A 17-doctor ob-gyn group in Florida discovered two keystrokes in its practice management software that helped boost revenue by $600,000 a year.
The group had struggled to collect from patients in the office. Staffers knew only one way to determine what somebody owed — looking up balances from past visits and services recorded in their program from IDX Systems, and adding them on a calculator. The process took so long that on hectic days, staffers gave up and let patients leave without paying, said Vic Arnold, a professional services manager for IDX. IDX representatives showed the group how to produce a grand-total patient balance on the computer screen by hitting “F4” on the keyboard while pressing “Alt.” Suddenly, collecting from patients became immensely easier.
Arnold’s story illustrates a common scenario: Physicians pay thousands of dollars for practice management software, but staffers don’t use the most basic features. It’s like buying a $225,000 Ferrari and driving it only in first gear.
Why the ignorance about software capability? Usually it’s because cost-conscious physicians don’t spend enough on training. Even when initial training is picture-perfect, doctors blow it when it comes to teaching new hires about the software or getting the staff educated about upgrades.
Short-term thinking also contributes to undercomputing. Employees caught in the daily grind don’t take the time to master software functions beyond scheduling patients, entering charges, and posting payments.
In an era of shrinking reimbursements, you can’t afford to waste the firepower of your practice management software. The following advice from consultants and vendors — focusing on features that are standard on virtually all products — will help you get your money’s worth from the technology.
Are You Missing Out on These Functions?
Some programs come with a default template that consists of 15-minute visits, but you can create templates that better suit your workflow. Jennifer Bever, a consultant with KarenZupko & Associates in Chicago, recalled how a Georgia surgical group made more work for itself by not learning how to customize its scheduling template. Staffers made appointments with their computer but scheduled surgeries on paper.
“They didn’t want to fill in eight 15-minute slots on the computer screen for a two-hour surgery,” said Bever. As a result, staffers had to share a single scheduling book, which wasn’t always at their fingertips. And they couldn’t automatically monitor whether a bill went out after a hand-scheduled surgery.
Electronic claims submission dramatically speeds up payments, but consultants say that many doctors use this only for one or two big payers, such as Medicare. Of course, not all payers accept e-claims yet, but whenever one begins to offer that option, physicians are slow to switch over, said Belleville, Ill., consultant Jerri Weith. Sometimes that happens because staffers don’t update payer profiles in their systems to indicate that they accept electronic claims. Without an updated payer profile, the system will continue to print paper bills, said Weith. She advises doctors to review these profiles every six months to keep them current.
A similar story plays out with line-item payment posting, a function that breaks down a lump-sum payment into dollar amounts for individual CPT codes on a claim. To use this function in IDX software, you must activate it for each payer with a few keystrokes, said Peter Butler, a consultant with Hayes Management Consulting in Redmond, Wash. “Many practices don’t take the time to turn it on.”
Is the payment you post the amount you expected to receive? The best software programs can tell if you’re being shorted. They’ll compare the dollar amounts listed on the explanation-of-benefits form to the fees that the insurer agreed to fork over for the CPT codes. The trick is, you first have to enter these fee schedules into your computer, said Butler. “I hear office managers sayy they’re too busy to load the fee schedules,” he said. “So they don’t catch a lot of underpayments.”
Without Reports, You Can’t Manage
Insurers that take three or four months to pay claims will dry up your cash flow. The typical practice management program can identify these laggards so you can take remedial action. One basic tool is a report that “ages” accounts receivable in increments of 0 to 30 days, 31 to 60 days, and so on. That’s not enough detail, though. You need a report showing aged A/R receivable by payer. Slowpokes will stand out like the sore thumbs they are.
The ability to slice and dice data is one reason they call it practice management software. The popular Medical Manager program can spit out more than 150 standard reports in addition to custom jobs. All this information can overwhelm a staff and induce paralysis, said Bever. “We help clients sort through the stack and choose 10 reports that they need to show their doctors each month.”
Off-Site Training May Be the Best Bet
Wasted software capabilities usually point to subpar training. Sometimes it’s the vendor’s fault. “Trainers may not give practical examples of why a practice needs a particular report,& said Weith. By all accounts, though, the blame for software illiteracy falls mostly on doctors.
Vendors commonly prescribe five days or so of training at about $1,250 a day when they install their product. Doctors often negotiate to shave off a day or two, arguing that they’re smart enough to teach themselves and their staff, said Jerry Schulz, director of sales and marketing at NextGen Healthcare Information Systems. “I tell them they’re buying more than a billing machine.”
Tammy Swanson of Misys said her company once scaled back training for bargain-seeking doctors, but now resists these requests. “We realized that we did clients a disservice when we reduced training. They’d get frustrated and say the system didn’t work.”
Doctors also shoot themselves in the foot by holding computer classes during office hours. “Employees become distracted because they still have to deal with patients,” said Curtis Mayse, a St. Louis consultant with LarsonAllen Health Care Group. He advocates training office staff on weeknights or weekends — and paying them for their time.
New employees need to go to software school, too. The in-house approach — letting old-timers teach rookies — makes sense, consultants say, only if the software vendor has trained a key employee, like the office manager, to teach others. Even then, you should limit in-house training to lower-level employees and cover only rudimentary tasks such as scheduling appointments, said Bever.
Vendor training is a must when you hire a new office manager or billing department chief, said Bever. She recalled one ear, nose and throat group that did it right. The group sent a new office manager out of town for two days of vendor training before he reported for work. And the practice made sure his first two weeks overlapped the last two of the outgoing office manager, who showed her replacement more about the system.
Software upgrades will quicken as the Health Insurance Portability and Accountability Act standardizes how healthcare information is transmitted electronically, making such transactions more commonplace, predicted Bever.
Continuing education from vendors isn’t cheap. Misys and IDX charge $1,250 a day — plus expenses — to send a trainer to your office. NextGen gets $1,520 a day. Training at a vendor site may shrink your bill considerably. A day of classes at NextGen’s facilities in Atlanta, Philadelphia, and Newport, Calif., costs $760.
You also can trim costs by dispatching employees to national and regional meetings sponsored by software vendors. To accommodate doctors who don’t want their staff to travel, more and more vendors are offering Internet-based training.
Learn From — and Lean on — Your Vendor
If you believe that your staff isn’t ttaking full advantage of your practice management software, contact your vendor. Software companies have internal consultants who can assess how well you’re using their products. These analysts can be just as pricey as on-site trainers, but if you let them know that you’re unhappy with the software, the vendor may not charge for a visit, said Rosemarie Nelson, a computer consultant in Syracuse, N.Y. “They’d rather help you than lose a customer.”
While vendors can help you find the treasures of your computer system, sometimes you have to hound them to do so. “I’ve seen medical offices give up on their software because they got poor response from the vendor when they asked for help,” said Terri Fischer, another LarsonAllen consultant in St. Louis. “Sometimes the company will blow them off by saying, ‘You’re the only practice I know that has this problem.’ “
No matter why your software doesn’t perform as advertised, don’t let up on the vendor, emphasized Fischer. “It takes perseverance to get them to make the system work.”
Robert Lowes is staff editor of Medical Economics. Copyright © 2002 Medical Economics Company at Montvale, NJ 07645-1742. The article has been condensed from the original and is reprinted by permission. All rights reserved.