It’s not the data that are necessarily important—it’s what you do with that data, and practices are discovering more ways to use their management resources intelligently.
As cardiology practices look for answers on how to keep pace with internal and external reporting requirements, shifting regulatory requirements and growing financial pressures, they are looking for ways to transform the revenue cycle with improved data management and cash collection, and by maximizing reimbursements—all while trying to keep costs under control. Today’s practice management (PM) software has moved beyond basic revenue cycle management to help practices work smarter, faster and more efficiently.
Practices are looking for software that can provide a full complement of clinical, administrative, business and management functions. Additionally, PM software increases its value when it can be integrated with electronic medical records (EMRs), business intelligence, electronic data services and quality reporting tools. From tools that help organizations find uncollected revenue and days on accounts receivable, and systems that track appointments and patient flow to payor mismatch reports, a variety of software options is available to help administrators tackle the biggest PM challenges.
Collecting for services rendered
Revenue lost through unbilled inventory, unclean claims, denials and rejections threatens a practice’s bottom line. Accurately capturing patient demographics, insurance information, pre-authorization status and existing conditions prior to performing procedures with PM software can only help to minimize lost revenues. If the front office can capture these data correctly, it can eliminate redundant work processes on the back-end and ultimately, drive inefficiency out of the office.
According to Ann Honeycutt, CEO, Virginia Cardiovascular Specialists in Richmond, with nine offices covering ten hospitals, moving things from the back-end to the front desk ensured information was getting collected the first time around, instead of spending more resources reworking claims. The practice implemented athenahealth’s athenaCollector, a web-based PM system, to do a better job at collecting its revenue for its physicians services, as well as transform how they did their work and processes.
Prior to athenaCollector, claims would be denied for eligibility, referral/authorizations, and medical records and the business office would re-work claims to provide the necessary information. A corrected claim or appeal would be sent to the payor, resulting in more claims processing delays.
To accommodate the new system, the practice completely changed its front-end office workflow. The software’s front-end Rules Engine and Auto-Eligibility were key components to pushing work back to the front desk instead of the billing office, since claims are held prior to the billing cycle for such denials, according to Robin Scott, director of the business office, who says the front office staff trained for weeks learning how to work out reasons for denials on the front-end before a claim went out the door.
Initially, athenaCollector costs about $2,000 and once the practice is on athenahealth’s web-based network, the software company takes a percentage of net collections based on type and size of practice. Honeycutt says that they have seen their return on investment. “Our collection percentage is up 1 percent since we started with athena, which is significant money,” she adds, attributing the increase in collections also to staying on top of underpaid claims.
Two sources of claims underpayments come from the payor accessing inappropriate discounts or not following the terms of the contract. Honeycutt says that athenaCollector’s ability to generate a monthly payor mismatch report to make sure new contracts are getting paid according to schedule is a major benefit of the software. The practice was able to completely recoup the software’s cost within the first year of go-live, with the overall collection rate increasing from 44 percent of charges to 45.2 percent. “In a declining fee schedule environment, a net 1 percent gain is extraordinary,” she says.
Honeycutt says they can track practice activity and claims in real time through athenCollector’s Workflow Dashboard, which allows her to see, understand and manage practice operations up to the minute, from anywhere. She monitors clinic productivity to see how well CT is performing, how far out echoes or nuclear slots