PA practice cuts reimbursement time in half with Care360 RCM

Care360 Case Study: Dr. Denis Boyle Jr.

Dr Boyle Quanum Case Study

Alison Boyle is the office manager for Dr. Denis Boyle Jr. in Upper Darby, Pennsylvania, located just a few miles west of Philadelphia. Dr. Boyle has been in general practice for 34 years and employs 5, including Alison, who has been with the practice for 6 years. Dr. Boyle sees 20 patients per day; 57% of those are Medicaid patients, and 25% Medicare patients.

Challenge
In 2014 the practice was making the switch from paper to electronic health records (EHR) to modernize their system and to meet the requirements of the Centers for Medicare and Medicaid Services (CMS) Electronic Health Record Incentive Program. This program encourages eligible professionals to implement and demonstrate meaningful use of certified EHR technology.

Solution
Dr. Boyle’s office was already using Lab Ordering and Results from Quest Diagnostics® when a Quest representative recommended the Care360 EHR.  After seeing a demonstration of the system, Dr. Boyle adopted the software in 2014.

In 2016 the practice added Care360 revenue cycle management (RCM) to improve the practice’s billing. Care360 RCM includes both their award-winning EHR and practice management (PM) components.

Quanum Testimonial
Dr. Boyle and his staff received training on the system and have been pleased with support. “The resources available to us as Care360 users are endless,” said Alison. “We had the initial training and were given access to representatives with extensive knowledge and experience in this field. If we have a question about billing, there is an account lead to help; if we have a question on the software, there is someone to assist. There is a transition specialist to help with general questions. This complete support has been wonderful.”

Results
Since Dr. Boyle’s office was already using the Quest lab service when it adopted the EHR, all patient demographics automatically transferred from the laboratory database to the EHR. Similarly, when RCM was added in 2016 the patient information automatically synchronized from the EHR to RCM and PM.

“The cloud-based feature makes managing all patient information very easy, and it has been a seamless transition,” said Alison. “When a patient comes in for their appointment we only need to update insurance information and copy their insurance card.”

Care360 iPad EHR

Care360 HD for the iPad ™

Within six months of implementation the practice had completely transitioned its records from paper to EHR. Dr. Boyle, who is not known for his typing skills, made the transition by dictating his notes into the system which is easily done without having to use a third-party medical transcription service.

“Care360 EHR is well suited to this arrangement because there are fewer fields to fill,” said Alison. The user can tab through the form and either enter or dictate notes right into the information fields. As Dr. Boyle dictates, the fields populate. Having this option has helped him acclimate to the EHR much faster.”

The staff also enjoys the mobility of the EHR. They can access it from a phone, tablet, laptop, or desktop computer, whether in the office or on-the-go. In the exam room, medical assistants use an iPad to log vitals and other information before the doctor sees the patient.

When it comes to reporting physician quality measures, Care360 EHR has been the perfect fit. A Care360 representative made sure Dr. Boyle’s team was comfortable running the reports needed to qualify for meaningful use (MU). The office attested for MU in the first year that it used the EHR, and has done so in every year since.

“Care360 makes reporting easy,” said Alison. “There is a tab you click on to generate the data and reports we need. After pulling those reports we can put them directly into the meaningful use attestation.”

This has not only helped the practice meet requirements for submitting quality of care measures, but has also helped it avoid Medicare penalties.

While all of these features have brought efficiency to Dr. Boyle’s office, perhaps one of the biggest benefits the practice has seen since adopting RCM is that reimbursements have increased and denials have decreased. Alison attributes this to the three-step process for claim submission.

“The doctor puts his subjective, objective, assessment, and plan (SOAP) notes in the EHR, along with his diagnoses and procedures, and we file the note,” said Alison. “As soon as it’s finalized, it goes to the PM system and then there’s a 24-hour hold on the claim. During this time, we view the claims, which are color-coded. The ones that are ready to be sent are coded green, the ones with problems are coded yellow, and the claims that need to be changed are coded red. The color coding helps you quickly see what needs your attention. If a change needs to be made, it can be quickly accomplished. After the 24-hour hold, we have time to make sure the claim is clean, and then it is submitted to insurance.”

Dr Boyle Care360 Case Study

Dr. Denis Boyle Jr. with staff.

If a change needs to be made after the claim is submitted to insurance, it can be accomplished and re-filed directly from Care360. There is no need to pull a paper chart or to re-check patient profiles or insurance.

“This really cuts down on time,” said Alison. “It is so much more efficient having all our claims in one place and for us to have the ability to file them electronically for faster reimbursement. With RCM we have cut our Medicaid reimbursement time in half. With 57% of our patients on Medicaid, this is a big deal for our practice.”

Another feature that is helping to increase reimbursements for the practice is the Care360 immunization registry interface. In previous years, Dr. Boyle’s office had trouble getting reimbursed for immunizations. Care360 RCM verifies that vaccinations being submitted are set up correctly and have the appropriate Current Procedural Terminology (CPT) codes.

“We no longer have to wait 45 days to be reimbursed for a flu shot,” said Alison. “Now it takes 10-12 days. From a financial standpoint, that is huge. And when it comes to delivering quality patient care, we are able to better meet compliance measures. For instance, we can track how many patients are receiving their annual flu shot. If a patient has not come in for their shot, we can send automated reminders right from our system. This has enabled us to administer more flu shots with fewer denials. And this applies to all of our claims, not just the flu shots.”

In addition to prompting patients to get their immunizations, PM sends general appointment reminders. The patient chooses their preference – email, phone or text – and receives a message the day before they are scheduled to come in. They are able to confirm or cancel the appointment when they receive that message.

“Our patients have been very impressed with this automated system,” said Allison.

Similarly, if a patient has forgotten when they’ve scheduled an appointment and they phone us to find out their appointment time, the staff has immediate access to the information.

“We used to have to physically look through an appointment book to find the patient’s name, which could take several minutes,” said Alison. “Now the patient’s name can be typed into the system, and seconds later you find exactly when their appointment is and what they’re scheduled for,” said Alison.

“It is all of these features that make Care360 a complete solution for any medical office. It makes day-to-day life easier and improves our practice.”


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