Sets a new standard for practice management,

On Wall Street, managers have little tolerance to walking away from money. In "Mission Critical Systems Management," Lirov's earlier book, he described lessons learned while implementing rigorous systems management processes across the trading floor of Lehman Brothers. Written 10 years ago, "Mission Critical Systems Management" remains today the single best reference source for centralized management of Straight Through Processing (STP) technologies, which continue to serve cornerstone to massive trade settlements accomplished within extremely tight and legally enforced time limits.
  
In Practicing Profitability, Lirov shares his unique experience of applying those same principles to the development of industrial-grade infrastructure for healthcare practice managers, engaged in a continuous struggle to get paid. His book shows how to design and implement standards for increasing both the scale and quality of medical claims processing. Vericle, the system described in Practicing Profitability, turns claims processing into a commodity, creating, growing, and sharing the benefits of economies of scale across all of its clients. Vericle reduces operations risk of medical practice, improves its cash flow, and allows the physician to focus on patient care. Stand-alone medical practices are unable to achieve such massive benefits in principle because of relatively small claims volume and corresponding limitations of personnel and technology resources. Practicing Profitability shows clinic owners and billing service managers how to overcome these limitations with Metcalfe's "network effect," by combining STP technologies in a Software as a Service (SaaS) model.
  
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.
  
Dave Macolino, President
Billing Dynamix, New York

Levels the playing field,

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. Using such a system makes sure that claims are 'clean' even before they are submitted. Moreover, it does not allow the insurer much time to delay thereby shortening the time for accounts receivable. This results in enhanced profitability for the practice, hence the name of the book, "Practicing Profitability." It should be required reading for anyone in private practice.

Ted Gutowski, MD

Best billing book I have seen,

Doctors don't understand medical billing. Medical billing is important, complex and increasingly adversarial. In these days of decreasing reimbursement, doctors in offices are pitted against large insurance companies with significant resources devoted to denying reimbursement. Federal law makes non-compliance with arcane rules punishable by both fines and criminal sentences. The doctors and staffs of small offices need the knowledge and tools to obtain the insurance reimbursement to which they are entitled.

"Practicing Profitability" is the single best book on medical billing I have seen.

It describes the complexities of medical billing as well as offering cost effective methods to optimize reimbursement while at the same time following all rules of compliance.

Complete, concise and well organized, written by a recognized expert in the field, I can recommend it without reservation.

Douglas Cassel, M.D. (los angeles, california)

The Best Modern Profitability and Billing Resource for the Physical Therapy Practice

The profitable Physical Therapy and rehabilitation practice requires sharp focus and excellent administrative skills in addition to assurance of best practices. Payers underpay Physical Therapy and rehabilitation offices more often than any other specialty. An average PT claim earns $55, which has dropped 17% over the past five years. Payers also audit Physical Therapy and rehabilitation offices more often than any other specialty because of inconsistent medical documentation and frequent problems with billing compliance. Instead of treating patients, practice owners spend excessive and wasted time fighting payers and payers' systems.

"Practicing Profitability" teaches how to implement scalable billing processes using modern Internet technology to match the power, efficiency, and scale of payers' systems. The examples in this book have a background in chiropractic office management and are directly applicable, equally relevant and extremely important in the advancement of Physical Therapy and rehabilitation billing practices.

Regardless if you are just starting your Physical Therapy practice or if you are a veteran rehab office owner, "Practicing Profitability" offers a wealth of knowledge in a tightly organized and easily digestible way. It is the best modern profitability resource for the owner of a Physical Therapy practice.

Gerilyn M. Gault, Physical Therapist
Co-Owner G&E Therapies
Rehabilitation Company, NY

A Must Read for Every Owner of a Rehab or Physical Therapy Practice

The physical therapist has a strong background and foundation of clinical orthopedics, physics, biomechanics, anatomy, neurophysiology, physiology, medical diagnostics for physical therapists, histology, and all other related subjects. That's the knowledge we acquire when preparing for our profession.

But no physical therapy or rehab education program prepares us for the harsh realities of daily struggle with insurance companies to get paid in full and on time. A recent physical therapy program graduate lacks basic knowledge about payer-provider adversity, HIPAA compliance, audit mechanics, SOAP note management, reporting tools, billing profitability metrics, and outsourcing opportunities. And no program teaches us how to use modern computer technology and Internet to accumulate and leverage our collective health care and practice management knowledge.

