Practice Management

Improvements With Huge Results: 60% Fewer Insurance Receivables & 40 More Patients Weekly

By Miki Lyn Zilnicki, OD, FCOVD,
and Jessica Licausi, OD, FAAO, FCOVD

May 19, 2021

Practice improvements give you a chance to do better for both your patients and practice. Here are a few changes we made that are helping us provide better service while strengthening our business.

Transitioning Billing to In-House Processing
Billing can be outsourced, completed remotely or done outside office hours. We tried two different arrangements in which our billing was completed out-of-house. The first arrangement resulted from our receptionist moving on to a position that was within the field she studied in school. She had learned billing while in the receptionist role and offered to continue as a part-time biller remotely after hours. This initially seemed ideal because she was already familiar with the ins and outs of billing for our office. We supplied an at-home billing office setup with a computer, printer, remote access and printing/mailing supplies. We learned over time, though, that even with communication protocols in place, tasks were falling between the cracks. Insurance receivable reports began to rise, which tipped us off that a change was needed.

Errors included billing submissions missed and paper denials that came to our office not addressed. Often by the time we found these errors the timely filing deadline had passed. We decided we needed someone who could perform some of the billing duties in-house, which would allow for more direct communication in-person with one of us and a more seamless pass off of printed documents.

We hired a certified biller, who worked at a local hospital. We created a system in which she worked a combination of in-house and at home remotely. This was an effective system that allowed for improved communication. Insurance receivables and billing reports began to reflect this with a 30 percent decrease in overall insurance receivables three months after this transition was made. However, once the COVID-19 pandemic hit, our biller’s obligations at the hospital increased and she was no longer able to commit the time necessary to our office. We decided to look for someone who could dedicate more in-office time to billing and found that person in our part-time vision therapist.

The pandemic proved to be the perfect timing to make this transition. Between our office closure, and then reduced patient flow after reopening, the workload for our vision therapists, particularly our part-time therapist, was greatly reduced. Our part-time therapist expressed interest in taking on the billing role. Our out-going biller agreed to train our vision therapist how to submit claims, navigate our online clearing house, correct denials and enter payments. We decided from the get-go that this billing transition would take place exclusively in-house, so we could assist with any questions and mitigate billing errors.

This transition did not cost us additional money initially since we moved billing duties to an existing employee. We were utilizing for billing the time she would have spent seeing vision therapy patients. Now that we are getting back to a more normal vision therapy schedule, she has to split her time between vision therapy and billing. To ensure that enough time would be devoted to each role, we increased her hours by one full day. This, in turn, increased payroll costs. We consider this additional expense well worth it.

Timely billing and reduced errors translate to an improved patient experience. Patient responsibilities, such as deductibles, co-pays and co-insurances, are communicated faster to the patient and submitted with greater accuracy.

Results: Insurance receivables are at an all-time low, having decreased overall by 60 percent from when billing was completely remote versus now that it’s done all in-house.

The new vision therapy room that has transformed the capacity of Drs. Licausi and Zilnicki to see patients–a renovation that cost around $5,000.

Office Expansion with New Vision Therapy Room
Prior to COVID-19, we were running three schedules simultaneously that looked like one of two scenarios: one doctor and two vision therapists OR two doctors and one vision therapist. In our previous space we were working with a vision therapy room, an exam lane and a pre-test room that served as an additional space to run a vision therapy session. Looking back, it was incredibly inefficient; we were often bouncing patients back and forth between rooms so the doctor could finish a dilation or pre-test a patient. It was a huge source of stress trying to figure out the logistics of who was where, when and with what patient.

Once we returned to the office after lockdown, we realized this system was not going to work with the cleaning protocols we were implementing. Being conscientious of the safety of our staff and patients was of utmost importance and spurred the change to give everyone their own space and practice in an efficient and healthy manner.

We had a large reception area that lent itself to an easy transformation to a second vision therapy room. We just had to build a wall, adjust power outlets and pull furniture from other rooms to create a usable vision therapy space in about three weeks’ time from start to finish. We only had to close the office down for one day when the major construction took place. The remainder of the work was easily completed either outside office hours or during patient care with no disruptions. It had a total cost of $5,000. Click HERE to read more about the logistics of this renovation. 

This change drastically improved the patient experience. Patients were no longer getting moved from room to room or tag-teamed between different providers to finish their exam/therapy session. We got positive feedback from patients, who told us they could see we were making their safety a priority, and that they felt confident they could visit us without worry to receive the care they needed.

Results: Creating this space allows our second vision therapist to see patients all day without interruption. She works part-time currently, which enables her to see 40 vision therapy patients per week. These additional slots helped us get back to our pre-COVID vision therapy session schedule.

Drs. Licausi’s and Zilnicki’s new vision therapists: L-R: Pam and Brittany. Pam is currently working toward becoming a certified vision therapist.

Hiring Vision Therapists
When we first opened the office, we wanted to limit payroll expenses, so it was just the two of us and a receptionist. As the practice grew and our schedules were maxed out, we realized we needed to add a vision therapist to make our practice more profitable.

The challenge when hiring a vision therapist is that training takes a long time before you can have them independently see patients. It typically took us about 12 weeks to feel confident about allowing a new therapist to see basic visual skills patients by herself. Our first therapist has been with us for about 2.5 years, and is now in the process of becoming a certified vision therapist through the College of Optometrists in Vision Development (COVD). The second vision therapist we hired picked up on things faster due to her background, but it was still an eight-week training period.

The initial hiring process comes with a period of associated decreased revenue. To offset this, we offer a training salary while our vision therapists are doing a combination of observing sessions and evaluations with us along with one-on-one classroom-type learning sessions. Once our vision therapists begin to transition to independently seeing patients, we raise their pay. The additional patients they are seeing increases our overall office revenue.

Results: Patients benefited from the addition of the therapist by having more available time slots for vision therapy and it eliminated a wait list to start therapy at the practice. Click HERE to read about the significant impact to practice revenues after hiring the first vision therapist.

Our schedule when we first opened was limited: We worked Monday, Tuesday and Wednesday together and then we worked individually on Thursday and Friday. On average* we could see 12 patients each/day (24 total), three days/week and then 12 each on Thursdays/Fridays. At our max, we had about 96 time slots available.

 With the addition of our vision therapists (one full time, one part time), we are now able to see up to 36 patients/day on Mondays and Thursday (three schedules running), 24 patients on Tuesdays doctor/one vision therapist), 30 patients on Wednesdays (one doctor, one full-time therapist, one part-time therapist working remotely) and 12 on Fridays (one doctor), leaving upwards of 138 potential patient time slots for the week. That is about 40 more patients per week, 160 patients per month and 1,920 patients per year!

* The average comes from the fact that vision therapy time slots take up 45 minutes for a 1:1 session. We do not believe in multi-patient therapy, even before COVID. The doctors schedules are more unpredictable as we can see more than just 12 patients per/day depending on exams, follow-ups, etc., but to keep it simple we left it there.

It is hard to quantify exactly that turn in sales from 96 to 138 patients per week due to the varying levels of reimbursement we get per session. Our private pay rate is a set fee/session, but the few insurances we take vary in reimbursement. The important take away here is that we have 40 more time slots for patients/week, which increases patients’ ability to get in for an appointment and delivers a large increase to our bottom line.

Miki Lyn Zilnicki, OD, FCOVD, and Jessica
Licausi, OD, FAAO,
FCOVD, are co-owners of Twin Forks Optometry and Vision Therapy in Riverhead, NY.

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