Strategic Steps for Year-End Healthcare Practice Optimization

The year is wrapping up fast, and now’s the perfect time for year-end healthcare practice optimization. From finalizing claims to preparing for deductible season, these simple yet impactful steps will ensure your medical practice is set for success. Let’s dive into how you can streamline processes, boost revenue, and enter the new year with confidence.

Key Takeaways

Finalize and bill all pending claims to avoid losing revenue.
Review CMS fee schedules and adjust practice charges accordingly.
Evaluate insurance contracts to prevent billing errors with new plans.
Tackle accounts receivable to ensure better cash flow in the new year.
Train staff for deductible season and end-of-year patient volume spikes.
Plan staffing schedules early to avoid holiday shortages.
Use year-end as an opportunity for strategic planning and goal setting.

Finalize and Bill All Claims from the Previous Year

The first order of business? Get all of last year’s claims out the door!

Insurance companies often have strict deadlines for submitting claims—sometimes as short as 30 or 90 days from the date of service. Missing these deadlines? That’s money left on the table. And while it’s frustrating to scramble at the last minute, leaving claims unfinished can hurt your continuity of care and the quality of service you provide to your patients.

Here’s the deal:

Even if you won’t get reimbursed for certain claims, completing and documenting them properly is still good medicine.
If you can still get paid for unfinished encounters, do it! Capture that revenue and close out your books with confidence.

Bonus Tip: Insurance companies tend to get slammed in the last few months of the year—and even into January—as practices rush to submit claims for the previous year. While processing may take longer, the sooner you send them out, the better chance you have of getting paid before deductible season kicks off on January 1.

Review CMS Fee Schedules

Staying on top of changes in Medicare/Medicaid reimbursements is non-negotiable. If you’re reading this in early November, chances are that next year’s CMS fee schedule is just about to drop—or maybe it already has.

Here’s why this matters:

Any changes in the CMS fee schedule could require adjustments to your practice’s fee schedule.
If your fees need updating, start working on those changes now so you’re ready to launch them by January 1.

What You Should Do:

Designate someone in your practice (or yourself) to monitor the CMS website for updates.
Compare the new fee schedule to your current one and decide whether you need to revise charges.
If adjustments are needed, communicate those changes clearly to your team before they go into effect.

Evaluate Your Insurance Contracts and Plans

Another crucial task for preparing your medical practice for next year is reviewing which insurance plans will still be valid in your area—and which ones are changing. Some plans may no longer be available, while new ones might roll out.

Why does this matter?

If you’re unfamiliar with new plans, it could lead to billing nightmares.
You’ll also need to know if prior authorizations or referrals will be required for these new plans.

How to Stay Ahead:

Contact your provider relations reps at each insurance company.
Update your front desk team so they’re equipped to handle these changes.
Notify patients about any major plan changes that could impact their care.

Tighten Up Your Accounts Receivable (AR)

Year-end is the perfect time to clean up your AR. Outstanding claims and patient balances don’t just hang in the air—they’re missed opportunities for revenue and can create major headaches as the new year starts.

Here’s your AR checklist:

Review what’s still pending with insurance companies.
Identify patient accounts that are overdue and consider whether it’s time to send them to collections.
Follow up on any major unresolved issues with payers.

The goal here is to start the new year with a clean slate, or at least a clear game plan for tackling lingering AR issues.

Prepare for Patient Volume Spikes

Let’s be real—December can feel like a mad dash in healthcare. Many patients who have met their deductibles are eager to schedule preventive exams, procedures, and treatments before the end of the year.

This means:

Your staff needs to prioritize patient scheduling wisely to avoid chaos.
You may need to adjust how you’re balancing appointments, particularly if your practice handles preventive care or elective procedures.

Quick Tip: Sit down with your team to discuss strategies for accommodating this rush without sacrificing quality care.

Staffing and Scheduling for the Holidays

Speaking of chaos, the holidays can make staffing a logistical nightmare. With people taking time off, skeleton crews, and unexpected gaps, it’s critical to plan ahead.

Double-check your staffing schedule for any days where you might be short-handed.
If you notice gaps, adjust your patient schedule or line up additional coverage now.
Make sure your front desk team knows how to handle day-of acute care needs and last-minute scheduling changes.

