In 2014, Reclaim Physicians Medical Group (Reclaim), a multidisciplinary, regional physician group based in Grapevine, TX, which comprises 11 physician practices and sees 5,000 unique patients annually, faced a challenge common to physician groups with multiple sites of service: how to optimize claims management and cash flow when RCM processes vary by location and medical billing efforts focus on front-end processes, not revenue cycle management as a whole.Process inefficiencies and lack of “systemness”—a similar experience no matter which location patients visit—had a deep impact on the physician group’s financial health:
- Fifty-two percent of claims hadn’t been paid in more than 120 days, and days in accounts receivable (A/R) was higher than expected.
- Inaccurate coding led to many denials. It wasn’t uncommon for current procedural terminology (CPT) modifiers to be processed incorrectly, and in some instances, CPT codes were not linked correctly to specific procedures.
- Practice leaders questioned whether the partners it had hired for RCM services were fully handling their financial responsibilities.
- Point-of-service collections were low, primarily because the data in the patient ledger didn’t match patients’ explanation-of-benefits statements. Patients were less likely to pay claims because they didn’t trust the amount billed by the physician group.
Patient frustration was high—and so was frustration among staff.That year, Reclaim made the switch to Pulse for revenue cycle management services because of their more than 20-year track record of success in working with insurance carriers, managing claims and resolving electronic data interchange claim rejections.Pulse was the fifth vendor Reclaim had worked with in recent years, and practice staff were skeptical Pulse could succeed where others had failed. But the level of expertise Pulse brought to Reclaim quickly became apparent to staff and leaders. Pulse introduced staff to best-practice revenue cycle workflows and engaged team members in implementing new RCM processes across the physician group’s 11 offices.Reclaim also worked with Pulse to enhance transparency around revenue cycle performance, providing leaders and staff with revenue cycle dashboards that enable them to view specific performance metrics at any time. Real-time access to RCM data generated excitement around the progress Reclaim made while empowering staff to pinpoint opportunities for improvement and act upon them quickly.Faster than ever, staff could visualize the impact of their work with Pulse on Reclaim’s financial health and the quality of patient financial services the practice provided:
- By standardizing workflows according to industry best practice, Reclaim reduced days in A/R by half. By the end of December 2017, more than 60 percent of Reclaim’s A/R fell under the 0 to 90-day buckets. Meanwhile, average days in A/R totaled just 38 days—an outstanding achievement.
- Point-of-service collections increased more than 12 percent since 2015, and patient complaints have been reduced by half.
- Automated system improvements generate more accurate, actionable data, increasing efficiency and the practice’s clean claims rate.
- Reclaim also experienced a significant drop in denials, driving enhanced cash flow while improving patient satisfaction.
“Our team is very excited about the progress we’ve made around revenue cycle performance since partnering with Pulse,” says Charles R. Stafford, DC, director of operations for Reclaim.
“Pulse’s customizable solutions have enabled us to meet the RCM needs of our high-volume practice while ensuring our revenue cycle team follows best-practice processes that support best-in-class results. Claims are approved sooner, with fewer complications, and days in A/R have been cut in half.”
Achieving Best-in-Class RCM PerformanceThroughout Reclaim’s four-year partnership with Pulse, workflows that maximize performance at each point in the revenue cycle—from patient registration and check-in to claims submission and payment—have boosted clean claim rates and cash collections.
“Our previous billers didn’t focus on the entire RCM process,” Dr. Stafford says. “When you consider that revenue cycle success starts with the quality of the data collected during patient registration and continues throughout the patient encounter, it’s clear that numerous staff have the potential to impact the organization’s financial health. Pulse has worked closely with our team to establish processes and tools that ensure claims are as clean as they can be before they are submitted. Right away, we increased our clean claims rate by 10 percent.”
The types of specialty care services Reclaim provides, from physical and occupational therapy to chiropractic medicine, urology services and more, typically require physicians and staff to build long-term relationships with patients. Pulse supports this goal by ensuring every financial interaction with patients is highly transparent, highly accurate and highly attentive to each patient’s needs and circumstances.A Comprehensive Approach to RCM ExcellenceRecent research shows healthcare organizations that rely on just one vendor for RCM services, rather than multiple vendors and multiple tools and systems, have lower rates of denials. Reclaim’s experience supports this finding, with tightly integrated tools and processes that support a healthier bottom line.For example, Pulse has found that the biggest revenue cycle challenges physicians face are collecting payment from patients with high deductibles and withstanding increased claims scrutiny from commercial payers. PulseRCM uses comprehensive claims-scrubbing logic to drive clean claim rates that are higher than 98 percent on first pass. With this system, Reclaim benefits from higher collection rates, shorter payment cycles and reduced operations expenses, with results that meet and often exceed MGMA best-practice benchmarks.Reclaim also relies on PulsePM, an advanced practice management (PM) system that provides Reclaim with next-level solutions for scheduling, patient registration, billing, coding and claims processing. PulsePM reduces the administrative tasks that formerly bogged down Reclaim’s specialty practice teams. The system applies automated workflow logic to financial, clinical and administrative processes, enabling physicians, staff and clinicians to focus on value-added work. Features include a dynamic workflow list, a patient reminder system, an automated patient statement generator, and more. PulseEHR positions Reclaim to configure features to accommodate practice workflows, with an advanced clinical knowledge engine that simplifies the documentation process; quality reporting features that enable Reclaim to easily meet requirements for MACRA, meaningful use, and more; an evaluation and management coder that helps staff calculate the recommended office visit level and adjust coding accordingly; a patient clinical snapshot that allows physicians and clinicians to view specific portions of a patient’s record over a timeline; and more.Soon, Reclaim also will implement Pulse’s InteliChart Patient Portal—a feature Dr. Stafford anticipates will have a significant impact on the patient experience and Reclaim’s bottom line. But for Dr. Stafford, the value of Reclaim’s partnership with Pulse is less about the advanced RCM and EHR solutions Pulse provides, and more about the strength of the relationships Pulse has built with Reclaim staff and physicians.
“The No. 1 way I evaluate a vendor comes down to the people who provide the services,” Dr. Stafford says. “Pulse is very attentive to our needs and the needs of our patients. You can’t overestimate the importance of customer service when it comes to specialty care. Pulse goes above and beyond in meeting our practice management needs. Ultimately, this strengthens not only our bottom line, but also our ability to provide high-quality care.”