How effective revenue cycle management helped fuel practice growth
Picture this: You start a new specialty physician practice during a public health emergency, providing critical point-of-care testing (POCT) and virtual visits to patients. As the practice takes off, capturing every dollar of revenue becomes critical to maintaining operations and fueling growth. Yet because the practice is new, the operational infrastructure needed to support effective revenue cycle management (RCM) isn't in place. You need the help of an experienced team.
Nicolle Sapo, director of billing for Quickmed Diagnostic and consultant to the Venice, California-based Sameday Health billing department, says that when Sameday Health launched, it contracted with a billing service to help manage accounts receivable. But the company's growing volume soon overwhelmed the small vendor. Rapidly changing rules during the COVID-19 pandemic also affected the healthcare revenue cycle industrywide. When mistakes began to slip through, it was time for Sameday Health to seek a more effective RCM solution.
Enter global revenue cycle management company,Coronis Health.
Through its alliance with McKesson Medical-Surgical, one of the nation's largest suppliers of medical-surgical supplies, pharmaceuticals and healthcare solutions,Coronis Health provides specialized RCM solutions to primary and specialty physician practices, including industry-leading technology and access to skilled team members.
“我们were able to come in and quickly put together a game plan for Sameday Health," says Barry Wulf, senior vice president, sales for Coronis Health. "We're more than just a billing company. We're a team of highly qualified and highly motivated individuals backed by tech-enabled services that deliver great results."
The challenge: Revenue cycle management in a rapidly changing environment
As the COVID-19 pandemic continued, many primary care and specialty physician practices found themselves short-staffed. Others experienced significant staff turnover, with new employees lacking needed revenue process knowledge. Some practices identified new opportunities for growth and expanded operations at a rate that created its own set of RCM challenges.
情况就是这样Sameday健康。日益增长的practice focuses primarily on COVID-19 testing, testing for sexually transmitted diseases (STDs) and access to direct healthcare and wellness services. Since its founding in 2020, the practice has experienced significant growth, expanding from one location to 55 locations across 15 states. Sameday Health offers patients access to a network of physicians who provide telehealth for basic services, as well as on-site visits and testing.
"The whole patient experience is very important to the company," Sapo says. "Our entire philosophy is making sure patients are able to be seen immediately. We want to be convenient for them."
Sameday Health's focus on providing exceptional and convenient same-day care to patients – and on maintaining a positive patient experience – led to increased costs during a time of rapid growth. As a new company working in a public health emergency,the young team didn't yet have a solid revenue cycle management foundation to support its growth.
Soon, the company reached a critical tipping point. Billing volume outpaced the capabilities of both their existing billing partner and the internal team. Revenue was not coming into the practice on time.
"Cash flow is important because we have to be able to operate and market. There was a lot more outstanding than what we were getting in receivables," Sapo says. "On top of that, there were a lot of errors and corrections that needed to be made."
Sameday Health needed a solution that could keep up with the demands of its operation by:
- Effectively handling the practice's billing volume and pace to promote healthy revenue cycle management
- Providing a revenue management team that was well versed in the changing rules and operational environment of a public health emergency across multiple states
The solution: How Coronis Health helped their client get cash flowing again
When Sameday Health decided to choose a new vendor to help manage its revenue cycle, the company chose Coronis Health. Leadership based its decision on the size, capabilities and reputation of Coronis.
根据Sapo救援是迅速的,。“他们were able to start enrolling us into different electronic remittance advice (ERA), electronic financial transactions (EFTs) and with payers, getting our platforms updated and integrated within their systems," she says. "There were a lot more tools available to us."
Coronis Health also assembled a dedicated team to attack a mountain of unpaid patient bills and payer claims. Sapo notes that about 100 Coronis Health team members have worked to reduce a significant billing backlog and correct errors. "They're doing an amazing job," she says. "They're recovering a lot of money for us."
Abby Arnold, president, primary and specialty physician services for Coronis Health, says that initially, the Sameday team wanted to implement the Coronis solution at just one location as a trial.
Coronis团队立即开始工作,scrubbing claims and getting them submitted. "We were able to show them an improvement and get money in the door for them while making sure everything was in place from a regulatory standpoint," Arnold says. "They were extremely impressed and ended up giving us the remaining part of their business."
Arnold notes that Coronis Health was able to clear a backlog of more than 100,000 claims in less than 30 business days – and recoup millions of dollars for the organization. "Coronis was able to surge in with staffing and expertise around the specialty," she says.
Wulf credits the partnership approach Coronis Health takes with its clients as the foundation for the company's strong reputation.
"We succeed by providing a very high-touch, tech-enabled experience that is more consultative," he says. "We try to set the stage by saying, 'We are going to be your business partner and we're going to take you through a world of how the RCM experience should look. More importantly, we're going to drive revenue back into your practice.'"
Having an effective partner in managing the healthcare revenue cycle means practices can concentrate on providing great patient care and not worry about whether they're getting paid, Wulf notes. He also acknowledges that insurance companies don't make getting paid easy for providers.
