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.

Outsourcing Accounts Receivable Follow Up

Tracking down past-due balances and claim denials from insurance companies and patients is tedious work and consumes precious time that many physician practices simply don’t have no matter if you have two or ten people on staff for front and back office work. This is also an area that can become incredibly costly for practices. We don’t have to tell you twice that if money isn’t coming in the door exactly when balances are due, the likelihood of capturing those balances lessens as time goes on.

Among other time-consuming areas physician and clinical practices must handle on a daily and weekly basis, this is an area of a practice that is especially ideal for outsourcing. Specialized organizations can devote the proper time to the process and have the expertise to maximize collections.

An outsourced accounts receivable collections process begins after the physician’s billing staff creates and sends insurance claims (electronic/paper claims or manual HCFA forms) to various insurance companies. Follow up on electronic claims should begin 10 days after submission, and paper/ Health Care Financing Administration (HCFA) claims follow up should begin 20 to 45 days after submission.

The follow-up process is divided into three methods:

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

These outsourced services can help practices delegate specific time-consuming tasks and maximize their collections to boost the bottom line. Get money flowing in the door today – don’t wait.

How to manage copays under the Affordable Care Act

This post was originally published at Multibriefs.

Now that the Affordable Care Act is in effect, many people have health insurance for the first time, and even more have switched to a new carrier. Insurers that your office may be very familiar with will have new policies in place for patient copays and deductibles. Along with all these changes, many preventive services must now be offered without copays, and new “out-of-pocket maximums” (OPMs) mandated by federal law mean that some patients will be liable for copays while others are not. Because of this confusion, millions of copays will go unpaid, and effective copay collection will be crucial for all healthcare billing services. For providers of durable medical equipment (DME) and home medical equipment (HME), staying current on best practices for copay collections may be the key to remaining profitable in the new healthcare economy. 

Copays add up 

If a typical medical appointment copay is $20, and a physician sees 25 patients in a day, that adds up to $500 each day in copays; with more than 200 workdays in a year, the annual total is over $100,000. Putting solutions in place to make sure all patients meet their copay obligations is fundamental for maintaining a solid financial basis for every medical practice. Collecting the copay when the patient checks in for their appointment is the goal that all of these policies should strive for, since this saves the time and expense of sending out bills. 

Communicate effectively with patients 

The first step is to give all patients a written copy of payment policies when they first have contact with your office. The timing and tone of such policies should be handled with sensitivity, since patients are consumers who can exercise choice. It’s important for a practice to convey the message that it is primarily interested in the patient’s well-being, while also being attentive to financial matters. It’s helpful to have patients sign and date a copy of your payment expectations, and to place a copy of this form in their file. You can also feature a prominent sign at the front desk that states that the copay is due at time of visit. 

Prepare reception staff 

A provider’s support staff should collect insurance information from a patient when he or she calls for an appointment. Verifying coverage and type of visit before the patient comes in allows billing specialists to check ahead of time for the individual’s required copay. Even if the insurer hasn’t changed since a previous appointment, the copay may be different for each visit. Furthermore, in some instances a preventive visit (requiring no copay) may turn into a different treatment category if a problem is found. In such instances, a copay may need to be levied after the fact. The American Congress of Obstetricians and Gynecologists suggests posting a sheet in the reception area and the billing office areas with the most common preventive care codes, so that all staff are clear on when they should request copays. 

As a general rule, however, a patient calling for an appointment should be politely reminded that if a copay is due, it must be paid at the time of the appointment. For front desk staff who feel uncomfortable asking for money, you can offer scripts for them to follow. For example, you can train a representative to ask, “How would you like to pay your copay today?” Also, make sure that your office easily accepts all forms of payments: Have enough cash on hand to make change, and also offer options to pay with debit and credit cards, as well as checks. 

A change in culture is necessary 

While optimal billing procedures sometimes include turning patients away if they are unable to pay the copay at the time of check-in, providers may wish to add some variability in to this policy. It may not be advantageous to turn away patients who are presenting with an urgent medical need, and some diplomacy and re-education may be needed for those patients who have a long-standing relationship with the practice. The American College of Physiciansreports that while requiring copays to be paid at the time of the visit can cause some upset among patients, this problem decreases over time as patients become accustomed to the policy. 

Collecting copays is not at odds with the practice of healing; instead, maintaining the financial well-being of your practice will enable you to keep your doors open to more patients, and to make a difference in the world. 

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Oregon’s new credentialing law could be hassle for locums

This post was originally published at Barton Associates.

Oregon’s state legislators recently passed a law designed to streamline the credentialing process for all healthcare organizations in the state. The bill, SB 604, requires the Oregon Health Authority establish an electronic database by 2016 that will contain all the information needed to credential a healthcare practitioner. All credentialing organizations, including hospitals and healthcare organizations, will have access to the database. The bill creates a system that is similar to neighboring Washington’s electronic credentialing system, except for one major difference. Oregon’s system is compulsory.

“When you don’t require something, and it doesn’t get used, you’re not really making a difference,” Jean Steinberg, CPCS, CPMSM, director of medical staff services for St. Charles Health System in Bend, OR, told HealthLeaders Media.

The news of a state-wide credentialing system may not be good news for locum tenens practitioners. Oregon is actually the second state in the country to require all healthcare providers use the state-managed credentialing body. Arkansas has its Centralized Credentials Verification Service (CCVS), which all organizations credentialing physicians for Arkansas and all physicians licensed in Arkansas must use. The CCVS system has done little to speed up the credentialing process in Arkansas. If anything it has made it worse. Whitney Jordan, credentialing manager at Barton Associates, says the turnaround time for Arkansas is one of the longest in the country, mainly due to the lack of staffing available at the state medical board and the lengthy CCVS process.