Coordinate Open Enrollment for Your Staff

If your medical practice offers health insurance to your employees, open enrollment season is likely in full swing. This is an often-overlooked—but essential—aspect of preparing your medical practice for next year.

Why is this important?

Ensuring your team has the right coverage means fewer interruptions in their personal lives, which can lead to better focus and performance.
Missteps during open enrollment can result in headaches for both you and your employees once coverage kicks in on January 1.

Here’s What You Should Do:

Work closely with your benefits provider. Whether you’re coordinating with a broker, a benefits department, or directly with an insurance company, make sure all the necessary paperwork and communications are handled in a timely manner.
Provide resources to your staff. Choosing the right plan can be overwhelming, especially for employees who don’t know the ins and outs of deductibles, co-pays, and networks. Offer cheat sheets or one-on-one sessions to help your team make informed decisions.
Track enrollment deadlines. Missing an open enrollment deadline isn’t just inconvenient—it can create huge problems for your staff. Double-check dates and send reminders as needed.

Tie Up Loose Ends with Staff Training and Communication

The end of the year is a great time to assess staff readiness for what’s ahead. Whether it’s training on new policies, updates to your workflow, or reviewing problem areas from the past year, now’s the time to tackle it.

Why is this crucial?

When your team starts the new year with clarity and confidence, you’re less likely to encounter mistakes or confusion in January—one of the busiest times of the year for most practices.

Suggestions for Wrapping Up Staff Training:

Review updates. This could include anything from new insurance plans your practice is accepting to updated CMS guidelines.
Revisit protocols. If recurring issues (like billing errors or scheduling mix-ups) occurred in the last year, use this time to retrain staff and tighten up those processes.
Hold a team meeting. Go over what’s changing, discuss goals for the new year, and offer your support. This is also a great time to field any questions or concerns from your team.

Prepare for Deductible Season

January 1 means one thing for most patients: deductibles reset. And let’s be honest—this can cause some hiccups in your cash flow as patients face higher out-of-pocket costs for care.

Here’s what you can do now to prepare:

Capture as much revenue as possible in December. Patients who have already met their deductibles may want to squeeze in last-minute treatments or procedures. Make sure your team is equipped to handle this increased demand.
Educate your patients. Let them know what to expect once their deductibles reset. A quick conversation at checkout—or even a printed handout—can help patients prepare financially for the new year.
Monitor patient eligibility. Deductible season can bring surprises for both patients and practices, so make sure your team is verifying benefits before every visit.

Look at the Bigger Picture: Strategic Planning for the Next Year

Once you’ve handled the nitty-gritty details, take a step back and think about your broader goals for the coming year.

What worked well last year? What didn’t?
Are there opportunities to streamline workflows, cut costs, or improve patient care?
Is it time to invest in new technology, expand your services, or hire additional staff?

End-of-year planning isn’t just about tying up loose ends; it’s about setting your practice up for long-term success.

Wrap Up Your Year with Confidence

The last quarter of the year can feel overwhelming, but it’s also the perfect time to get organized, improve processes, and make sure you’re ready to hit the ground running next year.

Remember: Planning ahead not only helps you reduce stress but also ensures you’re providing the best possible care to your patients.

If you’ve made it this far, pat yourself on the back—you’re already a step ahead of the game.

FAQs: Preparing Your Medical Practice for Next Year

Why is it important to finalize all claims before the year ends?

Finalizing all your claims from the previous year is crucial because insurance companies often have strict timely filing limits, typically ranging from 30 to 90 days. If you miss these deadlines, you may forfeit reimbursement for services provided, which directly impacts your revenue. Moreover, completing claims ensures better continuity of care for patients and sets you up to start 2024 with a clean slate.

What’s the big deal with the CMS fee schedule, and why should I care?

The CMS fee schedule determines the reimbursement rates for Medicare and Medicaid services for the upcoming year. These rates can affect your bottom line, especially if they drop. By monitoring the CMS fee schedule and adjusting your own practice’s fee schedule accordingly, you’ll avoid undercharging and ensure you’re billing accurately. Plus, staying on top of changes helps you remain compliant and avoid surprises.

