I Never Knew TMA: Offered Practice-Specific Help
By Phil West Texas Medicine December 2024

Marcial Andres Oquendo Rincon, MD, thought he knew a lot about running a clinic when he was preparing to open his Dallas practice in 2022.

That’s when the Texas Medical Association came in. “Every step of the way, there’s always something that I just didn’t know or needed to investigate,” he said, having used its site to answer questions about starting his practice.

Then, about eight months after it opened, he was having multiple payment issues. Again, he turned to TMA and brought in its Physician Payment Resource Center (PPRC) for an audit. The result: pronounced improvement in navigating issues with payers.

Knowing problems would still invariably emerge for his office, “we have them on speed dial at this point,” the pediatrician said. “There are always things that pop up, especially when you’re a busy growing practice.”

Teri Deabler, director of TMA Practice Services, specializes in fielding questions for physicians on how to run their practices – essential insights they typically don’t learn in medical school.

“We talk about things that you need to start your own practice, contract information, how to get a job if you’re going to be taking a job out of medical school or out of your residency,” she said.

In addition to getting resources to physicians, she delivers practice management presentations to county medical societies on TMA’s behalf. Her department created several online toolkits, free and accessible to members, with titles including “Hire, Train, and Keep the Best Staff” and “Keep Your Finances on Track.”

Ms. Deabler points out it’s also essential for practices to know when to hire, when to utilize existing technology to its fullest, and when to outsource.

“I always say there’s kind of a sweet spot for when you should be keeping it in house and when you should be outsourcing it,” she said.

And PPRC – which recovered more than $3.8 million for Texas physicians in 2023 – doesn’t just measure its success in dollars. The department calculates that in 2023, its recovery efforts saved practices nearly 1,000 work hours, with issues resolved in a little less than six weeks on average.

PPRC Director Carra Benson and her team advocate for practices working with Medicare and private insurers, fielding questions about prior authorization issues and reducing payer-related administrative burdens. She notes that resolving payment issues often starts with a practice’s staff, and has built a presentation that emphasizes maximizing revenue.

“You have to hire the right people and educate your employees, because you can’t afford to have those kinds of slipups when the profit margin is so small,” Ms. Benson said. “You need to make sure that the wheels and the cogs are turning the way they’re supposed to, and that you have a well-oiled machine internally.”

She also emphasized practices that invest in training employees “get it back exponentially once they do.” That’s especially important with prior authorization issues; she advises practices to submit a detailed appeal with supporting clinical documentation whenever a prior authorization request is denied.

Dr. Oquendo says his office has become more efficient in securing payment since PPRC audited his staff’s system and made recommendations. His staffer in charge of billing now directly connects with PPRC whenever new payment issues arise.

“A lot of times, they have a solution, instead of us trying to figure out a solution,” he said. “It saves not just me but also my staff a lot of time and frustration. It saves me time, saves me money, helps me produce more; I get to hire more people and worry less about the back office, and I’m able to focus more on my patients.”