Time will tell if Oregon’s process will be quicker. Oregon’s lawmakers have two years to iron out the details of their new system, including how closely the system will scrutinize the information entered by each physician. Steinberg predicts that many organizations, including her own, will continue to independently verify physician information when credentialing a new physician, which means physicians may need to go through two credentialing processes, one for the state and one for the facility, before they can practice.

Back Office Solution to Boost your Bottom Line – ClinicSpectrum

Are you having a hard time striking a balance between profitability and customer satisfaction?Are your clients complaining about reduced cash flows and renegotiating their contracts? There is a solution…Clinicspectrum. Clinicspectrum is the healthcare services outsourcing and back office solution leader. With our highly trained teams, innovative technology, scalable services and low cost solutions, we assume your most labor-intensive tasks, allowing you to focus on your core business and boost profitability. Transform your A/R collection processes Don’t wait until 2015, try our Accounts Receivable Follow Up Service today and your first 50 claims follow ups are FREE. After your trial, if you want to continue using our services, claims are just $1.25 per follow up. Your complete back office solution In addition to our A/R services, we excel at credentialing, eligibility verification, appointment scheduling, filing of scanned medical records, claims entry, and payment posting. Contact us today at (908)-834-1608 or vishal@clinicspectrum for your free A/R claims follow up trial or to learn more about our services.

ClinicSpectrum Introduces AutoCollectSpectrum at HIMSS14, Aiding Practices with Deductible Collection under the ACA

Company’s unique portfolio of solutions enable physician offices to maximize profitability and productivity

ORLANDO, Fla., Feb. 24, 2014 /PRNewswire/ — (HIMSS Booth #8244) – ClinicSpectrum, leaders in hybrid workflow solutions consisting of both an innovative software suite and back-office operations, today announced the introduction of its latest offering, AutoCollectSpectrum. The patent-pending solution is designed specifically to assist physician practices with the growing amount of deductible collection that will be necessary with the huge influx of eligible patients under the Affordable Care Act (ACA). AutoCollectSpectrum is being unveiled at the Healthcare Information and Management Systems Society (HIMSS) annual conference & exhibition in Orlando, Fla., February 24-27, and is expected to be widely available to physician offices in March.

“Our goal is to support physicians and their practices by enabling them to focus on medicine and maximize profitability while ClinicSpectrum’s solutions automate their billing and collection processes,” explained Vishal Gandhi, chief executive officer, ClinicSpectrum. “With AutoCollectSpectrum, we can readily help practices benefit from the changes brought on from healthcare reform.”

AutoCollectSpectrum is an automated program to expedite the collection of deductibles and other balances owed. The patent-pending and proprietary collection method uses automated secure text, patient portals and other messaging channels in place of traditional phone calls, and hard copy, mailed letters. By eliminating the representative involvement and automating the process, physicians reduce the cost and time involved with retrieving payments.

Other products in the ClinicSpectrum portfolio that also help enhance efficiency and maximize revenue include EligibilitySpectrum, as well as the patent-pending ProductivitySpectrum, InvoiceSpectrum and CredentiallySpectrum.

EligibilitySpectrum – With the enormous influx of patient deductibles in the health insurance market place, EligibilitySpectrum enables practices to readily manage the complete eligibility of all patients by combining software and back-office operations resources. The options include using a real-time connection with a clearing house, insurance companies’ websites, or live calls conducted by ClinicSpectrum’s eligibility team. This product interfaces via an API with any EHR / scheduling system.

ProductivitySpectrum – Focused on benchmarking on various tasks and instilling self-accountability through daily reporting, this product calculates employee desk time and reduces ideal time or non-productive time. It provides comparative analysis with respect to industry and / or office benchmarks, and expected weekly or monthly productivity.

InvoiceSpectrum – By using a unique payment and invoice processing rule setup for auto-fax, auto-email, auto-credit card processing and auto-paper statement processing, practices will benefit from saving time on template creation, follow-up and more. Additionally the product provides monthly forecast management, receivable management and sales force productivity examination for better cost/profit analysis.

CredentialingSpectrum – CredentialingSpectrum is an automated tool for the credentialing of providers’ profiles and insurance participation, as well as for contract management. It allows users to import CAQH summaries for faster data entry of a provider’s profile, and also auto populates participation application forms from most insurances. It also has a built in document management, task management, milestone management, and reminder functionality for expiration of various documents and credentials, as well as communication templates and messaging solutions for automated calls, secure email, secure text and fax. For more information about ClinicSpectrum or any of their physician practice products, please visitwww.ClinicSpectrum.com.

About ClinicSpectrum
ClinicSpectrum is a healthcare services company providing outsourcing/back-office and technology solutions for 17+ medical billing companies, 600+ medical groups/healthcare facilities including hospitals, and hospital medical records departments.

The company is promoted by technical experts from diversified industries. In a span of 12 years, ClinicSpectrum has been able to transform several billing companies and healthcare facilities nationwide with unprecedented efficiency. The company’s strategy is to build productivity through the use of technology, highly trained personnel who deliver results in a timely fashion, and customized consulting services. ClinicSpectrum has created a solution for all the problems in running a medical billing company and medical practice resulting in better clinical records, revenue cycle, and administrative task management. For more information, e-mail Vishal@Clinicspectrum.com or visit www.ClinicSpectrum.com.

For media inquiries, contact:
Kate Ottavio, KNB Communications for ClinicSpectrum
203-504-8230 x135
kottavio@knbpr.com
Sagar Shah