How Hybrid Workflow Changed Our Practice: 10 Questions with Practice Administrator Nelly Gamboa

Credentialing ServicesClinicSpectrum: How long have you been using ClinicSpectrum?

Nelly: Union County Cardiology has been using the full suite for about 10 years now. We began using billing services and expanded the relationship to use credentialing and billing services.

CS: What do you like the most?

N:  That’s easy. I enjoy that I don’t even have to think about eligibility—all of our patients are confirmed to have insurance prior to their appointment, which considerably cuts down on A/R follow-up and denials management. My monthly headaches have been greatly reduced!

CS: What was the key factor to your decision to implement CS solutions?

N: Time is incredibly important. Saving time means getting paid and settling claims faster, allowing us more time to work on the most important part of the business, our patients. Anything that is proven to save me time is a winner in my book.

When we were doing entire process ourselves time was 30 minutes and cost was $8 to 10 per claim. With ClinicSpectrum, the cost of denials came down to $4 to $5 per claim.

CS: What are the 3 biggest challenges faced by physician’s practices?

N: While I wouldn’t have stayed in this career for so long if I truly didn’t enjoy, the fact is, like with any company, there are daily challenges that the team running a practice faces. From my perspective, I’d have to say that the three biggest challenges are managing efficient operations, staying up to date with all the changes necessitated by healthcare reform, and lastly, and in part linked to the changes in healthcare reform, is managing patient eligibility.

The good news is that there are solutions that greatly aid us in addressing these challenges. ClinicSpectrum’s hybrid workflow model lends itself to efficient operations, by coupling automation and outsourced human follow-up, allowing us to make the highest profit. At the same time, it’s my responsibility to be informed of all reform changes, which can affect every part of our business.

Profitability is hugely determined by adherence to the frequent healthcare reform mandates, so it’s imperative that someone in my position remains aware of all changes.

With automated eligibility, ClinicSpectrum saved us lot of surprises.

For example, eligibility has become a huge challenge due to healthcare reform. An influx of eligible patients, in addition to changes in health plan coverage for patients that were already insured, has left many practices scrambling. Knowing that a patient’s eligibility has been confirmed in advance allows us to secure payment easily and transparently.

CS: What has been the biggest aid for you in tackling these challenges?

N: By switching to automated eligibility verification, we save an average of $3,700 per year, per physician, and by submitting electronic claims rather than paper claims, we save an average of $23,126 per year, per physician, which helps us to still turn a profit and manage efficient operations.

Outsourcing claims and eligibility work is also a huge help in taking on these challenges. My team is able to oversee operations without having to spend the time to do the paperwork and follow-up as well.

CS: What were you looking for in an outsourcing company?

N: We had a few ideal attributes in mind when we began the search for an outsourcing company. We needed a company that could handle claims, authorizations and eligibility—we didn’t want to work with multiple vendors, so instead sought a one-stop-shop. Making sure the company is accountable and accessible is also a factor. Claims processing is often a 24/7 endeavor and I wanted to work with a company that I knew would take my calls and emails in a timely manner. Lastly, ClinicSpectrum’s hybrid workflow model of both automated and outsourced human follow-up offered something that its competitors didn’t deliver.

ClinicSpectrum offers all of these services and scrubs up the claims so minimal interaction is needed by my administrative staff, which allows us to spend valuable time with patients that would have otherwise been spent on administrative work.

CS: What are some challenges of outsourcing?

N: Our patient’s privacy is of the utmost importance to us and outsourcing can put that at risk. We prioritize that our patient data is safe and secure and that the company we outsource to remains HIPAA compliant.

Nelly Gamboa is administrator for Union County Cardiology Associates in Union, N.J.

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How to create a delegated credentialing program?

Credentialing Services

This is part two of a two-part post that evaluates what is delegated credentialing and why healthcare provider organizations should consider it.

As explained in the first post of this two-part series, delegated credentialing is an opportunity for large provider organizations to take matters into their own hands, streamline processes and realize substantial benefits. These include getting providers credentialed quicker so they can generate revenue and expand clinical bandwidth.

So, how do organizations create a delegated credentialing services process? It entails establishing processes, as well as implementing tools to assist with workflow and manage the flow of data.

Key processes to implement include:

  • Adopting Credentialing Standards — The National Committee for Quality Assurance (NCQA) has already established standards for payers, as has the Joint Commission for providers. Standards from both organizations should be adopted, as well as any specific standards from regional payers.
  • Establish a Review Process — Create a committee to define processes and review provider credentialing.
  • Conduct Ongoing Monitor — Develop processes to continually monitor work quality.
  • Re-Credentialing — Create processes to easily re-credential providers on an ongoing basis.
  • Create Agreements with Payers — Delegated credentialing agreements need to be established, clearly stating structure and metrics, including:
    • Outlining the responsibilities of the payer and delegated entity.
    • Detailing metrics of how the payer can define and assess performance.
    • Developing ongoing oversight processes.

Accomplishing these processes requires sophisticated credentialing software that includes:

  • Analytics and reporting
  • Dashboard presentations and milestone tracking
  • Demographic import features
  • Document management
  • Reminders and notifications
  • Task management and assignment features

A key resource to assist with delegated credentialing programs is the Healthcare Billing and Management Association (HBMA). The organization has a number of useful resources that expound on the above in further detail.

Author Julia Solooki is a board member of the HBMA Education Committee.

Credentialing Dashboards Part 2 – Additional Capabilities to Evaluate  

Last week we wrote a brief overview of credentialing dashboards and several people contacted us with questions about additional dashboard capabilities. To address some of those questions, we’re highlighting some other important dashboard capabilities in this week’s post. Below are several key capabilities to look for when evaluating the dashboard components of credentialing solutions.

