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.