An outsourcing partnership combats rising costs and declining reimbursement - and reaps some unexpected benefits along the way.
By Jammia Shea
Medical Center Radiologists, Inc. (MCR), a 42-physician group in the Hampton Roads region of Virginia, has 55 years of experience in advanced radiology practice. Currently, our group provides radiology services in six hospitals and two imaging centers, operates a 24/7 teleradiology service and serves the broader community through many physicians' practices, nursing homes and correctional facilities.
In 2007, we faced a specific management challenge regarding billing, collections and insurance claims processing. A large number of personnel were employed to run our in-house billing department. We were feeling the strain of reductions in Medicare reimbursement and the impact of the Deficit Reduction Act on practice revenues. Pressure was also increasing from insurance carriers to directly submit more of the group's claims electronically.
At the time, we were using a claims clearinghouse, but there was a growing problem with carriers not receiving claims filed through the third-party service. Rapidly evolving reimbursement guidelines had rendered what we considered "not-so-old" and "not-so-inexpensive" software archaic. The increasing need for sub-specialization was making the risk of employee turnover unaffordable, especially in the case of experienced coders. It became clear that the investment in payroll, benefits and management was growing out of proportion to that of our practice.
After performing a comprehensive review of several billing service providers, we chose Zotec Partners to get the job done. The combination of service and software technology was key to our decision to outsource billing to this third-party service provider. The company's Electronic Billing Center (EBC) gives us direct interaction with claims, removes manual processes and provides an overall system of checks and balances that we didn't have before.
With its proprietary EBC software at the heart of its outsourcing operations, Zotec Partners performed services and displayed capabilities that we previously could not achieve on our own. The billing process was improved with features such as integrated document imaging, enabling all insurance and patient paperwork to be scanned and linked to patient accounts for improved service. Direct electronic payer submissions and remittances mean we receive insurance payments faster and more accurately.
The ability to electronically monitor contracted payments to identify variances has improved contractual collections through automated denials follow up. Appealing denied claims is no longer a mostly manual and employee-intensive process of sourcing, copying, collating and mailing paper. Instead, Zotec's outsourced billing solution uses completely automated software to re-file appeals with all the appropriate paperwork needed to make payers sit up, take notice and pay the appealed claims.
Zotec Partners also created a patient portal to allow our patients to access their accounts, keep insurance information up to date, make credit card payments or set up time pay plans via the Internet. With the rapid growth of health savings accounts and more responsibility for healthcare spending being given to patients, functions such as online payment have become an essential part of today's practice management environment.
Although outsourcing can sometimes mean a loss of control over the procedures and processes at hand, Zotec Partners stays very close to our physicians and management to ensure we have oversight and transparency in regard to all of its operations.
Zotec achieves this by providing a high-level account manager who meets with the group to furnish proactive advice and reporting that helps us manage our business operations. Clear and concise monthly reports on the data elements key to the group's cash flow and operational management are presented, and the Decision Support data mining and analysis software allows our physicians and management to drill down into any data deemed important to the practice. We bill an average of 55,000 procedure codes consisting of approximately 46,600 procedures each month. Since outsourcing to Zotec Partners, we have reduced the number of billing employees to just one billing liaison position.
Zotec allows us to keep our focus where it belongs - on the patient and not on collections. Its Decision Support reporting module generates detailed monthly reports that provide us with meaningful practice data that tells the story in full color.
Armed with information generated from Zotec Decision Support, we recently met with our largest payer and successfully renegotiated its contract to include increased rates. This was a major achievement for our group in an environment of declining reimbursement.
In addition to savings from billing operations of approximately 3 percent of gross receipts, collections have increased year over year - meaning a significant net improvement in revenues. We have also drastically reduced the number of extraneous duties performed among all employees.
Our team is now free to tend to the important issues at hand. We have streamlined the tasks that do not pertain to patient care, and it has made us substantially more competitive as a practice.
About the author
Jammia Shea is billing operations liaison, Medical Center Radiologists, Norfolk, Va. For more information on Zotec Partners, click here.