Change Management – Switching Your Billing Systems
Practice owners seeking better solutions often start with a vision of increased practice profitability while treating reasonable patient volumes. Their vision spans multiple aspects, including better reach to prospective patients, better reimbursement rates, full and timely payments by insurance companies, less time spent on visit documentation, improved documentation quality for better clinical follow-up and lower audit risk, and more free time for family. However, that vision conflicts directly with the payers’ goals to reduce costs and increase revenues. Payers’ goals directly conflict with a provider’s vision because cost savings for payers simply mean that providers treat more patients at lower reimbursement rates—or, in other words, providers work harder for less money. In addition to the basic payer-provider conflict, visionary practice owners must face the resistance of their office managers and colleagues. These people may be skeptical because they don’t trust the owner, have seen five other failed initiatives, or think they might lose something with the change. Significant time, enthusiasm, and resources are needed to change practice processes and technology and to retrain personnel while simultaneously managing the practice and treating patients. The challenge of overcoming resistance to change and implementing it in your practice is akin to enhancing airplane engineering while keeping the plane in the air. Thus, medical practice owners often find themselves in a dilemma between adopting new solutions or compromising the vision and returning to the old ways, along with shrinking revenues and growing frustration. One key area of medical practice that requires a huge transition is shifting from paper-based records to an electronic health record (EHR) system. Shifting from one EHR system to another is also burdensome and requires a systematic approach to achieve results. Several internet-based software and tools can aid medical practices in transitioning to electronic records successfully, leading to maximized outputs and better service delivery to patients. We shall look at how to adopt this change using a change model. EHR and billing processes can help providers cut costs, improve the quality and safety of care, and enhance the productivity of the employees. Most practices have adopted EHR and electronic billing systems to achieve the above goals, whereas some have stuck to using paper documentation and filing systems. Paper-based records are often tiresome to retrieve, prone to errors and misplacements in addition to being bulky and space-consuming to store. Paper-based billing systems have also been shown to take longer claims processing times than EHR due to the time taken to verify manually. To fully realize change and adopt it into practice, a stepwise approach has to be taken, failure to which frustrations and complacencies are bound to occur, leading to regression to previous ways. John Kotter, a Harvard Business School professor and the world’s foremost authority on leadership and change, discovered that transformation challenges span multiple industries and share the same characteristics. His book Leading Change lists an eight-step process for implementing successful transformations. The eight steps can be divided into 3 phases: creating the climate for change, energizing & enabling them, and implementing and sustaining the change (National Learning Consortium, 2013). The figure below illustrates these three phases. Figure 1: The three phases of Kotter’s eight-step change management model This model has successfully been used to help transition into an electronic health records system in clinical practices. For instance, North Shore Medical Center in Chicago, Illinois, successfully transitioned from 100 percent paper-based medical records to 100 percent electronic records in 2013 using Kotter’s eight-step model (Martin and Voynov, 2014). An orthopedic practice group in Ontario, Canada, also successfully transitioned from paper records to electronic records, achieving more than a 95% threshold using Kotter’s change model (Auguste, 2013). We shall look into the eight steps in detail using an example of a healthcare practice that desires to transition from paper-based records to electronic health records and billing. Step 1: Create a sense of urgency. In this step, a health practice can provide evidence to its employees on the need for an EHR. This can include faster claims processing, less bulky storage space, easy records retrieval, and better security. At this stage, the aim is for employees to buy into EHR and keep talking about the proposed change. Step 2: Form a powerful coalition. To help convince employees that change is necessary, the practice can develop a committee of committed and passionate individuals who constantly champion EHR. These individuals can work as a team to help identify barriers to implementation as well as help remind other employees of the need for EHR constantly. Step 3- Create a vision for change. The practice can develop a clear and concise vision through the committee, which motivates transition. An example of a vision