Discover the cutting-edge intersection of technology and healthcare business management as Dr. Sapna Shah-Haque teams up with Juli Quinn from GoSource for an eye-opening conversation. Together, we unveil how Electronic Health Record (EHR) systems are reshaping the landscape for medical professionals. Delving beyond the surface, we dissect the impact of sophisticated EHRs on practice management, from safeguarding financial health to enhancing patient care delivery. This episode promises to illuminate the often overlooked, yet critical, business savvy needed to thrive in today's healthcare arena.
Join us for a deep dive into the transformative world of medical billing, where precision meets efficiency within the realms of practice management software. Juli's expertise shines as we dissect strategies for optimizing billing processes, using electronic claim submissions, and leveraging internal audit features. With actionable insights, we share how to hit key business benchmarks and keep revenue streams flowing smoothly. Whether you're a healthcare professional seeking to refine your practice's financial operations or simply curious about the business behind patient care, this conversation is rich with guidance to navigate the complexities of modern-day medical billing.
Though I am a physician, this is not medical advice. This is only a tool that physicians can use to get ideas on how to deal with burnout and/or know they are not alone. If you are in need of medical assistance talk to your physician.
Learn more about female physicians' journey through burnout to thriving!
https://www.theworthyphysician.com/books
Let's connect for speaking opportunities!
https://www.theworthyphysician.com/dr-shahhaque-md-as-a-speaker
Check out the free resources from The Worthy Physician:
https://www.theworthyphysician.com/freebie-downloads
Battle of the Boxes
21 Day Self Focus Journal
Discover the cutting-edge intersection of technology and healthcare business management as Dr. Sapna Shah-Haque teams up with Juli Quinn from GoSource for an eye-opening conversation. Together, we unveil how Electronic Health Record (EHR) systems are reshaping the landscape for medical professionals. Delving beyond the surface, we dissect the impact of sophisticated EHRs on practice management, from safeguarding financial health to enhancing patient care delivery. This episode promises to illuminate the often overlooked, yet critical, business savvy needed to thrive in today's healthcare arena.
Join us for a deep dive into the transformative world of medical billing, where precision meets efficiency within the realms of practice management software. Juli's expertise shines as we dissect strategies for optimizing billing processes, using electronic claim submissions, and leveraging internal audit features. With actionable insights, we share how to hit key business benchmarks and keep revenue streams flowing smoothly. Whether you're a healthcare professional seeking to refine your practice's financial operations or simply curious about the business behind patient care, this conversation is rich with guidance to navigate the complexities of modern-day medical billing.
Though I am a physician, this is not medical advice. This is only a tool that physicians can use to get ideas on how to deal with burnout and/or know they are not alone. If you are in need of medical assistance talk to your physician.
Learn more about female physicians' journey through burnout to thriving!
https://www.theworthyphysician.com/books
Let's connect for speaking opportunities!
https://www.theworthyphysician.com/dr-shahhaque-md-as-a-speaker
Check out the free resources from The Worthy Physician:
https://www.theworthyphysician.com/freebie-downloads
Battle of the Boxes
21 Day Self Focus Journal
Whether we like it or not, technology is here to stay. In this digital era, leveraging cutting-edge tools and software is not just an option but a necessity, particularly when we're talking about streamlining and making healthcare efficient on the back end, with operations and all the parts that we don't discuss in medical school but allow a practice to run or even a hospital to run. So welcome to another episode of the Worthy Physician. I'm your host, dr Sapna Shahak, reigniting your humanity and passion for medicine. We're going to talk about utilizing technology for practice or business management of medicine. Why?
Speaker 2:Because we donbelly that nobody likes to talk about. So, julie, thank you, oh, thank you. I really enjoy being here and sharing with your listeners some of the business side of medicine. Which is probably bogging them down and that's why it's very relevant to your podcast is we want to support these physicians to not feel so bogged down and not see the business side as the enemy to what they want to do in their practice. So hopefully we can bridge that for them with some of these topics.
Speaker 1:That is definitely the goal right when we go into medical school or when we start that journey. Most of us want to be. When we think the word physician back in 2002, 2003 for me was completely different than what I'm doing now. It was a maybe a little bit old school, but more time with the patient. It was not so much of okay, here's a medication, I'll see you back in three months and we'll just see how you're doing. I think there was more communication on a person-to-person level, but now we have a system that we're really that time that we have with the patients.
Speaker 1:It's really squeezed almost to the bare minimum, but we still have to take care of patients. We don't we choose to be here. A lot of times a patient does not choose to be sick. But there's that cultural shift and with that cultural shift is how are things billed? How is that accounts receivable, managed? None of these things are talked about in medicine but whether we like it or not, it is a business we should treat of. Of course, people before money. But we can find that sweet spot as to understanding what is needed and the knowledge gaps from the physician standpoint to the business office standpoint we do need to be able to see both sides in order to have a comprehensive view of what medicine really is nowadays.
