3. Introduction
Bethlehem Ear, Nose and Throat Associates
A recent audit of the billing uncovered that the clinic is losing around 40 to
50 thousand dollars per year because of billing issues
This project was tasked with examining in detail the patient billing process,
with the goal of uncovering the root causes for under-collection of patient
accounts
3
4. Background
Bethlehem Ear Nose & Throat Associates(ENT)
A highly-regarded small private-practice specialty clinic with ties to the St.
Luke’s Hospital network
The Bethlehem ENT’s main office located in the north Bethlehem
Seeing the majority of their patients
Houses administration and accounting
4
5. Background
Bethlehem Ear Nose & Throat Associates
Had 4 full-time specialty physicians and 3 physician assistants (PA)
Providers who are on-site seeing patients varies daily
Seeing an average number of 70 patients per day
6
6. Background
Bethlehem Ear Nose & Throat Associates
Front desk, checkout desk, tech bar, billers’ office
3 Full-time billers (Certified Professional Coder)
Allscript Professional EHR
7
8. Methodology
This project:
Define
Identify the problems by observation and asking questions
Measure
Map the billing processes
Measure defects and their weights by interview and data collection
Analyze
Analyze the collected data and provide possible suggestions
9
9. Findings
The problem was defined as:
Issues lie in the billing process that cause financial loss
10
12. Findings
APPOINTMENT MADE
CHECK IN
SET UP IN EXAM ROOM
SEEN BY PHYSICIAN/PA
PROCEDURES
CHECK OUT
BILLING STATEMENT
STARTED
STATEMENT ACTIVATED
BILLING UNDERGOING
NECESSARY INFORMATION
INTEGRATED AND
AUDITED
CLAIM COMPLETED
SUBMITTED TO
INSURANCE COMPANY
PATIENT INFORMATION
INSURANCE INFORMATION
REFERRALS & OTHERS
SERVICE DOCUMENTATION (NOTES)
BILLING CLAIM
Timely filing
13
13. Findings
Timely filing
Providers must file claims for services furnished within a specific period of
time of the date of service
Varies by insurance companies
90 / 180 / 365 Days
Handling Timely Filing Claim Denials
Fill in a appeal form, attach a copy of the claim with proof of timely filing
The proof needs to be something that shows when the claim was
originally submitted or when and how many times it was resubmitted
14
14. Findings
Causes of loss:
CAUSES
ESTIMATE LOSS /
6 MONTH
NOT PARTICIPATING WITH
INSURANCE
Traditional Medicaid $46,144
OVERDUE BALANCE
Not enter insurance correctly
$27,409
No referral from primary physician
Claims are lost in the system
Insurance company doing review
DOCTORS' NOTES
Unfinished old notes
$75,000
Not having appropriate documentation
15
17. Findings
DOCTORS' NOTES
Incomplete old notes
By Jun 24th, 599 notes unfinished in period from Jan 1st to May 31st
$125 per patient
599 x $125 = $74,875
18
18. Findings
Data collection on number of finished notes:
DATE WEEKDAY TOTAL PATIENTS NEW NOTES OLD NOTES
7/25 MON 59 32 10
7/26 TUE 97 32 11
7/27 WED 36 27 2
…. …. .... …. ….
