Medical practices are often ill equipped to handle the mounds of paperwork and maze of bureaucracy required to receive full compensation from health insurance companies. As this process becomes more complex, physicians are finding it increasingly difficult to run a healthy practice.
One 10-physician group, South Florida Radiation Oncology (SFRO), found their complicated practice management needs were compounded by a merger, which grew the practice to 40 physicians. The group turned to an integrated system combining data, billing, and analytics. “This has given us the ability to scale quickly,” said Ravi Patel, SFRO managing director who is working with CareCloud, a Scottsdale, Az., cloud-based HIT (Health Information Technology) solution.
The right physician billing solution can help reduce costs and make operations run smoother and faster. At the same time, that help improve revenue, especially because more claims are being processed and less are rejected. But even more importantly, it allows doctors to focus on the delivery of healthcare without getting tangled up in compliance and regulatory processes. “A small practice needs a billing system that is independent of the physicians office staff, ensuring all claims go out without interruption and keeps up with the latest technology,” said Ronald R McLaughlin of RMK, a Chicago-based medical billing company.
Medical offices have gone from time-consuming manual entry to a confusing array of computerized capabilities, available from more than 300 vendors in the U.S. who peddle practice management systems. These systems have billing and collections-related capabilities, including electronic eligibility checking, advanced claims editing, automated payment posting, configurable reporting, and specialized Medicaid claims handling.
With on-site client/server systems, subscriptions to a Web-based system hosted by a third party, or a combination of the two, the software offerings also have services ranging from fully outsourced insurance billing to appointment scheduling. So, how to choose? “Small practices should look to new technologies that will help them scale and allow them to expand without the standard IT growing pains,” said Shelby Hollister, a spokesperson for CareCloud.
Some other considerations include:
* Will the system adopt to the idiosyncratic billing and reporting needs of your office without significant customization?
* If it’s a Web-based system, or cloud, this is a way to offload technology support and outsource the management of the revenue cycle. But what if the software or vendor changes or even becomes unavailable?
* If an EHR implementation is imminent or ongoing, how can the billing and management system smoothly integrate? “Avoid proprietary platforms with no EMR/EHR integration,” said Michael Sanderson, president of RemitDATA, an expert in reimbursement, utilization data and comparative analytics.
* How will upcoming developments in the healthcare system affect your system, including Medicare payment incentives for e-prescribing, the growth of high-deductible insurance plans, the advent of the “medical home” concept in primary care, and the proposed transition from ICD-9-CM to ICD-10 billing codes?
“Physician billing systems have become more advanced, as they boast improved claim scrubbing, heightened electronic payer connectivity, added capabilities to link to EMR systems, and enhanced reporting on common business reports,” said Sanderson of RemitDATA.
What does the future hold? Look for Software-as-a-Service, web-based systems designed for a specialty that can benefit smaller practices and the increased use of tablets for easier and more accurate physician coding. “Practices can also benefit from a billing system that enables comparative analytics, which means data can be extracted to benchmark performance against peers by specialty and region,” said Sanderon. “When juxtaposing performance against that of peers, it is easy to spot inequalities in coding denials and reimbursements.”
Cindy Atoji is a Boston-based journalist who specializes in technology, business, and healthcare news coverage. A former Boston Herald editor, Cindy blogs for the Globe and BodiMojo.com, and writes for various national publications. Visit her Website at www.CindyAtoji.com.