When it Pays to Sweat the Small Stuff. How loading the dishwasher relates to clinic optimization?

Anyone who’s ever reorganized a dishwasher understands the importance of optimization. You know that the dirty side of plates should face the middle. Utensils that are too tall to fit in the carriage on the bottom rack can be laid on their side in the top rack. If you’re just slightly obsessive, like me, you might place all the forks in one compartment, all knives in another, and so on to ensure that unloading will be a breeze. It can be a very simple and enjoyable process depending on how you prep. Even though the technology does the dirty work (pun intended), a human touch is still needed at certain points in the process.

What does loading the dishwasher perfectly have to do with your healthcare practice? Well, for starters, the details that staff members may treat as trivial can actually have a major impact on your bottom line. Details like what language to use when talking with patients over the phone or which process to employ when verifying insurance eligibility. You can imagine how a conversation or even tone of voice can affect a patient’s satisfaction levels and willingness to return to the clinic. By the same token, providers want to confirm they’ll get paid for their services before actually providing them. Both scenarios can greatly impact the practice’s profit margin.

This is why every single step of your practice’s workflow can and should be examined, no matter how small. Especially in this era of change in healthcare where more technology (EHRs, patient portals, etc.) is in place, payment models are starting to shift (PFS to PFP), and providers are faced with penalties for not keeping up with the pace, clinics nationwide would be smart to start optimizing every nook and cranny of their dishwashers, so to speak.

Let’s take the verification of insurance eligibility example. A lot of EHR vendors will proudly tell you that you can check procedure eligibility and copay in real-time through their technology. But what happens if there’s an error? Do you have a workflow in place to regularly check for mistakes and to quickly resolve them?

That’s where ClinicSpectrum’s Hybrid Workflow comes in. We have built our business on optimizing many of the workflows that are peripheral to technology. So, in instances where technology does the major lifting, but at some point falls short, we have engineered several tried-and-true processes for clinics to keep operating at maximum efficiency. Our human element wraps around any existing EHR/PM and works as a perfect virtual back-up to technology and existing team members.

No joke, we have analyzed all the touch points of EHRs, defined workflows that will not only make your job easier, but also your business stronger. We’re talking about everything from prepping charts, to sending clinical reminders, inquiring about claims, handling recalls, and of course verifying insurance eligibility.

We understand that a complex system is only as good as its weakest link and that sometimes it’s the small things that make the biggest difference.

“Patient Healthcare Costs Rise Again, Clinicspectrum’s Solutions Lessen the Burdens and Increase Revenue”

According to a recent article dated November 13th, 2014 on Forbes.com, “Worker Out-Of-Pocket Health Costs Have Doubled In Five Years”, the healthcare landscape is predicted to change even further in 2015.  “As the economy improves and employees spend more on health care, employer-paid premiums are rising again with an increase of 5.5 percent forecast for 2015 with worker premiums and out-of-pocket costs – which have doubled since 2009 – rising at an even faster clip.”  Additionally, the annual healthcare costs per employee have risen from $10,717 to $11,304 this year.  This means that more out of pocket expenses are outstanding and collecting that money can raise new challenges for medical groups.  Strategic solutions must be implemented in the areas of proper benefit verification, and automated patient collections to reduce revenue downfalls for practices.


In fact, practices are generating up to 30 to 40 percent of their revenue from patients who have high-deductible insurance coverage. Failing to check patient eligibility and deductibles can increase denials, negatively impact cash flow and profitability.

One solution is to improve eligibility checking using the following best practices:

-Check patient eligibility 48 to 72 hours in advance of scheduled visit using one of these three methods:

  1. Business-to-business (B2B) verification, which enables practices to electronically check patient eligibility using electronic data interchange (EDI) via their electronic health record (EHR) and practice management solutions.
  2. Look up patient eligibility on payer websites.
  3. Call payers to determine eligibility for more complex scenarios, such as coverage of particular procedures and services, determining calendar year maximum coverage, or if services are covered if they take place in an office or diagnostic center. Clearinghouses do not provide these details, so calling the payer is necessary for these scenarios.

