'Revenue cycle management' firms can clean up your claims-and your office processes-to speed up reimbursement.
Practice administrator Shari Reynolds knew that the group's obsolete billing system was a prime reason for this disaster. But the vendor wanted $68,000 for a "mandatory upgrade" of its Medical Manager system to meet Medicare and HIPAA standards.
"We couldn't afford that," says Reynolds. "But we were spiraling into a hole."
Within weeks of installing athenaNet, Paluxy Valley's denials plummeted. Three months later, almost 80 percent of the $771,000 in backlogged A/R had been collected. Three years later, denials run around 6 percent, and A/R days have dropped to 25.
Reynolds gives athenahealth's claims specialists much of the credit. The firm constantly updates its database of claims-filing rules from Medicare, Medicaid, and the private payers billed by its 9,000 physician clients in 33 states. In all, this "payer rules engine" incorporates about 40 million rules and permutations.
"We're a small rural practice, and we don't have the resources to go to seminars to keep up with all the rule changes," Reynolds says. "With athenahealth, we don't have to. They keep the rules up to date, so more of our claims are filed right the first time."
Athenahealth is one of an emerging breed of companies offering online access to revenue cycle management services. These firms' functions range from online eligibility and benefits verification to complete practice management outsourcing. But access to high-powered claims scrubbers is a top draw.
If you're having trouble getting paid on a timely basis, and you don't want to spend big bucks on a new practice management system, it might make sense to try one of these companies. Here's what you need to know.
Small practices can get large group capability
Revenue cycle management services give even solo doctors access to the claims editing and filing skills previously available only to large groups with in-house coding and IT experts. Indeed, the central rules databases these firms maintain are more comprehensive than those of big medical groups. That's because the revenue cycle management firms track claims filed by thousands of doctors to hundreds of payers all over the country, notes Patrick Hampson, CEO and chairman of MED3000, a management services and technology company in Pittsburgh, PA. Besides managing large IPAs, MED3000 also supplies web-based practice management software, claims scrubbing, and other technology services to about 2,500 doctors outside of those organizations.