Speaker 2:Yes, so I am. Background has been on the business side for 40 years. I have worked in healthcare business and hospitals private practice and now as a vendor with GoSource. We are a medical billing company and we work. Obviously we're remote but we work very closely with our practices to make that part be successful for them and keep the doors open so that you can keep seeing the patients.
Speaker 1:And that's a goal of. I think that's every physician's goal and that's every. On the business end, I think that's the goal too Rolling it together. We just have different parts to play. But why is technology and maximizing that such an important topic? Before the recording, you were giving me billing 101. But to me that just seems gosh. That would have been really nice to know, because it just helps, I think, open eyes and increase that understanding. So can you share that with the listeners?
Speaker 2:Yes. So we have other areas of technology in our office and new ones, I'm sure, coming soon but the one I want to talk about today is your EHR. Your EHR is both a medical record so an EHR is your health record and then there's the PM, the practice management side. You might have that integrated or it might be two systems. I'm going to talk about the PM side. This is the side that actually is helping you. I'm hoping it will make your listeners feel better that this is their friend, because they may hate their EHR for a lot of other reasons, such as it's costing them, it requires additional staff, it takes their time, they feel like they're typing into a computer instead of hands on the shoulder of a patient. I get all that and that'll be another episode, I'm sure. But today, if we talk about the part that is your friend and the reason that a good PM system in your EHR is helping you, I can just go down some of the bullet points.
Speaker 2:As you were saying, the Billing 101, when you create your encounter in this practice management software, it has, first of all, it's captured every single patient, or we can very easily. There's an internal audit who had an appointment does not have a claim, so there's no loss of a piece of paper that got misplaced or anything like that. So now we have a complete accounting of everyone seen has a claim and it has built in a scrubbing tool that will identify any critical errors before it is submitted out to the clearinghouse. And this is huge because it saves time. If you submit a claim with errors, it's going to get denied and sent back and then you fix it and get it back out again as a corrected claim. Why not save that time and identify as many of the errors before it's submitted, fix them same day. Next day it's back out or out for the first time with a better, clean claim rate, and that's going to bring in more revenue more quickly.
Speaker 1:So what you're saying is that this is going to allow the billing to be done faster, more efficient and, hopefully, a higher first pass rate, versus a lot of this hot potato. Okay, this was not done, so it's kicked back to you and by doing that, you're going to have less denials in theory.
Speaker 2:Correct and we have now the ability to submit electronically. Some of these insurance plans are processing an electronically received claim in as little as three days, as opposed to a paper claim which is going to be 30 days. And there's always that unknown of did they get it? There's no proof. So with your practice management software, not only does it get submitted, but we receive back an acknowledgement that it was received by the clearinghouse, and when the clearinghouse then passes it on to the health plan, it'll update the status that says it's now been accepted by the health plan, that says it's now been accepted by the health plan, and that takes a great deal of unknown out of the equation. We know they have it and we also have proof if we ever need to contest a timely filing denial.
Speaker 1:I mean 30 days. 30 days you would have to wait for any type of verdict on a paper claim, whereas it can be as early as three days with an electronic record, which that's a very efficient business model. And to the physician, listening to my bells and whistles are going off and I think, and there are days when I hate the EHR because it's so tedious. But I'm going to refer back to an episode I did with Dr Mary Lung and that's optimizing and utilizing templates and sometimes you have to put in that work, but a lot of these EHRs are very similar to like a Word document, so you can build in those templates and or have somebody do them for you, or a lot of them are available online. So utilize that knowing to cap off your visit and then really optimizing time to chart, and that episode will be in the show notes.
Speaker 2:Yes. And again, bringing it to the business office side, having those good notes is our best defense for appealing a denied claim. So we really cannot stress enough how a complete note will get you the level of visit and any additional services performed paid.
Speaker 1:And again, it's not about, oh, let's get rich off of the insurance companies or the patients. It's about getting paid fairly in an efficient and timely manner to keep what is a small business, or even a large business, open in order to keep taking care of patients and keep providing those services to. And I guess I want to circle back to three days versus 30 days. That's a big deal. That's a deal. I don't know any other business that would operate on revenue from 30 days previous, or maybe that's a standard for other things. But there's a lot of variables, a lot of variables there. Like we've covered before, there are so many barriers to actually getting reimbursed. So anything that would make that more efficient and because what is considered a timely file, Okay.
Speaker 2:So each health plan will state what their guidelines are in the contract. To submit a new claim has to be within a time period. A new claim has to be within a time period. Many are at 90 days now and 90 days sounds like a lot, but that's 90 days of a processable claim. So if you submit a claim with errors they kick it back. You have to correct it and, like you said, this hot potato back and forth. We're on the clock that if we don't get it figured out within that timely filing they will reject it.
Speaker 1:Defaulting back to oh, you didn't get it to us within 90 days of the date of service and to, like for diabetic management, you really want that A1c to be 7% or less. Are there any benchmarks for how well a billing team might be doing? Are there any benchmarks that we should be looking at? And I'm talking numbers, because I can definitely wrap my head around numbers, but it also gives me okay, this is what it should be and this might be where the team is performing, and so I want to know that gap, because that's money sitting on the table. So can you tell me more about that?
