Are you being appropriately paid for the work you are doing?

When working with clients in the medical space, oftentimes we are seeing providers and facilities not being paid for the hard work that they are doing. Over the past three years, it has been more difficult for organizations to get reimbursed from insurance contracts, and even self pay patients.

This requires a clean process that allows for easy tracking of metrics and for holding these other parties accountable. Related to this, JFS, LLC has a great story to share…

 

When JFS, LLC was engaged to support a small medical practice that specialized in primary care and behavioral health services, it became clear that the revenue did not align with the work performed and the expenses that were required to perform said work.

After deep diving into their financial data and electronic health record, it became clear that we had a couple of areas of opportunity.

First, was their billing company.

There was a clear lack of timely filing, coding accuracy, feedback loops for denials, and reporting that claims were not getting paid well or at all. This resulted in JFS working with the client to find a better solution, implement clear key performance indicators to hold these players accountable, and to streamline their internal workflows to help with the process.

The second opportunity was case mix.

Since the data was not clean to use for decision making, the owner of the entity was making decisions on patient care and services to offer with bad data. JFS supported by cleaning up their financial statements, clarifying how to run weekly reports around reimbursement, and how to engage other team members to make sure that the decisions were data-based and not just from a gut feel or from rumors within the industry.

The Third opportunity was Strategic Financial Planning.

Finally, there was no real clear strategic financial plan for the organization. By clearly setting goals and objectives decisions were then made that were in alignment with the long term plan.

 

Overall, facilities do not have the manpower or experience to identify these issues or on how to implement changes once they are found on their own. This is one of the many ways that JFS is happy to support our clients!