19
19. Findings
59
85
53
63
38
63 64 57
36
94
112
65
79
37
111
76
47
71
63 59
97
36
49 62
0
50
100
150
200
250
MON
TUE
WED
THU
FRI
TUE
WED
THU
FRI
MON
TUE
WED
THU
FRI
MON
TUE
WED
THU
FRI
MON
TUE
WED
THU
FRI
6/276/286/296/30 7/1 7/5 7/6 7/7 7/8 7/117/127/137/147/157/187/197/207/217/227/257/267/277/287/29
Number of Patients Seen vs. Finished Notes Per Day
OLD NOTES
NEW NOTES
TOTAL
PATIENTS
20
20. Findings
Jun 27th to July 29th (5 weeks)
Not a single day had all that day’s notes finished
1,576 Patients in total, 53% of their notes were done in the day of service
5 Out of 25 days the total number of finished notes exceeds the number of
treated patients
21
21. Findings
Jun 27th to July 29th (5 weeks)
Average number of: (per day)
patients: 66
Total finished notes: 56
notes of the day: 34
catch-up notes: 22
Unfinished notes: 10
15.2%
51.5%
33.3%
Unfinished Notes
Finished Intraday Notes
Caught Up Old Notes
22
22. Findings
Jun 27th to July 29th (5 weeks)
10 notes are left per day
10 bills are missed per day
10 x $125 = $1,250 per day
20 x $1,250 = $25,000 per month
23
23. Findings
Jan 1st to May 31st , 2016 (5 month)
Report on Jun 24th : 599 Incomplete notes
Report on Aug 3rd : 197 Incomplete notes
Caught up 402 old notes within 40 days
Jun 1st to July 31st , 2016 (2 month)
Report on Aug 3rd : 456 Incomplete notes
197 + 456 = 653
24
24. Findings
59
85
53
63
38
63 64 57
36
94
112
65
79
37
111
76
47
71
63 59
97
36
49 62
0
50
100
150
200
250
MON
TUE
WED
THU
FRI
TUE
WED
THU
FRI
MON
TUE
WED
THU
FRI
MON
TUE
WED
THU
FRI
MON
TUE
WED
THU
FRI
6/276/286/296/30 7/1 7/5 7/6 7/7 7/8 7/117/127/137/147/157/187/197/207/217/227/257/267/277/287/29
Number of Patients Seen vs. Finished Notes Per Day
OLD NOTES
NEW NOTES
TOTAL
PATIENTS
Catching up notes is slower that leaving note behind
25
28. Findings
Catching up notes is slower that leaving note behind
111 76 47 71 63
34 10183669 21 7346 50 357
368
11
OLD NOTES
NEW NOTES
PATIENT
NUMBER
29
29. Findings
Lag in notes can:
Cause loss on Time Value of Money
A dollar today is worth more than a dollar in the future
Lead to incomplete medical documentation
Create inefficient extra work
30
49. Conclusions
Incomplete notes are the bottle neck in the billing process, strongly affect
the speed of billing and payments receiving, and will lead to timely filing
claims denials that directly cause huge loss of revenue
Olds notes are being caught up but the speed of catching up is slower that
the speed of notes fall behind; based on current analysis, the clinic is
losing 10 bills per day on average
Even if all the old notes will eventually be finished before their deadline,
there is loss on time value of money and risk of having errors in medical
documentation
50
50. Conclusions
Not checking eligibility, errors in patient information, missing documents
and EHR system malfunction are also issues that hinder the process of
billing
51
51. Voices
About Notes:
“We are not educated and trained for typing notes, but now it’s taking the
most of our work time”
“Papers are better”
“Things will be much quicker when scribes are here”
“Sorry but I was just trying to get those notes done and get out of here”
About work:
“They don’t know how busy we are”
“They don’t understand how much trouble it can cause”
About the EHR Allscript Pro:
“Allscript ? Oh no……”
“It’s ok when it works”
52
52. Recommendations
The importance of finishing notes on time should be addressed, and it
must be made clear that it is impossible to catch up all the old notes when
leaving more notes unfinished everyday
Proper assistance should be provide to doctors to complete the notes and
make work easier. Scribes or virtual medical scribes can be considered to
implement in the practice
53
53. Recommendations
Developing a better way to check eligibility in the front desk will be helpful
to smooth the billing process and ensure timely payment
Plenary meeting should be held once a month for staff can get a better
idea of what others are doing and what kind of difficulties everyone is
facing, thus create a positive environment for further improvement
55
54. Acknowledgements
Robert Dallas
Melissa Emerick
Elizabeth Howard
Jessica Beatty
Maryann Martini
David Campbell
Nicole D’Amato
Amber Noel
Crystal Oswald
Helen Matthews
Terry Theman
Ana Alexandrescu
Siyang Liu
Jessica Johnson
Cathy Chunko
Jordyn Clark
Kathy Schlegel
Abbi Dougherty
Patricia Mcgoularick
David M. Yen
Jose I. Uribe
David M. Brown
Aaron J. Jaworek
Danielle Seiple
Vanessa Heimbach
Michelle Yost
Tracey Lee
56
55. References
How to Handle Timely Filing Claim Denials – CareCloud
Protect the financial livelihood of your practice through coverage verification and
balance collection – Healthcare Business Monthly
How to Improve Your Revenue Cycle Processes in a Clinic or Physician Practice –
Janice Crocker
57