Speaker 2:Yes, and again, this is where your practice management system is so highly valuable, highly valuable. It has built in all of these answers to those benchmarks as to how your billing is performing. Mgma is a professional organization that is known for the business benchmarks and, for instance, one benchmark is that you should be collecting 95% or more of your claims. Now that is adjusted taking into account the contractual write-offs. It's not your full charge, 95% of your full charge, it's 95% of after the contractual write-offs. You should be collecting 95%, and the system gives you that without having to do any outside analytics. It's usually built right in In most systems.
Speaker 2:I'll see that they'll give you the percentage of AR that's in current 30, 60, 90, and 120 plus, and that is a benchmark. Your 120 plus should be 10% or less. It should be under 10% and you could very easily, just looking at your dashboard or your aging summary report in your system, check that. Oh, we've creeped up higher than 10%. So now it's a conversation with the T what's going on and what can we do to resolve it. So the reports are extremely valuable and easy. It's not an additional person's job to be able to give you those answers.
Speaker 1:But it's important. I think anybody who is running a practice owns a practice even is employed. To me, these would be questions that I would want to ask and have answered, because then that also tells me when I am going into a contract negotiation, they're saying you're only generating X amount. I can also say look at this, this, instead of trying to point the finger. Or what can we do? Because if we're at 85%, we should be at 95% first pass rate. Or if we're over 10% of the 120 day plus bucket to me I'm looking at okay, that's a lot of money being lost from something that I've already done. So essentially I'm giving away services for free, which I don't agree with.
Speaker 1:Number two what can I do to get those percentages to where they should be? And then, number three how much are we talking about? Because if it's happening now, it's happened in the past and that can become a trend which is money bleeding out of a small practice, which a lot of them are family owned, or even a multi-specialty practice, or even a real hospital health of a company. If we look at some of the outside of medicine, some of the bigger corporations, we want to look at the financial health we also need to look at the financial health of a hospital or even of a practice, because that is going to bleed into how we staff, what we can pay. That does go back to retention rate. So this is all intertwined. So trying to keep these into two separate silos to me just doesn't make sense. So how do we know if our practice management software is optimal?
Speaker 2:I do work in several and I have to admit some are better than others. However, they all have the basic function to prepare the claim, submit it electronically and give you back feedback. And another area of feedback is rejection and denial management. Some are more sophisticated. Where it will, based on the denial code, it drops it into different buckets so the AR follow-up team can go in and address these are real quick fixes. It's just a demographic issue. I need to fix my demographics and get this back out.
Speaker 2:Or this category is coding related. We need our coder to look at these, get them fixed and back out. But it will categorize them for you. That is always very helpful. Where some it might just be a general denial area and you have to separate them yourself. So, yes, it's more optimal if it has some categories. You're still getting the information. It's just not as organized. Here's something really cool At GoSource we have designed our own software.
Speaker 2:It's an AI tool that we take the aging report from any of the systems out there and we load it into our tool and it categorizes it, as I'm talking about, to very high specificity so that we can then really knock out any either denied or just no response to get those cleaned up and out of the 120 category. We even can put in what the timely filing are for each of the insurance. So it will bring any coming up current or approaching that timely filing. It'll bring it up to the top of the word queue. So when the staff come to work it'll say these are critical work, these first. So it'd be great if practice management systems did that. Perhaps that'll be one of the advances we see. In the meantime, we have designed this to be able to do a better job and and stay ahead of again, like you said, all these reasons to not pay your client. We want to eliminate that out of the equation.
Speaker 1:So the software that you all designed is really like a personal assistant saying hey, go do this first. That's efficient. That's what a business really should optimize to. That should be the standard. I couldn't see that coming down the pipeline Five to 10 years, because nothing ever works efficiently. Nothing changes quickly in medicine. Let's put it that way, julie if a listener wanted to get a hold of you and to learn more about GoSource, about billing or even about software, how do they get a hold of you?
Speaker 2:Oh, yes, please come to our website, gosourcein, and we would love to talk with you about any of the topics. So we are a community to take on this project together. Sharing information, sharing stories is just as important, and it's not always being our customer, but let's just be in this community together.
Speaker 1:And that link will be in the show notes. And I love what you're saying about being in this community together, going back to our previous conversation, not being so much in our silos but collaborating together, because I think we're all looking to make life a little bit easier. Leave medicine better than the way we found it and what's one pearl of wisdom that you would love to leave our listeners?
Speaker 2:I would say don't be afraid of the technology, embrace what it can do to make your life more simple. If it's making your life complicated, then maybe that's not the right one, but there is a right one out there.
Speaker 1:It's like a shoe. Sometimes you got to try on a lot of different pairs until you find the right one. Julie, thank you very much. And to the listener go over to Okay, I'm gonna have to re-reduce. Thanks for listening. If you have found this helpful, go to Apple Podcasts and leave a five-star review. Share with a friend, because we can all use camaraderie.