How can I prepare my staff for deductible season starting in January?

Deductible season (when most patients’ deductibles reset) can lead to cash flow disruptions as patients face higher out-of-pocket costs. To prepare your staff:

Train them to verify benefits at every visit.
Teach them to communicate clearly with patients about deductible resets and what it means for their bills.
Emphasize the importance of collecting upfront payments whenever possible to prevent large outstanding balances.

What should I do about outstanding patient balances before the end of the year?

Now is the perfect time to address patient accounts receivable (AR). You can:

Send out payment reminders or offer incentives for paying overdue balances before the year ends.
Consider sending long-overdue accounts to collections.
Review your current payment policies and implement stricter protocols to avoid AR headaches in the future.

This improves cash flow going into the next year and gives you a clearer financial picture.

What steps should I take if my practice is short-staffed during the holidays?

Holidays can lead to staffing challenges, so it’s critical to plan ahead:

Review your staff schedule and identify potential gaps.
Adjust patient scheduling if needed to avoid overwhelming skeleton crews.
Line up temporary coverage or redistribute workloads to ensure smooth operations.
Communicate with your team to set clear expectations for how holiday shifts will work.

Proactive planning helps you maintain quality care and avoid liabilities due to understaffing.

How do I handle the end-of-year rush of patients wanting to be seen before deductibles reset?

The last quarter of the year typically brings a spike in patients wanting appointments. This happens because many have met their deductibles and want to take care of elective procedures, preventive care, or lingering issues before their out-of-pocket costs rise again.

To manage this effectively:

Prioritize patients based on medical urgency and available appointment slots.
Train your staff to handle scheduling efficiently and to communicate with patients about limited availability.
Encourage patients to book early next year for non-urgent concerns if appointments fill up.

What’s the best way to stay on top of new insurance plans or changes?

Insurance plans can change yearly, with some being discontinued and others introduced. To stay ahead:

Monitor communication from your contracted insurance providers.
Contact provider relations reps to confirm your participation status and learn about plan updates.
Train your front desk staff to handle eligibility verification and explain new plans to patients.
Update your billing and scheduling systems to reflect new plan requirements.

This helps prevent billing issues and ensures a smoother transition into the new year.

What should I include in my strategic planning for the next year?

Strategic planning sets the foundation for a successful year. Focus on these areas:

Financial goals: Review this year’s revenue and identify areas for growth.
Workflow improvements: Are there inefficiencies in scheduling, billing, or patient care that you can address?
Technology upgrades: Is it time to invest in new software, EHR systems, or tools that improve efficiency?
Staffing: Do you need to hire additional staff or offer training to improve team performance?
Patient experience: How can you enhance patient satisfaction and retention?

Take a holistic view of your practice and set realistic, actionable goals for improvement.

How should I prepare for open enrollment with my staff’s health benefits?

Open enrollment season is the time to ensure your team has the coverage they need. Steps to take include:

Partnering with your benefits provider to ensure enrollment deadlines are met.
Offering resources or meetings to help staff select the best plans for their needs.
Keeping track of who’s enrolled and double-checking for any errors or omissions before the new coverage begins in January.

A well-managed open enrollment process reduces stress for everyone and ensures your team is covered for the year ahead.

What are some overlooked tasks to handle at the end of the year?

It’s easy to focus on big-ticket items, but don’t forget these smaller (but equally important) tasks:

Updating provider licenses and certifications. Make sure everything is current for 2024.
Cleaning up your EHR system. Archive old files and organize patient records for better workflow.
Scheduling preventive maintenance. Whether it’s medical equipment or office technology, ensure everything is in top shape for the new year.
Reviewing contracts. Look at vendor and supplier agreements to identify cost-saving opportunities or better terms.

What’s the biggest mistake practices make when preparing for the new year?

The biggest mistake? Waiting too long to get started! The end of the year is already busy with patient care, holiday schedules, and closing the books. Procrastination leads to missed deadlines, financial strain, and overwhelmed staff.

Start early, create a checklist, and tackle tasks incrementally to avoid last-minute chaos.