Rosemarie Nelson

It doesn't matter how busy the other guy tells you he is; you know you are even busier. While you can fit more in a day than the average person and usually accomplish this before they even wake up, that doesn't mean you can't use a little help. Here are 10 time-saving apps and technology tips that can make your personal and professional life easier.

Want to meet Rosemarie Nelson and get tips on boosting your medical practice revenue, tips on productivity and compensation and more? Join us May 2 & 3 in Newport Beach, Calif., for 

, a new conference for physicians and office administrators.

 It's likely that you know about this mobile drug-reference resource. It's free and as many as 50 percent of U.S. physicians rely on Epocrates to help improve patient safety and increase practice efficiency. For an annual subscription fee, you can also have access to ICD-9 and CPT billing codes, lab tests and panels with reference ranges, and more.

By scanning a QR code (similar to a bar code) using a smartphone camera, you can access data that links your phone directly to a webpage. For example, if you add QR codes to patient statements, patients can easily link to your payment page online. There are multiple, free QR code generation websites: 

. Create the code, print it, and you're ready to go.

There are plenty of apps to help patients keep track of and understand their health, but two that are particularly useful are:

 (free in Apple app store) - physicians can sketch, stamp, or type on detailed anatomic images and then save them to the EHR and/or share images with patients.

(free in Apple app store) - patients can share information such as weight, blood pressure, and pedometer results with physicians, who can then send the information to their EHR.

 for your transcriptionist - think coding and billing staff and even phone operations. 

 Not just your practice management system, but your entire PC network so that all those documents and forms and accounts payable records are all safely stored and retrievable if a problem occurs. Investigate Internet-based services for data backup such as HP Live Vault or OffSite Backup.

 This app provides access to a social network for physicians and healthcare professionals across the United States - similar to "LinkedIn." Features include a free digital fax, ability to upload your CV, and earn honoraria. 

Passwords, while they can be troublesome, are a necessity. Be sure that you force a password change for all users on your network at least once per quarter. Do not allow staff to post their passwords 

 for all staff and providers whenever an employee resigns or is terminated. Check out RoboForm. It provides a master password and inserts a toolbar into your browser to auto-logon for up to 10 applications for free ($29.95 for more).

, a free app in Apple's online store, allows you to gather instant feedback on your practice with custom surveys; see compiled survey results in your account and get software alerts when a patient rates your service as poor.

Let your patients check-in and make their copayment at a kiosk in your reception area. Some kiosks will even verify insurance eligibility! A few of the vendors you might consider are: OTech Group, ClearWave, SeePoint, and Phreesia.

 Feeling great can help you be even more productive. Try these two apps for your smartphone:

Get your daily workout with how-to details, including video. Each workout will provide the benchmark for you and feedback from others attempting these serious exercises. 

Enter your daily calorie budget and throughout the day you can add the food you take in and the exercise you complete. Voila! Are you under (weight loss) or over (weight gain) your budget? The app is easy to use, allowing you to create "My Foods" lists, custom recipes, and brand name food lists. 

The approach to effective use of technology tools is incremental. If you wait until the next version comes out, or the next upgrade, or the complete interface, or … you will miss many opportunities to reap incremental benefits. "All or nothing" is a losing proposition. Take small steps down the path of technology and you will gain big returns for yourself and for your practice.

is a principal with the MGMA healthcare consulting group. She conducts educational seminars and provides keynote speeches on a variety of healthcare-technology and operational topics. Drawing upon her diverse experience, Nelson provides practical solutions to help medical groups succeed in their practices. She may be reached at 

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Here are 10 time-saving apps and technology tips that can make your personal and professional life easier.

Top Ten Tech Tools for Your Medical Practice

Front-office staff are the face of your practice - an expression of your practice's philosophy, attitude, and values. Therefore, it should be a top priority to hire and retain quality staff members for this position. In order to keep turnover and dissatisfaction down for administrative positions such as receptionists, phone operators, medical secretaries, and transcriptionists, you need to keep morale high.

