THE KEYS TO BILLING PERFORMANCE WHITEPAPER

Transcription

1 THE KEYS TO BILLING PERFORMANCE WHITEPAPER

2 1. The keys to billing performance Evaluate staffing, productivity in your practice for improved collections Like many employees who work in physician practices, billing managers have too much to do and not enough resources to do it. Making matters worse are the numerous underlying issues that may cripple revenue collection. These include insufficient or unqualified staff, poorly trained staff and practitioners, and failure to fully utilize EHR systems. Issues like these can lead to rejected claims, increased days in A/R, uncollected patient contributions, and write offs. Tasks such as posting payments to insurance companies, following up on claims, filing appeals for incorrectly paid or denied claims can consume the bulk of a staff member s day. They often prevent staff from completing more patient-oriented tasks. Or, these tasks might fall by the wayside and negatively impact your bottom line. If your practice is faced with these issues, it s time to consider relieving your staff completely or partially of the burdens of routine, increasingly detailed, and timeconsuming revenue cycle management (RCM) tasks. Is your practice keeping up? Time and resource challenges have a direct impact on practice revenue. Only 60% of practices review delinquent claims. Only 59% of secondary claims are filed. Only 32% of patients who own money receive a collection letter. 1 73% or providers report it takes one month or longer to collect from patients. 2 1 Stellar Analytics, Why outsourcing medical billing can be the best thing for your practice, October 18, Instamed Seventh Annual Trends in Healthcare Payments Report

3 2. Evaluate your staffing environment With constant changes to payer requirements and billing procedures, it s increasingly difficult to find billing staff with expertise both in your practice s specialty and software platforms. This leaves many organizations with insufficient or unqualified staff. We know that doctors can suffer burnout, but billing employees can, too. Due to constantly shifting, and more complex billing rules coupled with inconsistent payer behavior the sheer pressure to maximize revenue can take its toll. The Journal of General Internal Medicine reported on a study of burnout among primary care team members. The study found that the strongest associations with burnout were having incomplete teams, turnover among team members, and patient panel overcapacity. 3 If your staff is overwhelmed, if non-billing staff are regularly asked to perform billing tasks due to backlogs, and if physicians are regularly involved in billing, it might be time to evaluate your staffing environment. Your billing staff might be ill-equipped to handle the tasks at hand, or staff and providers might be insufficiently trained in coding best practices or in the use of your EHR system. When evaluating billing teams, critical questions include: Is your staff overwhelmed? Do they have billing expertise in all areas of your practice? Are they trained to collect increasingly important patient contributions? What are billing staff turnover rates? Depending on the answers to these questions, you may have an important decision to make. 3 Helfrich, Simonetti, Clinton, Wood, Taylor, Schectman, Stark, Rubenstein, Fihn & Nelson, The Association of Team-Specific Workload and Staffing with Odds of Burnout Among VA Primary Care Team Members, Journal of General Internal Medicine, July 2017, Volume 22, Issue 7, pp

4 3. Hire more staff, or seek an alternative? When hiring more staff, confirm that the local talent pool is deep enough to find the skills you need. Also, since staff salaries and benefits can consume up to 25% of practice revenue, consider the total cost of new hires. Training not only bears a dollar cost. It also can be a further burden on already-stretched staff resources. Include these associated costs if you re considering hiring more staff: Salary and benefits Training Vacation and sick time Employee attrition What about hidden costs? Responding to billing questions is a hidden cost many practices fail to consider. It can cost a five-provider practice that sees 3,000 patients per month 650 personnel hours, or almost $15,000/year to answer the average number of billing queries. Do you have the skills and data to optimize billing operations? Even with the proper staffing, it s a challenge to strike the right balance in billing priorities. The Healthcare Financial Management Association (HFMA) states it costs nearly $25 to rework a claim. Depending on your rejection rate from payers, which the Medical Group Management Association (MGMA) suggests is less than 5% of your claims, your billing staff could be spending more money working rejections than it costs to submit new claims. On the other hand, they may focus on new claims to the exclusion of working rejections and denials, which leaves uncollected revenue. Determining the right strategy for working rejections is a science specific to each practice. 2

