Medical billing – When to Outsource?

Medical professionals continue to struggle with ever changing reporting requirements. As the healthcare industry moves towards performance driven reimbursement it is likely to continue to grow. However, outsourcing billing is not an immediate answer. Electronic documentation with the aid of EMRs has moved things in a positive direction as it drives evidence based documentation and simplifies data transmission between providers and payors. With almost 57% of office based practices now utilizing EMRs, medical errors are likely to reduce over time which should result in more accurate documentation and reduced number of denials.

While completeness of documentation carries importance, most practices are able to improve returns by maintaining a consistent relationship with payors. An efficient billing team is likely to remain on top of changes in regulations and payment criteria which results in better claim management. Claims are likely to be denied on the basis of errors in medical billing and coding or if services rendered are not covered or considered as irrelevant. However, with regular analysis the billing team can identify risks and create an appropriate plan through continued learning of the practice.

Account receivables need to be consistently monitored. Most practices choose to utilize the aging scheme method by pooling accounts of a certain age and devising an age specific strategy. Different follow-up standards could be devised based on the materiality of the amount owed and the age of the receivable. If the account is due over 120 days, there is a good chance its due to an error either by the practice or the insurance company. Almost 19% of the claims denied can be attributed to errors by the insurance company.

An age of 120 days is unfortunately common for providers, as almost 10% of accounts receivables for most practices are likely to be above that figure and have to be written off as bad debts. Medical billing companies are slightly more aggressive in their approach, which can sometimes pay off where internal billing has been inefficient. Practices suffering from aged accounts are likely to gain more by outsourcing to an efficient medical billing service especially since most medical billing companies charge their clients based upon their collections.

How Meaningful Use of EMR Improves Patient Care?

We are all familiar with the clichéd argument for EMR adoption; “it is for the patients and improving the quality of care”. While it may be true to a certain extent, the practical implications are not as simplistic as in theory. A recently published report by the California Department of Health Care Services highlights the mounting concern of physicians failing to utilize EMRs in an effective manner. In order to ensure the optimum usage of EMRs, the government incentives for achieving meaningful use objectives are a step by step guide for medical professionals to achieve quality output through effective EMR utilization.

The government believes that meaningful use provides an effective connection between EMR technology and the outcome in form of improved healthcare. Farzad Mostashari, the National Coordinator for Health IT specifically stated that achieving meaningful use is based on the outcomes. As a result, around 90% of hospitals CIOs suggest that meaningful use is amongst their top two priorities for the next few years.

“We have to measure what we are doing because you cannot fix what you cannot see”, said Mr. Mostashari, before adding “…you cannot know how many patients you are controlling blood pressure for if you have a room full of charts”. He goes on to explain the need for decision support system and structured data, and how meaningful use is enabling physicians to overcome this hurdle. By utilizing an EMR completely, physicians would be able to create lists and determine which patients need attention, and the system will provide alerts for irregularities such as high blood pressure, temperature, etc.

The average medical errors per year are close to 200,000, while medication errors have the largest share. Mr. Mostashari explained how meaningful use of e-prescribing can help physicians to curb these problems. By utilizing EMR based e-prescribing, physicians would be intimated for drug interactions and allergies, whilst pharmacists would be able to correctly prescribe the medication as the problem of ineligibility would be rightfully addressed.

“The health does not happen in the doctor’s office, it happens with the patient.” says Mr. Mostashari while expressing that meaningful use of EMRs and patient portals would allow patients to be kept in the loop, and with relevant educational material patients would be able to keep track of the recovery. Mr. Mostashari also added that information exchange is the key to developing healthcare and meaningful use will allow physicians to play an extended role while the care system shifts to pay for value, not volume. “Meaningful Use is the blue print of how to deliver better care, it also the blue print of how healthcare providers can thrive in the healthcare markets.” he concluded.


EMR – The Selection Process

Electronic Medical Records were designed to facilitate the doctor and their practice to achieve efficiency and reduce hassle. Therefore, in order to get the most out of the product, it is essential to ask for valuable information from an EMR vendor before making a decision. Vendors usually provide users with free demonstrations to evaluate and compare the solutions. On one hand, demos are time consuming, but on the other hand these demos provide an insight to physicians and their staff on how suitable the solution will be for their practice and assess the amount of change that it may bring.

When it comes to health IT products, there are many choices available and therefore it is pivotal that the practice establishes their needs and wants before setting up the demonstration. Physician time is valuable and if vendors know the concerns and expectations of physicians beforehand, they can get straight to those relevant areas. Physicians and their staff can establish questions related to the EMR solution and either send them to the vendor representative ahead of time or simply ask them during the demo.

