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.”

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With reimbursements declining and costs increasing, managing your practice’s revenue cycle has never been more challenging or important. Over the last few years, practices have realized that they cannot afford to ignore the state of the economy or the pressures being placed on profits. Although the economy is showing signs of recovery, there are still other challenges that will impact revenue in the near future, including proposed Medicare cuts, the transition to ICD-10 and increased patient responsibility.

Adding to these trends is the pressure of implementing or upgrading an electronic health record (EHR) in order to achieve the government’s new requirements for ‘meaningful use.’ In the face of these pressures, now is an opportune time to re-examine your practice’s operational processes, especially your revenue cycle. You just may find that reengineering the revenue cycle will be the key to surviving – and thriving – in these turbulent times.

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After much anticipation and preparation, another annual HIMSS conference is now a mere memory. But last week’s gathering at the Orange County Convention Center in Orlando, Fla., clearly engaged a diverse cross-section of the healthcare industry. This year, three themes really took center stage among those I spoke with: accountable care organizations (ACOs), 5010/ICD-10 and social media. Each of those issues, if you think about it, plays a distinctive role in reaching “meaningful use” goals.

It’s hard to believe the difference just a year can make in regard to “meaningful use.” It was certainly the hot topic at last year’s HIMSS conference in Atlanta. Since at the time little was set in stone about the regulations, there was a lot of talk and little action. Healthcare organizations were biding their time, hesitant to purchase IT systems before knowing the exact “meaningful use” requirements.

This year, by contrast, people were actively shopping for those systems. In fact, I saw a few EHR vendors actually taking contracts on the exhibit hall floor! The writing is on the wall; clearly, the industry is beginning to move past the theory behind “meaningful use” and toward the practical applications to support it.

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Ask practices why they use a clearinghouse solution and they typically say something like, “We wanted to improve our billing efficiency.” Reaching maximum efficiency, however, requires using every tool at your disposal. Here are just a few of the time-saving tools offered by some clearinghouses to help increase your efficiency. Make sure you check with your clearinghouse to see which are available, and then make sure that you take full advantage of them:

Duplicate Claim Edit. This type of functionality allows you to work rejections faster and catch duplicate claims before they get to the payer. It usually works by comparing the current inbound file to previously sent claims. If you submit a claim that matches data provided previously, the claim will reject. In most systems the claim should not reject if the original is a non-active claim (i.e. deleted, cancelled, rejected, or filing complete). An optimal system will allow you to either “bypass” and resubmit the claim or cancel the submission.

Auto Cancel. Similar to Duplicate Claim Edit is Auto Cancel; you typically activate one of these functionalities or the other. Auto Cancel helps maintain workflow by preventing the need to manually cancel claims. With Auto Cancel, the rejected claim is automatically cancelled and the new inbound claim becomes the active claim. Practices that re-bill from their software may find Auto Cancel particularly useful. Read More ›

The prospect of obtaining stimulus funding has, not surprisingly, created an environment of intense focus on Electronic Health Records (EHRs). While that’s OK, I see a distinct limitation in looking at EHRs, practice management systems (PMS) and other applications as isolated pieces of hardware/software. Instead, I think the current atmosphere provides many practices the opportunity to step into completely new systems, with a completely new way of viewing the components.

Rather than contemplating an EHR purchase or PMS evaluation in the context of “what’s available,” consider how well these technologies will serve as your platform from which to custom-build, taking into account future needs as well as current ones. Read More ›

We now have our first look at the official shape “meaningful use” of electronic health record (EHR) technology will likely take – in the near future, at least. As many had anticipated, one of the principal underlying themes is interoperability.

The long-anticipated proposed rule defining meaningful use finally was released by the Centers for Medicare and Medicaid Services (CMS) on Dec. 30. On the same day, we also received the interim final rule setting initial EHR technology standards, implementation specifications and certification criteria from the Office of the National Coordinator for Health Information Technology (ONC).

You can view both rules in the Jan. 13, 2010, Federal Register at http://www.access.gpo.gov/su_docs/fedreg/a100113c.html. Read More ›