The Problem

Physical Therapy clinic in Council Bluffs, IA was experiencing fragmented job duties, making it difficult to keep up with its increasing claims volumes. The internal staff in charge of the RCM process were wearing multiple hats and found it increasingly difficult to ensure that charges were posted and transmitted in a timely manner. Even with the increased patient volumes, the clinic couldn’t justify hiring more support staff at the same scale they were operating.

The Approach

Ben Marcus consulting provided billing support on an hourly basis while the clinic worked on restructuring how its support staff operated. Clinic was provided with sample job descriptions to assist with this process.

As the clinic was using a free billing software without the ability to check claims for transmission readiness, cheat sheets were developed to assist with charge posting.

The Value Provided

Clinic was able to minimize its staff additions to 1.5 FTE, and was able to take its time selecting a quality candidate. Rejections and denials were reduced 10%, further reducing the workload pressure on existing staff.

Clinic was provided guidance on the benefits of a speciality specific paid software subscription and how to transition to such a set up.

The Problem

An ENT practice in Bellevue, NE had worked with an RCM service that wasn’t performing satisfactorily. Practice wished to transition the functions in-office, with guidance on transferring payor access, fee schedule information, and credentialing requirements.

The Approach

Ben Marcus worked with the practice to develop a transition timeline, as well as what software and payor access would need to be transferred. An assessment of accounts was performed to determine where the practice would need to focus its initial A/R management to prevent loosing balances to timely filing.

Ben Marcus worked directly with the clearinghouse to update connections, including setting up electronic claims and remittances for all applicable payors. Practice was trained on how to use the self-enrollment feature of the clearinghouse for payor additions and updates. Practice was trained on how to run billing reports to facilitate A/R management and track its performance.

The Value Provided

The practice was able to transition RCM functions to its office manager in just under two months, and fully released the RCM service at the end of its 3 month cancellation period.

Practice was provided with templates to develop and track a fee schedule matrix, as well as template workflows to better incorporate functions into its front desk and back office.

Practice receives ongoing advice on topics ranging from developing a private pay fee schedule to engaging a collections agency.

The Problem

A large multi-site ophthalmology practice in San Francisco, California has determined its billing department is underperforming. Practice needs to determine the efficiency level of its department to determine corrective action or if it should outsource these functions to a professional service.

The Approach

Ben Marcus consulting worked with key stakeholders holders and their support staff to develop a detailed picture of the practice’s current RCM cycle. Staff provided an overview of daily duties and mechanisms utilized to ensure their duties were completed in a timely manner and what level of training each possessed.

Billing data was extracted from the practice’s electronic practice management solution to develop internal benchmarks and provide trending for the previous six years. The practice’s fee schedule was reviewed for errors and completeness, while the scheduling data was reviewed for missed charges.

These data points were utilized to develop a detailed report for the physician partners to review that highlighted the actual performance of the billing staff, holes in workflows that would cause a drop in profitability, and a cost-benefit analysis to model the impact of outsource vs in-office billing.

The Value Provided

Once the assessment was complete, Ben Marcus Consulting developed a detailed report for the physician partners that highlighted:

• Actual performance of the billing staff
• Workflow Inefficiencies
• Missing reconciliation mechanisms
• Suggestions for improvements if billing remains in-office
• Cost-Benefit Analysis of In-Office vs. Outsourced Billing
• Suggestions on what KPIs to track monthly
• Review of underperforming indicators with potential explanation of cause

The practice received an updated fee schedule to bring its standard charges above contracted allowable and in-line with market rates. Using the billing assessment as a starting point, additional areas for improvement further “up the chain” were identified that would help the practice improve its overall performance.

Additionally, the practice was advised on what level of service it could expect from an outsourced billing service at various fee levels, ranging from core RCM functions to a full MSO engagement.