8 Strategies to Maximize Reimbursement in Your Healthcare Franchise Practice

By: Christine Dura

The key to success for any healthcare franchise is getting paid for the services you provide. Maximizing reimbursement for services rendered is crucial to the long-term success of your business. However, when it comes to the complicated world of medical billing, getting paid isn’t as easy as it sounds. Even if you’ve hired the best employee to handle your medical billing, sometimes things can slip through the cracks. Here are some ways to maximize your reimbursements and make sure your business isn’t losing much-needed income.

1. Start In-House. Take a look at the processes you’re using when it comes to registering patients and ensuring their information is correct. Making sure you have all the pertinent info from each patient can save a lot of time and struggle when it comes to billing. If something is missed, it can add up to costly delays and wasted time for your healthcare franchise.
2. Take Advantage of Pre-Authorization. Using a system that has credit card pre-authorization can save time and money. Because today’s healthcare landscape features numerous high-deductible insurance options, patients are paying for medical bills out of pocket. Pre-authorization allows medical staff to estimate the total amount of medical services to be rendered, alert the patient, and then the patient can sign off on the charges. This can cut down on payment delays and make the process easier.
3. Online Payment. Speaking of ease of use, set up a system so that your patients can pay online. Not only are the payments quicker than waiting for a check in the mail, it will incentivize patients to pay more quickly. As an added benefit, customers could select your healthcare franchise over another due to the convenience.
4. Set Smart Fees. Don’t set fees for services at the highest level set by payors. If you do, you run the risk of not keeping up with figures that change every few weeks. Codes change frequently and your healthcare franchise might not be notified. If you set your fees at the highest rate, you risk leaving money on the table.
5. Know Payor Fee Schedules. A majority of payors don’t provide a full list of fees, but you can request them. Get a schedule for at least 100 to 200 of the most commonly used codes and fees. It might not be easy to get this information and keep it updated, but if you do, you’ll have a better chance at getting money you’re owed.
6. Work with Insurance Companies. Reviewing and renegotiating insurance contacts can save your healthcare franchise money. Contracts decline in value as they age, but by renegotiating you can maintain the best deal. There is usually a timeframe within which you’re allowed to renegotiate, but it doesn’t hurt to ask.
7. Review charts. Codes and fee schedules change so frequently that it’s important your providers are up to date. Having a system that allows you to check for mistakes, and communicate new information to providers efficiently can save money.
8. Use Reporting Data. Make and review end of the month reports. Your healthcare franchise should have billing software that allows you to run reports at the end of each month. This report should show a breakdown of the financials and snapshots of outstanding accounts receivable.

OrthoNOW is the first and only Orthopedic franchise. Contact Christine Dura at Christine@orthonowcare.com for more information about franchise opportunities.

Christine has over 25 years of quantifiable executive management and franchise related leadership experience within the US and internationally with notable franchise startups in the service, technology, retail, food, health and wellness, financial service, medical care, technology and professional services.   As a Senior Franchise Executive and Entrepreneur, Ms. Dura has been both an individual contributor and has successfully led world-class teams.

Ms. Dura excels at partnering with all core business operations to significantly increase the company’s foot print, expand market share, and generate sustainable revenue and EBIT gains.  Her proven successes, combined with her Master Degree in Training and Development, have shaped Ms. Dura’s uncanny ability to identify opportunities, build mutually rewarding partnerships and produce remarkable results. 

In addition, as a four-time Master and Unit Franchise Owner, Ms. Dura is in a very unique position to leverage her experiences and reputation at all levels in franchising along with her vast personal and professional investor network to drive immediate and long term results.   As OrthoNOW’s Chief Development Officer her role is to identify critical gaps in franchise growth and implement strategies to drive results. Her unique background allows her to leverage past experiences and solid reputation to spearhead OrthoNOW’s national expansion plans.