Spartanburg Eliminates Transcription Costs, Improves Clinician Productivity and Documentation Consistency Using Chart Links
Spartanburg Regional Rehabilitation Services is a division of Spartanburg Regional Healthcare System, which is based in South Carolina and was named one of the nation’s “Most Wired” hospitals in 2007 by Hospital & Health Networks magazine. Spartanburg Regional Rehabilitation Services focuses on physical therapy, occupational therapy and speech-language pathology, and includes 68 clinicians and 10 support staff across eight locations.
At the time that Spartanburg Regional Rehabilitation Services began evaluating electronic charting solutions, the organization’s use of paperbased patient charts required advanced planning to ensure that the chart was available at the location where the patient was visiting. In addition, Spartanburg maintained the majority of its paper-based charts older than one year at an off-site storage location. As a result, the office often had to retrieve records from offsite storage before patient visits.
“One of the many disadvantages of using paper-based documentation was that the therapists had to complete a billing sheet with every patient encounter, which was time consuming, and on some occasions, was not completed in a timely manner,” said Kelly Sheppard-Fowler, Practice Manager at Spartanburg Regional Rehabilitation Services. ” Another challenge with our manual processes was the lack of electronic scheduling, which makes it all too easy to encounter scheduling errors when coordinating across different sites.”
“The other solutions evaluated didn’t have the rehabilitation-specific functionality that we needed, such as specialized reports and templates, as well as a way to link clinical documentation with scheduled appointments,” Sheppard-Fowler said. “Most importantly, the solutions didn’t track insurance authorizations for patient visits, or notify the therapists when additional visit authorization was needed for the patient. Chart Links had all of these capabilities, plus much more.”
Spartanburg went live on Chart Links electronic documentation in August 2006 following a six-month implementation that included the creation of an interface to the organization’s McKesson Star billing system. “The implementation of Chart Links was successful due to the extensive planning and knowledge of the Chart Links staff. It was very helpful that the implementation staff included a therapist from Chart Links that could relate with our clinical staff,” Sheppard-Fowler said.
Users quickly adopted the solution because it mirrored the organization’s workflow. “Illegibility problems were immediately eliminated and the accuracy and thoroughness of our documentation improved drastically,” Sheppard-Fowler said.
Using Chart Links, Spartanburg clinicians no longer have to fill out billing sheets for each patient, since the system automatically completes the task. Edits within the system check that charges are compliant with private insurance and Medicare requirements, and that any charging errors are routed into a queue for review. To further prevent errors, the interface with the McKesson Star system allows Chart Links to confirm that patient information is consistent between the two systems. Additionally, Chart Links alerts therapists if Medicare modifiers are missing, and the system tracks patient visits that count toward insurance authorizations, automatically notifying clinicians when additional visits will require reauthorization. Chart Links also allows the clinical staff to fax plans of care directly out of the system to referring physicians, and has a tracking system to ensure compliance.
Since using Chart Links, reimbursement has increased due to more accurate documentation and the ability to track insurance authorizations that help avoid lost charges. Chart Links’ edit capabilities that catch errors before claim submissions have enabled Spartanburg to decrease its error rates significantly, which has reduced accounts receivable days.
In addition, Spartanburg eliminated its $10,000 per month transcription costs since all documentation is now electronic. “Chart Links helped make our documentation consistent across all our sites, and it’s easy to access a patient chart from any of our locations,” Sheppard-Fowler said.
Spartanburg implemented the Chart Links electronic scheduling module one year after going live with electronic documentation. “Initially, we utilized the hospital’s centralized department/software to handle our scheduling needs but the existing system did not accommodate our different sites, clinicians and specialties. As a result we encountered extensive scheduling errors. Most of these errors were eliminated once we began using the Chart Links scheduling system,” Sheppard-Fowler said.