would be establishing the most secure health records for clinic patients. Step 4: Communicate the vision for buy-in. Once the vision is created, it must be communicated to the employees clearly explaining the benefits to encourage buy-in. This can be achieved through face-to-face meetings, sending email reminders on the transition from paper to EHR, and individual interviews. Step 5: Remove obstacles. There are 5 categories of barriers hinder any change from occurring in an organization, the biggest of which are complacency and resistance to change (IvyPanda, 2020). The 5 categories include complacency, Limited sharing of the vision, Different obstacles to the vision, Inability to accomplish short-term wins, and failure to solidify the change in the practice culture. Let’s briefly talk about the five categories of barriers. 1. Complacency– This is the most deadly of practice change management problems. Suppose you just plunge ahead with a new electronic medical records (EMR) system or billing process without first establishing a shared sense of immediate need or urgency because of increased audit risk or shrinking revenue. In that case, natural complacency takes over—and the entire change effort fails. It’s hard to drive people out of their comfort zones. Past failures, the lack of a visible crisis, low-performance standards, and insufficient feedback from doctors, office personnel, and patients—all add up to turning the best-intended change initiatives
Maximizing Chiropractic Efficiency: The Power of Integrated Software Solutions
In today’s digital age, the healthcare industry, including chiropractic practices, is rapidly evolving. With the rise of technology, there’s an increasing need for integrated software solutions that can streamline operations, enhance patient experience, and boost overall efficiency. In this context, the integration of platforms like Genesis Chiropractic Software and TrackStat is nothing short of revolutionary. The Need for Automation in Chiropractic Practices Automation is no longer a luxury but a necessity. With the increasing demands on healthcare professionals, manual processes can become tedious and prone to errors. By automating tasks such as patient management, appointment scheduling, and follow-ups, chiropractors can ensure a smoother and more efficient workflow. This not only saves time but also reduces the chances of human error, ensuring that patients receive consistent and high-quality care. Segmentation for Personalized Patient Care One size doesn’t fit all, especially in healthcare. Every patient is unique, with different needs and health conditions. By segmenting patients into different categories based on their health conditions, treatment plans, or other criteria, chiropractors can offer more personalized care. This not only enhances the patient experience but also ensures that each patient receives the most appropriate and effective treatment. The Power of Sales Pipelines in Patient Conversion A robust sales pipeline is crucial for any business, including chiropractic practices. By tracking new patients, their last and next visits, and other relevant information, chiropractors can gain valuable insights into their conversion rates. This data can be instrumental in identifying areas of improvement and implementing strategies to boost patient conversion. Enhancing Patient Retention with Data Analytics Patient retention is a critical metric for any healthcare practice. By analyzing data on patient drop-offs, chiropractors can identify specific points in the patient journey where they’re losing patients. With this information in hand, they can implement targeted strategies, such as educational workshops or progress exams, to enhance patient retention. Streamlining Operations with Two-Way Texting and Smart Reactivations Communication is key in healthcare. Two-way texting allows for seamless communication between chiropractors and their patients, ensuring that patients are always informed and engaged. Additionally, smart reactivations can help chiropractors identify and reach out to patients who haven’t been in for a while, ensuring that they continue to receive the care they need. Reducing Accounts Receivable with Integrated Solutions Financial health is crucial for the sustainability of any practice. By integrating solutions that help reduce accounts receivable, chiropractors can ensure a steady cash flow and financial stability. This not only ensures the smooth running of the practice but also allows chiropractors to invest in further enhancing their services. Conclusion The integration of platforms like Genesis Chiropractic Software and TrackStat offers a plethora of benefits for chiropractic practices. From automating tasks to enhancing patient experience and boosting efficiency, these integrated solutions are truly game-changers. As the healthcare industry continues to evolve, it’s crucial for chiropractors to leverage the power of technology to stay ahead of the curve and offer the best possible care to their patients. Note: For a deeper dive into these topics and to hear firsthand experiences from industry experts, watch the video at the top of this page.
Why ClinicMind?
