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Providers Often Choose Low-Tech Collection Solutions

Posted on October 6, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

As most providers know, it’s harder to collect money from the patient once they’ve walked out the door. This has always been an issue, but is particularly important today given that patients are being asked to bear an increasingly larger percentage of their healthcare bill.

In some cases, providers solve this problem by having their staff reach out directly via phone, rather than relying entirely on paper billing. Others address these issues with technology solutions such as offering payment options via a web portal. And of course, some providers do both.

But the question remains, which combination is most likely to boost collections efficiently without losing patients in the process? And it’s this question, which underlies all those other considerations, which a new study hopes to address. When reading the results, it’s good to bear in mind that the sponsor, BillingTree, is a payment technology firm and therefore has a bias, but the survey data was interesting nonetheless.

First, a look at providers’ collections challenges. Respondents told BillingTree that compliance and collecting payments once the patient has left the building were concerns, along with knowing the correct amount to bill after insurance and addressing the client’s ability to pay. Perhaps the biggest issues were a lack of payment channels – be they staffers, interactive voice response or website tech — and disputes over the amount billed.

According to BillingTree researchers, few respondents were using Web or automated phone payment collection technologies to bring in these missing dollars. While 93.9% accepted online and mail payments, and 86.7% said they accepted payments over the phone via a live agent, only 66.7% provided a web portal payment option, and just 6.7% offered the ability to pay via an interactive voice response system. Rather than add new technologies, respondents largely said that they intended to improve collections by adding staff members or outsourcing part of their collection operations.

On the other hand, technology plays a somewhat bigger part in providers’ future plans for collections. Over the next 12 months, 20% said they planned to begin accepting payments via a web portal, and 13.3% intend to add an IVR system to accept payments. Meanwhile, the 26.7% of providers who are planning to outsource some or all of their collections are likely to benefit indirectly from these technologies, which are common among payment outsourcers, BillingTree noted.

Among those providers that did offer phone or web-based payment options, one-fifth chose to add a convenience fee to the transaction. BillingTree researchers noted that given the low adoption of such technologies, and concerns about regulatory compliance, such fees might be unwise. Nonetheless, the data suggest that collection of such fees increase over time.

All this being said, the BillingTree study doesn’t look at perhaps the most critical technology issue providers are struggling to address. As a recent American Medical Association survey recently concluded, providers are quite interested in tools that link to their EMR and help them improve their billing and reimbursement processes.

Focusing on revenue cycle management issues at the front end of the process makes sense. After all, while patients are being forced to take on larger shares of their medical costs, insurers are still more reliable sources of income. So while it makes sense for providers to track down patients who leave without having paid their share of costs, focusing the bulk of their technology dollars on improving the claims process seems like a good idea.

Can An EMR Focus on Patient Care in the Current Reimbursement Environment?

Posted on March 6, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In response to a discussion I was part of on LinkedIn, Hirdey Bhathal, CEO of Zibdy Health, offered these interesting comments:

In your comment above you say “Doctor’s are eager to improve revenue”, “clinically based reimbursement” and “emphasizing the clinical documentation that needs to be the base line for billing”….Given that how can a EMR even try to focus on patient care? Two workflows are very different and probably mutually exclusive or very difficult to bring together with any degree of success. In a situation like that a new vendor like practice fusion or any other will be forced to comply with revenue needs otherwise no provider will adopt them. This is the first feature any EMR company sells.

Are quality patient care and quality reimbursement mutually exclusive in an EHR?

I think it’s a bit much to say that they are mutually exclusive. I think you can have both. However, I think that very few EHR vendors have both right now. Hirdey is absolutely right that no doctor would buy an EHR if they didn’t take care of the revenue needs of a practice. That is the first feature that most doctors look for when looking at EHR software.

As in most parts of life, you get what you pay for. Doctors are willing to pay for something that will increase their revenue. That’s why the EHR incentives worked so good (even if it’s fuzzy math). They saw some government money and so they adopted EHR to go after the money. I can’t remember someone ever asking if the EHR would make them more effective clinicians. I can’t remember them asking if the EHR would help them provide better patient care.

It’s kind of sad thing that are reimbursement system is so disconnected from the quality of care a doctor provides. The good news is that now that reimbursement is tackled and meaningful use is tackled, I have hope that EHR vendors will start to differentiate themselves from other EHR vendors based on their clinical abilities.

What do you think? Are we heading for a new era of EHR that’s more focused on clinical and patient outcomes and less on maximizing reimbursement? Or at least that we’ll see both?

MU Requirements Make a Decent EMR Suffer

Posted on July 22, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you’ve been missing the deep conversation we’re having in the “Develop Your Own EMR – You’re Still Crazy” thread, you’re missing some good conversation. Here’s one of the comments from Andrew Schechtman, M.D.

