Dr. Josie Sinclair
Problems: Low reimbursement rate and no time for oversight of billing practices
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.
Current Practice Analysis
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.
Start Script provided these solutions:
- 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.
- 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)
- Previous “take-home” pre-tax income: $207,742
- New “take-home” pre-tax income: $282,046
- Increase in personal income: $73,304
- 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.
- Patient and staff satisfaction was also noted to be higher, with a more organized office, and decreased telephone hold times.