Review
Lirov offers physicians and those involved in the field of medical billing reliable advice for improving their businesses and growing revenue.
When the author looks at the landscape of the medical profession, he sees a playing field tipped to benefit the payers and hurt the providers. By increasing billing costs, underpaying claims and conducting a growing number of post-claim audits, insurance companies strive to keep profits high by depressing those of individual providers. To counteract these methods, Lirov contends that healthcare providers need to streamline their business practices. He envisions the relationship between payers and providers as adversarial, and his book is a set of strategies that will allow providers to get back into--and hopefully even win--the game. The author seeks to show providers how to enhance their billing practices with a set of strategies designed to take advantage of the "network effect," a characteristic of systems that allows a large number of disparate providers to capitalize upon their strength in numbers. Lirov also presents a comprehensive model for improving many elements of the provider-patient experience. He offers helpful advice on building communication with patients, improving clinical documentation (notes physicians take when dealing with patients) and facilitating the scheduling of patient visits. Lirov helpfully notes that his book is not for the billing novice, and he directs beginners to a number of other helpful primers. But for those who already have a strong handle on billing--and have a need to improve their practices to increase revenue--the book is an invaluable resource.
Lirov's writing, though sometimes weighed down by jargon, is precise and evocative, and his methods are sound and clearly explained. A superior addition to the field of medical billing. -- Kirkus Reviews, February 13, 2008
From the Publisher
You want to heal the sick, but you waste your time fighting insurance companies and barely making ends meet in a conflict-ridden business environment. "Increasing complexity of billing creates opportunities for the payers to benefit at the expense of the providers," says Dr. Sigmund Miller, executive director of the Association of New Jersey Chiropractors (ANJC). "Endless claim denials, payment delays, and post-payment audits are all too familiar symptoms of dilettante billing. Doctors require professional solutions."
"Providers paid $3.1 billion last year in refunds and penalties-twenty times more than ten years ago," adds Jeffrey Randolph, ANJC legal counsel. "The payer's motive is money, the payer's means is a gargantuan statistical database, and every provider is an opportunity."
"Practice owners alone are helpless against insurance companies that are armed with powerful technology and focused on keeping providers' money to increase profits for their shareholders," says Dr. Yuval Lirov, who holds patents in artificial intelligence and computer security and is also CEO of Vericle Inc., a distributed practice management and billing technology company in New Jersey.
Practicing Profitability is the first book to systematically approach billing from the "payer-provider conflict" perspective and to apply the "network effect." The network effect is the most revolutionary characteristic of Internet technology. In short, it's when the value of a networked service to a customer increases in step with the growing number of customers. It applies to services like Google AdSense, eBay, Wikipedia, Skype, Amazon, Flickr, and MySpace-and it can be used by healthcare practice owners and managers to "level the playing field" with insurance companies.
"The network effect allows each member practice to gain more value as each new practice joins the Vericle network," says Lirov. "For practice managers, value is defined in terms of increased collections, reduced audit risk, better practice efficiencies, and added sources of revenue. This book demonstrates how practice managers achieve and take advantage of the network effect by combining Straight-Through Processing [STP] and Software as a Service [SaaS] architectures."
Practicing Profitability touches on every aspect of modern office management software-including workflow, reporting, outsourcing, scheduling, EMR, SOAP notes, care plans, coding, billing, collections, HIPAA compliance, and audit risk management. It shows simple steps that practice owners must take to increase practice revenue without wasting time, energy, and money on personnel, software, hardware, or any other resources that dilute their focus from patient care and practice development. The book spans thirty-five chapters and about two hundred pages, and it contains informative illustrations and an extensive index. It's aimed at practice owners, coaches, owners of billing companies, practice managers, office management consultants, billing specialists, and recent graduates of medical schools and chiropractic colleges.
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