The healthcare industry is certainly a unique blend of profit driven organizations intermingled with government services and controls. With the current political environment, state of the economy and major changes in the medical system in process, it is important for both profit-driven and non-profit medical organizations to streamline operations to control costs and minimize denials while participating in coordination of care. The ultimate goal is to achieve a “targeted bottom line”.
Avoid Duplication and Follow Guidelines
Primary care physicians take on the additional responsibility of directing and coordinating a patient’s care with a host of specialty practice physicians from cardiologists to orthopedists to urologists. When so many physicians are involved in a patient’s well being it is important for the ‘hub’, or primary care physician, to be aware of the treatment that the patient is receiving elsewhere and not duplicate the services being rendered. This will also help to prevent time consuming claim denials.
Both Medicare and private insurance groups have guidelines in place that limit payment for duplicated services in a fixed time period. Whether it is a certain laboratory test, imaging exam, or office procedure, the primary care physician will not be reimbursed for the cost of delivering care if that procedure is duplicated, even if the services are properly billed with all the correct billing codes.
Leveraging EMR/EHR and Revenue Cycle Management (RCM) Services
Incorporating Electronic Medical Records (EMR) and Electronic Health Records (EHR) into this process can be an important consideration to controlling operational costs. Not only does EMR/EHR reduce paper, errors, overhead, storage and office supplies, but EMR/EHR also improves efficiency by sharing information as reports can be scanned or electronically imported directly into a patient’s record reducing the time to search for a chart and file paper reports. Records never go missing or end up on a different desk awaiting insurance approval for a procedure, waiting for a test result or waiting for the physician to sign off on a report.
While EMR/EHR systems relieve the burden of controlling charts and keep health records at the employee’s fingertips, it is also important to utilize healthcare automation technologies within the billing process to improve coordination of care. When generating claims to payers that are substantiated by EMR/EHR, the reconciliation process becomes more streamlined and reduces denials, particularly important as Medicare and private insurance billing regulations evolve. This reduces claims that require recoding and resubmissions of various procedures. This not only benefits the provider, but also can reduce the cost to insurance companies to process these claims.
Utilizing a medical lockbox service can also consolidate the process further. Providers can have all claims, payments and denials sent to the lockbox to be scanned and entered into a central electronic location reducing the time and staff needed to process a claim and allow for greater ease in denial management and reporting.
Coordination of care and proper implementation of a wide range of technologies including EMR/EHR, billing systems and RCM solutions are key in keeping today’s medical practices here for tomorrow and profitable. They reduce cost, increase profit margin and ensure the patient is getting the care they need and deserve.