Client Success Story: Workflow Transparency & A New Pre-Payment Program
When Melodie Eaton became the new billing manager of Professionals for Women’s Health, she already had an acute understanding of the practice’s financial successes and challenges.
How?
Professionals for Women’s Health, an OB/GYN medical practice with 13 providers and three locations in the greater Columbus, Ohio area, is one of athenahealth’s clients – and so was the practice that Eaton came from. Knowing that Professionals for Women’s Health used the same “network” based system made Eaton’s transition seamless.
Because both her previous and current practices are athenahealth clients, Eaton was familiar with how athenahealth transformed the new practice’s finances. In 2001, Professionals for Women’s Health struggled with declining cash flow, losses from ineffective billing, and claims rejections that raised administrative costs and further extended its days in accounts receivable (DAR). The practice also faced skyrocketing malpractice premiums.
After a thorough search for a solution to their financial challenges, Professionals for Women’s Health went live with athenahealth’s services in August 2001 with virtually no disruption to the practice’s operations.
After implementation with athenaNet, Professionals for Women’s Health experienced an overall increase in gross charges because athenahealth’s billing workflow ensures that fee slips and charges aren’t lost in the maze of reimbursement processes (or on hand-written sticky notes). By analyzing the explanation of benefits (EOBs) and other detail-rich data provided by athenahealth’s reporting tools, such as its proprietary payer rules engine, the practice determined which coding combinations are rejected by certain payers and made the appropriate adjustments to maximize reimbursement.
What’s more, the practice was able to establish fiscal benchmarks; its accounts receivable cycle, previously ambiguous, is currently at 37 days and dropping by the day. This is especially critical as the practice moves towards a performance-based compensation model.
Professionals for Women’s Health also harnessed athenahealth’s ability keep up with new trends in the industry, such as pay-for-performance (P4P) and consumer-directed health care (CDHC). athenahealth helped the practice apply new P4P protocols from specific payers to the practice’s billing process and calculate the payment responsibilities in advance for patients with high-deductible plans under CDHC.
When Eaton arrived at the practice, she immediately began thinking about how the practice could build on the significant financial gains already realized by using athenahealth. She started planning new, practice-wide “best practices” for better reporting processes and transparency into workflow.
With this, one of the first initiatives Eaton undertook was establishing a new pre-pay program using athenaNet. The practice wanted to leverage the system’s real-time reporting capabilities to get a better handle on their pre-pay collections and worked with athenahealth to develop the program.
“As an OB/GYN practice it is vital for us to have the ability to quickly and accurately collect pre-payment from patients across all of our locations,” said Eaton. “athenahealth’s results-based approach had already allowed our practice to see a dramatic increase in revenue and decease in AR – now we wanted apply transparency to all aspects of our billing process.”
The practice’s new pre-payment program went live in January 2007. Leveraging new reporting and benchmarking tools, Professionals for Women’s Health collected over $60,000 in additional revenue due to the new program in the first month of it being implemented.
“We would love to say we are surprised that the pre-payment program is working out, but given athenahealth’s service-based approach we know we are aligned in business goals with them,” said Eaton. “The business goal of our practice – or any for that matter - is to collect payment in a timely manner for all the care that we deliver. athenahealth’s results-oriented approach shares this goal because it is the foundation of their financial model. When we don’t get paid, neither do they.”
Eaton concluded, “athenahealth has once again proved to be a catalyst for changing physician behavior and the practice’s care model on both the administrative and clinical fronts.”