Monthly Archives: July 2014

5 Barriers to EHR Replacement

5 Barriers to EHR Replacement


Replacing your current EHR is no easy undertaking. But it’s becoming a common trend, with about half of all providers currently unsatisfied with their EHR. The top five roadblocks that hold most practices back from moving ahead with a much-needed EHR replacement are:

  1. Cost concerns: concerns over EHR replacement costs can keep you up at night, but the benefits on the other side of replacement will make it all worthwhile. In fact, after a successful EHR replacement, many practices have acknowledged that the risk of doing nothing far outweighed the risk (and costs) of replacement. Unless you’re a cash pay practice, to play in the game, you need to be using an effective HER system. The right one makes your life easier every single day—and it’ll be worth every penny.
  2. Data conversion worries: when moving from one EHR to another, it’s important to bring over only what’s necessary and leave behind what’s not. You’re going to need to keep a copy of the old system for a while. Before you go live, do conversion testing and be sure it works. Let your new EHR partner lead you in this process by telling you how it works and advising you on what to do.
  3. Fears about losing productivity: careful preparation is the best way to prevent a significant drop in productivity—and its associated financial impact—after your EHR goes live. Make sure your staff is comfortable with your new workflow, interface, and technical requirements, and that your software meets the majority of their demands.
  4. Re-training angst: another round of EHR training doesn’t have to be that painful, especially if you have the right attitude and approach.
  5. Hesitation to go through another implementation: It’s all in the preparation. From front desk staff, to billing coordinators, to clinicians – all parts of the team need to be involved. It takes time, effort, dedication, and willpower to rally your staff for another implementation—and that takes strong leadership at the executive level

Replacing your EHR is a great opportunity to “re-engineer.” Now you have the chance to right the process. You’ve got lessons learned behind you—and the chance to clean the slate and do it the right way this time around.


Source: Gary Wietecha, M.D. (aka Dr. Gary)

7 Best Practices

7 Best Practices

Let’s face it – the healthcare reimbursement system is brutal. The rough economy has led everyone, including insurance companies and patients, to hold on to their money more tightly. Insurance companies and other payers have developed an increasingly complex and often confusing set of rules and processes that lead to more denials, underpayments, and lost or ignored claims.

Here are some scary figures:

  • Only 70% of claims are paid the first time they’re submitted, according to research by the Centers for Medicare and Medicaid Services (CMS).
  • The other 30% of claims are either denied (20%) or lost or ignored (10%). Of those claims, 60% of them are never resubmitted to payers.
  • That means medical practices never collect on a full 18% of claims.

Long story short: It’s becoming harder for doctors to get paid for the work they perform.

The Medical Group Management Association (MGMA) estimates that payers underpay practices in the U.S. by an average of 7% -11%. That means medical practices are failing to collect, on average, at least 25% of the money they’ve earned by treating patients. This translates to a total of $125 billion left on the table every year by American medical practices.

How can practices reclaim those missing funds? One major way is by simplifying and automating their revenue cycle management. New technologies such as electronic health records, patient portals, and practice management systems have created new opportunities for practices to cut operating costs and provide better care.

  1. One of the best ways for practices to improve their billing efficiency is to catch potential denials before the claims are submitted to payers so more claims get paid the first time around.
  2. Select software that ease the tracking of contracts and automatically compare the actual payments the practice received against the payments specified in each payer contract.
  3. Act on claims based on each payer’s individual schedule. It’s important to use a system that allows for daily aging of receivables.
  4. The most efficient medical practices use software to automate their workflow and eliminate tedious paperwork.
  5. It’s important to mine data for billing and collection trends to figure out where the practice can improve.
  6. One key element of an efficient, hassle-free revenue cycle is payment accuracy, so chose a system with the ability to post denials, making it easier to track, measure, and manage.
  7. The most effective A/R management applications need a variety of advanced tools to greatly improve a practice’s efficiency and workflow.

The revenue cycle for medical practices is complex and tough to manage. That is why it’s more important than ever to get a handle on the process and efficiently collect the money your practice is owed. Better billing and collections saves cost, adds revenue, and allows the medical practices to focus on what they do best – caring for patients.



