Background
Dr. J. Smith (name changed), a pain management specialist, reached out to us when he planned to set up his own surgery center. He planned to move his practice from a hospital setting to private practice and ASC. The hospital would co-own the ASC.
His team managed chronic pains via various therapies and procedures (e.g. epidural steroid injections, nerve ablations, spinal medication pumps, etc.). However, the practice often struggled with stable billing processes and EHR.
Summary of Challenges
- The doctor and staff were dissatisfied with the Electronic Health Record (EHR) system used at the hospital. It was complicated and antiquated. The system interrupted the natural workflow of his staff. It was disintegrated and a lot of time was spent in documentation.
- Our client and his team were extremely displeased with the frequent changes in the billing system at the hospital. These frequent changes distracted clinical care.
- The billing company didn’t cover certain protocols and as such compromised collections.
- The practice had to take care of laws concerning narcotics and it was challenging to stay compliant.
These problems caused frustration and instead of a concrete solution, the physicians, nurses, and the administrative staff had to just “deal with it”.
Our Solution
- We developed a seamless, integrated solution of both billing and EHR. Our systems AdvancedMD and enki are both cloud-based, immediately modernizing their systems.
- An expert team worked on the credentialing process and contract negotiations for the doctor to start billing from his new ASC. We shadowed the doctor’s workflow at the hospital to understand his requirements.
- We customized enki EHR to address the doctor’s workflow.
- We created templates to quicken documentation. The drag and drop feature facilitated an even faster capture of medical records.
- We provided on-site training for enki EHR and AdvancedMD practice management system.
- Expert coders looked into the coding process of office visits as well as procedures to ensure accurate reimbursements and compliance.
- Procedures that were not billed earlier in a hospital setup are now being billed with proper billing guidelines. The coding team shares periodical feedback to the practice on the coding guidelines and documentation.
- We set up a thorough pre-authorization process and extended eligibility verification to reduce insurance denials.
- We ensured access to patient records by seamlessly synchronizing and transferring data from the older system.
Outcomes
- Timely billing of charges and reduction in insurance denials helped the physician maintain monthly cash flow.
- With enki EHR in place, our client could focus better on patients and enjoy a better, frustration-free work environment.
- Rapid response from our Tech and services support team made the client feel comfortable throughout the transition. We made it easy.
- With stability in process and technology came a boost in productivity.
- Accounts receivable above 90+ is maintained at 10% (better than industry standards).
- Despite the COVID-19 pandemic, there was a 51% increase in the collections of Q4 2020 (when compared to Q4 2019).
Tackling COVID Together
Just as every other practice in America, our client faced many challenges due to the pandemic. The clinic quickly adapted to telemedicine. Our team provided the required support to the practice to understand the complex guidelines for telemedicine.
We provided timely updates on the changing CMS guidelines, billing and coding changes, and documentation requirements. That helped in the practices embracing telemedicine and switching to virtual visits.
Additionally, we provided timely information about CARES ACT and other regulatory updates. That helped the practice apply and receive funds via the Paycheck Protection Program (PPP) and other programs. It helped in managing cash flow and keeping the business going.