Article - June 29, 2008 - CRM Buyer

A Two-Pronged Approach to Better Medical Bill Collection

By Bette Warn

When two medical practices in Lakewood, Colo., began comparing notes in 2006, they discovered similar financial and operational challenges. In an increasingly competitive healthcare environment where costs were escalating while the pool of reimbursement resources diminished, leadership at each practice recognized the need for a re-engineered approach to revenue cycle management (RCM).

The innovative solution that the practices devised was to establish a common independent billing company -- ATD Resources -- that would focus solely on improving cash flow and performance.

To support its efforts, ATD Resources would invest in claims management technology capable of providing the business intelligence necessary for streamlining workflow, improving productivity and bolstering the bottom line.

The Problem

It was two years ago that a critical care/pulmonary practice and an emergency medicine group in Colorado began to investigate strategies for improving claims management. Physicians from each practice had privileges at the same hospital, used the same billing company and, not surprisingly, shared the same frustrations regarding revenue generation.

Both practices believed that their current billing company and clearinghouse were not equipped to help them optimize revenue. Outstanding claims languished in accounts receivable (A/R) and many were rejected during adjudication. Even more disappointing, however, was the fact that the practices were not getting the feedback necessary to effectively appeal rejections or make internal changes to correct error patterns. Leadership recognized that effective reporting and analysis could be used to train physicians and staff in order to eliminate problems that slowed reimbursement or resulted in nonpayment altogether.

Full story


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