Milestones — Dashboards also need to display progress toward, or the completion of, key milestones so users can view specific activities within the credentialing process. This enables users to quickly know what’s completed, needs to be done, is past due, and what are the new tasks that are entering the process.

Drill-Down Capabilities — An overview status of processes is valuable, but users typically need more information. Drill-down capabilities allow users to click on elements of the dashboard to display specifics, whether it’s information about individual providers, payers, or other elements of the process. This enables users to efficiently get the information they need within one or two clicks.

The Ability to View Tasks and Processes from Different Perspectives — Not all users of the dashboard are looking for the same type of information. Some may be interested in looking payer-specific details, while others are more focused on working on tasks related to individual providers. The dashboard needs to accommodate these perspectives in its display to improve staff efficiency and improved workflow. For example:

  • Payer Information — Sections of the dashboard should display payer-related information, such as payer contact details, insurance PDF forms specific to the payer, web links, as well as counts of providers with insurance and their credentialing status.
  • Provider Information — Other sections of the dashboard need to display provider-specific information, such as the number of providers being credentialed and the status of specific tasks within the process. Drill-down capabilities within the section of the dashboard should enable the viewing of details, including in-depth provider profiles that include all credentialing-related information, as well as the wealth of information imported from the Council for Affordable Quality Healthcare (CAQH).

Specialized Capabilities — It’s important for dashboards to be user friendly and include features that make it easier for the staff to complete their jobs. Leading credentialing solutions include advanced features such as the ability to easily attach documents to records within screens, and capabilities to upload information from other data sources (e.g., CAQH and others). These capabilities reduce data entry, and make documents easier to find.

With dashboards, everyone remains on the same page and is up-to-date with the status of tasks, which increases the efficiency and effectiveness of the credentialing process.

Patient Engagement for Financial Health

4155232663_796c0643e9_oA rainbow colored balloon hat. It is my method for engaging attendees at trade shows. Anyone who knows me knows that my work is not work; it is my passion to deliver the best tools that enable physician practices to maximize their workflow efficiencies to ultimately maximize their profitability. So when I see so many passersby at trade shows looking perhaps disinterested or overwhelmed, my colorful balloon hat is my method to ease their anxiety and engage with them.

Engagement with patients in healthcare is something that we have heard so much about in the last couple of years, and really not very different from opening people up to conversations and education at a conference. The focus we hear so much about has been clinical engagement, making sure that patients understand their health condition and how to best manage it. While no doubt that this is important, what should not be overlooked is financial engagement, particularly when it comes to the financial health of a physician practice.

According to an annual survey by the American College of Healthcare Executives, financial challenges ranked at the top of the list of worrisome issues for hospital CEOs. Not surprisingly, anxiety about money is also a key concern among Americans. A 2013 study reported that 69 percent of participants cited money as a top stressor. Practices must engage in thoughtful patient education and communication at every point in the revenue cycle – before the patient arrives, with them during the visit, and even after they have left and returned home.

Eliminate the anxiety and confusion not only about your patients’ health, but about their financial obligation as well as protecting your business’ bottom line by following these simple steps:

  1. Start with eligibility checks prior to patients arriving so that you are prepared to talk with them about the accurate cost of their care and what’s behind the cost/what the determining factors are.
  2. Many patients are unaware of costs for missed appointments. Automated appointment scheduling and follow-ups can save time and stave off headaches of possibly costly missed appointment fees for the patient.
  3. If patients do leave an appointment without paying, have auto collection methods in place. This will increase your practice’s chances of collecting outstanding balances and not only get money in the door, but help you collect faster.

Remember, engagement and education is the key. Start with advising your patients to ease anxiety and worry, and you will best enable your practice for financial success.

Credentialing Dashboards Keep Staffs on Task, Better Communicate Status

Credentialing Services

Dashboards. To some, the concept is met with open minds and eagerness to view the data in a snapshot. To others, the term conjures up a notion of marketing spin. Can anything really be that great? The answer is yes. If done well, dashboards can not only brilliantly communicate key data to your staff, but keep everyone on task and efficient.

When looking at physician credentialing, communications are a vital part of the process, as everyone needs to know the status of tasks—what’s in progress and what remains to be completed. This information needs to be shared among various stakeholders, such as the credentialing staff, providers, practice administrators, and others. For credentialing, communicating this information is vital to practice operations, reducing risk, and ensuring that providers are eligible to receive reimbursement for their work.

Using a credentialing software solution with a dashboard display is an ideal way to share this information in a format that is easily digestible so information becomes actionable. Dashboards are a graphic representation displaying an up-to-date snapshot of tasks, whether they’re newly assigned, in progress, on hold, or past due. A credentialing system dashboard should be easily accessed, and provide an overview snapshot, milestones, drill-down capabilities, and the ability to view tasks and processes from different perspectives. Here’s a look at the first two of these.

Easily Accessed — When users open the credentialing system, the first thing they should see is the dashboard display. This quickly communicates the status of tasks, and alerts them to issues that need resolving. The easy accessibility of the dashboard eliminates the need for users to click through menus to view the information. It also decreases the chances that important information will get ignored, overlooked or simply not communicated.

Overview Snapshot — The dashboard should display a broad overview of the process that users can click on to get more detail, also known as “drill-down” capabilities, which are explained below. This overview enables the dashboard to display information of value to multiple user types, whether they are providers, practice administrators, or the credentialing staff. The dashboard should display:

  • Status of providers being credentialed (e.g., new, in process, on hold, completed, or custom credentialing)
  • Counts of providers with insurance
  • Status of the credentialing process by task
  • Credentialing task aging (e.g., 0-30 days, etc.)

Start by looking for these items in your dashboard, and watch your credentialing process go more smoothly.

 

*Photo is under Creative Commons License.