DO YOU know a practice owner who wants more patients in her clinic, better pay-per-visit, and better collections? We all know healthcare practice owners who want to remain independent and grow and yet are frustrated by insurance companies and continuous battles to get paid and stay compliant. Now, as a patient, do you like visiting a healthcare practice, receiving bills, and reconciling them with your insurance company? You are not alone. As it turns out, most other people do not like their patient experience. The problem is that patient and independent practice needs have evolved in step with society and technology, but management methodology remained in the 19th century. There’s a fundamental mismatch between how healthcare practices and patients are managed — and the practice owners’ and patients’ expectations. We came to a startling observation: patients no longer want their care to be managed the way it used to be managed in the previous century. And yet, practice owners still use their old methods to memory-manage their practice. Who is taking advantage of this mismatch? The insurance companies – payers. From the outset, we knew that healthcare costs are spiraling out of control. We also knew that insurance companies, medical equipment manufacturers, pharmaceuticals, and hospital executives have been all making handsome returns and benefitting from healthcare cost growth. One question bothered us: why are the practice owners unable to participate in that growth? How was it that the key contributors to healthcare service were excluded from fair compensation for their work and grew exceedingly frustrated with rules and regulations? Some providers were selling their practices to join larger networks or hospitals, and others were moving to different industries. National studies have shown that physician burnout rates are climbing up. For instance, Mayo Clinic Proceedings reported that the prevalence of burnout among U.S. physicians was 63% in 2021, compared with 38% in 2020, 44% in 2017, 54% in 2014, and 46% in 2011. We also noticed that with experience, medical billing managers start cherry-picking insurance companies for easy follow-up. So, the practice owners could not get paid on time and in full by a growing number of insurance companies (payers). The more obstacles payers pose – the less paid the providers are. Payers were stacking the game against the providers by continuously adding new rules to reduce payments and increasing the frequency of provider audits. In addition to continuous consolidation, resulting in scarcity of payers (a market structure known in economics as Oligopsony), which allows the payers to drive the reimbursement fees down, they also have a two-pronged resource advantage: attract Ivy-league MBAs to build sophisticated claim-processing protocols and discover every little pretext to deny or delay claim payment leverage the most powerful digital technology to implement those protocols on the ever-growing volume of claims. ClinicMind was founded to address two basic challenges facing providers: a patient-provider expectations mismatch and payer-provider adversity. First, the patients have transformed how they expect healthcare service delivery, but practice owners have not adapted their practice management methodology. Second, insurance payers underpay and delay payments because they make a substantial profit from the “float.” The float is the money insurers hold onto between the time they collect premiums and the time they pay out claims. In summary, 1. The Basic Mismatch Between Patients and Providers: a. Background: The healthcare industry has undergone significant changes in recent years, with patients becoming more proactive in managing their healthcare and demanding a different level of service. This transformation is largely due to increased access to health information through the Internet and the rise of patient-centered care models. However, many practice owners, particularly in traditional healthcare settings, have not adapted their practice management methodology to meet these changing patient expectations. b. Conflict: Patient Expectations: Patients today expect convenience, transparency, and a more personalized approach to healthcare. They want to schedule appointments online, access their medical records easily, and receive timely, clear communication from their healthcare providers. Provider Resistance: Many practice owners and healthcare providers are accustomed to traditional, paper-based methods and may hesitate to embrace digital technologies or change their established processes. This resistance can result from the comfort with the status quo, fear of the unknown, or high implementation costs. c. Resolution: To resolve this conflict, healthcare practices must adapt to the changing landscape. This may involve investing in electronic health records (EHR) systems, online appointment scheduling, telemedicine services, and more. Additionally, training staff and providers to use these technologies effectively is crucial. Clear communication with patients about these changes, the benefits they bring, and how data security and privacy are maintained can help build trust and reduce resistance. 2. Payer-Provider Adversity: a. Background: In the healthcare system, insurance payers (such as health insurance companies) often maintain a substantial portion of their profit through a financial mechanism called the “float.” The float is the money insurers hold onto between the time they collect premiums and the time they pay out claims. This float can represent a significant source of income for payers. However, it can create a conflict of interest with healthcare providers. b. Conflict: Payer Profit: Insurance payers benefit from maintaining a healthy float, as they can invest these funds and earn returns. The larger the float, the more profit they can potentially make. Payers have a significant advantage over the providers because of the oligopsony and because of significantly larger resources for better talent hiring and data processing. Provider Concerns: Healthcare providers, on the other hand, often face challenges in receiving timely and appropriate payments from payers. Delays or disputes in claims processing can impact their cash flow and ability to provide care. Providers feel that payers prioritize maintaining their float over ensuring prompt reimbursement. c. Resolution: Transparency and fair contracting: Establish clear and fair contracts between payers and providers that outline payment terms, including prompt payment schedules and dispute resolution mechanisms. Industry consolidation: Metcalf’s Law states that the value of a network is
Factoring