This concise, highly informative, and expertly written book addresses a major educational gap. Practicing Profitability is a must read for every owner of a rehab or physical therapy practice.

Yaffa Liebermann, PT, GCS, CEO
Prime Rehabilitation Services, Inc.

Excellent book describing the modern business practice of medicine

Health care spending continues to rise at the fastest rate in our history. On one hand, the insurance companies, bio-tech and pharmaceutical companies, as well as lawyers, have increased their profits in step with the rising costs of health care. On the other hand, the medical and chiropractic office owners - the actual health care providers - have not only failed to keep up with raising costs but have lost a significant part of their income.

How such a paradoxical situation is possible without a deliberate strategy against health care providers?  

The best part of Lirov's book, for me, was understanding this paradox and becoming more conscious of how insurance companies manage to systematically reduce my income to improve their shareholders value. Lirov's book spells out the reasons for and the symptoms of the payer-provider adversity. The book outlines both the strategy and the tactics the insurance companies use to underpay or worse, take back the money already paid to the providers. This is not a theoretical work trying to lay out a strategy of underpayment. This is a road map for any insurance company interested in a simple and pragmatic system to increase its share value.

Next, Lirov's book outlines an Internet-based strategy for providers interested in leveling the playing field with the insurance companies. This is a toolkit, designed to give the reader a selection of tools for specific circumstances. The underlying theory is that multiple small practices can use the Internet to combine their insurance claim volumes to "transform the many into the mighty" and use Metcalf's law to guide them during such a transformation. Lirov's book tells you how to create a shared and continuously improving billing knowledge base and an integrated system for both front office and an outsourced, or even off-shored, billing service.

In spite of the title that mentions chiropractic, most of the information in this book is directly applicable to any health care provider running a private practice and dependent on insurance payments. The book is filled with valuable advice and simple examples about using modern technology to increase provider's revenue. The introduction of the billing network effect concept is simple and convincing. The audit part could use more examples but the parts on metrics and on outsourcing are both practical and easy to follow.

Overall, this outstanding book provokes thinking about best practices, scalability, and professional management of the physician's office. It should be required reading for practitioners at any level of business experience.

Prashant N. Pandya, MD
Billing Intelligence

Major milestone in billing evolution

The average practice submits half of its codes wrong. A poorly designed billing process fails to spot a line-item underpayment. Denial followup is frustrating and expensive. Taking advantage of practice management incompetence, the payers leave the clinic owner with disappointing revenue flow.

Lirov's Practicing Profitability teaches how to design industrial-grade claim processing systems and how to use Internet technology to manage them. This book maintains a bird's eye view of the entire practice revenue cycle, starting with patient appointment scheduling, pre-authorization, patient encounter note creation, charge generation, claim scrubbing, claim submission to payer, and followup, which in turn includes denial or underpayment identification, payment reconciliation, and appeal management. It also includes separate chapters on outsourcing, reporting, compliance and audit.

Written by an expert in billing and technology, Practicing Profitability is a major milestone in the evolution of medical billing from individualistic art towards disciplined and systematic process.

Michael McCormick, Paid Claims, LLC
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Delight your clients with greater collections and lower audit risk

Four years ago, I started Billing Depot, an outsourced billing service, and it has experienced profitability since its first month of operation. Within the first year, it was certified by New Jersey Department of Banking and Insurance and by the third year it became a Gold Business Partner of Medical Society of New Jersey. Billing Depot has been steadily growing in spite of shrinking reimbursements and mounting audit risks.

Our success is rooted in a disciplined and scalable approach to billing, which Yuval Lirov, a Math PhD, and Erez Lirov, a Princeton graduate in Computer Engineering, developed and implemented in Vericle. Dr. Lirov's expertise in straight through processing, combined with his continuous assistance through the use of Vericle, has been priceless.

Practicing Profitability lays out the techniques I use daily to develop Billing Depot and delight my clients with greater collections and lower audit risk. Read this unique book and return to it often to improve your processes, upgrade your technology, and manage your personnel.

Pat Freeze, President,
Billing Depot: Get Paid. In Full. On Time.

