Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

What Are You Doing to Monitor Your Claims?

Posted on June 18, 2015 I Written By

The following is an interview with Vishal Gandhi, CEO of ClinicSpectrum as part of the Cost Effective Healthcare Workflow Series of blog posts. Follow and engage with him on Twitter @ClinicSpectrum and @csvishal2222.
Vishal Gandhi
As practices prepare for the rollout of ICD-10, we’re seeing practices and hospitals make investments in upgrades to their technology to be able to support ICD-10. They’re investing in ICD-10 training in order to be ready for ICD-10. Some are even spending time and resources dual coding to make sure they’re ready for the change. While each of these are important, it’s surprising to me that we don’t see more healthcare organizations budgeting for additional help in following up with insurance companies to make sure that claims are being processed.

From my experience across hundreds of healthcare organizations, I’ve found that 20-25% claims are stuck in cyberspace at any one time. I’m talking about claims that practices assume have been delivered to the insurance company and are being processed, but instead the insurance company never received them or the claim was missing something and has gotten stuck in the insurance company’s claim process.

How many practices have a process for ensuring that their claims are being processed efficiently and effectively? Not many. That means they aren’t getting paid in a timely manner and in some cases aren’t getting paid at all.

When we send off an email or SMS, we don’t really think about whether those things are delivered to the recipient or not. We trust that they’re going to get there without issue because they usually do. It seems we’ve applied that same confidence to claims and that’s a problem. We can’t trust that claims have actually been delivered appropriately and are being processed since there are so many ways that they can fall through the cracks.

On October 1, 2015 (assuming no delays), ICD-10 is going to make this problem even bigger. ICD-10 presents a tremendous opportunity for insurance companies to lose more of the claims you’ve submitted. If you’re not checking with the insurance company regularly, you’ll have no way of knowing if an insurance company’s switch to ICD-10 has caused a glitch in their claims processing or not. The insurance company won’t care because the practice or hospital will be the ones left holding the bag.

This problem can be solved pretty easily. Your practice just needs to randomly select 100 or so claims and call (or hire an outside company to call) each insurance company to get an update on the status of those claims and verify that the claim is being adjudicated. We suggest you do this about 10-20 days after the claim is filed.

By checking on these claims, you’ll pretty quickly see which insurance companies are processing claims effectively and which ones are having issues so you can address the problem(s). Plus, you can evaluate if there are any workflow issues on your end with the claims your submitting.

Especially as we start implementing ICD-10, but also today it’s extremely important to verify how well your claims are being processed. If you’re not doing so, you’re probably not getting all your claims paid in a timely manner and could be missing out on additional revenue for your practice.

The Cost Effective Healthcare Workflow Series of blog posts is sponsored by ClinicSpectrum, a leading provider of workflow automation solutions for healthcare. ClinicSpectrum offers a Claims Watchdog service which monitors your claims for you to ensure you’re getting paid in a timely manner. Connect with Clinic Spectrum at HFMA ANI 2015 in Orlando, Booth #1256 or by tweeting @ClinicSpectrum.

Solving the Non-EHR Challenges Healthcare Faces

Posted on March 31, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is an interview with Vishal Gandhi, CEO of ClinicSpectrum as part of the Cost Effective Healthcare Workflow Series of blog posts. Follow and engage with him on Twitter @ClinicSpectrum and @csvishal2222.

As we head into the massive HIMSS healthcare IT conference in Chicago, I’ve been thinking a lot about the shift in healthcare technology that’s occurred over the past 5-10 years. When I first started attending HIMSS, I was all about the EHR company and what they had to offer. That trend continued on the back of $36 billion in government EHR incentive money. Now that EHR adoption is more mature, practices are becoming more and more interested in non-EHR technologies that can improve the way they work.

