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Austintown Pediatrics, a solo pediatrics practice in Austintown, Ohio, has achieved Payment Assurance Level One, reducing its patient bad debt by 50% and cutting payment processing time by 50%.

Here’s Austintown Pediatrics’ story:

The Issues Behind the Business Problems

Lack of Vendor Integration
Austintown Pediatrics leveraged a third-party billing company to manage payer and patient payments; however, the lack of integration with its practice management system led to inefficient processes, reconciliation difficulties and increased patient bad debt.

Lack of Claims and Payment Visibility
Without integration, the monthly reports Austintown Pediatrics received did not offer enough visibility into the status of the claims and resulting payer payments. Reconciliation between the reports from the billing company and the practice’s practice management system was difficult, requiring time-consuming, manual work.

No Eligibility Verification
A major challenge in the patient payment process, the practice did not verify patient eligibility ahead of time. Instead, practice staff would photocopy the patient’s insurance card and send it to the billing company with the claim information. If a patient had incorrect insurance coverage, the issue was identified long after the patient visit, and the billing company would have to follow up with the patient to acquire accurate coverage information, further delaying payment.

Insufficient Patient Payment Tools
After the billing company received paper remittances from the payers, it would send statements to the patients to collect the patient responsibility. Unfortunately, as Austintown had little knowledge of the details of the entire patient payment process, the practice noticed an increase in the amount that went uncollected. On average, the practice wrote off one-third of the amount billed to patients as bad debt, and the staff could not easily reconcile the amount collected with the amount billed. Additionally, Austintown Pediatrics could only accept cash or checks, complicating the process to accept payments.

The Solution

Integrated Healthcare Payments
Austintown Pediatrics chose a practice management system that offered integrated solutions for claims management and patient payments. With these solutions, Austintown Pediatrics has seen fewer rejections, improved administrative efficiency and accelerated patient and payer payments.

Eligibility Verification to Improve Accuracy
Today, the practice verifies all patient coverage in batch prior to scheduled visits or in real-time when the patient is in the office, which reduces errors.

Simple Claims Management
Following the patient visit, the with integrated claims management, practice staff can create claim files, identify errors prior to submission and submit claims to payers directly through the practice management system.

Automated Reconciliation with ERAs
Once the claims are adjudicated and the practice has received the payer payments, the electronic remittance advice (ERA) posts automatically into the practice management system, eliminating any manual work to reconcile payments.

Patient Payments Made Easy
After receiving the ERAs and billing the patients, Austintown Pediatrics accepts patient payments directly into its practice management system, automatically reconciling payments received to accounts receivable. In addition, the practice can accept payments via credit/debit cards, checks and cash while the patient is in the office, over the phone or by mail. With posting directly into its practice management system, the practice has complete visibility into all payment information, allowing staff to follow through with patients and collect more payments. Furthermore, Austintown Pediatrics now has the capacity to work with patients to set up alternative payment schedules, which helps to increase patient payments.

Full Access, Anytime
Throughout the healthcare payments process, practice staff can access all information related to claims and payments in real-time by quickly pulling up customized reports.

Powerful Results
By using integrated healthcare and payment solutions with its practice management system to manage the claims and payment processes in-house, Austintown Pediatrics saw significant financial improvement within six months. With more control over these processes, the practice has reduced operational costs and payment processing time by 50 percent, allowing the practice to grow in size without hiring more administrative staff. Finally, with more efficient and accurate claims management, payment processing and reconciliation, Austintown Pediatrics has cut patient bad debt in half.

Click here to download the Austintown Pediatrics case study.

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