Creating High Financial Performance in Private Practice
$158K is the average performance improvement of what top primary care private practice physicians earn compared to those who are average.*
*Source: MGMA, Physician Compensation and Production Survey: 2012 Report Based on 2011 Data
Top-performing physicians care about two things: patient care and financial performance. Because a practice’s financial health directly affects the ability to provide excellent care, top physicians carefully evaluate billing procedures in order to collect all available. This guide illustrates why medical billing processes, staff, and technologies are critical factors in maximizing revenue capture. On the surface, payment collection seems pretty straightforward: you provide service and get paid, right? Not necessarily. Often payments are interrupted by mitigating roadblocks that are expensive and time-consuming to navigate. Outdated billing software and procedures impact a practice’s capacity to collect; inaccurate coding and charge capturing often lead to insurance denials. Practices also struggle to maintain an efficient workflow as client/server practice management and health record software often do not interface. When considering the frequency of rejected claims, staffing costs, and delinquent receivables, billing procedures may be costing your practice thousands of dollars each year. There is a solution to this financial drain – ADP, a trusted company with nearly $11 billion in revenue and more than 60 years of experience. As one of the world’s largest providers of cloud technologies, ADP provides an estimated 570,000 clients with solutions for human resources, payroll, benefits administration, tax processing, and medical practice services. AdvancedMD by ADP offers physicians a complete solution for medical practice optimization. With AdvancedMD, providers can shift attention to what really matters—taking care of their patients.
Is your practice in line with industry averages?
Market analysts estimate that the U.S. healthcare system is so inefficient that 24 cents out of every dollar are wasted on administrative and billing expenses1. Quantifiable costs are often easy to recognize; however, outdated office technology quietly affect the bottom line. Inefficient workflow, high claim rejection rates, and excessive administrative costs also erode profits. Recent advancements in medical office technology are eliminating these operational inefficiencies and redundancies previously either unnoticed or unavoidable.
Office technology is the cornerstone of an efficient, profitable medical practice. According to a Modern Physician/Price Waterhouse Coopers survey, medical practice technology usage increases 40% every year. To stay competitive, medical professionals must invest in advanced technologies including tools that support a paperless office (i.e. electronic health records, online patient portals, electronic prescribing, remote access, central billing office, up-to-date coding and claims processing, offsite data storage). Physicians who consider clinical
U.S. healthcare is so inefficient that 24 cents out of every dollar is wasted on administrative and billing expenses.
New England Journal of Medicine
quality and increased profitability see good reason to invest in these new technologies. Examining industry averages will help to determine if your billing procedures are impacting your profitability and if it is time to upgrade your system. The assumptions below represent industry averages for solo and group practices taken from 2012 MGMA Cost Survey Report2.
Total medical revenue per FT provider (monthly) Total medical revenue per FT provider (annual) Total medical revenue after operating costs per FT provider Total A/R per FT provider Percent of total A/R 120+ days Days gross fee-for-service (FFS) charges in A/R Hardware/equipment/system software (per provider) Total operating costs as a % of total medical revenue
AdvancedMD can add 22% to the bottom line of a medical practice.
Using these assumptions, the following sections demonstrate how AdvancedMD increases a medical practice’s bottom line by up to 22%. AdvancedMD solves the problems that interrupt full, timely payments while eliminating common inefficiencies. AdvancedMD will take your practice from average to the top of the industry.
How much are you spending on office hardware and support?
Thousand of dollars are spent each year on medical office technology. The initial expense of hardware purchases is just the beginning: continual software upgrades and IT services represent significant portions of the average office budget. Traditional server-based programs require medical offices purchase and maintain expensive hardware. MGMA reports indicate a single-physician practice spends between $5,750 and $12,000 on hardware for their practice management software and an additional $1,750 annually for implementation, training, and customer support. With AdvancedMD cloud practice management
2. 2012 Cost Survey Report, MGMA
and electronic health records, expensive servers and support staff are no longer needed. A medical practice can easily save on hardware and support by outsourcing non-core business functions – allowing you to focus on what you do best – practice medicine.
Hardware Savings from Cloud Utilization
8,875 $ 1,750 $ 10,625 $ 3,000 $ 7,625
Typical hardware cost for a one-doc office
Yearly maintenance cost for a one-doc office
Total yearly hardware and maintenance cost
Cost to purchase computer for AdvancedMD
Savings using cloud practice management and/or EHR
Are you still using paper charge slips?
