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.

Building Accountability and Consistency Into Your Healthcare Practice

The following is a guest post by Vishal Gandhi, CEO of ClinicSpectrum as part of the Cost Effective Healthcare Workflow Series of blog posts. Follow and engage with him on Twitter @ClinicSpectrum and @csvishal2222.

Vishal-GandhiOne of the biggest challenges a leader in any organization faces is building accountability into their workflow. While we’d all like to think that
we’re hiring great people that will always work at a high level, we all know that even the best people’s work improves when you build in some accountability for the work they do.

What I’ve found in the hundreds of practices I’ve seen is that the majority of people in a medical practice are working hard. Sure, there are the outliers that are just coasting through the day, watching the clock for when they can punch out, but we all can recognize and deal with those people pretty well. The harder challenge is those staff who are working really hard, but are busy working on the wrong things.

How do you make sure that someone in your practice is working on the right things? The simple answer is to track and report on the work that matters most in your office. In some cases, this report can be something as simple as a text message or email. In other cases, you might automate the reporting so that the accountability is built directly into the practice’s regular workflow.

Reporting and accountability is an extremely powerful concept for a practice. Not only does it ensure that the practice is working on the right things, but it improves productivity as well. Reports that are collected and checked regularly encourage your employees to work harder and be more productive. It’s just human nature for people to want to look good on a report. This is a powerful part of accountability and reporting.

However, let me offer a few words of caution when it comes to measuring, tracking, and reporting on productivity in your office. First, make sure that you’re clear with your staff on why these reports are important to the office. Second, be sure they understand that you’ll be working together with them to make sure that you’re tracking and reporting is accurate and focused on the right things. Accountability and reporting is a double edged sword. If you’re tracking the right things, it can lead to tremendous results. If you’re tracking the wrong things, it can lead to negative results. Don’t be afraid to make adjustments to what you’re doing. Also, be generous with your staff and understanding when something doesn’t look or feel right. Dig into the data with them to find the real story before jumping to conclusions. Then, make corrections if necessary.

Be sure to leverage technology where it makes sense to automatically track and report the data that matters. Your goal should be to work with your staff to create a consistent and expected workflow that efficiently measures and reports on the key metrics for your organization. Not only will this consistency make your staff more efficient, but it will make it much easier when staff don’t show up to work due to some family emergency or the inevitable staff turnover.

When you create a practice that is process dependent instead of people dependent, it opens up all sorts of options and flexibility for your practice. This shift in mentality provides a buffer where a strategic sourcing partner can cover any “down time” your office may experience during staff emergencies or staff turnover. Plus, your ongoing tracking and reporting is the perfect way to hold this sourcing partner accountable for the work they do for your practice.

These measurements and reports also serve as a baseline benchmark for your practice going forward. As your staff turns over, you can easily assess the health of your practice and the quality of your future hires using these benchmarks. Plus, as you improve your clinic’s efficiency, you and your staff will be able to celebrate the success of beating previous benchmarks. In future posts, we’ll look at what benchmarks matter most and comparing your practice’s benchmarks against national benchmark data.

The Cost Effective Healthcare Workflow Series of blog posts is sponsored by ClinicSpectrum, a leading provider of workflow automation solutions for healthcare. Their Productivity Spectrum product provides a simple monitoring tool that provides time clock functionality, benchmarking and compliance, performance analysis, and productivity management for clinical practices. Stop by the ClinicSpectrum booth at MGMA (Booth 330) for more info.


Outsourcing Selected Back-Office Tasks at Physician Practices

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Each step within the revenue cycle management (RCM) process at physician practices builds on previous tasks, so mistakes made early in the process can end up snowballing into larger problems.

The task of verifying patient eligibility is a perfect example. If done improperly – or not done at all – claims can later get denied and the practice is forced to forego the revenue generated by that encounter.

Although vital to any physician practice, back-office functions are often tedious, time consuming and costly. To reduce the burden of these tasks, practices can choose to outsource specific RCM components to help streamline operations. Two specific functions that are ideal for outsourcing include patient eligibility verification and payment posting to help with the following:

1) Applying correct payment to patient responsibility as deductibles have become a big issue.

2) Applying correct payment to secondary responsibilities.

3) Creating a follow up work queue for denied or partial paid claims when compared with Insurance Fee schedule.

Eligibility checking is the single most effective way to prevent insurance claim denials. Outsourcing this service is simple. The service provider retrieves a list of scheduled patient appointments and verifies coverage using one of three methods:

  1. Online, using insurance company websites and payer portals
  2. Calling the interactive voice response (IVR) systems at insurance companies and working through menus to determine eligibility status
  3. Calling insurance company representatives directly when online or IVR options are not available, or to resolve more complicated situations

Outsourcing payment posting and reconciling is also a simple process, and enables providers to determine if full reimbursement was received. Outsourced service providers accomplish this via two ways:

  1. Manual posting – Paper explanation of benefit (EOB) statements received by physicians are collected and sent to the billing service by one of two methods. They can scan documents and send them to the service electronically, or they can simply send the paper documents to the service. Payment posting is performed in batches to ensure proper accounting and to reconcile bank deposits with EOB statements
  2. Auto posting – When EOB payments come in the form of electronic remittance advice (ERA), these files can be downloaded directly into the physician’s practice management system. All posting is done directly in the system, so providers can audit at any time.

Outsourcing selected components of the RCM process is an easy way for practices to streamline operations, decrease denials and ensure payment accuracy. More importantly, it’s a great way to get tasks completed correctly the first time, rather than having to endure the headaches of correcting them later in the RCM process.

By Julia Solooki
Director of Business Development/Marketing

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