10 Part Workflow Interview with Vishal Gandhi

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Don’t Lose Money as Deductibles Rise — Verify Eligibility

For many families, planning to spend $12,700 could mean getting a new car or college tuition. But in 2014, American families have yet another reason to save because they may need to make a big purchase on healthcare. According to the 2013 PwC Touchstone Survey of major U.S. companies, 44 percent of employers are considering offering high-deductible health plans as the ONLY benefit option to their employees in 2014. That’s a whopping 31 percent increase from just two years ago. Twelve thousand, seven hundred dollars is now the new maximum out-of-pocket cost limit for a family, and $6,350 is the limit for individuals. And of course, factor in inflation and many private plans are already laying the groundwork for members that costs will only increase in 2015.

As the trend for care continues to move out of hospitals and to physician practices and walk-in-clinics, physicians and office managers running these facilities will need to be prepared to collect all of these funds which will come in the form of deductibles, coinsurance and copayments.

Fear not — we’ve got you covered on this. With our new STAT Eligibility verification, we will take care of everything from eligibility verification to checking on necessary pre-certifications, how much of the deductible the patient has met to date and much more. In stark contrast to the high deductibles, your cost is low — a simple flat fee and everything processed and sent directly through a secure portal within one hour turnaround time. Say goodbye to paper trails and time-consuming process for your staff.

I’ve seen a quote that says, “Change before you have to.” In healthcare, you can debate if it’s “before” you have to, or at the critical point of “have to.” But when change is this easy, why wait another day? Seize the moment and maximize deductible collection.

Automate to Collect patient balances

Out of sight, out of mind. Applied to healthcare, this age-old saying is not only true, but also incredibly problematic for physician practices. All too frequently we hear from physicians the same story of providing care up-front, and subsequently facing a growing stack of un-paid deductibles, ultimately hurting the bottom line. No one is immune to this – not general practitioners, specialists, psychologists, nor dentists.

With the trend of increasing deductibles, there is only going to be more to collect. For 2014, the internal revenue service has defined high-deductible as $1250 for an individual and $2500 for a family. On top of that, maximum out-of-pocket expenditures are estimated at $6350 for individuals and $12,700 for families. That’s no small change; that’s real money when factoring in the number of patients you see.

Some practices may have an initial reaction of fear or a sense of alarm from these numbers however, these statistics should be the impetus to be proactive and put the right series of steps and technologies into place. Those steps include implementing a hybrid workflow model that starts with using an established eligibility checking system to identify a patient’s expected out-of-pocket costs prior to an appointment will significantly lessen the follow-up collections that are needed. However, when you do need to collect, make sure you are doing it smartly by leveraging the second piece of a hybrid workflow solution, an automated collection system to significantly increase the odds that you will collect more, and also collect it faster.

Recent highlights from the Pew Research Internet Project state that as of January 2014, 58% of adult Americans have a smartphone.  Doesn’t it make sense then that you should have an automated system that includes texting alerts instead of sending outdated hard copy letters? By replacing traditional collection methods with an automated technology platform that smartly uses decision rules to push out text and secure e-mail, and logs a record of all the activity, you can count your profits instead of counting the number of uncollected deductibles.

How to Select Credentialing Software

Whether you’ve done it just once, or hundreds of times, you know that physician credentialing is a labor- and time-intensive task. On the flip side, it’s also mandatory if you want to earn reimbursement from payers while also minimizing risks for your practice. Fortunately, there is a silver lining. Software solutions are available to help manage the process. Here are some key features to look for when selecting physician credentialing software.

Cloud-Based. It’s important to look for a cloud-based solution as opposed to traditional software that must be physically purchased on a disc, manually installed and then maintained. Cloud-based solutions can be easily accessed via a browser, are available on a pay-as-you-go subscription basis, and upgrades can be done quickly and nearly effortlessly from any location.

Automated reminders and alerts. Reminders and alerts are critical to notify users when tasks need to be completed. For example, credentialing software can remind users in advance when physicians require re-credentialing. Alerts help notify of important upcoming dates, such as when physician certifications and licenses are about to expire. These reminders and alerts, combined with reports listing upcoming tasks, help facilitate greater efficiency so organizations can always stay on top workloads.