Introduction Factoring can improve cash flow and operational efficiencies, and it is used in many industries, including the healthcare sector. With this strategy, businesses sell their accounts receivable at a discount to a factoring company (the factor), giving them access to quick cash. The burden of recovering the debt from the consumer who has not paid their invoice is transferred to the factoring company. The corporation has access to its earnings immediately, skipping the customary payout period (Ferguson, 2020, Factris, 2021). Popularity of Factoring The worldwide factoring services industry will reach USD 3.5 billion by 2032, growing 8.5% annually. The market’s growth is driven by cash flow management, working capital financing, and SMEs’ use of factoring services (FID Reports and Data, 2023). The U.S. factoring services market will reach USD 287.61 billion by 2030, growing 8.1% from 153.96 billion in 2022 (Grand View Research, 2023). According to a survey, factoring services have grown in popularity, especially among Micro, Small, and Medium-Sized Enterprises (MSMEs) that have trouble securing appropriate financing, particularly in working capital. There are 127 factoring companies in the US and Canada. Mazon Associates in Dallas, Crown Financial in Houston, Provident Commercial Finance in Chattanooga, Bankers Factoring near Atlanta, J D Factors in Los Angeles, and Velocity Financial in Midland are considered to be the top-performing 2023 companies (Factoring Club, 2023). A few other examples include (Treece, 2023): FundThrough offers 100% advance rates on up to $10 million in finance, with costs starting at 2.75%. Riviera Finance offers 95% advances on $5,000–$2 million loans. They are known for their individualized service and face-to-face knowledge. altLINE offers up to 90% advances and can quote lending amounts. They specialize in huge invoices and charge 0.50% APR. TCI Business Capital finance $50,000–$10 million at 60%–90% advance rates. They offer bespoke factoring solutions and don’t disclose their APR. Healthcare providers frequently encounter delays in receiving reimbursements from insurance companies. The quality of healthcare providers’ services may suffer due to delays (Fundbox, 2023). Healthcare providers use factoring firms to speed up the payment procedure. They sell the health insurance claims—basically unpaid invoices—to factoring companies, who recover the claim payments from the insurance providers. By ensuring prompt claim payouts, this method aids healthcare providers in maintaining their highest levels of operational effectiveness. On the other hand, some practice owners may disapprove of the factor’s specific approach to managing patient or payer interactions (Factris, 2021). Factoring Process Initially, healthcare vendors or medical providers send invoices (claims) to either a medical provider or third-party payer (Medicaid, Medicare, private insurance companies) for services rendered or goods provided. Following this, a copy of the invoices, along with any supporting documentation, is submitted to a factoring company like PRN Funding, LLC (PRN Funding, 2020). Subsequently, the factoring company purchases these invoices and advances 80-90% of their face value, with funds typically deposited directly into the vendor’s or provider’s bank account within 24-72 hours. The remaining percentage is used as a buffer in case some bills do not get paid or if there are billing errors. Eventually, the reserve, less the factoring fee, is released back to the vendor or provider after receiving payments (PRN Funding, 2020). Step-by-Step: Healthcare vendors or medical providers send medical claims to medical providers or third-party payers (such as Medicaid, Medicare, or private insurance companies). A factoring business (the factor) Receives copies of the invoices and any necessary supporting documentation. Purchases these invoices at a discount, typically around 80-90% of their face value. Advances the funds directly into the vendor’s or provider’s bank account within 24-72 hours. Holds a portion of the invoice amount as a reserve in case some bills go unpaid or there are billing errors. Assumes the responsibility of collecting outstanding payments from insurance providers, relieving the healthcare provider from the burden of debt collection. Collects the payments received from insurance companies or third-party payers. Releases the reserve, minus the factoring fee, back to the vendor or provider once the payments are received. How does the factor estimate the quality of the outstanding claims? The factor assesses the quality of outstanding claims through various methods and criteria. This assessment helps determine the likelihood of prompt payment, helps minimize non-payment risk, and ensures that the factor can provide immediate capital to healthcare providers while maintaining a reasonable level of risk. Here’s how the factor determines the quality of the outstanding claims: Evaluation of the payer: The factor examines the insurance companies or third-party payers responsible for reimbursing the claims. They consider the payer’s reputation, track record of timely payments, financial stability, credit scores, and payment history. Specific policies, guidelines, and requirements for claim processing. These include claim submission deadlines, pre-authorization requirements, and claim acceptance rates. Collaboration with healthcare providers: Factors collaborate closely with healthcare providers to gather information about outstanding claims. Providers may share their experiences with different payers, providing valuable insights into the quality and reliability of the claims. Verification of claim documentation: The factor reviews the supporting documentation accompanying the outstanding claims. This includes verifying the accuracy and completeness of the medical records, coding, and billing information. Thorough documentation ensures that the claims are valid and are more likely to be paid. Analysis of historical data: The factor analyzes the provider’s historical payment patterns from different insurance companies or payers. This analysis helps identify any trends or patterns of delayed payments or denials, providing insights into the quality and reliability of the outstanding claims. Industry Knowledge and Expertise: Factors with experience in the healthcare industry develop expertise and knowledge about various payers, their reimbursement practices, and the industry’s dynamics. They stay updated with industry news, regulatory changes, and trends that may affect payment processes. This industry knowledge enables them to predict payment delays and amounts. Strategies for Choosing the Best Factor for Your Practice The factor selection decision depends on the factor’s stability and track record, the factoring service fees (2%-3.5% monthly was typical in 2022), the terms of the factoring agreement, the type