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The term “administrative efficiency” has been popping up everywhere in the healthcare industry lately.  Most provider organizations, from the solo-physician practice to the large health system, should know that they need to make strides to achieve administrative efficiency.  However, how can you measure efficiency to tell if you’ve achieved it, or if your administration is still inefficient?

Faced with these questions, Judy Downing, the Billing Manager at Holly Springs Pediatrics, decided to quantify inefficiency in her practice by identifying her greatest pain points during the billing process.  Here were her signs that she was billing inefficiently, and the changes she made to improve administrative efficiency.

Sign: No Eligibility Verification

The only method Holly Springs had to verify patient eligibility benefits was to manually call payers over the phone, which the staff simply did not have time to do prior to patient visits.  As a result, the practice received a lot of rejected claims and spent a long time correcting and resubmitting claims.

Change: Holly Springs adopted an integrated tool to verify all patient eligibility in batch prior to the patient visits or in real-time during the visits.  This gave the staff more accurate information when creating claims, significantly reducing the number of rejected claims to reprocess.

Sign: Hours Spent on Claims Submission

To submit claims, the practice first had to manually create the claim files, a slow process taking staff up to two hours each day.  When claim responses came back, the practice then had to manually review each of the denied claims and then resubmit them to the clearinghouse one-by-one, on paper.

Change: Holly Springs began using a cloud-based claims tool that detects errors prior to claim submission.  With claims data hosted in a secure, private cloud, practice staff can access reports on the real-time status of claims to easily identify the errors in rejected claims and resubmit claims much more quickly.

Sign: Manual Payment Posting and Reconciliation

To process the remittances on approved claims, Holly Springs had to pull each remittance from the batch of claim responses received from its clearinghouse, and manually post them individually to its practice management system.  Then, staff would have to manually reconcile the payments with the remittances.  This was error-prone and took hours of administrative work to complete.

Change: With a clearinghouse that integrated with its practice management system, all payer payments automatically post directly into its system to make the reconciliation process simple and error-free.  This has improved accuracy and significantly saved the staff time on payer payments processing.

Sign: Mailing Multiple Patient Statements

Once the practice received remittances and could bill patients for the remaining amount owed, the staff used a cumbersome, time-consuming process to create the statement files for its print vendor to mail to patients. However, Holly Springs was unable to confirm that the statements had been mailed to the correct addresses, and patients frequently were unaware that a balance was due. As a result, the practice incurred additional costs from sending multiple statements to patients in addition to spending extra time researching past due balances when patients returned months later for another visit.

Change: Using an integrated patient statements tool, Holly Springs now prints statements from files generated automatically by its practice management system.  Now, as soon as patient statements are mailed, the practice receives an email notification to confirm that they have been sent to the correct address.  And with a more efficient claims and remittance process, the practice is billing patients sooner, therefore cutting down the amount of time before it gets paid.

Efficiency Pays Off!

By tackling its key pain points in the billing cycle, Holly Springs has significantly reduced claim denials, saved 60 hours of administrative work per week and is receiving patient payments two to three times faster.

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