Convenience features. Credentialing software solutions should also provide numerous other conveniences. Once physician demographic and other information is entered, the system should be able to reuse that information to pre-populate forms and other materials. In other instances, some software can also remove the need for data entry by pre-populating the physician data. Look for a system with import tools that allow for the seamless extraction of provider information from various forms, including insurance company forms and the PDF documents from the Council for Affordable Quality Healthcare (CAQH). Then, once imported, this information can be used auto-populate other forms. This eliminates the lengthy and time consuming process of re-entering information.

Document management. Systems should include document management capabilities to store forms, correspondence, credential verification materials, and more. This saves time by properly organizing documents into a logical order that can be easily navigated for quick reference, and rids office staff of the stacks of folders with hard copies.

With the right software solution, credentialing can be a more streamlined and consistent effort throughout any organization. With the right software, you just might welcome the new staff physician who needs to be credentialed.

Is Credentialing Important for Medical Practices? If yes, Why?

Untitled designThe credentialing process, notorious for its red tape and endless paperwork, can be a literal nightmare for private practices. Regardless of size or type of the practice, the stories I have heard from many are all similar: staff spending hours upon hours poring over intricate paperwork, overwhelmed by the threat of an incorrectly submitted and processed application. While there is no way around it, credentialing is an absolute necessity for billing purposes, legal protection, and the safety of patients – we frequently hear from practice managers who say the process is the most tedious and thankless part of their job.

The threat of negligent credentialinglooms over physician’s practices for good reason: in one reported case, a practice faced legal action from a patient injured during treatment. The physician hadn’t been properly credentialed for a particular procedure, and when the patient suffered complications following the procedure, he sued the practice for negligence, leading to a major financial blow to the practice. In a busy practice, it’s easy to overlook the fact that a physician’s paperwork might be out of date. The constant follow-up needed to keep a practice in good standing is incredibly time-consuming, but in a worst-case-scenario, a lapse in diligence could mean the closing of the practice.

While many practices want to maintain ownership of and control over the process, I’ve never met anyone who hasn’t been head-over-heels pleased with the dependable, consistent results and value that outsourcing of credentialing has brought to their practice.  ClinicSpectrum’s clinicspectrum.com

credentialing services provide 24/7 review and verification of a healthcare provider’s professional license(s), current Drug Enforcement Administration and Controlled Drug Substance Certificates, verification of education, post-graduate training, hospital staff privileges and levels of liability insurance. Once we have confirmed that a provider is up-to-date with their preferred health plans, we provide ongoing support to ensure that a physician is always in good standing.

End the nightmare. It’s easy. This added layer of consistent follow-up, including bi-weekly status reports to all of our customers, allows physicians and office staff to focus on the patients rather than the paperwork.

Credentialing nightmares

The credentialing process, notorious for its red tape and endless paperwork, can be a literal nightmare for private practices. Regardless of size or type of the practice, the stories I have heard from many are all similar: staff spending hours upon hours poring over intricate paperwork, overwhelmed by the threat of an incorrectly submitted and processed application. While there is no way around it, credentialing is an absolute necessity for billing purposes, legal protection, and the safety of patients – we frequently hear from practice managers who say the process is the most tedious and thankless part of their job.

The threat of negligent credentialing looms over physician’s practices for good reason: in one reported case, a practice faced legal action from a patient injured during treatment. The physician hadn’t been properly credentialed for a particular procedure, and when the patient suffered complications following the procedure, he sued the practice for negligence, leading to a major financial blow to the practice. In a busy practice, it’s easy to overlook the fact that a physician’s paperwork might be out of date. The constant follow-up needed to keep a practice in good standing is incredibly time-consuming, but in a worst-case-scenario, a lapse in diligence could mean the closing of the practice.

While many practices want to maintain ownership of and control over the process, I’ve never met anyone who hasn’t been head-over-heels pleased with the dependable, consistent results and value that outsourcing of credentialing has brought to their practice. ClinicSpectrum’s credentialing services provide 24/7 review and verification of a healthcare provider’s professional license(s), current Drug Enforcement Administration and Controlled Drug Substance Certificates, verification of education, post-graduate training, hospital staff privileges and levels of liability insurance. Once we have confirmed that a provider is up-to-date with their preferred health plans, we provide ongoing support to ensure that a physician is always in good standing.

End the nightmare. It’s easy. This added layer of consistent follow-up, including bi-weekly status reports to all of our customers, allows physicians and office staff to focus on the patients rather than the paperwork.