Another benefit of using Chart Links is the system’s ability to help track clinician productivity. “Although we haven’t changed our productivity expectations, we have noticed that more clinicians are meeting their productivity goals,” Sheppard-Fowler said. “Prior to Chart Links, clinicians would simply turn in productivity reports to their manager, who would only contact clinicians if they were not meeting their goals. Now, clinicians actively monitor their productivity using Chart Links, which promotes accountability and self-motivation toward obtaining productivity goals.”
Four Steps to Improve Your Therapy Revenue Cycle
This article is from IMPACT, January 2009, with permission of the Private Practice Section,
APTA. For a downloadable .pdf version of the article, click here.
Four Steps to Improve Your Revenue Cycle – Independent of Billing Systems or
Claims Clearinghouses
By Jim Hammer
The threat of a 10.6 percent Medicare payment reduction captured the attention of many
therapy practices this past summer. Ultimately, the payment reduction was voted down,
but the bill had an unanticipated impact on the industry. It prompted many practices to
evaluate how they could maximize existing revenue streams and better prepare for future
financial challenges.
One innovative approach recently implemented at many therapy practices focuses on
analyzing electronic remittance advice (ERA) to reduce denials and underpayments.
Using ERA data, as opposed to data posted in the billing system or culled from the
clearinghouse, gives therapists greater insight into denial rates, by payer, as a means of
recouping reimbursement. This wise approach allows therapy practices to:
1. Pinpoint reimbursement bottlenecks
2. Benchmark findings
3. Efficiently track and work denials to recoup revenue
4. Monitor payer contract adherence
Focusing on these four key components of the revenue cycle helps practices find missing
and overlooked reimbursements, while helping them with timely and efficient collection.
Most importantly, ERA data analysis allows practices to gain an understanding of why a
payer denied a claim so they can prevent future denials. The resulting analysis gives
power back to therapists for dealing with payers, and allows them to develop the best
possible processes to ensure the full reimbursement they are allowed with the lowest cost
of collections.
The power of Web-based applications makes this type of analysis possible, even for the
smallest of practices. Subscription-based services allow practices to upload their ERA
data to a Web application, where tools are available to analyze the data. By leveraging
Web-based applications, practices do not have to hassle with licensing, implementing and
maintaining software and hardware.
Pinpointing Reimbursement Bottlenecks
Optimizing the revenue cycle depends on identifying reimbursement bottlenecks, such as
tracking the average payment delay by payer, or documenting if above-average delays
tend to result when specific procedure codes are used in claims. Identifying bottlenecks
provides therapists, billing and collection staffers with valuable information as to where
they should focus their efforts and modify processes to reduce delays. From a manager’s
desktop, numerous probes into the practice’s data offer new ways to trend and measure
bottlenecks that impact the revenue cycle, such as tracking:
• Claim summaries by reason code and/or procedure
• Denial rates by procedure
• Days sales outstanding (DSO) by procedure
• Claims summary by reason code/procedure
• Average payment lag by procedure
• Aged claims
• Patient lag by procedure
Benchmarking Findings
Much of the value in pinpointing bottlenecks is that it allows practices to benchmark their
findings for comparisons against other peer organizations locally, regionally or
nationally. Leading Web-based analytical tools will provide benchmarking data as part of
the subscription service. Benchmarking reports allow practices to get answers to
questions, such as how long does it take a practice vs. peers to get paid for specific codes,
and how often does a payer deny claims for specific procedures?
Tracking and Working Denials to Recoup Revenue
Part of the challenge for today’s therapy practices is tracking denials, rather than letting
them slip through the cracks and lose reimbursement opportunities. Web-based solutions
are available to help, and can include decision-support tools to assist with reworking
claims for resubmission. Actual customer experience shows that the average time to
rework a claim is 45 minutes and typically costs about $73. Applications that can
expedite this process immediately reduce operational costs.
Monitor Payer Contract Adherence
Each practice loses $30,000 on average per year due to underpayments. Practices that can
systematically track payer compliance have an opportunity to substantially increase
reimbursement. To accomplish this, practices can load payer-specific fee schedules into
Web-based systems to monitor payer compliance by comparing reimbursement to
contracted amounts.
