Tackle wasteful spending at the practice level

Optimizing billing

On a national level, the JAMA study found “administrative complexity” responsible for $265.5 billion annually — more waste than any other category.

Scheduling, billing, and coding are essential functions for many organizations, but to what extent has administration become overly complex?

“A lot of waste, along with missed dollars — opportunities for revenue — can come from billing if documentation isn’t present to support the charges, or from inaccurate billing or coding of services,” said Casie Mellars, Compliance Specialist with Greenway.

Outsourcing billing services is one way to address administrative waste. Partnering with a medical billing service can give a practice greater insight into its financial standing and make revenue cycle management more effective.

By ensuring necessary billing and documentation requirements are present and reviewing for “red flags” and errors prior to billing the claim, a practice can reduce its risk of payment denial. Greenway Revenue Services helps practices understand why a claim might be denied, whether because of incomplete documentation, incorrect codes, or another reason.

“Working with certified coders who understand the system can be much more cost effective for a provider than having to maintain it themselves,” said Sherry de Cuba, Director, Compliance and Quality with Greenway.

Following administrative complexity, JAMA cited pricing failure as the No. 2 cause of waste, responsible for $230.7 billion to $240.5 billion annually, and failure of care delivery as the No. 3 cause, responsible for $102.4 billion to $165.7 billion annually.

The role of interoperability

Another top cause of waste is overtreatment, or “low-value care,” which drains the system of an estimated $75.7 billion to $101.2 billion annually.

At the practice level, the exchange of data between disparate systems can help resolve redundancies that lead to unnecessary tests and visits.

To this end, Greenway in 2013 helped found CommonWell Health Alliance, a nonprofit trade association dedicated to the availability of health data regardless of where care occurs. Recently, Greenway announced the integration of CommonWell services into the Intergy EHR platform.

Such interoperability allows providers to query participating healthcare organizations nationwide and to receive clinical data outside traditional connections.

Take for example a patient who has been discharged from a hospital where tests were done. If a practice doesn’t get the results soon enough, it may repeat the tests, slowing diagnosis and treatment and causing wasteful spending.

“Using CommonWell, we’ve been able to access testing patients have completed, thereby reducing over-testing,” Sherry said. “When clients subscribe to CommonWell and get it linked with their system, they have the most up-to-date information on the patient from a referral and documentation standpoint.”

Other ways to reduce waste

Sherry and Casie shared these additional tips to reduce waste:

• Use a patient portal to inform patients if documents related to a referral are required prior to a visit. That will reduce the need for return visits.
• Use an analytics tool to gather social determinants of health. That helps a provider understand aspects of a patient’s situation the EHR may not capture, such as transportation, availability or scarcity of food, and home situation. 
• Finally, use technology to ensure providers take proper steps to ensure patients’ wellbeing. “I know that’s what providers want to do — that’s their goal,” Sherry said. “Having a system that tracks what they’ve done and what needs to get done helps ensure the level of care they’re dedicated to providing.”

To read more about the findings of the JAMA report, click here.