Refining your RCM strategy: How this independent Tennessee orthopedic practice slashed its denials rate by 7%

Practice Management

The industry will continue pushing healthcare leaders to lower costs, and many providers are unaware of the significant savings they can accrue by fine-tuning their revenue cycle management process. Johnson City, Tenn.-based Watauga Orthopaedics, an independent orthopedic practice, previously devoted a large chunk of manpower and resources to connecting with patients prior to appointments and locating the best contact person for payers to collect on claims. These practices drained the practice of money as well as viable staff members.

This all changed in 2012 when the practice teamed up with athenahealth, which provided technology that allowed staff members to shift their focus from following up on claims to clinical care.

 

"There is a big difference from what we did pre-2012 and post-2012 in how we leveraged technology," says Kim Wishon, CEO of Watauga Orthopaedics. "We recognized changes that needed to be made in order to be successful and that is why our practice reevaluated our approach to revenue cycle management."

 

athenahealth has key tools that allowed the practice to truncate its denial rate and free up staff to perform other activities, as opposed to administrative tasks. athenaCollector assesses a patient's insurance eligibility automatically, thereby limiting the likelihood of errors that could occur during manual entry. Additionally, athenahealth's Billing Rules Engine checks clients claims for possible errors or omissions prior to a practice submitting a claim to a payer. After employing the technology, Watauga Orthopaedics eliminated six full-time positions and reduced its denial rate from 11 percent to 4 percent.

 

Bringing staff into the mix
Ms. Wishon explains every staff member plays a part in improving a practice's RCM process. Prior to 2012, Watauga Orthopaedics' providers did not view revenue cycle as a part of their overall jobs. The practice's partnership with athenahealth, however, changed this mentality as every staff member had a role to play in revamping their RCM process.

 

"For physicians, it is about education on the RCM process and making them understand how they can make a difference," she says. "Our staff and physicians had always had a hands-off approach. With how complicated it [the process] is, we needed a complete team effort."

 

Leveraging technology allowed the practice to transform many staff members' responsibilities. Rather then spending hours researching a patient's eligibility and calling various insurance companies to obtain the necessary information, athenhealth's technology does all that for the practice.

 

"You can reposition those staff members to something else they need to be doing," Ms. Wishon says.

 

As markets become increasingly consolidated, many independent practices may struggle to stay afloat without affiliating with a larger entity. A strong RCM partner may bode well for private practices by allowing them to avoid leakage in the RCM processes and stay ahead of industry change.

 

"We are seeing many practices combining with hospitals because they can't be profitable enough for the physicians [there]," says Ms. Wishon. "Focusing on RCM along with quality management and excellent patient care will continue the health of private practices across the United States."

 

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