The capabilities of Web-based solutions tailored for therapy-based practices continue to
advance. The best thing is, with no new software, hardware, long-term maintenance
contracts, or lengthy implementation projects, therapists can quickly drive more cash to
their bottom lines with these new tools. And, unlike relying on billing systems, these
new-generation Web-based tools are looking at payer-generated remittance files –
analyzing data that never even makes it into the billing software.
In this day of cutting costs and maximizing productivity, it pays to look at simple, Web technologies
to augment investments, instead of creating more capital expenditures. It’s
anticipated that future generations of these solutions will even be able to provide
practices with tools to determine the expected profitability of specific procedures based
on patient diagnosis. These solutions provide practices with powerful tools to avoid lost
revenue opportunities and identify processes that can be modified to support long-term
profitability.
Jim Hammer, Chief Operating Officer of Chart Links, can be reached at
jhammer@chartlinks.com
Ann W. Kummer to Speak about Speech Therapy Software at ASHA
We’re happy to announce that Ann Kummer, PhD, CCC-SLP, ASHA-F, will speak at the 2008 Annual American Speech-Language-Hearing Association (ASHA) Convention on November 22, 2008 in Chicago, IL from 8-9am. The presentation, entitled “It’s Not IF You’ll Computerize, It’s WHEN and HOW,” will cover 10 things that speech-language pathology (SLP) clinics should consider when evaluating speech therapy software to automate their documentation and administration. Dr. Kummer is the Senior Director of Speech Pathology at Cincinnati Children’s Hospital Medical Center (CCHMC) and Professor of Clinical Pediatrics at the University of Cincinnati Medical Center.
“More than a decade ago, we embarked upon a mission to reduce the documentation and administrative demands within our organization,” says Dr. Kummer. “Today, we leverage information technology to automate our processes, streamline workflow, reduce billing errors, increase coding compliance, and improve the quality, consistency and turn-around time of our documentation.”
In 1995, Dr. Kummer chose Chart Links Rehab Software to meet the unique documentation needs of a speech pathology department that couldn’t be met with a generic clinical documentation or electronic medical records system. Within a year of launching the system, the Speech Pathology Department at Cincinnati Children’s started realizing the benefits of automation, which included:
- 1-2 hours of increased billed time per week per full-time equivalent therapist
- Increased reimbursement resulting from consistent processes
- Decreased support staff costs
- Improved net revenues
- Improved staff and patient satisfaction
The cost reductions in computerizing the documentation and administrative processes continue to deliver a financial return to the organization each year.
Dr. Kummer’s department has been computerized with Chart Links Rehab Software since 1995. She is the author of Business Practices: A Guide for Speech-Language Pathologists published by ASHA. She is also the author of Cleft Palate and Craniofacial Anomalies: Effects on Speech and Resonance published by Delmar Cengage Learning, 2 Edition (July, 2007).
To learn more about Chart Links’ Rehab Software, visit booth #962 at the American Speech-Language-Pathology Association (ASHA) Annual Convention in Chicago, Illinois on November 20-22, 2008, call 888.369.0707, or visit our website.
Therapy Reimbursement Tool to Offer Benchmark Data for Rehabilitation
Chart Links will soon offer reimbursement tools and benchmark data to physical therapy, occupational therapy, speech-language pathology and audiology practices.
Payer claims data will be aggregated and analyzed from a Web-based suite of management reports and workflow tools that the therapist will use alongside any existing practice management or billing system.
By allowing therapists to identify and reduce denials and underpayments from electronic remittance advice, the solution will help to make therapy practices more profitable. It will also allow them to compare reimbursement data against regional and national averages.
Get more information about this Web-based tool for therapy reimbursement that will help manage denials and underpayments.
Read the press release about our partnership to provide these physical therapy reimbursement tools.