Regardless of how big or how small a medical group practice is, most of them share two common challenges: a need for improved billing management and integration of healthcare technology. Without an efficient billing set-up or current technological system in place, revenue opportunities and communication among colleagues, staff, patients and insurance providers can be a struggle.

According to The New England Journal of Medicine, nearly 31 cents of every U.S. healthcare dollar goes toward administrative and other similar costs. Considering the impact of that expense combined with typical medical practice obstacles involving improper coding, insurance verification, claim re-submittal and patient follow-up, the opportunity for lost earnings increases exponentially.

With the American Recovery and Reinvestment Act of 2009 (ARRA) in full-swing, incentive strategies have been established for hospitals and physicians that become compliant with healthcare information technology, namely Electronic Health Records (EHR). Not only will medical groups monetarily benefit from adopting “certified” technology, meaning that which shows ongoing, “meaningful use,” but they will also create an environment that yields favorable, cost-saving results and efficiency of daily operations.

Technology: Electronic Health Records

EHRs are currently used by only 12% of physicians and 11% of hospitals nationwide (Hagen, 2008). Despite the low adoption of EHR, the federal government is continuing to promote and push a universal nationwide implementation within five years. This initiative is based on the benefits that technology offers such as: reducing paper, creating an accessible information portal that enables physicians to coordinate care, use clinical research to devise the best treatments, encourage prevention and better manage chronic conditions (Deelsnyder, 2009).

Demonstrating how cost-effective healthcare technology can be is imperative for individual and group practices to realize in an effort to increase the current system adoption rate. An example of the savings gained by eliminating manual administrative processes can be seen in the state of Missouri. Missouri was able to reduce the costs of its Medicaid program by more than $117 million a year, while simultaneously improving patient care (Deelsnyder, 2009). Transferring this example to a private practice level can yield comparable results and savings.

To better understand why healthcare technology adoption is so low, Gans et al. (2005) surveyed experts at nearly 3000 group practices from coast to coast. Interestingly, findings revealed that the top two reasons cited for lack of implementation were lack of support from physicians and usability issues.

Gaining concurrence from all physician partners when selecting a healthcare technology system presents its own set of challenges. Comparing installation fees and set-up costs to how missed earnings can be tracked and received is not a tangible concept and it requires a balance of trust and risk depending upon the system selected. Not all technology is created equal. Choosing carefully will eliminate future frustrations and produce favorable outcomes. All changes, especially those involving technology, come with growing pains as processes change, systems evolve and the learning curve is conquered.

Examine the company behind the technology and consider the reputation, level of experience, testimonials of clients and overall ability to provide support and effective communication before deciding on whom and how the technology will be incorporated into the medical practice.

Research of healthcare information technology reveals that the Certification Committee for Health Information Technology (CCHIT), specifically states in its Certification Handbook (CCHIT, 2008) that “our criteria do not assess product usability.” This is important to note because usability issues were cited as a top reason for low adoption of EHRs by physicians.

According to the National Institute of Standards and Technology (NIST, 2007), usability is defined as follows:

Usability is the effectiveness, efficiency, and satisfaction with which the intended users can achieve their tasks in the intended context of product use.

Keeping this definition in mind, effectiveness can be seen as the percentage of users who can complete a task, efficiency can measured by the amount of time required to complete a task, and satisfaction is subjective, i.e., based on the user’s personal experience.

To better illustrate effective use of technology in regards to a patient, take a look at Margaret. Margaret is a diabetic on Medicaid. She feels ill, visits a doctor and is asked to fill out a form, recount her medical history and provide dosage details on her current prescription drugs – the accuracy of which is only as strong as Margaret’s memory. Because this patient is a diabetic, the doctor automatically orders a blood glucose test, which diabetics need every six months. Unless Margaret has regularly seen the same doctor, he has no way of knowing that Margaret had that test four months ago. He makes a diagnosis based on what he sees in the office and on that test (ACS, 2009). 

If the medical group had the technology available, they would have been able to access Margaret’s medical history, clinical lab results, the dates of the blood glucose tests and all the data needed to recommend appropriate action and course of treatment. “The physician is empowered to make more informed medical judgments; the payer is no longer burdened with the costs of redundant tests; and the patient gets the right treatment more quickly (Schumacher, 2009).”

Billing Management Solutions

If physicians are the engine of a medical practice then the billing department is the fuel. Keeping in sync with this analogy, the engine needs fuel to run and without a properly trained, educated and efficient team it will fail. According to healthcare industry insiders, about 20% of all invoices submitted from physician offices go unpaid (Taylor, 2009). This would be similar to someone working 40-hours per week and only getting paid for 32 of those hours. An entire day’s wages has been lost, not to mention the manpower that has not received proper compensation.

Utilizing a billing management service assists in reducing staffing needs, improves compliance and increases revenue for the medical practice. Even more importantly, a billing management service allows physicians to focus on patient care instead of accounting and administrative tasks.

Medical billing is a competitive industry and without a discerning eye, companies begin to look the same. Knowing what strengths to look for and what questions to ask a potential billing vendor can eliminate irritation, as well as provide commendable results and an outstanding vendor/client partnership.

