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Leveraging Multiple Tools to Improve the Revenue Cycle

For a long time, the practice I work at – North Platte Nebraska Physician Group – used a clearinghouse that made us feel as if we were sending claims into thin air. Although we were sending claims electronically, we never knew where they were in the processing cycle. Too often, we found ourselves bumped up against timely filing limits that hurt our reimbursement.

So we searched for a new clearinghouse that would provide the tools and the customer service we needed to improve our financial picture. After an in-depth review of our options, we selected an Internet-based organization for its terrific customer service, plain English reporting, and easy ability to view claims all the way through the revenue cycle. This new system has helped cut our timely filing reductions, decrease the number of duplicate claims, and improve our accounts receivable (A/R) tremendously.

In fact, since implementing our new clearinghouse, we’ve reduced our A/R by over 65 days—while adding providers and reallocating three billing FTEs. Here are a few of the ways we’ve leveraged multiple tools and features to increase staff productivity and shrink our days in A/R:

  • Scoreboards: Every morning, the first things our billers check are the scoreboards. They immediately work their claims from these scoreboards, with the additional benefit of electronic EOBs and ERA posting that reduces the amount of document searching we have to do. The scoreboards show where claims are, which ones have been rejected, and which ones are being held up because we need to make edits. We quickly work denials and rejections, usually correcting and resubmitting claims before they ever get to the payer. For example, we had a great success with our ERA processing. Using an ERA denial scoreboard helped us spot rejections and recoup about $40,000!
  • Eligibility: Running batch eligibility verification has had a huge impact on our A/R, plus it saved us a lot of staff time. It tells us right away if a patient has coverage, as well as whether we need to collect co-pays or deductibles upfront. In the past, we waited for a payer response indicating the patient didn’t have coverage, then tried to contact the patient for more information. Now, we usually know a day or two before a patient is seen if we need additional insurance information. That’s been especially useful for Medicare patients; we know whether Medicare is the primary or secondary payer, and can correctly capture co-pays and deductibles at the time of service.
  • Reports: All of the reports necessary to reduce A/R are available for quick access and review. For us, it starts with rejections and denials data that goes beyond just the numbers to help pinpoint where we can make improvements. Our revenue cycle committee heavily relies on these reports, but it’s also helpful for our clinicians. Reports that detail Correct Coding Initiative (CCI) coding edits are wonderful to share with the physicians, for instance, to show them which services are bundled.
  • ERA: We use ERA transmission and posting. Our electronic remits are available a day or two ahead of time, so the minute we get our EFTs we can immediately post those ERAs. This has enhanced workflow and time of posting. We love the fact that when those remits come in, we’re not chasing paper.

Overall, we’ve found the different tools, scoreboards, alerts and customized reports extremely useful. We’ve been able to use them for all sorts of physician and staff training, and our entire group sees the benefit as a result. Whether it’s the front office staff, the back office staff, or anyone in between, they have great tools that help them work together to get clean claims out the door—and revenue back in!

About the Author:

Becky Damoude is the Director of Physician Billing for North Platte Nebraska Physician Group in North Platte, Nebraska.