With that in mind, I took some time to sit down and talk with Vishal Gandhi, CEO of ClinicSpectrum to talk about their non-EHR solutions. Vishal and his team have been thinking about non-EHR technologies and pairing those with low cost human touch for a long time. For example, here’s a look at some of the challenges they’ve tackled:

  • Patient Collections
  • Physician Credentialing
  • IT Support
  • Medical Billing
  • Meaningful Patient Engagement
  • Staff Productivity

If your practice or company is facing any of these challenges, take a minute to watch my interview with Vishal to learn more about their unique approach to solving these challenges:

Also, if you don’t have time to watch the whole video interview, they’ve created this great graphic which illustrates the suite of challenges practices face today and solutions (click to see larger version of graphic):
ClinicSpectrum Healthcare IT Ecosystem

The Cost Effective Healthcare Workflow Series of blog posts is sponsored by ClinicSpectrum, a leading provider of workflow automation solutions for healthcare. Check out their suite of hybrid workflow solutions on ClinicSpectrum.com or schedule a meeting with them at HIMSS Booth: 5427 by tweeting @ClinicSpectrum.

How Can Human Resource Technology Better Help You Manage Your Employees

Posted on March 3, 2015 I Written By

The following is a guest post by Vishal Gandhi, CEO of ClinicSpectrum as part of the Cost Effective Healthcare Workflow Series of blog posts. Follow and engage with him on Twitter @ClinicSpectrum and @csvishal2222.
Vishal Gandhi
In healthcare we love to talk about ways we use technology with patients. We chart patient visits in the Electronic Medical Record. We schedule and bill patients and insurance companies from a Practice Management System. We interact with patients through a patient portal. All of these technologies can be great, but how come we don’t talk more about the way technology can improve how we run our practices and manage our employees?

One example of this is using technology to improve your HR. We see this in many other industries and at a few of the large hospital organizations, but for the most part healthcare hasn’t benefited from great HR practices that utilize technology. As healthcare organizations continue to consolidate, it’s going to be extremely important that every healthcare organization has a well designed human resource program to train, track, and retain key employees.

Let’s look at three areas you can use technology empowered HR practices to track, manage, and improve your human resource efforts:

Employee Growth Milestones
Are you creating a growth plan for your employees? Do you have a system that tracks that growth plan for your employees? If you don’t have either of these, then you’re missing out on a big opportunity. By setting growth milestones or goals for your employees you inspire them to be better and do more. Plus, employees love to know that there are opportunities to grow within your organization and a clear plan of how that growth can be achieved. However, along with setting these milestones, you also have to have a way to track how your employees are doing in their efforts to achieve these milestones. Otherwise, there’s no reason to set a growth milestone if you’re not going to evaluate it later.

Healthcare Human Resouce Management
While you could do this milestone tracking on paper or in a set of Word documents, we know what happens to those documents. They get filed away and forgotten. The better option is to use an employee management system which integrates these growth milestones into your employee’s performance milestones. Then, you can see how an employee’s performance corresponds to their growth milestones. Plus, with an integrated package, you can regularly be reminded of those growth milestones.

Employee Performance Milestone
Now that you’re setting growth milestones for your employees, let’s consider how you can track an employee’s performance. Doing so will encourage better performance and will provide you a way to reward those employees who are delivering great results and work with those employees who aren’t progressing towards their growth milestones.

A great example of this is with your medical billing staff. Using technology you can track the performance of that medical billing staff. How many insurance checks did they do? How many claims are they processing? How many collections phone calls did they complete? Each of these items illustrates how well that medical billing staff is performing their job’s duties. By integrating this tracking into your human resource management system, you have an objective way to evaluate and reward your employees.

Employee Benchmarking and Productivity
Now that your employees have a set of growth milestones and you have the ability to track their performance, you can effectively benchmark your staff and evaluate their productivity. Once again, while this can be done on paper, it’s much more effective and efficient with technology.

Benchmarking your employees against their peers is incredibly valuable because it helps a manager evaluate which employees might need more help and which employees deserve to be rewarded for their hard work. Without these benchmarks, we have to base our evaluations on how we feel and that can often be wrong.

A great human resource management software can facilitate an improved HR program for your employees. Doing so is extremely important to your organization so you can retain their key employees. Human resource management software gives the best employees a roadmap for how to be rewarded in regular performance evaluations. On the other hand, it also helps an organization evaluate their poorly performing employees so they can either help them improve or let them go. Healthcare organizations that choose not to utilize technology in their human resource management efforts are likely to lose their best employees as they fall behind their competitors. That’s a recipe for disaster in the competitive healthcare environment.

The Cost Effective Healthcare Workflow Series of blog posts is sponsored by ClinicSpectrum, a leading provider of workflow automation solutions for healthcare. Check out their healthcare Human Resource management module, HRMSpectrum to help improve your HR management efforts.