cracking the code
Thoracic and Vascular Consultants, LLC | Youngstown, Ohio
  • One doctor family-owned practice

  • Glob and purple location pin

    Based in Youngstown, Ohio

Challenges

  • Outsourcing billing/coding to third party meant:
    - communication lags
    - large volume of paper
  • One on-staff person working with third party meant:
    - potential processing delays
    - fewer Q/A measures
  • Laborious auditing processes
  • Unrealized opportunities for profit

Solutions

  • athenaOne®
  • athenaOne® Medical Coding

Results

  • Faster electronic communications
  • Faster claims processing
  • Coders identified additional profitable diagnosis codes
  • More time spent on patient care and outreach
  • Simplified auditing

Practice manager and certified professional coder Zaida McGarry is used to wearing many hats at Thoracic and Vascular Consultants, a one-doctor family-owned practice in Youngstown, Ohio. But the hat she’ll be happy to never wear again is that of the go-between shuffling printed encounters and billing slips twice a week to a courier. The courier used to drop off her stacks of paperwork to an outsourced local billing company. The results were an unpredictable timeline for billing and coding turnaround — due in part to back-and-forth questions being addressed via the courier service — along with higher claim holds and unrealized profitability.

Solution yields higher profits with less work, stress

Since going live with athenaOne® Medical Coding early this year, McGarry not only has less work to manage, but added peace of mind. “It’s always good to have more than one set of eyes on something. I just love the history and queries going back and forth,” she said of the direct-to-coder communication tool integrated into athenaNET. “As soon as encounters are signed off, I can just hit a few buttons and send it, and focus on other things. I can depend on the coder to say, ‘Hey, you’re missing documentation.’”

Turnaround went from a minimum of two weeks to merely code and bill using the outsourced company, to claims paid out by insurance companies in seven to 10 days using Medical Coding. Claims are also now paid at a higher rate due to athenahealth’s certified, HIPAA-compliant coders. Thoracic and Vascular Consultants has seen an average 67 percent increase in charges per claim, and a 98.6 percent increase in average payments per claim in the first five months of go-live.

Working on a team of one with integrated assistance means that McGarry no longer feels pressure facing potential backlogs, or to keep up with industry codes that change frequently. And in addition to those extra sets of eyes, she benefitted from extra pairs of hands when a bicycling accident prevented her from typing at a normal speed. “It slowed me down personally, but I knew I wasn’t going to see a dip in profitability or processing because I had to be out,” McGarry said. “I knew that there were claims sitting there, but I was able to just send them by clicking a button and not worrying about it.”

McGarry has been able to refocus some of her energy to enhance patient care in terms of outreach and follow-ups — especially with phone calls to a large population of elderly patients — and also further enhance the practice’s profitability. She now has time to coach Thoracic and Vascular Consultants owner Dr. Alejandro Franco on coding best practices that in turn informs his teaching of residents who treat TVC patients at the local hospital.

Quarterly audits, formerly a pain point for McGarry, are now easier with streamlined documentation that helps address insurance company overpayment claims. “I used to have boxes of stuff to shuffle through, but now I have the history of the conversation with the coder, and all of the documentation in athena that I need” to challenge claims, she said. “Boom — it’s all just right there. This service is such a huge game-changer.”

Thoracic and Vascular Consultants has seen an average 67 percent increase in charges per claim, and a 98.6 percent increase in average payments per claim in the first five months of go-live.

 

* These results reflect the experience of one particular organization and are not necessarily what every athenahealth customer should expect.