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medical billing case study

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medical billing case study

  1. 1. Medical Billing Case Study: Urology Specialty Care<br />How Urology Specialty Care Increased Collections while Reducing Expenses with Avisena's Medical Billing Software<br />Visit Avisena on Vimeo.<br />Call 1-877-Avisena Today to Learn How You Can Start Collecting More<br />Net CollectionsA/R Over 120 DaysUrology Specialty Care: 99.33%Urology Specialty Care: 9.39%Industry Average: 90%Industry Average: 25%Industry Best Performers: 97%Industry Best Performers: < 15%First Pass Resolution RateDays Sales OutstandingUrology Specialty Care: 94.13%Urology Specialty Care: 27 daysIndustry Average: 70%Industry Average: 55 daysIndustry Best Performers: 90%Industry Best Performers: 45 days<br />Background:<br />Urology Specialty Care (USC) is a 3 physician practice that operates under Urology Specialty Group (USG) which represents 26 physicians practicing in 19 offices across Miami-Dade and Broward counties in southern Florida. Each office is well-equipped to offer a complete range of urologic care, such as cystoscopy, complex urodynamic testing, in-office Vasectomy, laser prostate surgery and other procedures, and the group also controls its own pathology lab. In 2008, USG saw over 46,378 patients.<br />USC began when two Miami-based physicians, Cosme Gomez, MD and Robert Puig, MD merged their practices. Ultimately, Gomez and Puig envisioned a multi-location, single-specialty group practice that could offer the highest-quality and most innovative care to patients while also maximizing reimbursements from managed care companies and controlling overhead. But early on, they recognized this would be impossible to accomplish utilizing their existing medical billing service, which was a smaller company with limited access to technology or advanced collections expertise. Robust revenue cycle management and industry best practices were priorities for Gomez and Puig.<br />After extensive interviews with local and national medical billing companies, Avisena was engaged in the fall of 2005. USC’s overall priority for Avisena was to increase collections. Doctors Gomez and Puig also recognized they would need an easy and inexpensive way to manage the enterprise’s growth as they added doctors and new office locations. Avisena’s transparent, web-based medical billing platform would give administrators flexibility to manage and analyze the enterprise, and also add additional functionality over time.<br />Practice Management Implementation:<br />Avisena’s Internet-based practice management system was deployed within 30 days of contract signing. Training of the physicians and staff was handled on-site at the practice. For USC, Avisena implemented multiple technologies and industry best practices that would be used to reach the following practice management goals on an ongoing basis:<br />Submit cleaner claims faster utilizing the robust Avisena Rules Engine <br />Faster, more accurate payment posting <br />Faster, smarter and more aggressive collections efforts <br />Utilization of the Managed Care Contract Module <br />Advanced accounts receivable methodology <br />Data mining and analysis using the Avisena Perspectives system <br />Client service for USC is overseen by a dedicated Account Manager. The USC Account Manager is a high-level Avisena staff member with practice management and consulting background who is responsible for all results at the practice, and serves as a convenient, single point of contact. The Account Manager has 4 levels of responsibility, including collections, compliance, business analytics, and customer service.<br />Collaboration and Practice Management Analysis:<br />USC found that Avisena not only improved medical billing and collections, but provided them with robust data mining as well. Using Avisena Perspectives, doctors and administrators now have the ability to swivel data by procedure code, payer, provider, denial code, and a host of other measures to facilitate improved practice management and foster better negotiations with payers. <br />According to Gomez, “Perspectives allows us, in a very simple manner within a matter of minutes, to drill down and get the information we need.” Perspectives, along with Avisena’s reporting capabilities, allows the practice to research and analyze data they were otherwise unable to see.<br />USC found that the accessibility associated with web-based medical billing software was critical to the success of their multi-location group. “We found that web-based access is versatile, flexible, and allows you to move forward,” Dr. Gomez said. <br />Practice Management Results:<br />After the first year with Avisena, collections increased by 10.2 percent. By the end of 2006, they saw another 19 percent growth in collections. Combined, USC was able to increase their collections by over 29 percent within 24 months of engaging Avisena.<br />After 4 years with Avisena, their yearly increases in collections have positively affected their net collection rate and overall revenue. " Our net collection ratio is in the 98-99 percent range, which is quite spectacular," said Dr. Gomez. USC and Avisena achieved their initial goals of increasing collections. <br />“I can’t think of a better business partner.” –Dr. Cosme Gomez<br />