Required reading for the owner of a modern chiropractic office

No insurance offers protection against audit risk, which carries enormous potential penalties. Providers paid $3.1 billion in 2006 in refunds and penalties-twenty times more than ten years ago. The payer's motive is money, the payer's means is a gargantuan statistical database, and every provider is an opportunity. Lirov's Practicing Profitability shows how to use Internet technology to reduce audit risk, streamline SOAP note management, and maintain HIPAA compliance. This book is a required reading for the owner of a modern chiropractic office.

Jeffrey Randolph, Esq.,
ANJC Legal Counsel and author of the Audit Risk Webinar

Essential Reading for Chiropractors

"Practicing Profitability" is a well written and very thorough book that every chiropractor should take the time to read. I believe that this book will be well received by members of the chiropractic profession. I give Dr. Lirov's book five out of five stars and encourage students and doctors alike to get their hands on this text as soon as possible.

Dr. John L. Reizer
Chiropractor / Author

Read it and accelerate your practice building

Ask yourself: is my billing performance measurable, consistent, and scalable? Am I working to improve them or am I spending all my time chasing individual denials and arguing with insurance companies? Am I working "on" the business or "in" the business?

Billing, because of its complexity, creates opportunities for providers to commit fraud and for payers--to benefit at the expense of providers. But the playing field is uneven: the insurance companies are armed with a powerful three-pronged system to keep providers' money: solid business strategy, well-documented and professionally managed processes, and leading-edge technology.

Without an equally powerful methodology, how can you succeed? An in-house billing operation and a naive outsourced billing office owner are often helpless against the payers. Just like patients who lack education about their own body and their nervous system, practice owners are often ignorant about the reasons for their underpayment or for the lack of practice growth. A systemic office "subluxation" may not be immediately observable to a naked and untrained eye, yet it may cause major setbacks for the practice owner.

Lirov's Practicing Profitability outlines such a methodology. It's the first book to systematically approach billing from the payer-provider conflict perspective and to apply the "network effect"--the most revolutionary characteristic of Internet technology. It emphasizes the importance of integrated office workflow and it sharpens business focus. This book shows how focus and teamwork can be turned around systemically from being points of vulnerability to the strongest weapon for improving practice profitability.

Read it and accelerate your practice building.

Bran Capra, DC
Billing Precision: The CNS for the Chiropractic Office.

A superior addition to the field of medical billing

Lirov offers physicians and those involved in the field of medical billing reliable advice for improving their businesses and growing revenue.

When the author looks at the landscape of the medical profession, he sees a playing field tipped to benefit the payers and hurt the providers. Large insurance companies, still reaping the benefits from years of record profitability, continue to erect and maintain huge, costly infrastructures designed to chip away at one of the last sources of new revenue—provider claims. By increasing billing costs, underpaying claims and conducting a growing number of post-claim audits, insurance companies strive to keep profits high by depressing those of individual providers. To counteract these methods, Lirov contends that healthcare providers need to streamline their business practices. He envisions the relationship between payers and providers as adversarial, and his book is a set of strategies that will allow providers to get back into—and hopefully even win—the game. The author seeks to show providers how to enhance their billing practices with a set of strategies designed to take advantage of the "network effect," a characteristic of systems that allows a large number of disparate providers to capitalize upon their strength in numbers. Lirov also presents a comprehensive model for improving many elements of the provider-patient experience. He offers helpful advice on building communication with patients, improving clinical documentation (notes physicians take when dealing with patients) and facilitating the scheduling of patient visits. Lirov helpfully notes that his book is not for the billing novice, and he directs beginners to a number of other helpful primers. But for those who already have a strong handle on billing—and have a need to improve their practices to increase revenue—the book is an invaluable resource. 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

The most concise and thorough reference book

This is by far the most concise and thorough reference book on managing a healthcare practice. It provides practical business and process management guidance that is not taught in medical schools or chiropractic colleges.

The organization of the information is logical and useful. Covered aspects include review of payer's strategies to delay or deny provider's payments, billing workflow processes, electronic medical records (EMR), HIPAA compliance and audit, metrics and billing performance analysis, and outsourcing (offshoring). Advanced chapters discuss topics like Metcalfe's "network effect," Software as a Service (SaaS), Straight Through Processing (STP), Role Based Access Control (RBAC), computer-aided coding, and on-line analytical processing (OLAP).

If you manage a chiropractic or a medical clinic, pick up a copy of this book and keep it close. I do and I refer to it often.

William McCormick, Paid Claims, LLC
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