Like many small-to-medium-sized health care organizations across the country, Pickaway Plains/Health Pro Ambulances Service Inc. used to run its entire operation on handwritten notecards. To Sherri Cook, director of operations for Pickaway Plains, turning claims around in 24 hours seemed like a pie-in-the-sky dream. But with the quick emergence of new, more advanced technologies, she knew it was an option worth looking into.
Twenty years ago, Pickaway Plains, headquartered in Circleville, Ohio, started out conducting hospital-to-hospital transfers, quickly branching out into other areas, such as emergency response. Over the years, the ambulance service expanded to serve nursing homes, doctor offices and private individuals, and offers assistance for individuals in need of non-emergency wheelchair and chemotherapy transport. The service also has become a leader in emergency 911 response.
At the time Cook began considering an electronic system, the company made around 45,000 transports a year, with the details of each one contained in card indexes.
“It took forever to look up a patient, send statements on time, and make sure the insurance was filled out correctly,” said Cook. “If you couldn't read someone's handwriting, you were in trouble. On top of that, we hadn't worked out much of a correlating system of service and billing dates. The only thing we billed electronically was Medicare.”
Reporting claims wasn't a simple process either. Pickaway Plains mailed claims, usually waiting as long as 30 days before receiving a rejection from the provider.
Little inefficiencies such as disorganized billing periods, unreadable indexing and paper filing and billing statements resulted in a black hole in the payment collection process.
Pickaway Plains Ambulance is not the only health care organization in the country to experience this black hole. In fact, according Physiatrist Practice Management Resources, healthcare organizations around the country who have not adopted the current set of industry best practices collect only 50-60 percent of copayments.
THE SEARCH BEGINS
With very little computer background, Cook and her team went searching for an electronic records system that could serve as a clearinghouse for claims transactions. They evaluated three industry-leading clearinghouses and eventually chose Zirmed, a revenue cycle management solutions provider based in Louisville, Ky.
With Zirmed's claims management tools, Pickaway Plains is able to upload claim files to the system, which automatically sends the claims to the providers. Cook said the platform reduced average claim turnaround time from 30 days to between 24 and 48 hours. With around 200 claim submissions a day, Cook said rejections usually run about seven per batch, with corrections running through the system over a 24-hour period.
The claims management tool allows Pickaway Plains to overcome rejections, delays, denials and anything else standing between the company and reimbursements. Clean claims are delivered to payers the first time and tracked, eliminating the possibility of lost claims through detailed reporting of payer reception, delivery and acceptance of claims. Online tools included with the suite help staff to quickly research, edit and resubmit rejected claims.The system's eligibility verification tool can help reduce preventable claim errors and offers close to a 75 percent cost savings over manually verifying coverage.
Cook remarked that the electronic platform “enabled us to work directly with the clearinghouse instead of running insurance eligibility queries through the insurance company. With everything saved electronically, we always have proof for ‘untimely filing issues’ disputed by insurance companies. It is great we have the date and the time that the insurance company accepted the claim.”
If claims meet with rejection, Cook says she can correct the claim online and immediately re-submit. With the “name match” feature, she can cross-reference them to correctly locate an odd payer within the system, resulting in a quicker dollar return. If the payer is not found within the system, there is an option to drop it to paper. When an electronic claim is rejected, the system prints out the claim and mails it for Pickaway Plains, reducing the time associated with snail mail claims.
By going electronic, Pickaway Plains has been able to eliminate thousands of dollars in costs associated with paper records and statements and mailing. “It's hard for me to put a dollar amount on how much we've saved by going electronic because there are so many factors involved, but it's been a huge savings. It has freed up internal staff to focus on becoming more efficient billers,” said Cook. The new system helped educate the billing staff to the exact reason a claim was being declined, in layman's terms.
The platform's payer analysis capabilities let Cook make better informed decisions when a contract comes up for a specific payer. The company can pull up a report that shows all payers in the area and make an enrollment directly through the system.
Cook also said the electronic platform has taken the hassle and disorganization out of the patient billing process.
“The software creates neat, readable rejection codes. The billing staff is better able to accurately share with our patients why a claim has been denied. This results in a more involved, informed patient and a timely statement being sent,” she explained.
The powerful health care analytics tracking tool gives companies the power to keep a closer eye on revenue cycle process, measure overall performance, benchmark that performance against other health care organizations and identify root causes behind denials, zero pays and claim reversals.
Since implementing the revenue cycle management platform, Pickaway Plains/Health Pro has grown to around 65,000 transports a year, 225 full-time employees, 38 ambulances and 20 wheelchair vehicles.
With the new system, “Growth is a painless process,” said Cook. “We never worry if they can handle a new demographic or payer because they are such a diverse clearing house.”
Mark Sherbin is a freelance journalist who writes about progressive and relevant technologies from healthcare software to “green” computing.