A few years ago, our practice, Excel Eye Center in Provo, Utah, stood at a crossroads. We wanted a higher level of efficiency from our revenue cycle, and contemplated whether we could gain greater control over our financial future with more productive revenue cycle management (RCM) tools.

Our practice was experiencing rapid growth-and revenue cycle slowdowns as a result. We averaged 48 days in accounts receivable (A/R), with A/R greater than 90 days running at 20 percent and a net collections average of 88 percent.

At the time, there were seven ophthalmologists and three optometrists, operating in four locations across Utah County. Each location had its own in-house billing staff, and in total, the practice handled about 200 claims per day. Unfortunately, the clearinghouse we had didn't offer the necessary reporting and claims-scrubbing expertise we needed to handle a claims volume of that size. We did not want to just "submit and hope" for reimbursement anymore.

Instead, we wanted to put RCM firmly in our own hands through the use of a transparent claims processing solution with faster access to claims data. We also wanted the ability to process Explanation of Benefits (EOB) documents electronically-which in turn would make secondary insurance filings a less time-consuming, labor-intensive proposition. Since we were already planning to implement a new practice management system, we decided to simultaneously begin looking for a new clearinghouse solution.

Searching for Automated Solutions
After purchasing and selecting the new practice management system, we began a wide-range search for a clearinghouse that would effectively complement the new system. We sought recommendations from other ophthalmology practices and also developed a list of "must-have" criteria, which included the following:

• Real time-eligibility response: To avoid waiting 30-45 days to receive paper EOBs from payers.
• EOB download capabilities: To reduce the need to manually enter information.
• Electronic secondary claims submission: To move away from paper secondary filing since Medicare and Medicaid would soon require electronic submission.
• Quick turnaround: To gain transparency and the ability to track each claim through the revenue cycle.
• Claims correction: To see claims errors and fix them in the clearinghouse prior to submission-without having to go back into the practice management system.

After evaluating a number of clearinghouses, we eventually narrowed the field to three vendors. After demonstrations, we listed the pros and cons of each of the top contenders. In the end, we chose a web-based solution from Navicure because of its advanced functionality and ability to work hand-in-hand with our practice management technology.

Committing to Rapid Implementation
The transition occurred virtually overnight from our existing system to the new practice management and clearinghouse systems. The practice management system was implemented first through an approach that called for a hard stop on the old system. Then, shortly after, we transitioned to the new clearinghouse. The decision to switch both systems at the same time was fairly ambitious. However, we wanted to use this opportunity to cross-train more of our staff on the end-to-end claims submission process. Prior to the conversion, only one or two people truly understood the process. Now several staff members have this expertise.

Soon after the new systems went live, we began receiving same-day responses from the clearinghouse regarding claims submission. This was something we were eagerly anticipating because we knew it would streamline workflow across the revenue cycle. While we were pleased with the increased efficiency, the quick turnaround did create some changes in workflow.

Transitioning from waiting a month or more for responses to our claims submissions, to receiving 20 on the same day was a new challenge. As a result, we did experience an initial backlog as we tried to clear out old accounts and simultaneously process new ones. It took a few months, but ever since overcoming the initial backlog, we have enjoyed the ease that comes with real-time responses.

Achieving Higher Productivity with Fewer People
Since going live, three more physicians and a physician assistant have joined the practice. A fifth clinical location and optical shop were also added. We have centralized our billing office and now process about 300 claims daily. Even with additional clinical staff and a larger claims volume, we have been able to efficiently manage all of our revenue cycle processes-and we're doing this with less full-time equivalent (FTE) revenue cycle staff. We previously employed one FTE at each practice location for charge entry alone. Now, just one FTE enters all payments and handles denials for all locations. We also shifted one FTE from folding and mailing paper claims to a more productive, revenue-generating role.

Electronic remittance advice (ERA) functionality has also increased staff efficiency. This especially holds true when it comes to processing claims for Medicare-one of our main payers. Whereas it used to take an entire eight-hour shift to manually enter one Medicare EOB batch, payments are now posted and EOBs attached with the click of a button. Because all EOBs are filed electronically, there are no more hours wasted digging through file cabinets just to locate a single document.

We also leverage our clearinghouse technology to check patient enrollment and eligibility in real time, prior to service. The technology helps staff work smarter and focus attention on those patients who "fall out" of the verification system. Automated eligibility verification has cut down on our correspondence time with insurance companies and staff seldom needs to call and wait on hold to get an insurance question answered.

Getting Paid Faster with Fewer Errors
Electronic secondary claims submission and electronic funds transfer (EFT) are two other capabilities that have allowed our practice to shorten reimbursement turnaround substantially. On average, payments are received and entered within 14 days which has helped our average days in A/R drop to 30 - representing a 63 percent decline. Days in A/R greater than 90 days also has dropped to just seven percent-less than half what it was before implementing the new systems.

In addition to speeding reimbursement, we have also been able to improve the accuracy of our revenue cycle process. With the edits available in our clearinghouse solution, we are able to catch any claim errors and correct them prior to submitting the claim to the insurance company. This has helped us reduce our denials and eliminated a lot of unnecessary work for billing staff on the back end. Even when there are denials, the "plain English" message information and a knowledge base resource make it easier for billing staff to research-and correct-the problems. As a result, our net collections have improved by 11 percent, reaching 98 percent overall.

By switching to automated RCM tools, Excel Eye Center now receives more of the money it is owed faster, and with much less manual hassle. While the practice has achieved success in enhancing efficiency and productivity, it is not resting on its laurels. Our numbers are good, but we are always working to make them better. Our efforts to leverage technology will certainly continue as we strive to discover ways to expand our business while furthering efficiency.

Brittney Wachter, CPC, OCS is the business manager for Excel Eye Center. Excel Eye Center consists of nine ophthalmologists, three optometrists, and one physician assistant. Excel Eye Center has five office locations in Utah County and seven satellite sites in rural Utah. Ms. Wachter oversees the practice management system and the operations of EHR.