Look to tech to solve billing errors

H1606 Kareo Cloud Computing Tom Giannulli 181x235

Tom Giannulli, MS, M.D., CMIO, Kareo

If you have been in healthcare for more than 10 years, you may remember there was a time when there were no EHRs. There was nothing for practice marketing or patient communication. Scheduling was done in a book, and patient notes were handwritten.

The one thing that had started to change was billing. Medical billing using computers had already been around for 10 to 15 years before EHRs started to emerge. The billing systems weren’t cheap or easy to maintain, but they had the power to make the process faster and more accurate.

As other industries raced ahead of healthcare by embracing technology – and as billing solutions continued to improve – it became clear that there was a lot of potential there. Expanding software to help with scheduling, continue to improve billing, and document patient encounters could reduce errors and costs. A famous IOM report suggested that the rate of deaths from medical errors was as high as 100,000 and it could be reduced with, you guessed it, technology.¹

Many in the healthcare industry and elsewhere got on the technology bandwagon. President George W. Bush called for the full adoption of EHRs within 10 years. Soon after, EHR incentive programs were launched, and adoption of EHRs took off.

The problem with this approach soon became clear: Systems both within practices, and between practices and hospitals, couldn’t communicate well. Integration and interoperability had not been the top priorities, and that was beginning to show. Practices were feeling the burden of managing multiple systems and passwords, especially with server-based systems that required more maintenance and were more difficult to update.

At the same time, the process of getting paid has been getting more complex. Value-based reimbursement is growing, patient-due amounts are increasing, and the industry has been going through the ICD-10 transition. In addition, to stay competitive, some practices have begun to test alternate models, like telemedicine and direct pay programs, only adding to what needs to be managed to get paid.

For the last few years, Black Book Market Research has been asking physicians and office managers about this burden.² The focus has been on whether they see outsourcing and/or integrating their technology as a solution.

The answer has been a resounding “yes.” In the 2016 survey, which was just released, 95 percent of managers said their old practice management and revenue cycle cannot accommodate upcoming changes. Nearly 90 percent said that their financial software ad workflows are unprepared for ACO or value-based care participation.

Many of those interviewed for the survey (93 percent) said that an innovative, seamless revenue cycle management and EHR system would ensure long-term practice independence, and greatly improve productivity and profitability.

So the question is, “Why does integration matter so much?” What is it about having that seamless system that makes such a difference for healthcare providers? When you look at the data on the best-performing practices and the perceptions around revenue cycle management when using the right technology, it becomes clear. The right solutions, used to maximum efficiency, do improve the bottom line. And, based on the response to the Black Book survey and other research, more and more providers and practice managers can see the benefits.

According to a study conducted by Deloitte, 74 percent of physicians now believe that using an EHR results in faster and more accurate billing.³ The data shared above from Black Book suggests that it isn’t just the EHR – it’s really the whole end-to-end system. Here is why:

Patient demographics and insurance information only have to be entered once. The more times you have to enter data into disparate systems, the more opportunities there are for human error. Today, according to MGMA, only 35 percent of practices follow up on denials. For many, that could be money that is simply lost.⁴
Using an electronic superbill results in more accurate coding and higher charges than paper. One study suggested simply using an EHR increased charges by 5 percent.⁵ The electronic superbill also saves time for billing staff, allowing them to focus on other tasks, like patient collections. Patient-due amounts now make up as much as 35 percent of practice accounts receivable. It is critical that staff have the time and resources to implement and support an effective patient collections process.
An integrated system that includes patient communications cannot only enable appointment reminders by pulling data directly from the schedule, but it can also be used to develop an effective recall program using data in the EHR. Reminders can cut no-shows by 30 to 50 percent, and recalls are a great way to fill open appointments with preventive care visits. For the average primary care physician, these two things can help retain or fill two to four appointments a day. This can result in an extra $50,000 to $100,000 a year in revenue.
Value-based reimbursement puts more weight on outcomes and patient experience. By automating and streamlining tasks across the practice from eligibility to coding, staff can focus on the tasks needed to ensure the practice can reap those value-based payments.
Finally, there are integrated platforms available today that are affordable and cloud based. They cost less than the old server-based technology and are easier to maintain. In addition, training, support, and upgrades are generally included. As a result, the return on investment is higher.

These are just some of the benefits of a single end-to-end software for your practice. The fact is, integration saves time and has the potential to increase revenue, allowing practices to thrive and, in many cases, remain independent.

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