Case 2: No Time for Oversight of Billing Practices |
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Dr. Josie Sinclair
Specialty: Gastroenterology
Problems:
Low reimbursement rate
No time for oversight of billing practices |
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Dr. Sinclair finished a gastroenterology fellowship
4 years ago, and established a practice shortly afterwards,
in a small city with a population of approximately
52,000. Being the only gastroenterologist in town,
her practice blossomed. A busy practice, combined
with her academic commitments, left her little time
for oversight of her billing practices. The staff
turnover was relatively high, and reliable personnel
were difficult to find. This left her income vulnerable
to a frequently changing staff, with differing levels
of billing expertise in her office. Attempts were
made to improve reimbursement by purchasing practice
management and billing software, and increasing staffing
levels to assist with data entry, EOB reviews and
phone calls to insurance companies for eligibility
and denial resolution. However, despite the increased
staffing and spending $4,800 in updated software,
the reimbursements never rose above 82%.
These deficiencies were primarily attributable to
lack of employee oversight, combined with a high employee
turnover. Dr. Sinclair’s income fluctuated significantly
with employee changes, and there was a significant
backlog of uncollected bills. The employees would
work from 8 am to 4 pm, and when 4 pm came, everyone
went home, regardless of the number of pending denials
left to be addressed the next day. This led to persistently
pending claims and denials, which were left to expire
un-addressed, leading to low rates of reimbursements.
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Current Practice Analysis:
Reimbursement
Rate by Year |
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The improvement of the reimbursement rate up to 82
percent in 2003 correlated with the purchase of the
practice management and medical billing software.
However, as the practice became busier, and the oversight
decreased, the decline in reimbursement rate was again
apparent in 2004.
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Start Script Intervention:
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Practice
analysis performed, which identified problems,
determined deficiencies and established a
recovery plan.
Backlogged claims processed
Staff training was trained, re-oriented,
and relieved of billing responsibilities.
Using the existing software, all subsequent
billing functions were taken over, including
claims submissions,
EOB analysis, updating patient data, patient
eligibility verification, denial analysis
and resubmissions,
post-payment submissions to secondary insurance,
and telephone contact with insurance
companies whenever necessary.
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Result:
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| Improvement of reimbursement
rate to: 98.9 %. |
| Amount billed: $435,800 |
| Amount collected:
$431,006 |
| New overhead expenses:
$148,960 |
Change in overhead
expenses +$12,420
(Including Start Script charges and reductions
in staffing expenses) |
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| Previous “take-home”
pre-tax income: $207,742 |
| New “take-home” pre-tax
income: $282,046 |
| Increase in personal
income: $73,304 |
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Benefits:
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Dr. Sinclair’s personal
income rose by $73,304, which amounts
to an increase of 36 percent.
The need for oversight was reduced significantly,
and Dr. Sinclair could use the little
time to oversee clinical matters in her
office, rather than billing.
The fluctuations associated with frequent
employee turnover were eliminated, as
was the cost of training new employees
in medical billing practices. Additionally,
the reimbursements were no longer subject
to the whims of undedicated staff that
never stayed past 4pm to re-submit a claim
or call the insurance company for verification.
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Patient and staff satisfaction
was also noted to be higher, with a more organized
office, and decreased telephone hold times.
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