In the past few years, new practice management technology and software have been developed to help physician CEOs manage orthopedic practice revenue cycles and improve their practices' bottom lines. Software is available to help with the billing and coding process, credentialing, patient payment reviews and payor contracts. Dave Wold, CEO of Healthcare Information Services, explains four different types of software practices should invest in. "If the physician hasn't upgraded his or her practices' technology, there is a good chance he or she is leaving money on the table," says Mr. Wold.
1. Code deciphering software. If a practice has not staffed a professional coder to decipher the physician's report, coding software can help the physician identify the correct CPT codes from the claim documentation. The physician downloads surgical reports and the software assigns CPT codes for the claim, which Mr. Wold says certified coders identify as accurate 80 percent of the time.
Coding software also allows the physician to design individual payor edits and regulations to ensure claims are appropriately filed and will not be returned. This eliminates the need for manually entering codes into the claims. For the best results, Mr. Wold suggests physicians speak with certified coders about key words to use in their reports for improved accuracy during the transcription between codes and physician documentation.
2. Eligibility software. One of the ways practices most frequently lose money is by seeing patients who are not eligible to receive coverage on their treatment. Eligibility software allows physicians to check the availability of the patient's coverage before he or she comes into the office. The software will show the patient's coverage status and whether the patient has unmet deductibles. If the patient does not meet coverage requirements, the practice has time to speak with the patient before the appointment and make prior payment arrangements.
3. Payment tracking software. After a physician enters into a contract with a payor, he or she often assumes the contracts are met. However, payors sometimes underpay on contracts and losing this money can make a big difference to the practice. Mr. Wold said one of his clients recently identified over 500,000 underpayments while another discovered 100,000 instances where the payor stopped paying for a second procedure when contract guidelines stated the payor would. Payment tracking software allows the physician to enter in different negotiation schedules and then run the payments through to ensure the payor is meeting contract guidelines with each claim.
4. Credential software. This software allows physicians to enter in the pertinent information from their CV and licensing number in order to facilitate the credentialing application. This software records information about when the application was sent to a payor and alerts the physician when too much time has lapsed before hearing back from the payor. Mr. Wold says Medicare and other payors are sometimes behind in processing or lose applications, so physicians must follow-up.
The software also notifies the physician when a contract expires so the physician can decide whether to renegotiate the contract or let it automatically renew. If the contract is old and serves a high percentage of the patients, the physician can renegotiate for a better contract once the initial contract is expired.
Learn more about Healthcare Information Services.
Read other coverage on orthopedic practice management:
- 4 Best Practices for Expanding Your Orthopedics-Driven ASC
- 7 Best Practices to Improve Efficiency in Physician-Owned Orthopedic Practices
- 4 Tips to Prepare Your Practice for Change From Midwest Orthopedics CEO Dennis Viellieu
1. Code deciphering software. If a practice has not staffed a professional coder to decipher the physician's report, coding software can help the physician identify the correct CPT codes from the claim documentation. The physician downloads surgical reports and the software assigns CPT codes for the claim, which Mr. Wold says certified coders identify as accurate 80 percent of the time.
Coding software also allows the physician to design individual payor edits and regulations to ensure claims are appropriately filed and will not be returned. This eliminates the need for manually entering codes into the claims. For the best results, Mr. Wold suggests physicians speak with certified coders about key words to use in their reports for improved accuracy during the transcription between codes and physician documentation.
2. Eligibility software. One of the ways practices most frequently lose money is by seeing patients who are not eligible to receive coverage on their treatment. Eligibility software allows physicians to check the availability of the patient's coverage before he or she comes into the office. The software will show the patient's coverage status and whether the patient has unmet deductibles. If the patient does not meet coverage requirements, the practice has time to speak with the patient before the appointment and make prior payment arrangements.
3. Payment tracking software. After a physician enters into a contract with a payor, he or she often assumes the contracts are met. However, payors sometimes underpay on contracts and losing this money can make a big difference to the practice. Mr. Wold said one of his clients recently identified over 500,000 underpayments while another discovered 100,000 instances where the payor stopped paying for a second procedure when contract guidelines stated the payor would. Payment tracking software allows the physician to enter in different negotiation schedules and then run the payments through to ensure the payor is meeting contract guidelines with each claim.
4. Credential software. This software allows physicians to enter in the pertinent information from their CV and licensing number in order to facilitate the credentialing application. This software records information about when the application was sent to a payor and alerts the physician when too much time has lapsed before hearing back from the payor. Mr. Wold says Medicare and other payors are sometimes behind in processing or lose applications, so physicians must follow-up.
The software also notifies the physician when a contract expires so the physician can decide whether to renegotiate the contract or let it automatically renew. If the contract is old and serves a high percentage of the patients, the physician can renegotiate for a better contract once the initial contract is expired.
Learn more about Healthcare Information Services.
Read other coverage on orthopedic practice management:
- 4 Best Practices for Expanding Your Orthopedics-Driven ASC
- 7 Best Practices to Improve Efficiency in Physician-Owned Orthopedic Practices
- 4 Tips to Prepare Your Practice for Change From Midwest Orthopedics CEO Dennis Viellieu