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Physician Practice Perspectives

For the past two years, Southeast Texas Medical Associates (SETMA) has been on a journey to be recognized as a patient-centered medical home (PCMH)—although, in truth, the journey began more than a decade ago. 


When you’re scrambling for revenue anywhere you can find it, terminating a managed care contract may sound like the last thing you should do. But in fact, getting rid of a contract that is not working for you can actually make your practice more profitable.


In one of my favorite sections of David McCullough’s biography of John Adams, the author relates a vivid scene of Adams and Benjamin Franklin about to share a room in Newark, NJ, and not being very happy about the prospect. They argued over whether to keep the window open. Adams, saddled with a head cold, didn’t want any part of the chilly night air, whereas Franklin enthusiastically sought out the fresh air. In the end, Franklin won; the window was left open through the night.


With about 10% of claims denied on average, a physician practice must have a specific plan in place to respond to denials. Otherwise, you are forfeiting a significant amount of revenue that is rightly yours, says Brian Sanderson, JD, a partner with Crowe Horwath, LLP, in Oakbrook, IL.


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