Apex Cardiology, a small cardiology practice in Inglewood, Calif., provides a full range of services to improve the cardiovascular health of its patients. Its seven physicians, multiboarded in internal medicine, cardiovascular diseases, nuclear cardiology, interventional cardiology and cardiac electrophysiology, see nearly 200 patients a day. Apex Cardiology, however, found optimally managing the practice’s reimbursements for its billing department challenging. Nearly half of Apex Cardiology patients are covered by Medicare. “Managing claims for Medicare patients is a particular challenge, as patients’ Medicare plans, eligibility and benefits often change,” says Naomi Osugi, billing specialist for Apex Cardiology. In order to check patient Medicare eligibility and benefits, the Apex Cardiology billing team would contact Medicare by phone and was limited to only three patient inquiries per phone call. This added up to an average of 30 phone calls a day to Medicare, which the practice found to be inefficient. With growing financial pressures, increased costs and rapid change across the healthcare industry, healthcare practices like Apex Cardiology are struggling to take advantage of every reimbursement opportunity they can. Keeping up with the latest health plan policies and opportunities for reimbursement, however, can be challenging. Staying current with the complex information and knowledge requirements to maximize revenue in the practice is a full-time job for physicians, office managers and staff – a job that begins with checking eligibility and benefits for each patient that walks through the door. To improve work flow management within the billing department, Apex Cardiology needed an efficient way to interact with plans, predict patient and insurer financial responsibility, collect from all sources, and understand how to stratify and address patient debt. It needed a fast and easy way for its seven-person billing department to access patients’ financial, administrative and clinical information, all while operating under time and budget constraints, and maintaining staff and physician satisfaction. A study conducted earlier this year found that physicians and medical administrators spend an average of three weeks a year interacting with plans at an estimated annual cost to practices of $31 billion. Nearly 75 percent of respondents said their costs of interacting with health plans have increased over the past two years. If a physician practice is not interacting with health plans electronically, it may be losing significant revenue and wasting invaluable time. Practices need to keep up with new or updated health plan products, as well as specific changes to their patients’ insurance coverage and care information – and they need this information instantly. To alleviate the inefficiencies associated with communicating with multiple health plans, Apex Cardiology began using NaviNet, which connects more than 770,000 providers with payers across the nation – all from one Web site. Apex Cardiology first began by using NaviNet Medicare Eligibility to access patient eligibility, benefits, claims status information and clinical histories. The practice saw the solution’s value almost immediately, in the form of time savings, lowered administrative costs, increased revenue, and improved collections, patient care and satisfaction. NaviNet Medicare Eligibility delivers benefits information and offers a direct connect to Centers for Medicare and Medicaid Services to perform transactions and eliminate phone calls and unproductive wait times. “Now, from a single Web portal, our billing department checks patient Medicare eligibility in real-time prior to appointments to ensure that the coverage on record is current,” Osugi offers. Even when submitting claims electronically, up to 14 days might be necessary for Apex Cardiology to determine if a claim was submitted properly and that the practice would be reimbursed in a timely manner. By using NaviNet Medicare Eligibility to obtain eligibility and benefits information before claims are submitted, the billing department increased the accuracy of its claims submissions, reducing denials due to incorrect coverage information. The portal also has enabled Apex Cardiology to improve patient relations and service because its staff now have the data needed to discuss and provide accurate, up-to-date insurance information to its Medicare patients prior to care. “All the information our billing department needs to do our job is now at our fingertips, which allows us to give attention to other pressing issues,” says Osugi. “Our team now spends only 20 percent of its day processing Medicare claims, allowing them to give attention to other pressing issues and improve patient care.” For more information about Navinet, click here.
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