To usher in this new era, the seven-physician practice last year deployed kiosks and touch-screen monitors, which interface with its electronic health record and practice management system. The kiosks, manufactured by NCR and running software from Patient Point Solutions, enable patient self-service at both check-in and check-out. Moreover, the set-up brings patients into the financial loop as well, alerting them at the end of the visit about their financial obligations. That's due to an interface with the group's real-time claims adjudication transaction capability it has set up with its major payers. "For over 40 percent of our billing, we do real-time claims adjudication," Vangala says.
The new system, Vangala says, has produced benefits for both the practice's patients and its bottom line. From the provider standpoint, incorporating real-time claims adjudication into the revenue cycle process significantly shortens the billing cycle. Traditionally, a patient comes in to a doctor's office, shows an insurance card, receives care and is long gone before a claim is settled with the insurance company. If, say, a month later, the insurance company determines the patient is responsible for more of the bill then was paid during the initial visit, it falls on the practice to collect from the patient.
At Orlando Internal Medicine, the process is streamlined as the technology enables the practice to contact payers in real time and calculate the payment and patient responsibility automatically. At the end of the patient visit, the biller is alerted through the provider's practice management system. After the proper billing codes are entered, the charge goes to the payer. The claim is adjudicated and the information about patient obligation comes back to the biller. The patient is prompted at the kiosk and, if they so choose, can pay instantly with a credit card.
Thus, the patient knows the exact amount of their obligation before they leave the premises. "It's much like a credit card transaction-you get an answer right away before the patient leaves." Vangala says, estimating that almost 50 percent of patient financial obligations in health care is written off as bad debt. "This is tens of billions of dollars written off annually. It is imperative that physicians collect the money that is due to us."
Since moving to real-time adjudication in the fall of 2009, Vangala has seen a 12-percent decrease in bad debt.
There have been other financial benefits too. One is lower billing costs, as electronic processing eliminates the expense of sending multiple statements to the patient long after the services have been provided. Another benefit is a marked reduction in time spent interacting with patients' health plans.
What's more, providers embracing real-time claims adjudications will see a significant reduction in the gap between the time of billing and actually getting paid, Vangala contends. "Instead of 60 to 90 days waiting for payment, you get the money in your bank account within seven days," he says. "All this converts into a significant amount of money for the practice that was not there until now."
While self-service kiosks are commonplace in airports and banks, they have struggled to gain a foothold in the customer-facing aspects of health care. "The concept is not new or ground breaking," Vangala says. "It's been around awhile, but it's never really taken off."
Vangala says kiosks in health care are a tough sell for a variety of reasons. One reason was cost, with practices unwilling to pay upfront for a novel technology. Additionally, some systems suffered from cluttered interfaces or had screens that pestered patients with advertisements.
The system Orlando Internal Medicine chose surmounts these problems, Vangala says, and includes other technological features that helped convince the practice to take the plunge. One such feature is built-in prescription adherence management software. Prior to meeting with the physician, the kiosk shows patient a list of medicines and asks if they are taking them, so that the physician has information handy prior to seeing the patient. "The software has some really cool built-in features that are medically useful," Vangala says.
Why Now?
For example, during check-in, the software identifies a patient's pharmacy benefit manager membership and tells them about savings opportunities such as generics that can and reduce their bill. "When you save them hundreds or thousands of dollars you end up looking like a hero to your patients," he says.
In addition to improvements to the technology, Vangala sees other, external forces pushing providers to examine real-time billing. One reason, he says, is looming Medicare cuts.
"Reimbursements are going down and physicians are looking at ways and means to save money," he says, adding that physicians need to think like small business owners. "As much as we would love to just see our patients, it's a business."
While much talk (and stimulus dollars) has coalesced around electronic health records, customer-facing technology has been largely ignored. "Everybody talks about digitizing medical records but what about the front office?" Vangala asks. Another factor buoying real-time claims is the move toward patient-directed health care as health savings accounts gain in popularity. "Now it's more relevant than ever," Vangala says.
Despite this, Vangala acknowledges there was some initial concern on his part as the practice implemented the system. "One thing physicians are concerned about is how any new technology will affect patient flow in the office. The absolute beauty of the kiosk system is that there is no disruption in the patient flow."
Vangala also fretted how his patients would react to the new system. But removing some of the opacity from the process from the patient perspective and empowering them with data, has allayed those fears, he says. "Initially there was a small amount of apprehension about how our patients would take it," he says. "With very few exceptions, our patients have been overwhelmingly receptive to the idea. Once you show that to the patient it makes it much easier. Ultimately, you are going to have difficult patients to deal with whether you use real-time billing or not."
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