"For example, I knew the nurses would have to have a particular scheduling feature. And so I took those needs and filtered out certain vendors during the first phone interviews before I'd even sit down with them," says Mentzer. "In addition to the basic requirements, we were looking for flexibility, because that's something we feel we didn't have before. Our doctors informed me that they didn't think that any system, right out of the box, would be appropriate for radiation oncology — they felt that whatever it was, it would have to have some type of customization ability."

The results? Thanks to more accurate billing and quicker payment-posting, Arizona Oncology Services has increased revenues by 22 percent and decreased days in accounts receivable from 77 to 43. The system also has made staff management and retentions easier, according to chief operating officer Timothy Mc-Keough, because it makes certain tasks easier and provides managers with productivity data on each employee.

"That leads to being able to clearly tell someone whether they're doing a good job or not," McKeough explains. "That's good for staff retention — it might mean letting someone go, but at least when you have to sit down with someone you don't have to say, 'Well, I think you're not doing a very good job.' You can say, 'This isn't working — here's your data.'"

The know-what-you-need approach is appropriate for every major technology shopping expedition, including those for an electronic medical record (EMR). (See our story on using a request for proposal (RFP) to select technology vendors, page 55.)

Mentzer says he sees practices all the time basing buying decisions on factors that should be largely irrelevant to the group, because it hasn't thought carefully enough about its needs. That makes the practice vulnerable to being awestruck by a system's bells and whistles, only to learn after buying it that it doesn't do what they want.

"We have two to four practices a month come through our offices to see our software, [and] to see how we did it, and the biggest problem with them is they don't know what they need," says Mentzer. "They get 'feature shock,' as in, 'This is really neat; this is great,' and they allow that to influence their decision."

Or as McKeough puts it, "You can end up getting something that looks like a Jaguar and runs like a Yugo."

As tough as it is to find the right product, one thing about a good practice management system is that it can help you boost revenue, reduce denials, and fight back against stingy payers.

Speaking of which ...

Challenge: Dealing with payers

When it comes to dealing with payers who downcode or bundle your charges without alerting you, who underpay on certain codes inexplicably or don't pay in a timely manner, or who simply deny claims that you think should be paid, a good practice management system is invaluable in helping you understand what's going on and respond effectively.

"The only way to deal with those payers is through technology," insists Mentzer. "You have to be a step ahead of them. Right now I hear that so often from practices — I'll ask them what's going on with their billing, and they say, 'Well, I don't know.' And they have no way of knowing. And that's one of the great things about our system: We can build in the allowable for each payer, and whenever a payer pays us at an allowable below what's in the contract, the system immediately creates a task and assigns it to a user."

Reynolds and others agree: the most efficient way to handle payer problems is to do so in aggregate, and the only way to do that is to utilize technology. Use your system to run reports on specific codes and/or payers to get a sense of what services are — and are not — being paid. If you're supposed to receive a particular sum from Payer X for a specific code, and you're getting less than that or nothing at all, find out why. If you think you're right and the payer is wrong, gather all the disputed charges and address the issue as a whole. And if it's your practice that's wrong, make sure you understand the problem and correct it. Your system should be able to help you with that, too, by flagging charges that don't look right.

"A lot of these difficult issues with payers are caused by a group failing to bill something right," says Mentzer. "If you know you're not supposed to bill this code with that code because it's bundled, why do you keep doing it? If you know ahead of time there are things you can and can't do, and you can place some bottlenecks or edits in there to keep these things from even going out the door, you can avoid most of these headaches. It's so much easier to deal with this stuff before it's sent to the insurance carrier than after."