Charge slips are the foundation of accurate medical office billing, but most offices still use awkward paper slips for each patient visit. Paper slips must be entered manually by billing staff, which is tedious and prone to error. Missing information can cause services to be improperly or never entered. Industry experts estimate that up to 10% of paper charge slips are lost and never billed—each one accounting for revenue loss. Electronic Charge Capture from AdvancedMD streamlines the charge process: it eliminates the need for paper and enables the provider to enter services-rendered directly into the system at the time of service. Partners Healthcare System found an increase of up to 5% in overall billable charges through improved charge capture using software like AdvancedMD. With electronic charge capture you need not worry about lost revenue from missing or underbilled charge slips.
Is it time for your practice to go paperless?
A paper filing and prescription system may be costing your practice more than you suspect. When considering all the factors associated with paper charts and prescriptions (creation, storage, retrieval, and staff time), the cost of maintaining paper files accounts for thousands each year. Time is the most valuable resource in a busy medical practice. Clinicians spend 38% of their time updating medical charts. Nearly 30% of the time, medical records are “not found,” representing hours of lost time each year. The portability of EHR technology allows providers to record notes as they meet with their patients, reducing the overall time of post-visit paperwork. There are a variety of costs that can be decreased or eliminated with the implementation of eRx and EHR. Consider the following expenses3 :
• Creating a new chart costs $7. • Replacing a chart costs $8. • Pulling a chart costs $5. • Mailing records costs a minimum of $.44 in postage. • Faxing records costs $.15 per sheet. • Storing charts costs $1.75 per square feet each year.
Additionally, eRx software provides a way to submit prescriptions electronically and reduces refill processing time from 15 minutes to 3 minutes.4 Assuming 20 refills each day, nearly 4 hours of staff time is saved each day. You will not only save on operating costs by implementing EHRs and eRx, but AdvancedMD is a great tool in reaching Meaningful Use requirements for Medicare and Medicaid reimbursements. Federal incentives for using EHR technology can result in $39,000-63,750 in additional funding for your practice. Use of AdvancedMD will assist you in meeting Meaningful Use requirements while keeping your records accurate and safe
Revenue Gain Using AdvancedMD EHR
960 x $7 $6,720 7200 x $5 $36,000 $42,720
Average new patients per year Cost for creating a new paper chart Annually
Average number of charts pulled each year Cost for pulling a paper chart Annually Additional revenue realized with AdvancedMD EHR
3. Dunne, Anne M. Measuring & Improving Your Medical Practice’s Financial Performance, live presentation given on September 13, 2012 4. Leveraging HIT, Improving Quality & Safety, Journal of Healthcare Information Management
Is your coding as accurate as it could be?
Accurate coding also adds revenue for the independent medical practice. When using the AdvancedMD Claim Inspector, a provider can expect a revenue increase of .5%. The Claim Inspector highlights procedure codes with potential problems by checking coding combinations. For example, if an injectable drug is billed, the Claim Inspector crosschecks the companion procedure for administering that drug. Missed codes may be inevitable; however, “scrubbing” the claims before they go out significantly reduces coding errors and increases revenue.
Additional Revenue from Accurate Coding
739,828 x .50% $3,699
Total office revenue Added revenue per physician per year Additional revenue per year using AdvancedMD coding tools
How are rejected claims impacting your bottom line?
Above-average claim acceptance can make a medical office successful—and above-average claim rejection can break it. Industry experts report the average rate of claim rejection is as high as 30%5 ; therefore, a single-physician practice can expect 69 rejected claims per month. But claim denial is just the first part of lost revenue; consider the substantial costs of resubmitting a claim. The experts agree: “The cost to simply resend a rejected claim to a payer exceeds $6.63. When calculating the additional costs of phone inquiries, duplications, and extra administrative expenses, resubmissions can cost as much as $57.46 per claim.”6 Additionally, the Academy Coding Edge found that regardless of transmission method, electronic or paper, “25%-40% [of rejected claims] are never resubmitted for payment.”7
The AdvancedMD Claim Center™ includes unlimited claims submission and a proprietary Claim Inspector™, which checks 3.5 million coding combinations to guarantee a 95% firstpass acceptance rate. Most AdvancedMD customers report even greater acceptance rates of 98% or higher. With AdvancedMD, you can expect to add $3,260 monthly ($47,400 annually) to your revenue by simply improving the rate of first-pass claim acceptance. Electronic claims take just seconds to prepare and are often processed by carriers within hours, not days.
Consider the average amount of each claim that your office never resubmits for payment. You may be surprised how much revenue is lost
5. The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting Paid, 2nd Edition, published by the Medical Group Management Association (MGMA) 6. Mendicino R, Gupta A. Achieving Transparency in the Claims Payment Process. Health Management Technology, November 7. Academy Coding Edge
Revenue Capture Using AdvancedMD Online Claim Submission
57.46 x 69 $ 3,950
Cost for resubmitting claim Average rejected claims (monthly) Monthly
57.46 x 12 $ 689.52
Savings using cloud practice management and/or EHR Total yearly hardware and maintenance cost Total yearly hardware and maintenance cost
Additional revenue realized with AdvancedMD
How do outstanding receivables decrease your profitability?