Getting Your Practice “In the Zone”

Getting Your Practice “In the Zone”

Health care providers are working harder than ever before and spending less time with each patient with very little increase in their income. They have to cope with an avalanche of complex rules, regulations, and administrative processes just to run their practices. At the same time, costs are increasing and reimbursement rates are declining.

Your practice is in the zone when:

  1. Your work processes are structured, systematic, and comprehensive.
  2. Your office workflow is optimal, so you can see more patients and still provide high-quality care.
  3. Your providers are focused on high-quality patient care and successful outcomes rather than on worries about practice operations.
  4. You’ve reduced your no-shows and have a patient panel sufficient to re-fill most cancelled appointments.
  5. Your claims spend far less time in accounts receivable.
  6. You get paid a higher percentage of your total charges.
  7. You’re driving more revenue with less work.
  8. You’re collecting patient co-pays and deductibles at time of service.
  9. You’re receiving additional income from Pay for Performance (P4P), PQRI, Medical Home, and HITECH Act incentives.
  10. You have better insight into, and more control over, your practice’s day-to-day operations and future growth.

The health care system has become more complex, and providers are struggling to concentrate. But there are ways to reduce complexity and make patient encounters and administrative processes more efficient within your practice without sacrificing quality of care.

The right practice management partner can also make it easier to turn your practice around financially and enable you to focus on quality patient care, good outcomes, and building the practice. Systematic processes and expert assistance can help your practice manage today’s demands and enable you to keep an eye to the future, developing a game plan for ongoing success and growth.

The only way for a practice to achieve financial health in this demanding environment is to learn how to operate at a level of peak performance.

  1. Figure out what you can do, can’t do, and could do better.
  2. Convert “lost” patient time into billable time.
  3. Pre-process patients to ensure efficient, profitable appointments.
  4. Don’t let money walk out the door.
  5. Bill appointments immediately and make sure claims are received.
  6. Swiftly review and appeal denials and underpays.
  7. Track, benchmark, and improve practice performance.


Don’t Just Get By; Thrive

Don’t just get by; Thrive


  • Get more money faster: check eligibility. It all starts with checking a patient’s eligibility, so use an effective tool to verify each patient’s eligibility, plan specifics, and copays/deductibles.


  • Knowledge is power: A/R transparency can transform your business. Measuring and monitoring your revenue cycle allows you to compare key indicators of billing and collections performance from month-to-month and year-to-year. You will also be able to compare your performance to industry and specialty standards.


  • Use best practices for cleaner claims and appeals. Even experienced billers can miss errors when reviewing claims manually. Implementing “claim scrubbing” software, which identifies and fixes problem claims automatically, can save billers time, ensure greater accuracy, and generate faster error resolution.


  • Capture, analyze, and act on denial data. Effective denials management is about being proactive and diligent. Engaging in eligibility verification prior to a patient’s visit is one front-end strategy to reduce denials. On the back-end, develop a routine system for denials monitoring.


  • The right approach to write-offs. A write-off is an amount that a practice deducts from a charge and does not expect to collect. Successful practices have established sound policies and procedures in place for “write-offs” and have a formal manual to ensure that they are taking advantage of all available ways to increase their bottom line. To stop providing free services to patients and leaving money on the table, providers and practices need to employ proactive financial policies that are shared with their patients and then enforce them.


  • Appointment reminders boost A/R. Ensuring all appointment slots are filled and patients are confirmed is critical to financial success. Appointment no-shows impact your bottom line with staff time costs but can be reduced with an automated appointment confirmation system. HIPAA considers appointment reminders as a part of treatment. They can be made without an authorization, but require you to do what you can to accommodate a patient’s preferred method of communication. You can remind patients by mail, email, text, and/or phone.


  • Make the most of “ERAs”. To expedite cash-flow and payment posting mistakes sign up for Electronic Remittance Advices (ERAs) today. Electronic claim submission maximizes claims processing efficiency. Paper submissions do not. About 99% of payers accept electronic claims, and Medicare requires them. It takes an average of two weeks to receive reimbursement for an electronic claim if you establish an ERA, and six to eight weeks for a paper one.


    According to the American Medical Association (AMA), the average cost of processing a clean paper claim is $6.63. The same claim sent electronically costs only $2.90.