5 4. The decision If you discover issues in your RCM operations, you have a decision to make: Do you hire more in-house staff? Is the local talent pool deep and wide enough to meet your needs? Do you have appropriate training in place? What is that employee s monetary value to the practice? Have you considered all associated costs such as benefits, training, and time spent on associated tasks that net zero revenue? Or, do you seek a billing partner that can work with you to handle any aspect of revenue cycle management? Managing claims Filing secondary claims Managing and reworking denials Training your internal staff on technology, processes, and best practices Providing billing expertise in all of your practice areas Fielding patient billing queries 3

6 5. What makes a good billing partner A valuable RCM team doesn t just submit claims on your behalf. Here are a few things to look for if you re considering outsourcing any aspect of RCM: Integration with your EHR/PM Synergy between your billing and EHR/PM technologies enables efficiencies and visibility that can save your practice time, money, and headaches down the line. Training in your specialty Each specialty has distinct billing requirements. A valuable RCM team trained in your specialty can guide your team on best practices, proper coding, and payer behaviors, thus reducing your practice s denials and rejections. Transparency and excellent communication Your billing partner should function like an extension of your in-house team. Ensure that you ll have regular weekly and/or monthly check-ins to review key performance indicators, the health of your practice, and any issues that may have surfaced. 4

7 6. Greenway Revenue Services: The better choice Otolaryngology Physicians of Lancaster s (OPL) small, three-person billing team was struggling to keep up with the five-provider practice s volume, causing a rise in outstanding claims and balances. The team also struggled to stay current with changing reimbursement requirements. With much of its patient population on medical assistance, getting paid often required repeat statements and follow-up calls. The billing department had too much to do and insufficient resources to do it. The question was, should we go with Greenway on the billing side, or should we hire a billing manager to clean things up for $50,000 to $60,000 a year? said Marie Anderson, practice manager. Ultimately, Marie and her team compared the cost of Greenway Revenue Services to hiring a billing manager, and the analysis identified Greenway Revenue Services as the better choice. OPL now receives payments in a timely manner. Days in accounts receivable have decreased, and more claims are paid within 60 days. OPL also saves $2,000 in billing costs each month. Besides not having to pay the salary of a billing manager, OPL no longer has the costs associated with printing statements, postage, or following up on overdue bills. Staff that previously worked in OPL s billing department have moved to the front desk, where the phones are no longer ringing off the hook with patients upset about bills. Now that employees spend significantly less time answering and transferring calls, staff satisfaction has improved and customer service along with it. 5

8 7. Partner with the leader Greenway Revenue Services has earned the top ranking from KLAS for Ambulatory Revenue Cycle Management in the 2018 Best in KLAS: Software & Services report. Greenway Revenue Services also earned top KLAS rating for Ambulatory Revenue Cycle Management Services Small Clinics in A full 100% of respondents described Greenway Revenue Services as a true business partner stronger partnerships, more proactive with above average quality of guidance. - Last year, Greenway Revenue Services earned top marks in the small-market category of practices with 11 or fewer physicians in all four scoring categories: general, implementation and training, sales and contracting, and service and support. - Greenway Revenue Services received the highest satisfaction in managing denials and rejections a process that is still a chink in most RCM vendors armor, the KLAS report said. - Greenway Revenue Services also earned the highest marks for transparency into billing and financial operations. Between us and Greenway, we share a lot of responsibilities. It s a good work collaboration, and that really helps us. Stacey Fines at Kearney Clinic 6

9 8. Greenway: Dedicated revenue services partner Greenway Revenue Services provides a dedicated team that functions like an extension of your practice. Each Greenway team member is personally invested in your success. A dedicated team gets to know your unique practice. Whether your goal is expansion or increasing revenue, our team can scale with you. Greenway does not replace your existing staff. We supplement it. Current staff knowledge can be transferred to revenue-generating roles such as population health initiatives or following up on patient payments. Collaboration and communication are key. If we see an issue looming, we ll help you get ahead of it. If we see a process that isn t properly executed, we ll propose a solution. Your financial success becomes a collaborative effort between your practice and your Greenway team of experts. Greenway Revenue Services A dedicated team that gets to know your needs Scalable with your practice Shared responsibility with your team Deep body of knowledge about your specialty, and your local payers Staff training on systems and in best practices To learn more about Greenway Revenue Services and how Greenway Health can help increase your practice revenue, call or visit greenwayhealth.com. 7