"When you work with a trusted partner like Coronis, we can alleviate that burden because we understand the process," Wulf says. "That's where we really shine as a partner."
Sapo appreciates that partnership focus, noting that communications with the Coronis Health team have been excellent. She also appreciates the reporting capabilities of the company's technology. She's been working closely with the Coronis team to refine reporting and generate customized data that meets Sameday Health's needs.
"We have our KPIs, where we keep track of what our goals are and what we need," Sapo says, adding that revenue information is critical to making operational decisions about services and growth. "We take into consideration all the costs that come into play."
Why a healthy revenue cycle is critical for primary and specialty physician practices
Practices that want to grow or maintain financial independence need to keep a watchful eye on their revenue cycle. But not all practices have the skills, staff or technologies they need to successfully manage this function.
It's typical for primary and specialty physician practices to prioritize patient care and improved health outcomes over business process improvements.
"The focus of most practices is truly on patients and the work providers are doing," Arnold says. "So that's where a lot of the focus goes, and that's where it should go. Providers aren't always thinking about all the different connecting pieces that drive the revenue cycle."
That's exactly why the revenue cycle management expertise of Coronis Health delivers so much value, according to Wulf. "Physicians are focused on patients, but they're also running a business," he says.
To manage your business and help it grow, you must have access to cash, Arnold notes. Butbringing revenue into your practice is about so much more than the patient services you've billed. The healthcare revenue cycle includes many workflow steps that, when not managed properly, can cause a loss of revenue known as revenue leakage.1Leakage in practice revenue can occur when:
- Insurance information isn't verified
- Referrals aren't captured correctly or don't exist
- Errors occur in service coding or billing
- Claims are underpaid
- Payers deny appeals
Clean claims are critical to effective RCM. Clean claims are those that go to a payer and pass through all administrative tasks and edits without rejection. "When you have a clean claim, usually that means the claim will be paid immediately," Arnold says. "Quicker claim turnarounds help shrink down your days and outstanding revenue."
The process of getting to a clean claim begins much earlier than many physicians and practice managers may think, Arnold notes.
"We focus on that very first contact with the patient," she says. "We look at the first phone call where you're gathering patient demographics and insurance information. We break it down for our partners to show the breadth and depth of the revenue cycle and how that truly leads to your fiscal success."
Arnold notes that small details make a big difference in whether claims get rejected or get paid on time, including:
- Is the patient's name spelled correctly?
- Was the patient eligible for specific services?
- Did you need to get an authorization?
- Do you have to attach a modifier?
"There are a lot of different nuances that go into it," she says. "When we talk to practices, we try to help them understand that the first phone call with the patient is the start of the revenue cycle."
Coronis Health helps improve your existing RCM workflow and establish new processes that help you capture every dollar. The company helps streamline your practice's RCM operations with:
- Easy-to-implement technology:Coronis technology works with your existing EMR. There's no need to buy expensive new software or spend precious hours getting your team up to speed on a new system
- Accessible customer service:Coronis Health is with you every step of the way. Team members answer every question and address your concerns so you and your staff can focus on providing excellent patient care
- Across-the-board services:The Coronis team helps with billing, coding and collections
An expert RCM partner with specialized knowledge
Another important factor in RCM is staying on top of changing rules– including those of regulators and payers. That can get particularly challenging in an environment like the one Sameday Health experienced from the first day of its launch during a public health emergency.
"During the pandemic, it felt like insurance companies were changing every day. We stay on top of regulatory changes," Arnold says. She also notes that the Coronis Health team is keeping a watchful eye on regulatory changes in the coming year. "We're sending out educational documents to our practices, and our teams are having conversations about them."
Arnold says Coronis Health is currently tracking coding for monkeypox, an emerging infectious disease, so clients are going to know how to bill for testing and care. Having a partner capable of managing new coding requirements is critical for clients like Sameday Health, which expects to add monkeypox testing to its services.
Coronis Health clients also benefit from the wealth of expertise that has grown from the company's nationwide presence. With clients in all 50 states, the Coronis team has an opportunity to learn from one another, Arnold says. "It gives us the ability to expand our knowledge and help our clients," she adds.
That level of expertise also helps the Coronis Health team smooth over inevitable bumps in the road when working with clients. "We're not going to come in and tell you your billing's going to be perfect because we're dealing with payers," Arnold says. "We want practices to understand that we're going to help you through unexpected changes. If there's a denial because a payer changed something, we're going to identify the cause and put audits in place so it doesn't happen again."
Wulf saysclients get most excited about revenue from opportunities the practice didn't realize it was missing– another area where Coronis Health's expertise shines. The Coronis team completes a comprehensive analysis and takes a proactive approach to adjusting workflows and implementing best practices.
Too many practices operate in reactive mode when it comes to RCM. But Coronis Health can help.
"We show them where they're leaking money," Wulf says. "We come in and say, 'This is where you're losing money, and this is how we're going to fix it for you.'"
Learn more about Coronis Health, the future of medical billing for primary care and specialty physicians.
1:https://afiahealth.com/understanding-the-healthcare-practice-revenue-cycle/
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