“Patient Healthcare Costs Rise Again, Clinicspectrum’s Solutions Lessen the Burdens and Increase Revenue”

According to a recent article dated November 13th, 2014 on Forbes.com, “Worker Out-Of-Pocket Health Costs Have Doubled In Five Years”, the healthcare landscape is predicted to change even further in 2015.  “As the economy improves and employees spend more on health care, employer-paid premiums are rising again with an increase of 5.5 percent forecast for 2015 with worker premiums and out-of-pocket costs – which have doubled since 2009 – rising at an even faster clip.”  Additionally, the annual healthcare costs per employee have risen from $10,717 to $11,304 this year.  This means that more out of pocket expenses are outstanding and collecting that money can raise new challenges for medical groups.  Strategic solutions must be implemented in the areas of proper benefit verification, and automated patient collections to reduce revenue downfalls for practices.


In fact, practices are generating up to 30 to 40 percent of their revenue from patients who have high-deductible insurance coverage. Failing to check patient eligibility and deductibles can increase denials, negatively impact cash flow and profitability.

One solution is to improve eligibility checking using the following best practices:

-Check patient eligibility 48 to 72 hours in advance of scheduled visit using one of these three methods:

  1. Business-to-business (B2B) verification, which enables practices to electronically check patient eligibility using electronic data interchange (EDI) via their electronic health record (EHR) and practice management solutions.
  2. Look up patient eligibility on payer websites.
  3. Call payers to determine eligibility for more complex scenarios, such as coverage of particular procedures and services, determining calendar year maximum coverage, or if services are covered if they take place in an office or diagnostic center. Clearinghouses do not provide these details, so calling the payer is necessary for these scenarios.

-Determine patient financial responsibilities – high deductibles, out-of-pocket limits, then counsel patients about their financial responsibilities before service delivery, educating them on how much they’ll need to pay and when.

-Determine co-pays and collect before service delivery.

Another area of potential pitfall for revenue optimization comes from collecting patient balances after the services have been rendered.  It is imperative for medical groups to turn to automated solutions to help recover those balances seamlessly and effectively.

Automated collection software can be installed and managed by practices to relentlessly – within regulations – contact debtors to increase collection rates. Traditional collection methods of standard mail delivery and costly representative phone calls are replaced by a more elaborate, seamless, cost-effective auto collection process.  Automated collection methods using technology platforms, decisions rules and messaging such as text, email, push notifications on smart phones and automated calls to allow seamless, consistent results for balance collection.

For more information on ways we can help, visit our website, www.clinicspectrum.com.


Operational Cost Reduction in a Changing Healthcare Environment

With cutting edge technology and daily medical breakthroughs our healthcare system appears to fit the mold of streamlined perfection, however the rising challenges of daily medical group operations are quietly overlooked without an obvious solution.

Doctors are challenged to divert their focus from treating patients, to tedious claim chases and endless denial follow ups, causing additional frustrations to the already perplexed lowered insurance reimbursements. Office managers are equally defied; faced with high turnovers, limited solutions and high operational costs, the days at the office just got longer. And it’s no wonder, as the cost of maintaining a profitable business the old fashioned way is not a sustainable option.

So what is the solution? Hybrid workflow! Imagine this: You walk into your office, log in to your computer and the first email you see depicts a picture perfect world, full of clarity and insight. Easy to understand spreadsheets with complete breakdowns of outstanding accounts receivables and valid reason explanations for easy claim correction and resubmission. Or better yet, a full report of your patients’ appointments confirmed in advance with detailed eligibility and benefits verification with authorization codes available prior to treatment. How about pages of scanned documents which are seamlessly indexed to their designated folder? It can happen! I know what you are thinking, this is too good to be true, a sci-fi flick with virtual reality inserts, no such solution exists in real life. Wrong!

Eligibility Verification

Unique back office solutions can significantly enrich your current workflow in the areas of Claims Entry, Payment Posting, Accounts Receivable Follow Up, Denials Management and Credentialing. The hybrid workflow model ensures resourceful manpower, extensive healthcare expertise, and warrants the tedious work of aggressive follow ups, amongst other services, to be completed, all while away from your office. A virtual office genie can do all your work and increase your bottom line by up to 20%, all while reducing operational cost by as much as 30%. In order to survive the changes in the healthcare environment, medical groups can outsource various billing modules to third party solutions to maintain profitability. Off-shore labor power allows lowered operational costs and increases profitability instantly, putting medical groups in a lucrative space yet again. Don’t let your frustrations slow you down, Eligibility Verification solutions are here to stay.