Lower A/R, both in age and amount — Expect most of your claims to come back within 30 days. “Blue Cross is our best payer — typically seven days,” says Fowler. “That makes my books look awesome.”
Trickle-down cleanup — Your billing solution or service can “learn,” so to speak. “If the ZIP doesn’t match the state, PayerPath will flag it as invalid. Then we can go back to our practice management system and fix it,” says Vitug. With increasingly more robust edits on the front end, you’ll get more and more squeaky-clean claims ready for submission, or “low-hanging fruit,” as Lewis describes it. You won’t be able to completely eliminate denials, but you’ll be able to fix them sooner and faster. Shah says, “If my docs pick a code which is not at the highest level, the code scrubber runs behind the scenes, picks it up, and drops it into a ‘bucket.’ We have one or two people assigned to clean up these claims. With the old system, this would put us behind 60 to 90 days. Now, it’s in the bucket immediately.”
Better patient care — Improved claims processing will directly affect your patients, eliminating the insurance eligibility game that your front-office staff currently has to play. They’ll know instantly whether the insurance info on the card is valid. Moreover, Web-based software will check patients’ copays. “We don’t have paperwork, and we don’t have to worry about handing it all to a clerk at the end of the day,” Shah says. “You have a clean bill submitted electronically while the patient is still in the parking lot.”
Compliance watchdog — Practices need all the help they can get to stay abreast of changes to healthcare regulations — handy in a business where the rules shift more often than a viral flu strain.
Happier staff — Expect a more relaxed atmosphere. Now there’s time to do what you need to do, so who wouldn’t be happier? “We now try to concentrate on fee schedule changes, compliance, and helping indigent patients,” says Cottrell. When’s the last time you took a look at your payer contracts? Your budget? Job descriptions? Mission statement (you have one, right)? With the pressure off, thanks to a good billing solution, you can direct your focus to these important but often neglected issues.
Fowler found he was able to realign some duties that pleased his staff. The receptionists now do the precerts — and with the billing application it’s a breeze. “And I tell the nurses they don’t have to know any coding, but they do have to mark the right vaccine.” A clearly laid out work flow also eases tension, says Shah, and increases staff morale; everyone knows what to do and when to do it. “If you have a system that forces you to do the next step before moving on to the next patient, you’ll get it done.”
Final considerations
Are you comfortable with the idea of entrusting an important part of your business to someone else? “Control is a major issue,” says Lewis. “If it’s my business and my practice, I’d think long and hard before relinquishing control.”
Fowler concurs, and also suggests that perhaps less is more, noting that “healthcare has created so many ‘little children,’ or ‘in-betweens,’ providing services.” Will adding this layer benefit you? Southeast New Mexico says yes. Village Pediatrics says no. Fowler (of Village Pediatrics) is the only biller for the two-provider, one-nurse practice. He single-handedly processes 500 claims a month. But with the practice growing as fast as the kids they treat (they opened just 18 months ago with zero patients), they may need to revisit their billing protocols soon.
Remember, the most important aspect of a billing solution is whether you actually make use of its capabilities once you have it. “What groups need to think about is how can they grow and [still] have the same amount of staff,” Navicure’s Craig Bridge says. “Employees want higher wages and insurance companies are lowering reimbursement rates. So you have to find a tech solution. If you’re not willing to use it, you won’t get the benefits.”
Shirley Grace, senior writer for Physicians Practice, holds an MA in nonfiction writing from The Johns Hopkins University. Her articles have appeared in numerous publications, including The Washington Post and Notre Dame Business magazine. She can be reached at sgrace@physicianspractice.com.
This article originally appeared in the October 2007 issue of Physicians Practice.
