The service provides industry-specific business intelligence, allowing staff to effectively data mine, drill down, chart and analyze data.
While many companies continue to liquidate, downsize and even close their doors for good due to the economic downturn, others are increasingly searching for ways to continue to improve their business. What many people do not realize, however, is that medical practices and institutions are constantly susceptible to the same pressures. As one of Nevada’s largest medical imaging companies, Desert Radiologists in Las Vegas needed to look for ways to reduce its overhead and improve revenue cycle management.
The service provides industry-specific business intelligence, allowing staff to effectively data mine, drill down, chart and analyze data.
While many companies continue to liquidate, downsize and even close their doors for good due to the economic downturn, others are increasingly searching for ways to continue to improve their business. What many people do not realize, however, is that medical practices and institutions are constantly susceptible to the same pressures. As one of Nevada’s largest medical imaging companies, Desert Radiologists in Las Vegas needed to look for ways to reduce its overhead and improve revenue cycle management.
“In 2008, we made the financial decision to outsource our billing, with the aspirations of improving collections and accounts receivable management,” says Desert Radiologists CEO William Moore II. “Prior to this shift, we used a local medical billing company. After assessing that their services were not up to par, we attempted to move the billing operations in-house.
“We quickly discovered that we could not sufficiently monitor our patient’s accounts with the software we had purchased,” he adds. “With more than one million exams completed annually, the volume was simply overwhelming. We were struggling daily to keep up with accounts receivable. As a result, patient accounts were not being worked appropriately, placing a revolving burden on our practice.”
The system allows practices and physicians to predict future revenue. The data provides accurate gross percentages, allocating future numbers and whether or not adjustments in charges need to be made.
A nationwide search led Desert Radiologists to Zotec Partners, which provides medical billing services and licensed software to physician specialty practices across the country. The final decision to outsource to Zotec over other revenue-cycle management (RCM) solutions companies was largely due to its robust Decision Support (DS) reporting module, which offers the ability to make informed, critical decisions.
The DS system was integrated into the company’s electronic billing center, which was designed to efficiently help maximize reimbursement. It provides industry-specific business intelligence, enabling staff to effectively data mine, drill down, chart and analyze data in a meaningful way. DS uses key performance indicators that allow practices to monitor their RCM based on defined metrics and then compare them to industry averages.
“Since utilizing the DS system, we have not only advanced our collections, but we are saving more than $2 million annually compared to our former outsourced billing company and $2 million annually compared to our former in-house billing operations,” offers Moore.
“We wanted to have a system that would allow us to electronically track every exam from order entry by scheduling to billing and payment – every step in that process,” says Whitney Edmister, M.D., of Desert Radiologists. “With the DS system, we are able to effectively track and monitor our charges, payments and accounts receivable.”
“Utilizing DS has allowed Desert Radiologists to become more equipped to ensure that we monitor and collect the correct amount of costs and reimbursements for procedures and services performed,” Moore adds.
“Using the DS system, we get near real-time billing information so we can track every aspect of the billing cycle,” says Edmister. “Access to this information is extremely powerful, as we can now make business and contract decisions based on actual reimbursement data.”
For example, staff can drill down and compare reimbursement for thyroid biopsies by carrier to determine if procedures are being adequately reimbursed by all payers. If a particular carrier is not paying adequately, staff can talk to them to renegotiate that portion of the contract.
The automated billing process begins immediately as the exam or service takes place. All reports are processed directly to Zotec Partners electronically.
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In the past, billing procedures handled manually were prone to delays or actual lost reports.
The process and the technology ensure all charges are billed, paid appropriately and reported. “Our group is able to access and audit billing volumes daily, weekly, monthly or annually per location, modality, carrier and referring provider,” says Edmister.
“You can very quickly get a snapshot of where you stand on your billing,” he adds. “This gives me more time to focus on interpreting studies and caring for patients, which is the real business of radiology.”
The system allows practices and physicians to predict future revenue. The data provides accurate gross percentages, allocating future numbers and whether or not adjustments in charges need to be made.
Thus, if a certain payer mix is returning subpar reimbursements at one location, the data is analyzed and opportunities identified to maximize reimbursement, which includes ensuring that what is due from the patient at time of service is collected. As a result, fewer accounts are turned over to bad debt.
Data from referring physicians also is accessible. “We can scan top referring doctors to look at the number of studies ordered and revenue that is generated, and also by making quarterly comparisons between referrals,” Edmister says. “Tracking the top referring physicians creates a larger revenue base and stronger vertical relationship within the radiology field.”
Finally, DS examines performance and under-performance of both practicing physicians and individual imaging centers as a means to reduce costs. The measurements can determine which sites are most productive, employee productivity and which are over-staffed, and which centers produce the most revenue.
“In the long run, everyone is held more accountable,” says Moore.
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Five Technologies for Survival
With downward pressure on reimbursement continuing to increase, physician practice administrators need to learn how to do more with fewer resources. The complexity of coding is also about to take a quantum leap. Here are five areas where information technology can help meet the challenge:
ICD-10 transition. Every practice will have to use the ICD-10 diagnosis codes by 2013. In addition, a new HIPAA transaction set must be tested and put in place by Jan. 1, 2012. Besides the additional training both will require, all practice-management (PM) and electronic health record (EHR) software will have to be updated. If an organization has an older PM system, its fields might not accommodate the new, longer codes.
If purchasing a new billing system, consider an integrated system that includes an EHR that can qualify for government financial incentives. Not only will an EHR help physicians with the extra documentation ICD-10 requires, but it will also help them pick the right codes. An integrated system gives billers instant access to the patient records they need to check before submitting claims.
New PM system functionality. The latest systems – whether standalone or integrated – offer an array of tools that can make a practice more efficient. Among them are: integrated payment card solutions that help collect from patients at the point of service; denial tasking, which allows routing of denials to the appropriate billers and auditing to ensure those claims are being worked; EFT lock box functionality that automatically posts online payments; and dashboards that enable monitoring of a practice’s financial health.
One older tool in the PM arsenal that too few practices use correctly is the appointment reminder function. This tool can help a practice improve the quality of care and earn pay for performance, medical home and physician quality reporting initiative incentives. The PM system should allow tracking of diagnosis codes, matching them to dates of service. That will alert staff to call back patients who need preventive care or follow-up visits for chronic conditions.
Revenue-cycle Management. A PM system should enable staff to check eligibility and claims status via clearinghouses, without having to log onto multiple health plan portals. It should also be able to run eligibility requests in batches the night before visits so that staff can deal with any issues at the front end. Staff also should be able to see which claims have been denied or are pending before receiving an explanation of benefits or electronic remittance advice.
Claims scrubbers are present in most advanced PM systems. Scrubbers should be able to update themselves automatically to reflect the latest changes in health plan rules. This will increase the percentage of claims that are accepted on the first pass.
Electronic prescribing. More physicians are e-prescribing these days because of the CMS 2-percent incentive. E-prescribing has other benefits, as well: Refills are more easily accomplished, and staff will receive fewer phone calls from pharmacists if prescriptions are always legible and if they can send their questions to nurses online.
Consumer-friendly technology. Practices that already have an EHR, or those in the market for one, might consider including a patient portal. Portals offer the ability to make appointments and refill requests, receive lab results, and get timely health alerts. They can also enable patients to enter medical histories online prior to visits.
If a vendor offers a patient portal, make sure it is fully integrated with the practice’s PM and EHR systems, so that patient requests flow directly into the database. Otherwise, staff will have to monitor an electronic mailbox and enter the data manually.
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Jennifer Sirkowa is director, Product Marketing, Sage, Tampa, FL.