A lot of practices tend to think of EMR vendor demonstrations as training sessions and may overlook their primary concerns and expectations during the actual demo.  There are also those that have a pre-defined idea of how an EMR system will work in their practice and may not be flexible enough to accept an alternative. Therefore, it is important to remain open to possibilities where the vendor representative may offer an alternative approach to accomplish a certain task. The vendor is trying to educate you on the system; hence it would be apt to make the most out of it by participating as much as possible. The more you ask, the more you learn, so it is important to share your thoughts throughout the demo.

This helps getting the right knowledge about the product and in building a relationship with your vendor representative, which helps them propose more viable solution based on your requirements. In the end, a quality feedback is essential to wrap up the demonstration. If you have made relevant notes during the demo, you should go over them immediately after the demo has ended to communicate these points to the vendor representative. Given the rising interest in EHR solutions and the limitation of available time, it is essential to schedule follow-up demos for a later date or time, if any questions remain unanswered. However, one should also keep in mind that, more research may result in more confusion.

Once you accumulated all the relevant information about your preferred EHR vendors, you get to the most important stage of the selection process, making a decision or and a long term commitment. Given the cost and contractual obligations involved in EMR contracts, performing an in-depth cost benefit analysis is very important. So, the final question has to be, “Is the solution worth my money?”.


EMR Mergers and Consolidations

I was highly intrigued by Katherine Rourke’s article on EMR vendor consolidation. While I may not agree with the entire article, Katherine has raised some valid points. The health IT industry has seen enormous growth in the past few years and has to lead to an increase in highly sophisticated systems that are designed to run on multiple platforms and devices.

The problem for most EMR vendors is remaining competitive in the constantly evolving world of IT and the highly variable dynamics of the healthcare industry, do not aid their cause. While we have seen many products that have been withdrawn from the market, we have also witnessed a marked increase in new vendors. Consolidation and mergers usually occur in industries that have reached a stage of maturity, so this simply cannot be said about today’s highly volatile health IT industry.

Although we may witness small acquisitions every now and then, high profile mergers continue to be rare given the current market schematics. Interoperability is a major issue and most vendors require major work on their HIE networking. Many vendors should have accumulated sufficient finances from the growth in EMR adoption to fund the research and development work required to build these HIE interfaces.

It is not uncommon for IT based companies to generate external funding given market perception. Most IT companies have always been rated favorably in stock exchanges. However, companies starting afresh do not have a significant base to build upon. The competition in the EMR industry has helped improve the overall quality of solutions while it has brought the cost down. This has understandably impacted the amount of profits, which are not as significant as before.

The reason why we may not see competitors consolidate their business is user base and product identity. A merger is likely to alienate the user and could result in loss of business. The EMR market is highly segmented, where Products are sold regionally with local repute helping most vendors sell better. There is also the distinction of products that are designed for practices of a specific size and specialty. The products must complement each other for a successful merger, for example an EMR vendor merging with a Practice Management vendor. However, given the likelihood of health IT vendors developing elements missing in their solutions themselves, they are likely to refrain from mergers.


What to Ask About Your EMR Vendor?

Collecting EMR references has to be one of the underutilized methods of evaluating and selecting an EMR solution. If you cannot buy a laptop without asking around first, how would you want to get into a contract that spans over multiple years? Relying simply on what was promised is not a wise choice. User feedback can help physicians get a holistic view of the product along with the possibility of identifying various tips and tricks to better utilize such systems, particularly important for providers with no prior EMR usage experience.

Work can be split between staff members for better productivity and ideally physicians should participate with their administrative staff. This would help in establishing peer to peer level communication, allowing participants to gauge questions and responses better. While the practice may adopt multiple ways of communication, visiting the reference site in person or conversing over the phone may help in providing a more personalized outlook.

Another key is to not be limited to the contacts provided by the vendor. Physicians can find other practices by joining user communities or professional societies. Once you have established a reference sheet, the next step is preparing a questionnaire.

The most important questions to include in this questionnaire are:

  1. How long has the practice been using the EMR solution?
  2. How long did it take for the implementation to complete?
  3. How was the implementation experience?
  4. How long was the training process?
  5. Were the allocated training hours adequate?
  6. Did the application appear to be as easy as seen in the demonstration?
  7. How much of the annotation process is templates driven?
  8. Has the documentation process improved since implementation?
  9. How many patients were seen in a day before and after the implementation?
  10. How would they rate the quality of the exam note? Pre and Post implementation.
  11. Has the use of paper charts been completely eliminated?
  12. Did they consider or use scribes? If yes, what about the cost and quality?
  13. How would they rate their overall experience? And would they recommend the EMR to another practice?

Although this list is not by any mean exhaustive, but by asking the above questions most physicians will be able to gauge how suitable the EMR would be for their practice.