Multi-specialty Medical Billing Company Achieves More than $75,000 in Annual Operating Cost Savings
Billing Service Profile:
Engage Medical, Inc.
Reston, VA
Specialties Served: Multi-specialty, multi-location practices with deep experience in Ob/Gyn, Internal Medicine, Cardiology, Radiology
Company Size: 75 FTEs
Client base: 50 clients, and a division representing one client which is a university group with 700 physicians
Change Driver: Moving off two older platforms and too many paper-based processes to a single platform able to support a highly automated operation. Also motivated by the industry mandated change to 5010 and ICD-10.
Platform Selected: Engage Medical Inc., manages the ADS software on Engage’s own servers.
The Challenges
Founded in 2004, Engage Medical, Inc. doubled its client base in 2010 through the acquisition of another billing service company. Anthony DeSola, Director of Operations for Engage, was brought onboard prior to the acquisition to ensure a successful integration of the acquired company and to take Engage Medical to the next level of growth and profitability. Both companies had been operating on older software platforms which lacked sophisticated automation technologies.
“Part of my responsibilities was to assist in the search, selection and implementation of a new Practice Management system,” Mr. DeSola said. The effort took nine months and began with a target list of ten candidate vendors.
Mr. DeSola’s selection criteria included a vendor with strong support and service offerings and a product that could be customized to meet specific client needs for such items as superbills and scheduling.
Among the many operational challenges that Mr. DeSola wanted to correct with the selection of a new platform was the ability to process secondary claims electronically and to execute electronic, real-time eligibility checks. When he joined the company, billing secondary insurers was a paper-based process and eligibility checking was handled through phone calls to the insurance companies.
With no integration between the billing company and his clients, information transfer was taking place by paper, and pickup was by courier or fax. “Experiencing a seven-day delay between the pickup of superbills and the start of claim processing was common,” said Mr. DeSola.
Additionally, patient statement printing could not be pre-scheduled. Mr. DeSola recalled that someone had to access the system and manually kick-off the process.
Getting to 5010 and ICD-10 on the previous platforms presented another hassle. “It was going to be a significant upgrade,” said Mr. DeSola, who added, “Plus, neither vendor had an EHR strategy.” This shortfall did not meet his vision of offering the Engage Medical client base the option of a fully integrated EHR and practice management solution.
Overall, the cost of operating Engage’s previous systems was not within an acceptable range. “Software maintenance fees were too high and we were paying per-claim submission fees,” said Mr. DeSola. “On the older systems, our team had a paper workflow to deal with in preparing and managing claims and EOBs were being handled manually. I was looking for a solution that would enable a tight integration with the practice side.”
The Solution
Having compressed the initial group of ten candidate vendors down to three finalists, Mr. DeSola selected the MedicsPremier PM system from Advanced Data Systems (ADS) in February 2011. Engage Medical’s implementation period took about 60 days from date of approval to production for the first group of clients. This timeframe included training a staff of 20 billing professionals.
The client migration plan called for all of Engage Medical’s clients to utilize the MedicsPremier platform in phases. Twenty-five clients are planned to be in production on MedicsPremier by December 2011, with the company adding ten more clients per month going forward into 2012.
One of the many advantages of selecting ADS was the company’s experience in data conversions from older billing system products such as the two on which Engage had been operating. This experience helped speed up the migration process, as well as reduce uncertainties for the Engage operations team.
Once Engage Medical is fully transitioned to the MedicsPremier platform, Mr. DeSola expects to realize annual operational savings of $75,000 to $100,000. He expects a 25% gain in staff productivity, enabling him to reallocate 25% of his staff to new functions. “And that’s a conservative estimate,” Mr. DeSola said. A 20% reduction in redoing work related errors and denials is already evident. “I expect that number to continue downward as we utilize the MedicsPremier system,” Mr. DeSola added.
Savings are coming from a number of areas, many of which are workflow related. For example, electronic integration with the company’s medical practice clients is a big advantage. “The interactive electronic encounter form (superbill) is a huge feature,” remarked Mr. DeSola. This capability allows for claims processing being almost immediate after the physician completes a patient visit. The manual data entry and the problem of paper pickup is eliminated.
Remittances are auto-posted. Details include deductible status or whether the claim was denied. Secondary insurers can now be processed electronically. When a claim payment is denied, the billing team can see the reason for the denial and address the problem almost immediately, instead of waiting for paper denials to arrive. If the denial reason involves a secondary payer, for example, the system automatically drops the payment down to that secondary payer.
Patient statement processing is now pre-scheduled and transferred to a third party vendor for printing and mailing.
“Engage Medical’s clients now have access to electronic eligibility checking, which delivers a response in about 15 seconds,” said DeSola. The system also offers batch verification checking and generates a report showing only the exceptions that need to be worked by staff before the patient visit.
Another major savings area is in the cost of claims submissions. In the past, Engage Medical was paying per-claim fees. Now, through the MedicsPremier system, Engage realizes unlimited claims processing at no cost through Emdeon’s clearinghouse.
Reports was an extra big selling point for Mr. DeSola. He has access to numerous practice analysis reports, including a detailed financial snapshot of Engage’s business as well as any physician client at any moment in time.
Mr. DeSola said, “MedicsPremier is flexible in that a report can be processed based on either the date of service or the date of posting. When a report is set to date of service, regardless of when the payment was received, that payment will be applied back to the date of service. This feature enables Engage to identify areas that require attention, as well as providing us with a true indication of how we are processing claims. I can also run reports showing payers who are fast and slow, since it is critical to be aware of both. MedicsPremier has reports that help us manage contracts as well. One report in particular will track expected payments and advise which carriers are paying true to contract.”
“Reports are the backbone to any medical billing company, and MedicsPremier certainly does not disappoint in that department,” Mr. DeSola said.
Mr. DeSola finds the central billing office features very helpful in terms of managing Engage’s team members, in that certain people can be assigned to particular activities or “queues” such as Medicare denials, handling A/R, or charge entry for assigned groups of clients. The MedicsPremier system will report on each employee’s activities and show employee productivity statistics.
Looking ahead, Mr. DeSola is very interested in offering Engage’s clients an integrated EHR component that complements the MedicsPremier PM system, with the ADS MedicsDocAssistant EHR being an ideal solution for them.
MedicsDocAssistant v 5.2 is 2011/2012 ONC-ATCB Certified by CCHIT® as a complete EHR for Stage 1 Meaningful Use, helping to ensure that Engage’s clients who use the system will obtain their financial incentives.
In fact a number of Engage clients have already obtained MedicsDocAssistant, with others expected to do so in the coming months.
“We liked the fact that the MedicsPremier and MedicsDocAssistant systems operate as a single, unified solution, but that ADS also makes them available separately based on the needs of the practice while offering an HL-7 interface to other EMR systems,” Mr. DeSola said.
In ADS, Engage Medical found a company with all of the key ingredients needed: reliability, longevity in the industry, proven software solutions that are flexible and truly based on the needs of the end user, and with implementation, training and support, all of which comes at very reasonable pricing.
Mr. DeSola concluded by saying, “ADS is the company to look to, whether you are operating a medical billing service, or are a medical practice in need of automation solutions. They deliver what is promised, and what they deliver is outstanding.”
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