Before you begin refusing patients, however, you should carefully read through your payer contracts. They may contain limitations on when and why you can refuse their clients.

Another method of controlling your payer mix is through scheduling. Again before you make any of these changes you need to consult all of your payer contracts.

Some physicians set aside blocks of time for scheduling patients who work with certain payers. For example, if your managed care payers are a better source of revenue than others, you may want to set aside a day of the week or a portion of a day where you only see that payer's patients. By doing this, you can assure yourself a certain amount of revenue from that payer each week.

Alternatively, if you have some payers, such as Medicaid, which are not as good for your practice's bottom line, then you may want to schedule those patient's appointments at longer intervals. For example, instead of scheduling several Medicaid patients for one week, you may want to see one per week or a couple each month.

The basic idea behind using scheduling to control your payer mix is to develop your schedule around the ideal percentage of revenue you want to receive from each payer. For example, if you want 20% of your revenue to come from Medicare then 20% of the patients you see each month should have Medicare.

Payer Mix Decisions

Keep in mind that controlling your payer mix is going to require you to sometimes make some tough decisions. In fact, you might even have to decide to end your relationship with certain payers. If one of your payers is not providing you with sufficient compensation for your services or is consistently slow in providing payment, then you may be better off breaking free from the arrangement. The same is true for payers who require extra paperwork and other stipulations before making payment.