This is a challenge because these positions can include high stress and low pay. Try something different - pay more for the right candidate. If you pay someone more than they think they're worth, they'll work up to that level. If you pay people less, they'll work down to that level.

One of the stressors for front-office staff is that many of the patients they interact with are unhappy simply because they're not feeling well. Although it can be difficult, this fact makes it even more important that front-office staff smile, make patients feel welcome, and convey a happy attitude. To lessen the likelihood of burning out the person at the front desk, rotate these staff members throughout the practice. As a result, you can enjoy the benefits of cross-trained staff as well as increased loyalty.

Here are some other ways to empower your staff and give them the tools they need to excel at their jobs:

Treat your front-office staff with kindness and respect. Beyond a friendly hello in the morning, be sure your staff has the right equipment to do their jobs.  Keep equipment working and up to date.  Make sure staff knows how to use the equipment and make it convenient for them whenever possible. For example, if the receptionist needs to scan/copy patients' insurance cards, place the scanner/copier near her desk.

Even with the best intentions, front-office operations are prone to kinks. At times, phones may go unanswered, patients may reach the exam room already dissatisfied, and these bumps can lead to sinking front-office morale and even resentment among staff members. A staff fallout can then affect patient flow, feeding an ongoing negative cycle.

Hold all staff to the same standards - the mini-max performance rule: "The minimum you get from one employee is the maximum you can expect from another in that position, in terms of performance."

Periodically use a chart to track incoming calls. Create a matrix with hours of the day along the right, and the reasons for the calls across the top - to schedule an appointment, talk to a nurse, refill a prescription, or get a referral. For one week every quarter, you can track the number and types of calls coming in at certain times of day. If you find you get numerous appointment calls in the morning, you can then staff accordingly. By tracking what's coming in, you can proactively plan for peak demand, rather than reacting to long wait times and angry patients.

Your phone company can provide you with additional information, such as the number of incoming calls, hang-ups, and busy signals. So if you discover after a month that 10 percent of callers get a busy signal or that 5 percent hang up, you know you need to improve your phone service by adding more lines, more people, or both.

You might also consider adding or tweaking your existing automated phone system. Program your automated system to play the greeting first, and then identify your practice. The first option should ask callers whether they want to make an appointment, and if so, transfer them to the operator. You can also include an option to hear directions to the practice or to refill a prescription. Although people are used to such phone trees, make sure it's clear, available, and friendly - especially for new patients.  And, remember to direct patients to your website for access to online services.

There should be no backlog of phone calls at the end of the day. Voice mail should be checked every hour. If there are too many voice mails to keep up with, you need to get someone, such as a float nurse, to provide extra help.  Use technology for the routine requests, so that your staff can use their talents to serve the patients.

Be smart with staff resources - for instance, reducing phone-call volume by using a patient portal on your website. A portal is an interactive tool that can answer patients' questions, schedule appointments, deliver test results, process prescription refill requests, provide directions to the practice, and more to save staff a tremendous amount of time, while improving service to your patients.

One of the best ways to keep your front office streamlined is to ask staff for suggestions.  We think we know the answers as managers, but we're not doing it every day. You're also likely to get higher buy-in for staff to carry out their own ideas.

Your front office is the face of your practice, therefore, it should be a top priority to hire and retain quality staff members.

Staffing Your Medical Practice for Excellence 

Revenue cycle management (RCM) is the lifeblood of any practice - private or nonprofit. Effective patient registration, insurance and benefit verification, charge capture, and claims processing are essential to maintaining practice viability. Before you can improve any process, you need to assess where you are now. Here are some questions you should think about:

• Do you know if you are achieving best practice standards in accounts-receivable management?

• Does it take your practice too long to collect, and/or are your write-offs and adjustments too high?

• Do you know your claim-denial rate on first submission (4 percent of claims or fewer is best practice)?

• Have you determined that you are not leaving any money on the table with a reimbursement analysis?

• What are your days in A/R? What percentage of your accounts receivable is more than 120 days old (10 percent or less is best practice)?