I’ve found the MU requirements can make an otherwise decent EMR suffer. For example, I previously used a web-based EMR that implemented an allergy documentation component that met MU requirements but was impossible to use in real-world clinical care. It didn’t allow one to enter a class of drugs (“I’m allergic to sulfas”) only specific agents. It didn’t allow an allergy entry without specifying the type of reaction. As any practicing doc knows, a good chunk of allergies come in as “I don’t know what reaction but my mom told me I’ve been allergic since I was a kid.” It met MU requirements but it was truly unusable. It continued in this unusable state for more than a year. I think it’s fixed now although I no longer use that product.

I’ve seen this from EHR vendors many times I’ve done demos. I’ll ask why something is there and then I’ll realize that it’s to satisfy meaningful use. I’ve often said something very similar about the healthcare billing requirements. EMR software could be so beautiful if it weren’t for insane healthcare billing and other government regulations like meaningful use.

I realize that it’s kind of water under a bridge at this point. Meaningful use is here to stay and the EHR incentive money is too tasty for most doctors and hospitals to ignore. However, I think the meaningful use requirements will eventually create an amazing opportunity for disruption. It will take a number of years for the billions of dollars of EHR incentive money to be spent. Plus, I think we’ll need some sort of healthcare collapse, possibly similar to the real estate collapse, to awaken people to the insane healthcare reimbursement. Both of those could create a tremendous opportunity for an entrepreneur to do something amazing for healthcare.

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 51-55

Posted on August 30, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

55 Discover how easy it is to interface to the EMR.
One good indication of how easy an EMR system is to interface is to look at how many companies they interface with. Another is to talk with other users of that EMR that have had to have an interface created with said EMR. As I mentioned in a recent comment response, just because they say they “can” or “could” do an interface doesn’t mean that they actually will. Add interface requirements in your contract if they’re needed. Be sure to include the expenses related to the interface in there as well.

54. Make sure to understand the licensing model
There are a lot of ways for an EHR vendor to make you pay. So, be sure you’re aware of all the expenses related to buying and implementing an EHR. Instead of recounting all the possible EHR costs here, I’m just going to link you to my pretty comprehensive list of unexpected EHR costs. Going through that list will help make sure you know what you’re getting into cost wise. You can be sure the EHR salesperson won’t be giving you this list.

53. Does your product handle billing?
Many people love the integrated billing in an EHR. Some can get away without it, but most people I know prefer some billing component as part of the EHR.

52. How is licensing managed?
While related to #54, I see this EHR tip as understanding when and how they’ll charge for licenses. Do you have to buy a whole group of licenses which you may or may not use or can you add licenses later as you grow your practice? As Shawn suggests in this tip, it’s best if you can do “just in time licensing.”

51. Make certain you know what upgrades for license expansions cost
Understand the costs related to expanding into a new line of service. Do you have all the modules you need? What’s the cost to add new modules? Will your server support that new module?

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 56-60

Posted on August 22, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

60. Reporting, reporting, reporting, reports
What’s the point in collecting the data if you can’t report on it? I’ve before about the types of EMR reports that you can get out of the EMR system. The reports a hospital require will be much more robust than an ambulatory practice. In fact, outside of the basic reports (A/R, Appointments, etc), most ambulatory practices that I know don’t run very many reports. I’d say it’s haphazard report running at best.

Although, I won’t be surprised if the need to report data from your EHR increases over the next couple years. Between the meaningful use reporting requirements and the movement towards ACO’s, you can be sure that being able to have a robust reporting system built into your EHR will become a necessity.

59. Are the meaningful use (MU) guidelines covered by your product?
Assuming you want to show meaningful use, make sure your EHR vendor is certified by an ONC-ATCB. Next, talk to some of their existing users that have attested to meaningful use stage 1. Third, ask them about their approach for handling meaningful use stage 2 and 3. Fourth, evaluate how they’ve implemented some of the meaningful use requirements so you get an idea of how much extra work you’ll have to do beyond your regular documenting to meet meaningful use.

58. It they aren’t CCHIT certified take a really really hard look
Well, it looks like this tip was written pre-ONC-ATCB certifying bodies. Of course, readers of this site and its sister site, EMR and HIPAA, will be aware that CCHIT Has Become Irrelevant. Now it’s worth taking a hard look if the EHR isn’t an ONC-ATCB certified EHR. There are a few cases where it might be ok, but they better have a great reason not to be certified. Not because the EHR certification provides you any more value other than the EHR vendor will likely need that EHR certification to stay relevant in the current EHR market.

57. What billing systems do you interface with?
These days it seems in vogue to have an integrated EMR and PMS (billing system). Either way, it’s really important to evaluate how your EMR is going to integrate with your billing. Plus, there can be tremendous benefits to the tight integration if done right.

56. How much do changes and customizations cost?
In many cases, you can see and plan for the customization that you’ll need as part of the EHR implementation. However, there are also going to be plenty of unexpected customizations that you don’t know about until you’re actually using your EHR (Check out this recent post on Unexpected EHR Expenses). Be sure to have the pricing for such customizations specified in the contract. Plus, as much as possible try to understand how open they are to doing customizations for their customers.

Check out my analysis of all 101 EMR and EHR tips.