Outsourcing Selected Back-Office Tasks at Physician Practices

Each step within the revenue cycle management (RCM) process at physician practices builds on previous tasks, so mistakes made Credentialing Servicesearly 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:

  • Online, using insurance company websites and payer portals
  • Calling the interactive voice response (IVR) systems at insurance companies and working through menus to determine eligibility status
  • 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:

  • 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
  • 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.

Payment Posting can be done via two methods

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Explanation of Benefits (EOB) payment posting is done as a service using two methods described below:

  • Manual Posting – EOBs are sent to the posting team by scanning them in at the doctor office level, shipping them in pre-paid envelopes, or having them picked up directly at the provider’s location. Once they are retrieved posting is done only after creating batches of payments. This batch system allows for proper accounting making sure that the money deposited into the doctors’ checking accounts matches our posting “penny to penny”.
  • Auto Posting – EOB payments come in the form of ERA (Electronic Remittance Advice) files which are downloaded directly into the provider’s Practice Management system. All posting is done directly in the system so the provider can audit at any time.

When necessary secondary claim submission, patients statements submission, and denials tagging can all happen at the time of payment posting.

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

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

SOURCE ClinicSpectrum