Customer Reviews

Practicing Profitability - Billing Network Effect for Revenue Cycle Control in Healthcare Clinics and Chiropractic Offices: Collections, Audit Risk, SOAP Notes, Scheduling, Care Plans, and Coding

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Doctors don't understand medical billing. Medical billing is important, complex and increasingly adversarial. In these days of decreasing reimbursement, doctors in offices are pitted against large insurance companies with significant resources devoted to denying reimbursement. Federal law makes non-compliance with arcane rules punishable by both fines and criminal sentences. The doctors and staffs of small offices need the knowledge and tools to obtain the insurance reimbursement to which they are entitled.

"Practicing Profitability" is the single best book on medical billing I have seen.

It describes the complexities of medical billing as well as offering cost effective methods to optimize reimbursement while at the same time following all rules of compliance.

Complete, concise and well organized, written by a recognized expert in the field, I can recommend it without reservation.

A comprehensive analysis of the losing battle physicians find themselves in with unpaid and underpaid claims due to the insurance companies' powerful computers and software. Insurers will pick out small inconsistencies and reject claims, delaying for weeks or months the payment the physician has earned. The approach outlined in this easy to read book explains how the doctor can level the playing field by equipping his or her practice with equally powerful software to match the insurers'. Dr. Lirov, a renowned computer expert, outlines the various strategies of his system to overcome the payers' continuous attempts to underpay or delay payment to the practitioner. Using such a system makes sure that claims are 'clean' even before they are submitted. Moreover, it does not allow the insurer much time to delay thereby shortening the time for accounts receivable. This results in enhanced profitability for the practice, hence the name of the book, "Practicing Profitability." It should be required reading for anyone in private practice.

The profitable Physical Therapy and rehabilitation practice requires sharp focus and excellent administrative skills in addition to assurance of best practices. Payers underpay Physical Therapy and rehabilitation offices more often than any other specialty. An average PT claim earns $55, which has dropped 17% over the past five years. Payers also audit Physical Therapy and rehabilitation offices more often than any other specialty because of inconsistent medical documentation and frequent problems with billing compliance. Instead of treating patients, practice owners spend excessive and wasted time fighting payers and payers' systems.

"Practicing Profitability" teaches how to implement scalable billing processes using modern Internet technology to match the power, efficiency, and scale of payers' systems. The examples in this book have a background in chiropractic office management and are directly applicable, equally relevant and extremely important in the advancement of Physical Therapy and rehabilitation billing practices.

Regardless if you are just starting your Physical Therapy practice or if you are a veteran rehab office owner, "Practicing Profitability" offers a wealth of knowledge in a tightly organized and easily digestible way. It is the best modern profitability resource for the owner of a Physical Therapy practice.

Gerilyn M. Gault, Physical Therapist
Co-Owner G&E Therapies
Rehabilitation Company, NY

The physical therapist has a strong background and foundation of clinical orthopedics, physics, biomechanics, anatomy, neurophysiology, physiology, medical diagnostics for physical therapists, histology, and all other related subjects. That's the knowledge we acquire when preparing for our profession.

But no physical therapy or rehab education program prepares us for the harsh realities of daily struggle with insurance companies to get paid in full and on time. A recent physical therapy program graduate lacks basic knowledge about payer-provider adversity, HIPAA compliance, audit mechanics, SOAP note management, reporting tools, billing profitability metrics, and outsourcing opportunities. And no program teaches us how to use modern computer technology and Internet to accumulate and leverage our collective health care and practice management knowledge.

This concise, highly informative, and expertly written book addresses a major educational gap. Practicing Profitability is a must read for every owner of a rehab or physical therapy practice.

Yaffa Liebermann, PT, GCS, CEO
Prime Rehabilitation Services, Inc.

On Wall Street, managers have little tolerance to walking away from money. In "Mission Critical Systems Management," Lirov's earlier book, he described lessons learned while implementing rigorous systems management processes across the trading floor of Lehman Brothers. Written 10 years ago, "Mission Critical Systems Management" remains today the single best reference source for centralized management of Straight Through Processing (STP) technologies, which continue to serve cornerstone to massive trade settlements accomplished within extremely tight and legally enforced time limits.

In Practicing Profitability, Lirov shares his unique experience of applying those same principles to the development of industrial-grade infrastructure for healthcare practice managers, engaged in a continuous struggle to get paid. His book shows how to design and implement standards for increasing both the scale and quality of medical claims processing. Vericle, the system described in Practicing Profitability, turns claims processing into a commodity, creating, growing, and sharing the benefits of economies of scale across all of its clients. Vericle reduces operations risk of medical practice, improves its cash flow, and allows the physician to focus on patient care. Stand-alone medical practices are unable to achieve such massive benefits in principle because of relatively small claims volume and corresponding limitations of personnel and technology resources. Practicing Profitability shows clinic owners and billing service managers how to overcome these limitations with Metcalfe's "network effect," by combining STP technologies in a Software as a Service (SaaS) model.

