Reduce AR Days With Web-Based Billing Software

By Erin Harris, Editor, Health IT Outcomes

A Web-based billing software and services solution helped Adventist Health Medical Group cut its AR cycle by nearly 30 days.

Physicians practices have long known that the manual processes supporting paper-based remittance systems are fragmented, inefficient, and error-prone. Indeed, Laurien Hamilton, patient financial services director, and Rachel Russell, business office manager, at Adventist Health Medical Group, a rural health clinic located in southeastern Washington, know this to be true. In addition to a time-consuming claims processing system and the lack of a clearinghouse, Adventist Health did not offer an online payment option for its patients. Burdened by the problems associated with disparate and inefficient processes, Hamilton and Russell explain why Adventist Health chose an automated medical billing solution and services, and the benefits the clinic has reaped as a result.

Adventist Health Medical Group was purchased from a private group in 2008. Adventist Health inherited the private group’s practice management software, developed by TriMed Technologies, which is still in use today. However, from its inception, Adventist Health processed claims manually — a process that took up to 2 hours per day and was riddled with countless potential billing errors. “First of all, we were on dialup at the time, and we used that dial-up connection to manually transmit the claims batches to Premera [local Blue Cross],” laments Hamilton. “We often transmitted hundreds of claims per day. But, if we were unable to connect with Premera, we couldn’t bill that day. We submitted claims directly to other insurance companies, and most of them did not accept direct files, so we had to bill them using paper claims — a process that drastically slowed down reimbursement.”

Most insurance companies have 30 days before they must recognize the claim and load it into their system. Adventist Health found that it would take at least 30 days before the group received a letter in the mail alerting them that they had submitted an invalid identification number. At that point, the group would have to call or look online to find the correct ID and send out a new claim. Sometimes it would be one or two months before the payment was received. In addition to timely claims processing problems, patients would question the long lag time in receiving their bills. “We simply had too many software solutions, none of which were integrated,” says Russell.

FLEXIBLE PAYMENT TECHNOLOGY SOLUTION REDUCES INEFFICIENCIES
In 2010, TriMed Technologies recommended that Hamilton consider ZirMed, a Web-based medical billing software and services provider, to remedy Adventist Health’s billing problems. After researching ZirMed on her own, Hamilton had Adventist Health’s clinic administrator review the solution, too. After a successful review, the clinic chose to implement the solution. “What attracted us to the solution was that it is not only a back-end product,” says Hamilton. “It is a solution that includes front-end value in terms of batching for eligibility requests, which was a huge problem on the front-end side of our business (e.g. verifying that the patient has insurance, accepting patient payments efficiently on the front-end, and ensuring that the claims are clean).”

Russell explains that Adventist Health subscribes to seven of ZirMed’s services (i.e. professional claims, institutional claims, electronic remittance advices [ERAs], eligibility, print services [for patient statements], e-Delivery [email delivery of patient statements], and ZPay Collect [Webbased credit and debit card processing solution]). Russell considers subscribing to each of the seven services individually to be an advantage for a small office. “For example, not all physicians bill Medicare Part A, so they would not need the institutional claims service,” explains Russell. “A medical group may print their own statements or check eligibility by calling the insurers. If an office does not need one of the services ZirMed offers, they simply do not subscribe to that service.”

CLEARINGHOUSE SOLUTION PROVIDES THE RIGHT TOOLS TO SUPPORT YOUR STAFF
The ZirMed and the TriMed practice management software are integrated, alleviating errors and discrepancies on most claims. Not only does the new clearinghouse enable Adventist Health to transmit batches to more insurance companies, it’s also completely automated. “We schedule the claims batches to run at night, and I receive a message in the morning letting me know the outcome,” says Hamilton. “ZirMed has pre-edits. We work only the claims that have been flagged for errors. If there are errors, we look them over immediately. What used to be a labor-intensive process now saves our employees 8 hours a week.”

Adventist Health now has the ability to exchange eligibility request files. Three days prior to a patient appointment, ZirMed sends an eligibility request to the insurance company to ensure that Adventist Health has the patient’s current insurance information on file. “ZirMed’s registration assist provides automated insurance verification,” says Russell. “It puts the results right into our scheduling system, so the registration clerk doesn’t have to search for the insurance eligibility.” If a rejection notice is returned, which states that the patient is no longer covered with that insurance, Adventist Health is able to follow up with patients before they even come in, and have the correct information available upon their arrival.

The vendor’s print services have proven efficient and popular with patients for Adventist Health. Previously, patients’ statements were printed by a different company twice a week. ZirMed offers both printed and e-delivery statements (an email with a secure link). “Because of the print services, our statements are automatically dispatched every night. Our patients have expressed appreciation that they have a choice regarding how they receive their statements — electronically or paper,” says Hamilton. “ZirMed’s credit card processing, ZPay Collect, prints a daily report of all the cards that were charged. Not only has this provided useful reporting, it has also enabled us to eliminate the physical credit card machines and their monthly rental fees, saving us $120 a month.”

LEVERAGE ONLINE BILL PAYMENT TO QUICKLY COLLECT PAYMENTS
Prior to choosing the new clearinghouse solution, Adventist Health was unable to accept online payments from insurance companies and patients. For example, if a patient phoned wanting to pay their bill with a credit card, a receptionist would have to manually key the number into the credit card machine. “We had a credit card terminal in the central registration office, so the account representative would have to walk down there, get the patient back on the phone, and key in that information,” states Russell. “Now, the patients can log on, create their own password, and view their statements online in ZirMed so they don’t need to involve us unless they prefer to do so.” Patients receive either a paper statement or a secure email, which includes a link to their statement, allowing them to log on to ZirMed and pay with their credit card. ZPay Collect handles all payment types — those that are mailed in, called in, and made online.

Hamilton and Russell deem the entire project a success. When Adventist Health began using the ZirMed product, its days in AR were 94.7. In May 2012, the company’s days in AR had been reduced to 66.6. “We still have work to do, but the new solution has helped us reduce our days, which positively affected the clinic’s cash collection,” says Hamilton. “Our cash collection has doubled, in part, due to the implementation of the ZirMed product and the standardization and efficiencies it brought to claims and payment processing.”