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.

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Needless Ways Your Practice Is Losing Money

bank-notes-bills-buy-2114-723x550Did you know that between 2009 and 2012, insurance denials for claims for reasons like inclusive procedures, not meeting medical necessity, required medical documentation, among others, has increased by almost 37 percent? Additionally, did you know on average, 32 to 35 percent of claims can go unaddressed for lengthy periods of time costing practices real money? Should we even mention patient responsibility for one claim visit has increased from approximately $12 to $30 on average?

It’s as if getting money in the door for your practice has become increasingly impossible. If it’s not one thing keeping you from healthy revenue, it’s another.

While we at ClinicSpectrum offer a number of easy and comprehensive ways for you to streamline the accounts receivable process (there is help!), we also want to take a moment to inform you of some of the common ways practices lose money, and to laugh at the hilarity and sometimes sad instances when claims get denied or patients won’t pay their remaining responsibility.

And so we present to you the top 3 silliest and needless ways to lose money in the A/R process:

  • Following up with patients on their owed amount following insurance collection, and even alerting credit agencies to past-due balances is about as fun as a cross fit class. It’s just plain exhausting. With patient deductibles increasingly susceptible to larger deductible amounts with certain aspects of the Affordable Care Act (ACA), it’s no surprise that many patients get sticker shock when they receive a bill. Pair this with a lack of patient education on their responsibility before services are rendered and you’re likely to end up with a lot of “I’m not paying this.” Some people even get so emphatic that they write entire blog entries on how they simply won’t comply with Obamacare. Yikes.

Don’t lose money in the patient responsibility collection piece of accounts receivable. Educate your patients about their responsibilities before they receive a bill they might not be able to afford in full at the time. ClinicSpectrum’s Eligibility Verification can help in this area.

  • We have heard terrible stories from our customers prior to our engagement, of the slightest minutia of information being listed incorrectly on a claim. These small errors, often credited to a busy office and innocent human error, can cost your practice time and money. We’ve even heard claims going unsettled for nearly one year because of a spelling error, misdiagnosis or number listed incorrectly.

To the rescue! ClinicSpectrum also has knowledgeable staff, products and solutions to make sure headaches like this don’t happen.

  • You call, call, and call – and call one more time – but the insurance company is just plain UNAVAILABLE to help you on a claim. We can bet you have one thousand better things to do during your busy day than to remain ear attached to the phone hitting redial or trying to navigate complicated automated phone system menus.

ClinicSpectrum can easily save you from all of this hassle. We have a proven insurance claims follow-up process divided into three methods:

  1. Online Claims Follow-Up – Using various Insurance company websites and internet payer portals, we check on the status of outstanding claims.
  2.  Automated Claims Follow-Up (IVR) – By calling Insurance companies directly, an Interactive Voice response system will give the status of unpaid claims.
  3.  Insurance Company Representative – If necessary, calling a “live” Insurance company representative will give us a more detailed reason for claim denials when such information is not available from either websites or Automated phone systems.

Is that a collective sigh of relief we hear?

Don’t lose money when it comes to collecting money owed to your practice. Contact us for an assessment. We want to help you get money in the door.

A Complete Guide of our Technically Sound Product : CredentialingSpectrum

A complete credentialing profile module for:

  • Management of Credentialing and Re-credentialing activities and reminders
  • Complete Cloud based Documents Management for Credentialing Documents
  • Reminders on Expiration of various credentials such as CDS, DEA, License, CAQH, Board Certification, Mal Practice , Hospital Privileges
  • Facility Credentialing Management
  • Insurance Participation Agreements and/or Contract Management
  • Auto-fax, Auto-email and Secure Messaging Capability
  • Extensive Report and/or analytics Module