BEST PRACTICE BILLING WORKFLOW
Penny Gilmore, Professional Medical Management, Inc. Philip Collins, Southwest Diagnostic Imaging Center Jeffrey Atkin, Reston Radiology Consultants
Facilitated by Shannon Marshall, Merge Healthcare
Monday, August 27, 2012
session objectives
Provide attendees with real-world case studies on optimizing the Merge Financials™ system Enable discussion and problem solving with peers on additional Merge Financials situations Learn to use Merge Financials in new and
different ways
Connect with peers and Merge Financials best practice users
discussion topics
Introductions Case studies Panel Q&A
Penny Gilmore, Billing Office Manager Professional Medical Management
my background
I have been with Professional Medical Management (PMM) for 12 years
I have a B.S. in Business Management
16 years of medical billing experience 14 years of billing professional services 12 years working with Merge and its
predecessors
Transitioned from Sentinel to Merge Financials in October 2008
Professional Medical Management
’
s background
PMM is a multispecialty billing company
Bill for nine tax id #s (practices)
Five specialties (radiology, family practice, wound healing, mental health, and chiropractic) In 2011 we billed 323,466
procedures
298,311 were radiology procedures
208174 were hospital based procedures
90137 were clinic based procedures Iowa Radiology
20 radiologists
Reading at 12 Iowa hospitals
Over reads from local physicians group
Merge products utilized at PMM
Merge PACS™ Merge RIS
Merge Financials
Moved from Sentinel Merge Dashboards Merge Documents
my case study
With interfaces into Merge Financials we are able to import demographics from 11 of the 12 hospitals Iowa Radiology provides radiology services
Merge RIS is used in all five clinics
We utilize RIS Charge Outs to import demographics into Merge Financials
We have an interface from Coderyte into Merge Financials for all our charges
Results
Our average time from DOS to date of claim is five days
We have our 1st payment in 26.62 day Our net collection % for 201
Hospital based 88.65% Clinic based 96.61%
8
Our office used to have shelves full of demographics & charges waiting to be manually entered into Sentinel. You will not find a shelf like this at PMM today!
while I have the microphone
…
.
I wish I had time to explain other benefits that Merge Financials provides over Sentinel
Use the credit card portal to import & post patient payments made directly on Iowa Radiology’s website
Reduction of paper
Increase of patient satisfaction of our billing practices
I would also like to explain how we use Documents in conjunction with Financials I am interested in learning about the eligibility feature in Merge Financials
If someone uses this feature, I would like to hear your best practices on this topic
Philip Collins, Director, Business Services Southwest Diagnostic Imaging Center
my background
Some things to know about me
28 years experience in healthcare finance including:
Hospital Physician Cardiology Radiology
Revenue cycle consulting
Merge RIS user since April 2010 Merge Dashboards since April 2010 Merge Financials since January 2011
Southwest Diagnostic Imaging Center
Some things to know about my billing business 26 years in business
One 35,000 sq. ft. location Eight modalities
60,000 avg procedures annually
Bill for TC only
Staff of 18
YTD Cash collection percentage is 98.96%
A/R days = 26
Bad debt = <1.8% net & 0.89% gross
Key products used
Merge RIS v7.2, Merge Financials v6.1.4, Merge Dashboards
Soon will have Merge Referral Portal & iConnect
Market: DFW metro area – 3 “major” competitors 6,000 referring physicians
Merge products at Southwest
Merge CADstream™ Merge RIS
Merge Financials
Moved from Sentinel Merge Dashboards Merge Documents
my case study
Merge Financials provided effective:
A/R management
Staff productivity and accountability The legacy way
Manual approach using Excel spreadsheets by employee
Manual review of account action per employee by management WORK QUEUES! !
Alleviated the manual approach
Staff account assignments
Breakout of denials, insurance, and patient accounts
Ability to sort by payor
Clear staff productivity; Accountability
Coverage possible during staff absence
Financials reporting capability
A/R days decreased from upper 30s to mid to upper 20s
Increased cash intake; Lower percentages in aging categories
while I have the microphone
…
Additional best practices exist! I wish I had more time to share…
See me after the session if you want to collaborate about Merge RIS/Merge
Financials integration or any other process functions
Looking for peers to share / collaborate about…
Interest payments show on actual account
Adjustment reason more easily shown
Jeffrey Atkin, Chief Operating Officer Reston Radiology Consultants
my background
COO at Reston Radiology for the past four years Prior work
PACs/RIS Account Exec w/McKesson
Director Financial Systems w/Prince William Health System
Education
BS in Nuclear Medicine
MBA MISM
CPHIMS IT Certification
CIIP PACs Admin
Nuclear Certification NMTCB
Reston Radiology Consultants
Bill for five Practices
One hospital 200 Bed
Large MRI center
PET practice
Two outpatient imaging centers Billing Office
6.5 FTE’s
Billing manager
Reston has multiple Merge products
iConnect® Access
Merge RIS™
Has attested for Meaningful Use Merge Financials
Integrated with Instamed patient portal Previous Sentinel user
Merge Dashboards™ Merge Documents™
cost savings
Cost savings with Merge Financials
Coding Director sending less charges to aLife for coding
Decrease in staff
Currently have six full time, one part time, + Billing Manager
Decrease of 4.5 FTEs and outside consulting
Payroll has been cut in half
Annually from $900,000 to $470,000
Overtime dropped from $50,000/year to $0.00
Zero overtime shop
$30.00 in OT in first six months of 2012 Increased electronic footprint
Less paper in the office
Payments are the only paper in office
Fighting denials is a quicker process
More Room for front office
4.5 FTE reduction allowed pre-authorization team to relocate to billing More procedures administered
relocating staff and more
Relocating Pre Authorization Moved from the front end to the back end Staff is now sitting with the billing department
Allows the staff to be more up to date on billing rules and regulations Newest upgrade to Merge RIS
Can use Merge RIS Work Queue’s in a much more manageable way
Moved from resource based assignment to work queue priority
Each user works the queue according to priority
Went from losing significant sum of money to virtually zero loss in per cert issues
‾ The process was fully manual before
integration with Instamed
Increased collections
Integrated with Instamed
Patients sign onto a portal and make payments online
Scan/track patient checks from front office
Working with Instamed’s eligibility 24
if I could go on
I would discuss the relationship between the Merge Products
Merge RIS and Merge Financials
Merge RIS/FIN and Dashboards
Merge Financials and Documents Implemented multiple products and systems
Breadth of offerings elsewhere not as complete
session objectives – met?
Provide attendees with real-world case studies on optimizing FinancialsEnable discussion and problem solving with peers on additional Financials situations Learn to use Financials in new and different ways
Connect with peers and Financials best practice users
