6 TIPS FOR MAXIMIZING
YOUR PRACTICE
BILLING SYSTEM
IDENTIFYING THE BARRIERS
Practice Management (PM) software is what runs the business side of healthcare; from scheduling patients, to billing to generating monthly reports. And a lot of details in between. There are many PM systems out in the marketplace today and many offer what they call distinct differences that make their software more appealing to your practice.
And while some are designed for large practices, some are called “enterprise” systems interfacing hospitals and providers, and some are designed for smaller practices they each have one primary function: collect dollars owed from insurance carriers, federal payers and patients. The functionality may differ, the bells and whistles may differ, how they transactions are handled may differ...but the goal of the software is the same, collect all the available dollars from insurance carriers, federal payers and patients. All systems claim to optimize revenue, maximize quality, increase practice efficiency, and reduce waste. All claim to have superior reporting capabilities with dashboards and custom reporting abilities built into product. In addition, new mandates of the health care reform act have resulted in many PM systems offering a seamless interface between EHR and billing systems. Of course no interface is really seamless, but there are clear advantages to the interface and the future of healthcare billing as it now stands.
The complexity of the PM system has grown over the years as customers insist on more and more flexibility to meet the changing relationships and contracts within the organization. Reporting needs have become more and more demanding as discreet information from the executive level summary to the detailed transactions that make up the summary are called for. Additionally, as a general rule, physicians do not get involved with PM systems until something goes wrong; like they don’t get paid, the get constant complaints from patients about the billing process or staff, or they get paid, but their pay is trending downward. More and more, consultants are hired by organizations because there is the perception that the PM software doesn’t work, or doesn’t work the way they need it to work, or has lost transactions, or doesn’t apply payments correctly, or and the list goes on.
The reality is much different: the barrier between the PM system and the performance is rarely the system, but the failure of the management and staff to have correct expectations of the system and use it the way it
is designed. I’ll pause for a minute to let that sink in.
TIP #1
-
KNOWLEDGE IS KEY
Whether you have recently purchased a practice management system, are struggling with an existing system or are thinking
about changing systems; you
must thoroughly u n d e r s t a n d how the system is
designed to operate, the flow of transactions and the database that supports that flow. Too many timeswe have seen instances where once a practice management system is purchased, and users try to bend the system to accomodate their existing work flow. It simply never works. And while, of course, you do not want a PM software to drive your business objectives, the reality of the workflow of transactions and the work flow of staff must be in harmony to achieve success. All too often, to much time is spent trying to bend the system is designed and adjusting processess accordingly. Along with any major acquisition of technology, re-engineering workflow must accompany that effort. Every person on the staff must have a clear and proper understanding of how thier function will change with the PM software.
Efficiencies can be gained and cost reduction acheived by simply knowing exactly what the software does and how it does it followed by making appropriate adjustments to staff activity. Not only should you spend time and dollars on training, you should also visit other practices using the same
software. By Networking with others solving the same issues with the same software, innovations
can be found, cost savings on updates needed in
common can be taken advantage of and learning from more experienced users is always helpful. You should also be working with a vendor representative who is getting to know you and your business well enough to make concrete and frequent suggestions to you on how to optimize the software. You can never, ever learn too much about your PM system and what you learn will only enhance your position within the organization to be able to proactively work that system to the practice advantage.
“The barrier between the PM system and the performance is rearely the system!”
TIP #2
-
RESIST TEMPTATION
There is always a temptation to customize the software to accommodate some business scenario you believe can be handled no other way except through some custom changes. Resist that temptation if at all possible. While the sales person may tell you that it can be done for “X” price; the key word there is sales. The database of the software is built on a specific design. Compromising that design will always, always cause a domino effect to the flow of transactions. Most systems today are designed with built in flexibility to accommodate almost any business objective or scenario. Take time to investigate how the system will handle your specific scenario and what the
TIP #3
-
REVIEW, REVIEW, REVIEW
Review options on a regular basis. When a PM system is purchased, choices are made given the level of knowledge and sophistication of the persons making those choices. Over time, as further knowledge is gained about the system; a review of options may open new doors to efficiency and cost reduction. Updates are also regularly made by PM vendors and by thoroughly analyzing these updates and incorporating them into
your billing operations new levels of proficiency can be gained.
Having a person or persons who thoroughly understand the data base, the software and accounts receivables is invaluable to your organization. This person(s) should be tasked with reviewing options, and making suggestions to management based on business objectives. Obviously, this person is not your average accounts receivable line employee. They may have a degree and are fully equipped with critical thinking skills. Let me give you an example:
“In a PM system that we were asked to evaluate recently, there was an option to turn on pre-collection letters. As self pay (SP) continues to be a growing part of AR, the efforts a practice can make in collecting prior to turning over to a collection agency will only benefit the practice. The practice involved had no idea this option even existed. We established the criteria for turning on the option, designed the wording of the letters, gave patients options prior to turn-over. It wasn’t rocket science, but it did make a huge difference in the response the practice received from patients with unpaid balances. Patients were set up on payment arrangements, referred to Medicaid (MCD) or another possible help organization or had their questions answered in order to understand why they owed the balance. That simple option made a huge difference.”
In every practice management system, there are numerous options. As an owner of PM system, you have to take the time to review and make a decision about those options. Sometimes, simple decisions can reap huge rewards. But you have to know what options are available to you to be able to do that. Don’t take for granted that you have exhausted all the system options.
