Lynn Bennett
Area Director
UGA SBDC at Valdosta State University
lbennett@georgiasbdc.org
The topic of healthcare is more than just a touchy subject these days for most Americans. With the continuous rise in insurance premiums and more and more rural hospitals closing due to exorbitant costs, people are increasingly concerned about where they will get their medical treatment and how they are going to pay for it. For many rural areas, nurse practitioners are a cost-effective solution to this problem.
Many practitioners now seek to open their own clinics to provide healthcare in rural areas. In order for them to be successful they must understand the business side of operating a clinic. Some universities are exploring the idea of offering a dual degree—Masters of Nursing with a Masters of Business Administration—because of the lack of business knowledge for nurse practitioners who want to set up their own clinics. The combination of these two degrees would prepare the nurse practitioner for success.
Nurse practitioners who desire to open their own clinic should assess their business knowledge, focusing on strengths and weaknesses. It is good to have a basic understanding of business accounting and marketing, and once you learn your weaknesses you can hire experts who can help you with those areas. Three specific areas of concern are fees associated with the collaboration of a physician, hiring an experienced medical biller, and ensuring the right payer mix.
Georgia is one of 29 states that still require physician oversight for nurse practitioners. Many nurse practitioners would love to see Georgia join other states and remove the physician oversight requirement, but until that happens, nurse practitioners desiring to open their own clinic need to be prepared. While the nurse practitioner can diagnose, provide treatment and prescribe some medications, the qualified physician must still review the patient charts. A nurse practitioner looking to open their own clinic would need to seek out a physician to provide oversight ahead of time and discuss fees that would be charged to review the patient files. Failure to find a physician willing to provide oversight can delay the opening of the clinic.
Nurse practitioners should seek to hire an experienced medical biller to handle the billing function, while maintaining close oversight of this position to ensure payments are being received in full. Many mistakes can occur from the time a patient makes an appointment to the time the bill is paid in full and this can hinder the billing process causing a loss of cash. Some areas of concern include incomplete charts, failure to submit claims, uncollected co-pays, invalid insurance data, and lingering accounts receivable balances just to name a few. Nurse practitioners need to implement good systems that can track revenue cycles. Not only is it important to track the information, but it is also important to review the data frequently and discuss with the employees so they understand why this is crucial to the clinic’s success and have a game-plan ready for any issues that arise.
A nurse practitioner’s payer mix can play a huge role in the cash flow of the clinic. The payer mix is the distribution of commercially insured and uninsured patients, as well as Medicare and Medicaid patients. The practitioner must understand the scope and limit to the services that can be provided in order to produce a profit for each payer type. A key function that can be used to manage the payer mix is proper scheduling along with targeted marketing that can attract patients with more desirable payers. Nurse practitioners can deliver quality care to their patients while ensuring their practice stays profitable.
Proper planning can create a foundation of success for a nurse practitioner who desires to open their own clinic. Gaining the business knowledge along with the nursing degree is the winning combination. If you need assistance with your medical practice you can contact the UGA SBDC nearest you for assistance.