Many physicians struggle to find and retain qualified staff to run the insurance claims side of their practice. In Jacksonville, Fla., where the local economy went into recession, hiring was a particularly painful process.
PracticeSuite Helps Jacksonville Practice Clear Up $900,000 AR Backlog
In fact, an inability to engage experienced billing staff led one Jacksonville internal medicine practice to accumulate $900,000 in accounts receivable (AR). Although the practice implemented PracticeSuite’s medical billing software in an effort to streamline and improve its billing process, high turnover foiled the plan—the two-physician practice hired and let go of four billers in as many months.
Each time, the physicians thought they were hiring experienced billers, but there was an enormous disconnect between how the billers looked on paper and how they performed. As a result, hundreds of claims for the practice, which typically brought in yearly revenues of $1.2 million, were filed with errors, filed with omissions, or simply not filed.
Finally the lead physician began reaching out to revenue cycle management (RCM) companies about taking over claims and billing and addressing its enormous AR backlog. Although each company he spoke with was eager to take over billing going forward, none wanted the daunting task of finding and filing claims that had never been submitted or were submitted with errors/omissions.
Then the physician reached out to PracticeSuite for help, telling CEO Vinod Nair that the situation was dire—the practice had not generated sufficient revenue in many months, and he had already used money from his retirement savings to cover rent and payroll.
By researching, correcting, and re-filing problem claims from the past 11 months, the PracticeSuite team was able to collect $110,000 in 31 days (February 24 to March 31), raising the practice’s income from $25,000 per month to $75,000 per month.
Although not all claims could be resubmitted, PracticeSuite software made it possible for claims experts to examine every claim from April forward (when the system was installed), correct each one based on clinical notes from paper-based patient charts (the practice does not yet have an EMR), and resubmit claims that had not expired. The result was a 30% decrease in aging claims in about a month.
PracticeSuite’s Nair notes that physicians faces a unique predicament.
“For most people, the amount of money they make depends on their competence. For physicians, that’s not the necessarily case. A physician’s income also depends in part on a sometimes low-paid billing staff who may be inexperienced and who’s pay is almost never incented to follow up on claims.”
Nair cites this paradigm as a primary reason physicians chose to outsource their billing or are considering doing so. He explains that Revenue Cycle Management (RCM) companies are only paid on how much revenue they collect for practices, so they are highly incented to submit error-free, 100% complete claims and to follow up on all unpaid claims.
Contracting with the right RCM company can not only significantly reduce practice administrative overhead by +- $44k annual, but also eliminates the hardships associated with finding, hiring, training, and retaining billing staff, which has become especially difficult in areas of the country hit hard by the housing downturn where skilled workers have moved elsewhere to find better jobs.
Additional advantages to outsourcing are that RCM companies provide a billing team rather than a single worker, and 100% coverage via a team of billers means that every claims get submitted on time and worked through completion regardless of vacations or sick time.
Like many physicians, those in the Jacksonville practice had been reluctant to outsource either due to not knowing their options or fear they would lose control of their internal processes and cashflow. But because PracticeSuite is a cloud-based system, every detail regarding billing, revenue, and cashflow can be viewed by any authorized user from anywhere, on any device, putting control back into the hands of the physician or practice manager.
The Jacksonville physicians are understandably relieved to have recovered large amounts of overdue income and are instituting new processes to facilitate collections and prevent future issues.
come to the office for an appointment. Thus, looking a day ahead is essential. As part of the ongoing recovery process, the expert team at PracticeSuite examines the next day’s appointment list for:
- Any outstanding patient balances and
- Rechecking the eligibility and benefits of each patient.
“The expert team at PracticeSuite examines the next day’s appointment list.”
When patients arrive for an appointment, frontoffice staffers know their level of eligibility for the visit or procedure, their co-pay for the visit, any coinsurance, the patient-pay portion of the procedure (if any), and the exact amount of their outstanding account balance. In some cases, patients receive a letter or email prior to their visit stating the amount they need to bring to their next appointment.
The practice also plans to implement PracticeSuite’s EMR, which will allow information from every encounter to flow seamlessly into the billing system, including the clinical notes so critical to proper coding and claims submission.
Most importantly, the practice is back on its feet. Both physicians are determined not to slip back into dangerous AR territory and are welcoming all new processes that help them move toward profitability.