-Determine patient financial responsibilities – high deductibles, out-of-pocket limits, then counsel patients about their financial responsibilities before service delivery, educating them on how much they’ll need to pay and when.

-Determine co-pays and collect before service delivery.

Another area of potential pitfall for revenue optimization comes from collecting patient balances after the services have been rendered.  It is imperative for medical groups to turn to automated solutions to help recover those balances seamlessly and effectively.

Automated collection software can be installed and managed by practices to relentlessly – within regulations – contact debtors to increase collection rates. Traditional collection methods of standard mail delivery and costly representative phone calls are replaced by a more elaborate, seamless, cost-effective auto collection process.  Automated collection methods using technology platforms, decisions rules and messaging such as text, email, push notifications on smart phones and automated calls to allow seamless, consistent results for balance collection.

For more information on ways we can help, visit our website, www.clinicspectrum.com.


Practice Revenue Growth Case Study

CASE STUDY: Medical Group, Union NJ (2 Providers)

An Internal  Medicine/Primary Care office located in Union, NJ was quite overwhelmed with the overbearing costs, administrative hassles, staff issues and gross collection deficits.  An administrative decision to sell the group was earnestly deliberated.  With an average monthly collections between the 2 providers totaling less than $60,000 while estimated hospital based physician salary is nearly $220,000, a quick resolution was necessary.  In 2011, in an attempt to save the group, ClinicSpectrum was hired by the administrative team.  Immediately, imperative key issues were discovered, and a revenue maximization strategy for cost efficiency was implemented.

Step 1: Operational Restructure through Hybrid Workflow Model

ClinicSpectrum immediately identified all the office tasks including inventory management, cleaning of exam rooms, scanning of documents, appointment confirmation, eligibility services, preparing patient in exam room before physician walks in, and many others.  We assigned those tasks/activities between LOCAL EMPLOYEES in the office and OFFSHORE employees in our back-office operation.  Our back-office employees took over eligibility verification, indexing of scanned documents; follow up on outstanding claims, transcription services, appointment confirmation, missed appointments management and procedure recalls. The group’s local team members were then separated into an administrative team, billing team and clinical team combined with DAILY REPORTING to build self-accountability.

RESULT: With the above planning in place the practice is running smoothly and seeing 55+ patients’ on a daily basis without depending on an “Individual Team” member to run the office.  Step 1 took care of operational efficiency and cost reduction through our back office team members.

Step 2:  Medically Necessary Tests/Procedures for better Outcomes and Risk Management

ClinicSpectrum introduced a concept of collaborative medicine by joining an IPA (Independent Physician Association) which has turned into an ACO now. By joining an IPA, we participated in several incentive programs for Risk Management and reducing cost of care for payers. We created a clinical team that went through each patient’s clinical notes. Based on medical necessity and evidence based medicine we recommended TESTS/Procedures that were urgently needed. This resulted into better care for patients.  Utilization of clinical resources/teams and diagnostic equipment made a difference in patients’ lives and saved money for Insurance companies.

RESULT: The implementation of Step 2 has resulted in significant revenue growth averaging an additional $30,000 per month over the last 4 years.  At present the practice collects $1.1M per year.

Step 3: Monthly Audit

Nothing is taken for granted. Every task/office function gets audited randomly across the practice. A knowledgeable audit team focuses on the following areas: End of week supplies inventory check, daily closing report for copay/co-Insurance/deductibles, outstanding balances, patient clinical non-compliance, reminders for tests/procedures, follow up with insurance companies with outstanding claims, medical necessity compliances, proper documentation, complaint resolution and voice message tracking.

RESULT: Efficient checks and balances mechanism in place lessened errors, and improved efficiency.