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Boosting the Bottom Line through Transparency and Interoperability

Increase-cash-flowIt’s hard enough to manage the revenue cycle in an OB/GYN practice because of all the unique billing rules and bundled payments associated with maternity care. It’s even harder when the practice doesn’t have full transparency into its claims rejections or hospital admissions for its patients.

Doctors May Grant Associates is a 33-provider, six-location OB/GYN practice based in Lancaster, Pa., that needed full revenue cycle transparency and interoperability with Lancaster General Hospital.

The practice serves nearly 25,000 individuals annually and generates 350 to 500 claims daily. Although it had an electronic health record (EHR) and practice management (PM) system, for years the group didn’t have interoperability that allowed it to manage real-time information for patients being treated at the hospital. Imagine having to rely on notes jotted on pieces of paper—or even napkins from the hospital cafeteria!

Plus, its clearinghouse didn’t offer online claims management functionality. Every day, staff had to print stacks of reports to determine which claims were rejected and then work those claims manually.

That’s why, in July 2010, the practice implemented a new clearinghouse solution that not only eliminated time-consuming manual processes, but fostered interoperability between its in-house IT systems and those at Lancaster General. The practice can now manage the entire charge process electronically and get an up-to-date snapshot of its patient population at any given time.

The harmony between the practice’s Navicure clearinghouse solution, its EHR and the hospital information system not only gives the practice a much better handle on hospital charges, but it also improves workflow and enhances claims management. As a result, the practice has experienced substantial bottom-line benefits that include a 22 percent reduction in days in A/R, a 50 percent decrease in claims rejections, an 11 percent improvement in its first-past clean-claim rate, and a 48 percent decrease in the time it takes to receive claim payments.

The entire staff at Doctors May Grant works hard to ensure a healthy revenue cycle. Through partnership with its clearinghouse, the practice has gained the interoperability, transparency and efficiencies needed to realize measurable financial results in just a few short years.