The revenue cycle starts with patient registration. Patient registration begins with a phone call for an appointment request. Your front-desk staff should interview the patient on the phone to collect billing and insurance information;  invite the patient to go online to your website to complete their registration information; and follow up if registration isn't completed two days prior to the appointment - so that the patient's insurance coverage can be verified. You can use an in-office kiosk for patient check in and to collect demographic information. Some kiosks will automatically verify insurance eligibility too.

Transferring patient charges from the EHR to your practice management (PM) system should be seamless - electronically transmitting data is an example of efficient workflow. But, if you are forcing your providers to first complete a paper visit-encounter form, and then transfer that information to the EHR, it can lead to inconsistencies, lost data, and redundant work processes. Furthermore, asking your check-out station to compare electronic patient information against the paper encounter form is burdensome and creates even more work when discrepancies arise.

Automatic payment posting can significantly reduce staff work, so why don't more billing staff embrace and drive implementation of auto-post opportunities? Holding tight to the status quo - manual payment posting and reconciliation - is an inefficient use of our most costly resource: staff.

Routinely ask your payers, clearinghouses, and software vendors about new services coming online, and roll out every new payer as electronic remittance and auto-posting become available. Investigate a bank lockbox service that converts the paper explanation of benefits (EOBs) to electronic transactions (837s) for automatic posting to patient accounts.

Investigate and incorporate automatic insurance eligibility verification into your work flows. You can use your clearinghouse service to upload the appointment schedule a couple of days in advance, in a batch process. For walk-in patients, use real-time verification through your PM system. An integrated verification solution creates a history within the patient's record that supports follow-up collection efforts, if there are later discrepancies with the payer.

Consider using a clearinghouse. Yes, clearinghouses have a cost. But, in-house personnel come with a cost as well. Do the math; it is unlikely that you can complete the same tasks (claims submission or eligibility verification direct to a variety of payer web sites, patient statement processing, automated appointment reminder calls, etc.,) more cost efficiently in-house than by outsourcing services and paying a monthly subscription cost or a per transaction fee.

You can improve your collections by billing closer to the date the patient received services. Do this by generating patient statements every week. Each patient will fall into a 28-day cycle, and a statement will be created during the week that they were seen, or the week that you received their insurance coverage. This way the incoming patient payments and questions will be distributed across the entire month, rather than overwhelming your billing department one week each month. Studies have shown that you collect faster too when the patient is presented with their bill closer to their care encounter.

Weekly statement generation is easy to accomplish when you outsource statement production. Does this mean that you can reduce staff members if you outsource? Maybe, maybe not. But it does mean that you will improve the results you get from your current staff because they will be attending to tasks that require personal follow up, instead of performing tasks that can be automated and/or outsourced more economically.

Have your staff focus on labor-intensive tasks like appealing denied claims; working claims that were underpaid; validating appropriate payments from payers; and uploading reimbursement schedules for your dominant payers.

Effective patient registration, insurance  verification,  and claims processing are essential to maintaining practice viability. Here's what you need to know.

Revenue Cycle Management Is More Than Billing Patients

Vendor relationship management, done with purpose and thoughtfulness, can deliver a successful partnership benefiting any medical group - small or large, multispecialty or single specialty. As the healthcare environment continues to increase in complexity, a true vendor-partner can serve as a consultant to your practice.

As a responsible buyer for your medical group, you need to know what solutions are available in the marketplace.  However, in this very complex and volatile market, it is a challenge to stay "in the know." Vendors perform a very necessary role by educating buyers about products and services. Consider how providers learn about the new solutions in the pharmaceutical world - isn't that type of introduction to a new product helpful to making an informed decision?

Vendors want to establish a relationship with you - they recognize that delivering quality information and proving to be a reliable resource for you will lead to long-term investment in future sales. You can start things off on the right foot by helping the vendor understand your medical group: explain your decision-making process and timeline, identify key stakeholders in your organization, and the process you envision. Lay out your needs and preferences for a solution to meet your objective. Be open to a dialogue that allows the vendor to ask probing questions and even challenge some of your assumptions. Transparency in decision-making can help develop successful relationships.

