Customer service is a big deal for ACT Health Management Services. We pride ourselves on offering quality client service to the 65-70 providers that make up ACT Medical Group of Wilmington, N.C. We expect the same dedication to service from our vendors, but unfortunately we haven’t always received it. In fact, lack of good customer support was one reason we left our former clearinghouse. We wanted a system with more robust and better functionality, as well as a business partner that would take our unique challenges as seriously as we do.
In 2010 we decided to go live with a new clearinghouse at the same time that we adopted an electronic health record (EHR). With two implementations going simultaneously, we discovered firsthand just how valuable a teamwork approach can be. When the inevitable snags delayed parts of our EHR installation, for instance, we ended up going live with our clearinghouse’s Electronic Remittance Advice (ERA) feature before we had any place to store the data. The situation could have been a nightmare, but it wasn’t. Our clearinghouse was supportive throughout the process, helping us develop the necessary “workarounds.”
It also helped us restructure the way our providers were set up on the system for greater efficiency. You see, our providers include physicians, mid-levels and clinical social workers who work primarily in non-office settings (assisted-living centers, skilled nursing homes, and other long-term care facilities). They deliver primary care, psychiatry and psychotherapy services. Most of our patients are elderly, and many have little or no family nearby.
All of these factors create rather unique operational issues. Clinically, it’s difficult for providers to gain a complete picture of their patients. Financially, we’re always working in the rear on our billing. That’s why it’s been so important to receive on-the-spot rejections from our new clearinghouse. We now re-work and re-submit rejected claims promptly, rather than waiting weeks to receive a denial from the payer before re-submitting.
Here’s an example: Too often our providers will list a code that can only be used as a secondary “manifestation” code as the primary diagnosis. Such incorrect coding now is stopped immediately, before reaching the payer. This enables a quick clean claims turnaround that has become a tremendous asset, keeping our accounts receivable from getting too old.
When implementing a clearinghouse—or any revenue cycle management system, for that matter—make sure you involve your entire team. Not just your managers and vendor support staff, but your compliance, billing and coding staff as well. Encourage support from all sides. Bringing all perspectives together gives you a better “big picture” view. Not only do you understand how data is captured, but you begin to see how it should be captured to gain greater efficiency for your practice.
About the Author:
Cheryl Macias, CPC is the compliance specialist at ACT Health Management Services.