Slashing administrative waste: Pennsylvania medical group uses Web technology to reduce the expense of interacting with health plans.

With today's rising healthcare costs, specialists are under the gun to save money wherever possible, while still providing top-notch care. Providers stagger under the weight of administrative loads generated by even small practices, while the demands of patients, affiliated health plans and referring providers grow each day.

By moving paper-, phone- and fax-based processes to the Web, healthcare organizations can help slash the high cost of administrative waste. One important element of successfully managing and streamlining the administrative flow of interacting with health plans is Web-based connectivity.

Health Plans Can Help

Not long ago, Orthopedic and Sports Medicine of Erie (OSM) was a prime example of an overburdened provider. With three physicians and 35,000 patients, the practice was overwhelmed with the paperwork required to correspond with its affiliated health plans. Finally, with no viable solution to help her staff as they struggled to stay on top of the workload, Practice Manager Charlene Kellerman began looking for a way to handle the day-to-day functions required to keep the practice running smoothly.

With 30 percent of OSM's patients covered by Highmark Inc., Kellerman went directly to the health plan to lobby for a better way to handle administrative transactions. "We asked Highmark to find a way to use the Internet for some of our paperwork and other manual processes," she said. "The paper chase for referrals alone was unbelievably difficult, and our staff could barely keep up with the workflow. Highmark took our request seriously, and we were one of the health plan's first providers to begin processing transactions via the Web." That was in the fall of 2000, and Kellerman and her staff have been enjoying the benefits of Web-based connectivity ever since.

Pain-free Connectivity

Luckily for OSM, choosing the technology was painless. The practice did not have to endure the process of evaluating its needs, debating whether to buy or to build, choosing a technology vendor or integrating the technology into new and existing processes. Highmark had already done that homework and deployed the technology, NaviMedix's NaviNet platform, offering it to OSM and the rest of its network providers free of charge.

NaviNet's Web-based platform connects health plans with physician offices and hospitals to conduct more than 50 different transactions such as referrals, claims investigation, and eligibility and benefits verification. To get started, all OSM had to do was encourage internal use of NaviNet--a challenge that would prove easy to overcome.

After acquiring a PC and Internet connection, training was OSM's first--and only--step in deploying the technology. Always wary of something new, staff members arrived for training expecting the application to be unreliable or difficult to use. But in only half a day, all of the front office staff designated to use the platform were fully trained and using the application with ease. Today, nine staff members in the office use NaviNet.

For OSM, the most compelling reason for converting administrative processes from manual methods to Web-based automation has been the increase in revenue and collections since implementation--$120,000 a year for claim investigation alone. Before NaviNet, it took six months on average to submit and resolve a claim, taking 30 minutes just to prepare the paperwork for each claim. For each dispute, OSM had to write a letter, include a paper appeal and then wait. Now the staff can simply logon, select the claim and click "investigate." This takes less than two minutes to enter and 30 days to process, producing an 85 percent time reduction for claim investigation.

This has proven invaluable to the practice, according to Kellerman. "Before, it was a toss-up as to whether we would even take the time to investigate a claim. Now, we investigate every claim, every time."

Today the staff resolves disputes quickly and ensures that OSM receives payment for disputed claims. Due to the substantial time savings for this process, the practice's staff members are investigating more claims than ever, yet still have an extra two hours each week for other tasks.

Streamlined Verification and Authorization

With such a large patient load, it was impossible to verify eligibility without a tool to speed the process, so patients were most often treated "at-risk." When the practice had time for verification, it took approximately 20 minutes to verify three patients--about 17 hours per week before NaviNet. Now with the application, it takes about 30 seconds per patient. Checking eligibility for the same patient volume now takes one hour per week--a savings of 16 hours per week--which reflects a 95 percent reduction.

"This has really freed our staff to concentrate on other matters such as patient service. Eligibility verification is crucial to our office, and being able to verify every patient who walks in--without calling Highmark--minimizes the hassle for our patients and staff surrounding office visits," says Kellerman.

Authorizations for surgery or outpatient test scheduling is another area where the practice has put Web-based connectivity to use. As an orthopedic practice, OSM gives plenty of surgical authorizations--about 10 each week for Highmark patients. Before NaviNet, this process took 30 minutes to 60 minutes for each authorization inquiry--approximately eight hours a week. Now the process takes two minutes per authorization. At 20 minutes a week, the office experienced another 95 percent reduction in time spent on authorizations.

"We have been able to eliminate the difficulties of scheduling surgery on the phone," says Kellerman. "We don't have to pull charts for referrals or surgery dates, and the phones aren't tied up when patients call. We are in control of the process and can conduct authorizations when it's convenient for us."

Recredentialing is also available online, eliminating the need to fill in the same information on forms year after year. This feature eliminates the need to rewrite or retype anything. All OSM has to do is validate the information using the automated feature and enter any new data. It saves the staff about two hours per entry, according to Kellerman.

She explains how the office quickly came to rely on Web-based technology. "Our Internet service provider recently went down--for seven days. During this time, we realized exactly how much we depend on NaviNet. The loss of efficiency was crippling for our staff. It's amazing how a new technology has quickly become crucial to the livelihood of our practice."

Source

Charlene Kellerman Practice Manager Orthopedic and Sports Medicine of Erie Erie, Pa.

Product/Company

NaviNet NaviMedix Inc. Cambridge, Mass. www.navimedix.com would even take the time to investigate a claim. Now, we investigate every claim, every time."