Vendors often lead the market with innovative solutions. Allow them to inform you about new products that may solve problems or create new efficiencies in your practice. If you're working closely with a vendor on a key part of your operation, invite representatives to sit in on strategic meetings.

Vendors employ experts that are well-versed in their products and solutions, so tap into that expertise in order to give your practice a competitive advantage. Take notes, recap action items, and follow up with the vendor when you need additional information or budgeting numbers. Let the vendor know what you expect from it, and don't forget to ask if your expectations mesh with the vendor's ability to deliver. Remember, your vendor expects a certain level of commitment from you too.

Once you have settled on a solution, make sure to set objectives well before contract discussions. Know what you want as an end result, and try to set aside preconceptions about how to get that result.

Be prepared: Collate all the information that will be helpful to the vendor in preparing a solution and a thorough quote for you; examine your past purchase history; invite the staff who will be most affected by the purchase to participate in the vendor exploration. If you don't manage the process, the vendor will and their timeframes may not mesh well with your timing.

Contracts are critical documents that are important to buyers and sellers. Be sure to take note of important items discussed throughout the sales process and include specifics in a contract addendum to establish the importance of each of those items. If you're using an RFP (request for proposal) in your purchase process, let the vendor know you plan to include their RFP response as a contract addendum - so it can prepare a specific response to your needs.

Healthcare may at first glance appear to be a very specialized market, but it is a business like all others when it comes to relationships and managing vendors. Get your game plan in place and be prepared to deliver honest and deliberate communications in your quest to obtain the right solution for your practice. Invest in your relationship with your vendor to develop a partnership that will reward your practice over and over.

Vendor relationship management, done with purpose and thoughtfulness, can benefit any medical practice - large or small.

Vendor Relationships and Your Medical Practice 

What does the Internet mean for your practice? It should mean a great opportunity. A well-planned practice website that also includes a secure patient portal can reduce the time your staff spends on the phone, improve communication between physicians and patients, provide patient educational materials, and remind patients that you care enough to provide prompt access to providers and staff. This means increased efficiency and reduced costs for your practice, and ultimately better patient care.

A Harris Interactive poll tells us that almost 

 of patients have access to the Internet. In the same poll, 55 percent of those patients who use the Internet said the ability to communicate with their doctors via the Internet would positively influence their choice of health plans.

So knowing that patients are asking for greater access to your practice through the Internet, where are the opportunities to maximize patient care and provide excellent customer service? Here are a few functions that are tailor-made for a patient portal:

It saves time to make appointments online instead of via the telephone. Plus, it can give patients a feeling of control to be able to pick from several choices instead of being given limited options over the phone. Posters and postcards in your office will promote this service, but you'll also want your front-desk staff, your check-out staff, and especially your nursing staff to introduce the service to patients so they are encouraged to get online.

Add in a document that allows your patient to complete the practice registration before arriving at the office, and you'll find that the information is more accurate and complete. With patient registration information in hand prior to the visit, staff can validate insurance coverage and make informed requests for copayments. Develop and train your telephone staff to offer patients the option to register online prior to coming into the practice for their appointment. Show staff how much time this will save them and they will eagerly embrace this new technology.

Online bill paying services are predominantly safe and easy to use. Implementing a quick and easy pay-online service through your practice portal will focus your patients' visits on their clinical issues instead of their financial balances. Automatic transfer or download of payment data to your patient accounting group increases accuracy and saves staff time with reduced paper processing. Meet with your billing manager to discuss getting started and how to implement the service so that every patient is aware of the availability. Ask your vendor to train a billing staff member on how to reconcile the automatically deposited payments and you'll reduce the uncertainty the staff will have about the new processes.

Messaging systems through your portal can improve secure communication among colleagues within the practice. Messaging systems also save time as physicians and nurses can answer patient questions electronically, at their convenience, instead of playing phone tag with the patient. Automated messaging systems can also allow lab results to be delivered securely to patients, with an explanation of the results, in a timely manner. Patient satisfaction scores soar after practices implement automated test-result e-delivery.

