Key Acceleration Questions

Which success factors do you consider to be the most important indicators of forward progress for your medical practice?

• Improved care quality
• Satisfaction and retention for:
  • Patients
  • Physicians and clinical staff
  • Business staff
• Earning money
• Saving money
• Desire for more business control
• Improved accuracy and efficiency
• The latest technology
• Audit-readiness

At White Plume Technologies, our experience reveals the majority of medical practices in operation today have significant performance gaps that prevent them from reaching their full potential in all of the categories listed above. We invite you to consider the following in-depth questions, their implications for your business and how the inability to resolve some of these complex issues might be holding your practice back from prosperity and growth:

• What is your organization’s tolerance level for change and what obstacles must you overcome whenever change is implemented within your practice, i.e. fear of adopting new technology, fear of high cost without return or fear of too much change from how things are done today?
• How strong are the processes and staff you have in place for making sure charges are accurate and you are getting paid appropriately for services delivered?
• How do you compare the sophistication of your current charge entry and claim filing process with other well-run medical practices?
• How do you overcome struggles your clinicians face in documenting charges appropriately and the administrative problems that result from their errors?
• What are the consequences of charge collection pitfalls and what steps are you taking to overcome these business hazards?
• How does your practice stack up against industry norms in clean claim electronic submission rate, first pass yield, claim denial rates, claim refiling percentage, claim refiling confidence factor and claim follow-up percentage?
• What quality processes do you currently have in place to ensure charge entry coding compliance, perform pre-submission claim auditing, guarantee that diagnosis codes substantiate the level of E/M code submitted and reduce the risk of damaging audits for over-coding?
• How much money is your practice losing on labor costs associated with excessive paperwork, charge data entry and other manual processes that focus on identifying, researching, refiling and following up on problem claims? How could you utilize time gained if these tasks were reduced?
• What is your risk profile related to staff turnover/illness/extended leave and what impact do these situations have on co-workers/management/business processes?
• How do you currently compare and contrast physician and mid-level provider behavior across the practice and what determines your physicians' compensation? Productivity/total charges? Collections/reimbursements?
• How do you currently handle extreme billing and administrative complexity, including:
  • Extensive claim edits and exceptions and the need for highly granular exception suppression?
  • The need to track and bill more than 4 diagnosis codes on a single encounter?
  • Ranking immunization diagnosis codes, linking them correctly, and remembering to bill the administration fees?
  • Application of modifiers during charge entry due to special billing rules that vary by carrier?
  • Procedures that always includes additional procedures to be performed along with it such as bundled CPT codes?
  • Unique coding requirements that differ from national standards?
  • Alteration of provider or location for particular lines items, override situations, transcription from paper records, manipulation of quantities/units, use of multiple superbills, tracking which providers are credentialed for which carriers and so on and so on?
• How effectively does your EMR system pass charges along to your billing system – is it from a different vendor than your PMIS, making charge passing difficult or impossible?
• How well are you positioned for practice growth in your coding and charge entry resources and if you are at capacity, how would you handle added workload without having to hire more staff?

White Plume works with physician practice organizations across the United States, helping them make a positive impact on all of the areas mentioned above. Exploration of these and other related issues in our “Medical Practice Results Acceleration Index” can help you better assess your potential for operational improvement. Contact White Plume today for more information about this process. We believe the small amount of time you invest in this evaluation will pay big future dividends for you and your physicians, your staff and your patients.