Industry veterans suggest looking for the following qualities when choosing your billing services provider:

Experience. Absolutely, the most important metric to consider is experience. A vast majority of medical billing vendors are mom-and-pop-shops and fly-by-night set-ups that open and close without notice or regard for the clients they’ve contracted. A vendor with strong community ties, cumulative expertise in the field and satisfied client references offers the most promise for the success of a practice.

Technology. The billing company should have current technology that is able to handle up to 100 carrier payment schedules per client, data transfer capabilities and remote access to accounts and reports, does not use proprietary software, and be proficient in electronic claim submission.

Staffing. A dedicated account representative assigned to each client is a must-have to insure consistent communication, accuracy of patient demographics and regular updates and progress reports. Furthermore, a low employee turnover and little to no reliance on subcontractors will make a major difference for both doctors and patients.

Protocols. Having the knowledge and understanding to change CPT and ICD-9-CM codes when a claims data error occurs; employ certified coders for reviewing denials, downcoding and articulately launching appeals; clear defined policies to follow-up on unpaid, underpaid and rejected claims; assertiveness on correct form submission; and working the phones to get checks sent out to clients (Zupko, 2009).

Conclusion

DoctorsXL recognizes that no two medical groups are the same and for this reason, it is able to present services on an as needed basis to its clients. The components offered are: billing management services, technology (EMR and mobile charge capturing), practice management, clinical research, and consulting. Whether there are 12 doctors or one doctor, clients are able to pick-and-choose services from our product line-up that best fit their needs. The benefit of this is that DoctorsXL is not a one-trick-pony: we’re truly able to customize solutions for individual medical practices.

Based on the client’s needs, DoctorsXL is able to meet with physicians and staff on-site and conduct an assessment to analyze the practice’s strengths and weaknesses. Upon conclusion, findings are presented and solutions and suggestions are offered that will assist the practice in maximizing their profitability and streamlining of their daily operations. DoctorsXL becomes a resource for the practice and works to maximize the practice’s profitability, growth and overall earnings potential.

Security Every part of the DoctorsXL system and technology utilizes the highest security protocols and is 100 percent HIPAA (Health Insurance Portability and Accountability Act) compliant. Our Chief Technology Officer ensures that the online system is updated routinely to keep up with HIPAA changes and policies that take the worry away from clients. DoctorsXL uses the same state-of-the-art security technology used when consumers go shopping, conduct banking or trade stocks online.

Reports Clients have the ability to access their data in detailed reports that highlight a wide range of accounting functions to determine payables, receivables and totals. Data is electronically archived and available for easy reference and download with the click of a mouse. Unlimited scalability, a wide range of customization choices and a large selection of useful features allows clients to dictate what and how they want their information.

Training Staff and physicians can be trained on-site or remotely so that all personnel are educated on system functions, accessibility options and usability of hardware. Our training enables clients to roll-out procedures and teach processes to their new employees themselves. This approach is effective for medical practices that are in a growth mode and acquiring new staff.

The combined medical and healthcare experience of the DoctorsXL team is more than 100 years. This level of expertise and understanding brings an exceptional level of professionalism and industry insight to medical practices and their teams.

DoctorsXL is not a medical billing company—we are a revolutionary group of dedicated people that are committed to the business goals and endeavors of our clients, as well as the needs of the patients that they see.

For more information or to schedule an assessment with DoctorsXL, please contact Lori LeBlanc at (775) 784-3325.

References

Certification Commission for Healthcare Information Technology. (2008).

Certification Handbook. CCHIT Certified® 08 Programs. Retrieved November 10, 2008, from http://www.cchit.org/files/certification/08/Forms/CCHITCertified08Handbook.pdf

Deelsnyder, C. (2009).

Electronic Health Records and Health Information Exchange. Retrieved June 12, 2009, from http://www.acs-inc.com/assets/0/24/820/830/fcf6fe71-6f05-4acc-8c72-56dda18d75fa.pdf

Gans, D., Kralewski, J., Hammons, T., & Dowd, B. (September/October 2005).

Medical groups’ adoption of electronic health records and information systems. Health Affairs, 24(5), 1323-1333. Retrieved November 17, 2008, from http://content.healthaffairs.org/cgi/content/full/24/5/1323

Hagen, S. (2008). Estimating the Effects of Health IT on Health Care Costs

(Congressional Budget Office). Retrieved January 30, 2009, from http://www.himss.org/advocacy/d/2008PublicPolicyForumHandouts/StuartHagen.pdf

National Institute of Standards and Technology-NIST (2007).

Common industry specification for usability – requirements NISTIR 7432. Retrieved from http://zing.ncsi.nist.gov/iusr/documents/CISU-R-IR7432.pdf

Schumacher, R. (2009).

How to Select an Electronic Health Record System that Healthcare Professionals can Use. Retrieved June 12, 2009, from http://www.usercentric.com/publications/2009/02/05/how-select-electronic-health-record-system-healthcare-professionals-can-use.pdf

Taylor, J. (2009).

Medical Billing Services to Increase Practice Cash Flow. Retrieved June 17, 2009, from http://www.manta.com/coms2/page_VS_medical_billing

Zupko, K. (May 2009).

Outsourcing Your Billing. Physicians Practice, 16. Retrieved June 17, 2009 from, www.physicianspractice.com