and start so plan carefully and way in advance. Give yourself several months lead time and a reasonable expense budget to get this done. Other options exist that will accelerate joining a long but not complete list thats reasonably well negotiated, but may not include contracts with Blue Cross, Blue Shield, Optum or Aetna. To join may be expensive but access gets accelerated and the reimbursement reates may be greater that what one can accomplish on their own.
Planning and not approaching this last minute is the best approach, when possible. PSB can guide you through this process and advise on decision making.
Are you feeling stuck and is your practice just not producing enough for you to be comfortable?
Would you like to be assessed for the addition of new business lines or services to add-on for more and increased profitability?
Are you willing to expand a bit and want some coaching and advice in this area?
Are your operating expenses out of wack?
Let PSB help you.
Mark R. Brown has successfully provided part-time CFO and/or Business Manager services to many. Perhaps too expensive full-time, but very cost effective on a part-time basis, knocking down barriers, and bringing a fresh perspective and creativity to the mix.
We are problem solvers and fixers.
With the goal in mind of profitability, most benefit from creating a plan and allowing Mark to execute the plan with you practice and get through your primary responsibilities. Tell us your issues so we can discuss solutions and a plan.