Brief and informative, Lirov's book offers a modern technology perspective to the most frustrating billing problems, faced today by tens of thousands of small practice owners. Practicing Profitability sets a new standard for practice management processes.

Dave Macolino, President
Billing Dynamix, New York

Ask yourself: is my billing performance measurable, consistent, and scalable? Am I working to improve them or am I spending all my time chasing individual denials and arguing with insurance companies? Am I working "on" the business or "in" the business?

Billing, because of its complexity, creates opportunities for providers to commit fraud and for payers--to benefit at the expense of providers. But the playing field is uneven: the insurance companies are armed with a powerful three-pronged system to keep providers' money: solid business strategy, well-documented and professionally managed processes, and leading-edge technology.

Without an equally powerful methodology, how can you succeed? An in-house billing operation and a naive outsourced billing office owner are often helpless against the payers. Just like patients who lack education about their own body and their nervous system, practice owners are often ignorant about the reasons for their underpayment or for the lack of practice growth. A systemic office "subluxation" may not be immediately observable to a naked and untrained eye, yet it may cause major setbacks for the practice owner.

Lirov's Practicing Profitability outlines such a methodology. It's the first book to systematically approach billing from the payer-provider conflict perspective and to apply the "network effect"--the most revolutionary characteristic of Internet technology. It emphasizes the importance of integrated office workflow and it sharpens business focus. This book shows how focus and teamwork can be turned around systemically from being points of vulnerability to the strongest weapon for improving practice profitability.

Read it and accelerate your practice building.
Bran Capra, DC
Billing Precision: Build your practice. Not overhead.

Ask yourself: is my billing performance measurable, consistent, and scalable? Am I working to improve them or am I spending all my time chasing individual denials and arguing with insurance companies? Am I working 'on' the business or 'in' the business?

Billing, because of its complexity, creates opportunities for providers to commit fraud and for payers--to benefit at the expense of providers. But the playing field is uneven: the insurance companies are armed with a powerful three-pronged system to keep providers' money: solid business strategy, well-documented and professionally managed processes, and leading-edge technology.

Without an equally powerful methodology, how can you succeed? An in-house billing operation and a naive outsourced billing office owner are often helpless against the payers. Just like patients who lack education about their own body and their nervous system, practice owners are often ignorant about the reasons for their underpayment or for the lack of practice growth. A systemic office 'subluxation' may not be immediately observable to a naked and untrained eye, yet it may cause major setbacks for the practice owner.

Lirov's Practicing Profitability outlines such a methodology. It's the first book to systematically approach billing from the payer-provider conflict perspective and to apply the 'network effect'--the most revolutionary characteristic of Internet technology. It emphasizes the importance of integrated office workflow and it sharpens business focus. This book shows how focus and teamwork can be turned around systemically from being points of vulnerability to the strongest weapon for improving practice profitability.

Read it and accelerate your practice building.
Bran Capra, DC
Billing Precision: Build your practice. Not overhead.

Most billing services stall because the founders start a business without the necessary skills, methodology, or technology to run a scalable business. They quickly discover that managing a growing business requires different skills than familiarity of billing or great fun at coding. Medical billing business is especially difficult because it must succeed in an adversarial business environment, where providers may overcharge the payers and payers may underpay the providers.

Practicing Profitability is a pragmatic look at the complex medical billing process from entrepreneurial perspective. It is also a first-hand personal account of a pioneering development of a powerful system to run a solid and scalable medical billing business, including professionally managed processes, leading-edge technology, and outsourced and off-shored personnel. If you plan to build a medical billing business or if you have already built one but you don't know how to improve its profitability or scale it up - buy this book and keep it close for frequent reference.

Maureen Ennis, Certified Facilitator and Business Coach
The Alternative Board
[...]

I love books that take me beyond theoretical discussions about complex problems and show real life solutions! Dr. Lirov has not only developed a powerful approach to an amazingly complex problem but also explained it in simple and straightforward terms.

Practicing Profitability is a great book about an awesome system that packs in plenty of practical ideas for many medical billing problems. A must read.

Nissim Daunov
REMIKA LLC
Management Consulting

The average practice submits half of its codes wrong. A poorly designed billing process fails to spot a line-item underpayment. Denial followup is frustrating and expensive. Taking advantage of practice management incompetence, the payers leave the clinic owner with disappointing revenue flow.

Lirov's Practicing Profitability teaches how to design industrial-grade claim processing systems and how to use Internet technology to manage them. This book maintains a bird's eye view of the entire practice revenue cycle, starting with patient appointment scheduling, pre-authorization, patient encounter note creation, charge generation, claim scrubbing, claim submission to payer, and followup, which in turn includes denial or underpayment identification, payment reconciliation, and appeal management. It also includes separate chapters on outsourcing, reporting, compliance and audit.

Written by an expert in billing and technology, Practicing Profitability is a major milestone in the evolution of medical billing from individualistic art towards disciplined and systematic process.

Michael McCormick, Paid Claims, LLC
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