According to the 2012 MGMA Cost Analysis Report, typical medical offices have an average days sales outstanding (DSO) of 41 days, and more than 17% of their A/R balance in excess of 120 days out. Higher DSO numbers translate to increased account receivable balances and negatively impact the cash flow of a medical practice. Are you tired of chasing money? Submitting claims electronically significantly reduces the DSO of a medical office. The average DSO of paper claims is 41 days. But 93% of electronic claims are processed within 14 days.8 Shorter processing times mean improved cash flow for your practice. Aside from a reduction in payer processing time, electronic submission decreases claim preparation time. According to American Health Insurance Plans (AHIP), in 2011, 25% of claims were received from the health care provider more than 30 days after the date of service. Preparing, checking, and submitting claims are arduous processes that cause longer DSO. Simplify the process by submitting them electronically with AdvancedMD.
8. AHIP Center for Policy and Research; “Rise in Electronic Claim Submission,” February 2013.
Are you getting paid for the work you’ve completed? Are You Getting Paid for the Work You’ve Completed?
National Average vs. AdvancedMD
% 30 Claim
Claim Acceptance Guaranteed!
Aside from a reduction in payer processing time, processing claims electronically decreases the amount of time necessary to submit the claim.
Claims Never Reworked
Additional Cash Flow from a Reduction in DSO
61,652 20 $ 3,082 31 $ 95,560
Average monthly revenue Operating days per month Average per-day billed revenue Additional days of cash flow Additional cash flow using AdvancedMD
Should you outsource your billing?
ADP provides optional medical billing services that could eliminate your need for in-house billing. Often, medical practices find managing their billing and receivables unmanageable, even impossible. There are several factors to consider when deciding whether your billing should be outsourced:
• Hiring, training, and managing staff is expensive and challenging. • Office staff may not be familiar with the most updated procedures, policies and coding. • Private practices often have limited resources to bill and collect for services. • In-house billing software and hardware can be expensive to implement and maintain.
Outsourcing billing to one of the most trusted companies in the world, ADP, may be the answer to your billing headaches. Outsourcing medical billing will reduce the time and expense of managing your collections in-house and improve your practice’s overall profitability.
Are your patient records accurate and safe?
How you store your records can make a big difference in the security and reliability of your data. Electronic records are easily updated, retrieved, and shared, which provides for a better patient experience and accurate, real-time data. Additionally, records can be safely accessed anytime, anywhere with the flexibility of cloud technology. If you are thinking of implementing an electronic (paperless) storage model, consider outsourcing your complex IT needs to one of the world’s largest providers of cloud technology—ADP. We provide security features to protect your records:
• Built-in disaster recovery in the event of natural disasters or server failure • Secure storage in data centers • Secure access • Encrypted medical records with online access
The AdvancedMD integrated Practice Management (PM) and Electronic Health Record (EHR) software suite offers the flexibility and security that client/server technologies can’t. Are you ready to improve your profitability? Quite simply, the financial health of your practice is a reflection of getting paid in full for the services you provide. Consider the variables: How long do you wait to get paid? How much are you spending to collect payments? How often are you unknowingly underpaid for your services? How often are you not paid at all? AdvancedMD has the features to optimize your medical office’s business operations and collect the money you have earned:
1. Claim Inspector eliminates the costly claims resubmission process with a guaranteed 95% first-pass rate which will add an estimated $3,260 each month. 2. Electronic claim submission decreases DSO to less than 21 days and adds an estimated one-time $95,560 to an office’s cash flow. 3. Coding tools add $3,699 in yearly revenue by updating codes annually and checks 3.5 million coding combinations. 4. The cloud platform saves $7,625 in annual hardware, IT, and software upgrade costs.
Total operating costs take up to 65% of an average practice’s revenue. By using the AdvancedMD full-featured, cloud practice management, and EHR you can reduce your operating costs to as low as 38%, dramatically improving your profitability. There are also additional benefits that create a better work environment and patient experience including improved efficiency, billing, coding, charge slips, backups, anytime access, disaster recovery, and 99.99% uptime. Now is the time to experience the benefits of a software suite that does it all. Rise above the average and contact AdvancedMD today.
Colette Weston currently serves as Manager, Product Management for AdvancedMD. She joined the company in 2003 and has served many roles within the organization. Her 25-year healthcare career started by processing claims, just prior to joining AdvancedMD, managing a billing service with more than 200 physician clients. Ms. Weston also managed a family practice clinic, provided implementation and training for medical billing software, as well as editing for a medical necessity review service. She is passionate about healthcare billing, customer service and ADP AdvancedMD.