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 (Paperback)

~ (Author), DC Brian Capra (Foreword)
Key Phrases: financial care plan, billing transparency, patient relationship management, Correct Coding Initiative, Straight-Through Billing, Wonderland Lewis Carroll (more...)

Editorial Reviews

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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Product Details

• Paperback: 220 pages
• Publisher: Affinity Billing, Inc (September 1, 2007)
• Language: English
• ISBN-10: 0979610117
• ISBN-13: 978-0979610110
• Product Dimensions: 8.9 x 6 x 0.6 inches
• Shipping Weight: 10.4 ounces (View shipping rates and policies)
• Average Customer Review: 4.6 out of 5 stars  See all reviews (16 customer reviews)
• Amazon.com Sales Rank: #814,837 in Books (See Bestsellers in Books)

Customer Reviews

Most Helpful Customer Reviews

8 of 8 people found the following review helpful:

5.0 out of 5 stars Best billing book I have seen, October 12, 2007

By	Douglas Cassel "M.D." (los angeles, california) - See all my reviews (REAL NAME)

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.

5 of 5 people found the following review helpful:

5.0 out of 5 stars Levels the playing field, December 30, 2007

By	Ted Gutowski "Dr. T. Gutowski" (New Jersey, USA) - See all my reviews (REAL NAME)

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.

4 of 4 people found the following review helpful:

5.0 out of 5 stars Sets a new standard for practice management , October 19, 2007

By	D. Macolino "Billing Dynamix - Hands-on Profi... (Long Island, NY) - See all my reviews (REAL NAME)

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