Case Study #1
Office #1 was founded in 1979 and has since been one of two major core centers for dental care for the lower- to middle-class population of the area. D-TECH was engaged by Office #1 to assess and implement a systematic reconciliation of their patient demographic and financial database. Further, D-TECH was charged with developing and maintaining business systems which would be in compliance with new and ever-changing federal regulations, in particular the Healthcare Information Portability and Accountability Act (HIPAA).
Having fluctuated in staff size and patient demographic make up over the course of several years, D-TECH found it necessary to re-evaluate the business systems and implement a new strategy for maintaining the integrity of the patient database for HIPAA purposes. In addition, D-TECH was also challenged with the task of developing policies and procedures for staff members in order to satisfy the quickly approaching HIPAA deadlines.
The first task at hand, the database assessment, determined there to be significant coding deficiencies, an inadequate fee structure system and a considerable lack of financial controls. The claims processing systems were outdated and the electronic claims process was yet to be implemented.
Tracking of treatment encounter forms was poorly documented and there was a serious and imminent risk for clinical liability due to diminished record keeping practices. Improper and archaic coding techniques were being utilized resulting in a reduction of revenue and cash flow.
D-TECH is directly responsible for reducing the insurance accounts receivable from $112K to the current average of $5K. Total patient accounts receivables were reduced from $198K to $42K in one year.
This achievement is attributed to the implementation of the electronic claims process, which also reduced receipt time for claims revenue from 90 days to an average of 7 days. Having verified a favorable HIPAA compliance status of both the clearinghouse, as well as the Practice Management System, we restructured the patient billing process to include electronic patient billing and automated collection techniques.
Overall, the electronic submission systems reduced billing and claims overhead by 24% while accelerating turnaround time for patient and insurance payments. Office #1 also realized a decrease in processing time and processing errors.
D-TECH conducted a thorough an extensive fee assessment for Office #1, using a combination of comparables from local area clinics, assessment of time, materials and labor cost analysis by procedure code, and the office budget analysis. We affected a 21% fee increase which established a financial surplus for the office for the first time since its founding.
Medical cross coding is an under-utilized facet of the claims submission process. It involves the converting of standard Current Dental Technology (CDT) codes into International Classification of Diseases Version 9 (ICD-9) coding.
In the case of Office #1, crosscoding is an effective method of revenue capture due to an unusually high volume of oral surgery. D-TECH established a viable solution for claims submission using the cross coding technique. This process allowed Office #1 to offer the unique service to patients, encouraging an increased new patient stream, specifically emergency and accident cases.
The CDT coding system was newly introduced at the onset of this project. The new coding brought with it a myriad of definitions, deletions, replacements of existing codes and the expansion of the procedure code base.
D-TECH fully trained the business and clinical staff on proper coding technique for optimal reimbursement. We established and streamlined the encounter form process, increasing supplemental payments by 80%.
This restructuring process allowed us to identify those Healthcare Maintenance Organizations (HMO) that had the highest utilization among the existing patient base, paving the way for successful fee negotiations with the top 3 HMO plans-Aetna US Healthcare, Connecticut General Life Insurance Company, and United Concordia Companies, Inc.
Our most rewarding, yet challenging task, was to implement comprehensive guidelines and security systems to bring this office into full HIPAA compliance. Plagued by years of inadequate and poorly-trained staff, obsolete policy and procedures manuals, lack of continuing education training and a deficiency in funding, Office #1 required an aggressive approach to obtain full compliance within limited time frames as dictated by the HIPAA regulation. We implemented a strategic clinical documentation process, which fulfilled the HIPAA requirement, as well as reducing the office liability risks. In addition, D-TECH created standardized forms to allow for the restriction of access to patient Protected Health Information (PHI).
We established staff guidelines for PHI disclosure, using their existing Practice Management System (PMS), Dentrix, as a tool. D-TECH conducted a thorough chart audit in order identify and archive inactive patients, enhancing the accuracy of the patient database.
The anticipated end result of the project included full HIPAA compliance at the physician level, established coding and cross-coding protocol, effective clinical documentation methodologies, automated billing and collection systems, continuous and compounding profitability increase, and a stabilized and fully trained core staff. We fully expect to provide ongoing support and training, enabling Office #1 to enhance its competitive standing in the local healthcare arena.
