Practicing Profitability — Billing Network Effect for Revenue Cycle Control in Healthcare Clinics and Chiropractic Offices
– by Dr. Yuval Lirov
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.
REVIEWS: “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
Amazon readers also gave this book high marks, rating it 4-1/2 out of 5 stars (with 16 reviews). Here’s what a few of them had to say:
“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.”
“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.”
“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.”
A word of caution: Many of the “reviews” on amazon appear to have been taken from the book and are not by actual readers. A few of the reviews from amazon readers aren’t as complimentary. One says: “The book was a quick and easy read. I am a physical therapist operating 5 privately owned clinics. I was hoping to find a resource to improve the efficiency of our billing and collections processes, but this was not it. This book provides a basic description of what technology can and should do to assist a practice operate more effectively, but there are no real world answers. I read it, but then was happy to resell it. Not a resource worth keeping.”
Order now from amazon.com
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