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:
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:
“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.
Achieving Best-in-Class RCM Performance
Throughout 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.
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 Excellence
Recent 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.