TIP #4
-
WE’VE CRACKED THE CODE
The backbone of any PM system is the files and codes that drive the processes. Everything from procedure codes, to department codes to provider names and numbers to remark codes from insurance carriers to carrier names and number are covered in the files and codes. The care
and maintenance of these files and codes should be the responsibility og the business office. While IT may control the hardware of the system, run the daily jobs and be responsibile for the over-all performance of the system; giving IT responsibility for the files and codes is a mistake. Files and codes is not a one time setup and forget it issue.
It is on-going. Departments are added, providers are added, carriers are added... things change in a practice almost daily or at least weekly. Relying on IT to make the needed chnages in a timely and consistent manner does not always work. Let me give you an example:
“A large clinic in the northeast has an enterprise situation. A 500 bed hospital and rehab facility with an adjoining clinic of over 300 providers and 30 satellites with an additional 200 providers. The IT department owns files and codes for the practice management system. When one needs changes made to a file or a code, one fills out an electronic work order and sends to IT. It is also overseeing the implementation of a new EHR. Guess what priority a work ticket for a code change from the business office gets?”
In the big scheme of things, that one code change request is a very little piece of a very large pie. However if that code addition is a new provider who cannot bill for services until that code is entered into system; that piece all of the sudden becomes quite large. IT typically does not have the depth of knowledge into the workings accounts receivables (AR) to understand what is and isn’t a priority. By allowing the billing office to “own” files and codes, changes/additions/ deletions are made without impact to the IT department and efficiencies gained by timely changes means that provider who couldn’t charge for services because IT didn’t have time to add the code is added and charges go out the door and are paid without incident.
Our solutions piece together the puzzle of practice operations including practice management, revenue cyle management, government compliance, and providing optimum patient care. Medical Management Services provides the peace of mind you need to focus on patient care and outcome.
Practice Management Healthcare Consultants
• Interim and Permanent Management Services
• Governance/Corporate Structure • Physician & Executive Recruiting • Practice Management • Physician Compensation • Provider Enrollment • Compliance • Strategic Planning • Training Programs Practice Management Speciality Specific Assessments
• Business Valuation/Assessments • Strategic Planning
• Finance
• Revenue Cyle Management • Compliance Practice Management Business Development • Compliance • Business Development • Strategic Planning
• Joint Venture Opportunities • Acquisitions and Leases
Medical Billing Solutions
• Optimum Reimbusements • Carrier Compiance • Software & Systems*
TIP #5
-
HOW DO YOU HANDLE DENIALS?
Files and codes are set up correctly, all the work-flow is being managed appropriately, patient registration has been done accurately and the first time, charges go into the system
and pass all the system edits, the clearinghouse sends the charge through just like it’s supposed to without a hitch. The carrier receives the electronic charge file and sends through their system for processing. An electronic remittance file is received, payments are posted and remark codes are posted for denials. Now what happens? What should happen next is the denials that are posted today are worked today. Knowing how your PM handles denials is the single most important function to understand and incorporate into workflow. There are countless details with every PM system that must be understood; however, but given that the most costly part of AR is reworked claims, having a clear plan to deal promptly and efficiently with denials will save you an aging AR and thousands of dollars. Of course the overall goal should be to reduce denials. Your PM system should be able to give you statistics about common denials that you can communicate to providers and office staff and coders and thus preventing reoccurrence. In today’s insurance environment denials are inevitable. Understanding the details of your PM system handles denials is paramount to keeping aging in control and cash flowing.
TIP #6
-
IS YOUR PM FINANCIALLY HEALTHY?
Last but surely not least is your PM system’s and reporting. You are only as financially healthy as your reports tell you. Thus analyzing billing reports is escalated into the strategically critical column on your monthly must do list.
Every PM system has “canned” reports that are basically a combination of what users have said they need and vendor experts think you need. The reality is most canned reports are either too detailed for the executive summary level or not detailed enough for the end user level. With relational databases, there should really be no issue with creating a data warehouse that contains every available data element needed to support both the
executive level and detail level reporting. Or is there? In every practice a need to understand three primary areas is necessary (1) revenue cycle (2) cost efficiency) and (3) net revenue per patient encounter. The real challenge for most practices is knowing how to best use the reporting tools offered to get the “look” most
“Understanding the details
of how your PM system
handles denials is paramount”
executives want and need (dashboards are popular) and using those same tools to get the level of detail needed to truly analyze the business. This area is where IT can be very helpful. (see MMS blog on reports every manager must have) Take the time to first of all know what reports you need and at what level you need them. This is probably the most difficult task. Data in and of itself is pointless unless it is used to improve/ status practice processes. The true value of data is how it is used to improve performance/productivity (i.e. cash) and monitor that activity. Leverage the technology your PM system offers. Learn it, use it, get creative with it, let the PM system work for you.
Whether you use one of the top 10 practice management systems (PM) (Nexgen, Athena, Mckesson, AllScripts, GE Health, Epic, Cerner, Vitera, advanced MD, EClinical) or another system, success with that PM system is only as assured as your knowledge of that product. There are no short-cuts or easy buttons to push in this effort, however the rewards you will reap through your efforts of learning and taking ownership of the system will pay for itself many times over.
Meet the Author
Lin Dworshak
Business Development Specialist
Lin Dworshak has over 25 years experience in the healthcare industry. As Business Development Specialist for Medical Management Services, Lin specializes in enhancing current medical practice operations through the cultivation of strategic-channel relationships. Lin’s extensive healthcare experience allows her to identify client needs through the evaluation of current business potential.