Patients need time to understand a new diagnosis or to learn how to care for themselves. Often, the shock of a new diagnosis can leave patients not understanding or remembering everything a clinician has told them. What does this mean for your practice? Usually, a stop in the hall or a phone call after the patient has left. Your practice's portal can be instrumental in informing your patients about a newly-diagnosed condition, helping them to understand their options prior to making a major health choice, and building on self-care knowledge for people with chronic conditions. Develop your telephone support staff so they are able to walk the patient or family member through your website to those resources that can be most helpful to them.

A practice website and accompanying patient portal is an easy way to show your patients what services your practice provides. If they already trust your doctors for their primary care, for example, why wouldn't they want to come to the same facility for an ancillary or elective service? Shouldn't your practice be your patient's medical home for all their healthcare information? Give patients the services they want and you'll reap the benefits in customer loyalty, increased practice efficiency, and reduced costs.

A patient portal can reduce the time your staff spends on administrative tasks and remind patients that you care enough to provide prompt service.

Is Your Practice Fully Engaged With Its Patient Portal?

What does a successful EHR implementation look like?

• Is it the elimination of patient charts?

• A reduction in medical records staff and no more chart hunting?

• Easy and accurate identification of patients overdue for follow-up care or screenings?

• Physicians leaving the office on time most days?

• Increased charge capture and/or improved coding support for billing?

• Remotely accessing patient information such as medications and test results?

• Tracking outstanding orders for test or imaging results?

• A reduction in phone calls from pharmacies?

• Addressing incoming patient phone calls without taking messages?

• Collecting and reporting on clinical information to participate in pay-for-performance programs?

By optimizing your EHR implementation process, your practice will have most of these characteristics. Even for small practices, technology has leveled the playing field and has changed what is possible for many physicians. Wondering where to start? Try a good old fashioned assessment.

First, look at your work flows - who does what and how often? Also look at your template development; comparing ease of use and available functionality within each template. Invite your vendor to assist with your assessment.

Now that your practice has successfully transitioned from paper charts to virtual, electronic health records, it is time to spruce up your virtual "chart room." Identify which processes work well for your day-to-day operations and what you'd like to see changed. Give your vendor the opportunity to identify functionality that you and/or your staff are underutilizing. Ask about features you haven't adopted that could drive further efficiencies into your operations?

Once you have a better understanding of weaknesses you've found in your own practice, visit other practices who use the same EHR and shadow them for a day. Observe how they've integrated the EHR into their work flow. By being present in another practice and freeing yourself from your own daily routine, you're more likely to think creatively and challenge the status quo of your own office. Read white papers and case studies of other practices' EHR implementations to learn how those medical groups have succeeded (or how they've failed, so that you can avoid that as well). And, you might want to bring in outside assistance to perform a gap analysis of your existing implementation.

After completing an assessment and observing your own practice, it is time to look at the specific functionality of your existing EHR/technology. Have you implemented a patient portal and promoted it to your patients? Increased use of the patient portal will drive practice efficiencies. Patients can complete many tasks on the portal that otherwise would mean a telephone call to the practice to ask for help, which frees up your staff and improves the service level provided to your patients.

Patient registration via the portal eliminates data-entry tasks by your staff. And you can create rules within the health maintenance and disease management aspect of your EHR to support your quality initiatives; such as quality measures reports delivered to the clinical team daily.

And don't forget to examine which documents get scanned routinely, while looking for ways to determine how to reduce the volume of scanning. Is it possible to have the information interfaced into your EHR? Look at a digital fax service, which minimizes the number of touches for each document, which will drive more staff efficiency.

Finally, focus work-flow assessment on nursing operations. How can your EHR system facilitate the nursing staff's ability to support the physicians? Nurses touch the chart much more often than physicians. Messaging is a good example - nurses typically touch every message twice for each touch by the physician. Have you created standard message formats for the high-volume requests, such as repeat lab work, medication requests, etc.?

These are just a few ideas to get started on optimizing your own EHR. Good EHR adoption is iterative. Manage change by managing the evolution of your EHR adoption and you will realize the benefits you dreamed about when you started down the path to EHR acquisition.

What does a successful EHR implementation look like? Consultant Rosemarie Nelson spells it out in four easy steps.