One of the avoidable missteps often made when a practice implements a new electronic health record (EHR) is failing to train staff adequately. Tom Giannulli, CMI officer for Kareo, told Physicians Practice it’s not wise to try to learn a new system and see patients at the same time, going so far as to suggest doing so will ultimately “waste time and increase frustration.” Many industry experts agree with Giannulli. Most warn medical practices who don’t take the time to initiate a full-scale training program on the new technology, they can expect productivity and accuracy to suffer, at least in the short term. Of course, few practices can financially afford to shutter their office for a week of intensive training. Their patients may experience unnecessary stress and cash flow will be interrupted. For some independent physicians it boils down to a “pay now or pay later” decision.
Another area where inadequate training can dramatically impact patient experiences and financial viability is in-house billing and collections processes. While, every practice administrator will ultimately make the decision whether to close the office for practice-wide, intensive EHR training or try to stage training, revamping billing and coding protocol is something every practice, whether paper-based or digital, can, and should, do to improve revenue capture and boost patient satisfaction levels.
Seven Strategies to Revamp Billing, Coding & Collections Protocol
Create a training chart to monitor who has completed training, and who needs additional training to develop competencies on technology and office policy.
Make sure staff are cross-trained in all departmental tasks. This step not only ensures the office functions at peak performance even when key employees are absent, it adds a level of transparency and accuracy that improves patient experiences and employee confidence.
Train all patient-facing staff how to discuss finances and collection policies in role-appropriate ways. This may involve knowing how to access patient accounts to view self-pay requirements, insurance eligibility and balances or simply knowing which staff worker to refer the patient to for a personal consultation. The key is to never miss an opportunity to capture payment on services as early as possible.
Implement an electronic prior authorization (EPA) protocol to reduce labor costs and save time. If you aren’t familiar with EPA, talk to your EHR vendor about steps to integrate EPA into the EHR.
Use coding support tools within the practice EHR to identify appropriate codes with higher reimbursement rates and review patient files for under-billed or “never-billed” services and products.
Benchmark practice KPIs against peers and similar practices in your region. Knowing how your “competition” manages patient flow, A/R balances and collections will give you an idea of which areas need improvement in your practice.
Take a tip from medical consultant, Mary Pat Whaley. Use denials to improve revenue capture. Office protocol must include a comprehensive review of every denial. Learn from coding errors and claims rejected because supporting documentation was not sent with the submission. Discussing reasons a claim is reduced or rejected at weekly meetings will help ensure future claims are processed correctly.
Ensure patient contact information and insurance coverage is verified at every interaction. People change jobs, addresses and phone numbers more often than many practice managers realize.
Major Problems Require Major Changes
Sometimes, it takes a large-scale change to achieve large-scale results. When staff resources are limited or practice managers cannot find time to conduct a comprehensive revenue cycle audit, hiring professionals to assist may be the fastest way to get measurable results. Hiring a professional process management firm to review processes and policies is one option that won’t disrupt normal operations. Outsourcing billing, coding and collections to a qualified vendor will eliminate many of the burdens associated with scrubbing claims, customer service duties, and denial follow-ups.
Providing adequate training is an essential first step in moving a medical practice toward higher profit margins. Properly trained employees help patients understand their financial responsibilities and they know how to process point-of-care charges accurately and efficiently. Patients benefit, employees are more confident and happy performing their roles and practices enjoy a healthy revenue stream.