By Dean Brown
As profit margins tighten, physician practices must focus on ways to reduce costs and grow revenue. Technology can support this effort by refining business processes and streamlining workflow. For example, an automated claims clearinghouse can assist a practice in getting patient claims out the door faster and more accurately. Such a system also provides information to help a practice better understand which claims are being denied and what the practice might do to reduce those denials long term.
Last year, Alabama Orthopaedic Clinic-a 20-physician practice located in Mobile, Alabama-decided to consolidate its two clearinghouses into one web-based system with the goal of improving practice efficiency, cash flow, and revenue.
The Benefits of a New System
After researching the different options available, Alabama Orthopaedic Clinic chose Navicure, a system that was both easy to navigate and cost effective. It also seamlessly integrates with Greenway's PrimeSUITE, our electronic health record (EHR) solution.
Having systems that integrate is key to realizing greater efficiency and productivity. For example, the clearinghouse and EHR system automatically sync up, so that when business office staff correct a claim in the EHR, the clearinghouse is automatically updated as well. This eliminates both double work for staff members and unnecessary discrepancies.
The integrated systems also support automatic eligibility verification-checking that patients are eligible for the services they are going to receive. By the time our patients check in, we know whether their insurance is current, and what their co-pays and deductibles are. We can collect the patient's contribution upfront, when he or she is invested in the transaction, as opposed to 30 to 60 days later when the need to pay is no longer top of mind. This shift toward proactively verifying coverage and determining patient responsibility has increased our up-front collections dramatically.
In addition to strong integration, we chose a system that clearly communicates performance. Our new clearinghouse has a dashboard feature that allows us to drill down into various metrics. For example, practice staff can sort rejections to look at the data from a variety of perspectives. The clearinghouse outlines the reasons behind any rejections, which helps us easily see what needs to be fixed in order to get a claim moving again and prevent future rejections.
It's Not Only About the Technology
During the clearinghouse selection process, Alabama Orthopaedic Clinic considered more than just technological capabilities. We also took the vendor's level of client service into consideration. The clearinghouse vendor we chose offers an innovative three ring policy-where every client service call is answered within three rings. Because of this guarantee, we are confident that if we reach out with a problem, someone will be available to provide assistance and address the problem promptly.
Making the Move
There is always anxiety when you make a large technology shift, and we did have a few reservations about making the change. After all, it is a big transition, and the potential for problems is very real. However, the switch went extremely smoothly. All of our payers were enrolled properly, and there was no disruption in cash flow or accounts receivable. Our collections actually went up the month following the transition.
The implementation results were especially welcome in light of the fact that we switched to the new clearinghouse about the same time as the 5010 conversion. Unlike some practices that used different clearinghouses, we did not have any issues with the 5010 transition. However, when we did have questions, the client service department was able to address them immediately.
Bottom-line Impact
Making the decision to consolidate clearinghouses has proved to be a wise one. We have seen significant shifts in key performance metrics-our denial rate, accounts receivable aging, and collections have all improved. Specifically, we have reduced denials by approximately 20 percent, dropped days in A/R by seven percent, and increased the month-to-month collections rate by 10 percent.
Since making the switch, the practice has also redeployed members of its staff to other revenue-generating tasks, allowing for a better use of resources. The time we spend responding to claim rejections has dropped by 40 percent, freeing staff to focus on other areas of the business office that need attention.
Uncovering ways to streamline operations is one way medical practices can prepare for the coming changes in healthcare. Leveraging technology, such as a web-based clearinghouse system, can improve practice workflow and ensure business processes are functioning at the optimal level.
Dean Brown is CEO of Alabama Orthopaedic Clinic, a 20-physician practice located in Mobile, Alabama.
