Front-desk freedom
How automating functions frees up CA time
By Gregory T. Church

Business students traditionally spend six years to earn an MBA degree, which certifies them as experts in one or more aspects of business.

Chiropractic students typically spend at least six years in college as well to earn a DC degree, which certifies them as experts too — as professionals in a healthcare specialty.

Post-college, the MBA grad is free to practice his or her specialty. But the same freedom does not necessarily apply to the chiropractor, who often finds the professional degree does not equip him or her to be a business manager.

Few chiropractors emerge from chiropractic college with more than a cursory understanding of business methods.

In any business, the objective is to deliver the promised product or service in an efficient way at the lowest reasonable cost commensurate with earning a fair profit. Most businesses of any size have learned that by automating various activities they can minimize labor, gain greater productivity, and reduce costs overall — all of which can lead to greater profitability.

CHANGE ONLY WHAT YOU MUST

It is generally agreed that the professions have lagged behind general business in the adoption of office optimization solutions. The good news is specialized hardware-software solutions are available to make them technologically current with their business peers. Chiropractic-specific systems can fully automate front offices, which handle the business side, at reasonable costs.

Scheduling, billing and collections, and office management are the chief responsibilities of the front office. Within these categories lie such functions as intake registration, managing patient visits, confirming the insurance eligibility of patients, securing treatment authorizations, submitting insurance claims, and managing accounts receivable.

All of these functions can be performed manually using paper-based procedures, but historically, the result has been cumbersome and time-consuming.

In an electronic office, an inexpensive PC can not only do the bulk of the busywork, it can minimize the amount of paper required to execute the required office functions.

Ideally, when you automate the business side of your practice, you don’t want to subject yourself and your staff to major change. Rather, most practitioners making the conversion prefer to replicate existing policies and paper-based procedures as nearly as possible in the new electronic world.

These policies and procedures are already known and used, and it is far preferable your automated system accommodate your practice than force your practice into a new mold that you and your staff must learn from scratch.

CURRENT WORKFLOW

Generally speaking, office workflow follows a straightforward path that starts with the patient calling for an appointment.

Front-office staff searches the appointment book, offers appointment options, and pencils in the patient’s choice.

Phone calls follow to obtain authorizations and ascertain coverage, and these, too, are recorded.

When the appointment nears, the patient’s file is pulled and given to the doctor. The doctor sees the patient, performs or arranges for the indicated treatment, writes SOAP notes indicating diagnosis and change, and on completion, fills out the charge sheet and returns sheet and patient to the front desk.

The patient pays the co-payment, gets a receipt, and leaves. The front-desk clerk enters the notes into the file and fills out and submits a claim form.

Then the waiting begins. If payment is not forthcoming, phone calls follow. Front-office staff retrieves files, explains charges, and gets a commitment from the payer.

And waiting begins again.

This is often the scenario when you deal with third-party payers. It is perhaps a little better in cash-only practices in which payments might be spread over a period of time. Even in cash practices, collection letters are often required.

THE AUTOMATED ALTERNATIVE

Within the past 10 years, most third-party payers have relaxed their document requirements, opting to accept claims and supporting documentation electronically. The reason is totally self-serving, but perhaps under the law of unintended consequences, it also benefits the healthcare professional by enabling the elimination of up to 90 percent of the paperwork.

Paperwork reduction is a powerful motivation for converting your practice to an automated system, as the following model shows:

When a patient first enters the practice, he or she presents his or her identification and insurance card to the staff.

After the staff enters the important demographic and insurance information, thereby insuring accuracy of the claim submission, the patient is directed to or handed a small tablet PC “kiosk” in which to enter important information about his or her medical and family history and current condition.

The information is input through answers to simple questions and clicking on visual representations of the body. The patient’s e-check-in time and signature are also recorded in the kiosk to accommodate insurance plans that require those records.

Information input via the kiosk creates the patient’s new electronic chart and is immediately available to the doctor via his tablet PC as he begins the examination.

During the patient encounter, the physician reviews and annotates the data that has been input by the patient and enters the findings, observations, and clinical record of today’s treatment into his tablet PC.

When the physician finishes the patient visit, his tablet PC software automatically saves today’s clinical data along with the CPT and ICD-9 billing information needed to produce insurance claims and patient charges. This billing information is then automatically transmitted to the front desk check-out computer.

This automated system approach to practice management also tracks and records the patient’s other activities in the office, such as therapy, diagnostic testing, and neuromuscular massage therapy — important for documentation of the patient’s activity history if the practice is audited by an insurance company.

This new operational model for the chiropractic office also gives patients a sense of empowerment, since they contribute directly to their treatment through direct input of their medical complaints into the kiosk.

At the conclusion of the visit, the patient returns to the check-out desk, where on a single check-out screen, the office clerk can easily post charges and payments (automatically producing the insurance claim submission), make future appointments, and produce a receipt for the patient’s payment or co-payment.

Immediately after the patient departs from the office, a few keystrokes generate the insurance claim for payment (either electronic or CMS-1500 paper claim) and print a paper copy of today’s clinical record if it is required to be sent with the claim. Each office function is performed in an essentially paperless environment.

Once a claim has been submitted, the system tracks it and alerts the front office if follow-up action is required.

The process is repeated patient-by-patient, and at the end of the month, the system automatically produces management reports that precisely document practice activity.

MULTIPURPOSE SOFTWARE

Because you are in an electronic environment in which data can be applied to multiple purposes, the range of reports is almost unlimited — patient population growth or recession, patient dependability (show/no show, cancellations), patients-seen and treatment administered, revenue statistics, and payer reimbursement performance to name a few. This information is vital to building a successful practice.

Along with this professional information, a comprehensive front-office solution also provides practice-management information — patient accounting and cash flow, employee performance, payroll, staff management and scheduling, vacation and days off, and more.

This brief discussion covers only a few examples of how automating a chiropractic office can speed up processes, unburden front-office staff, develop a better and faster payment collection rate, and ultimately enable you to grow your practice by reducing obstacles to patient population growth.

The bottom line: Cash flow is the fuel that drives a practice, and the speed and efficiency of an automated office makes it a cash-flow engine. Envision what you’re now doing manually, the staff and financial resources that manual operations consume, and the case for an electronic office, which has the necessary business skills built right in, becomes crystal clear.

Gregory T. Church is vice president and general manager of ACOM Healthcare Business Division (www.acom.com), which provides integrated document-management systems. He can be reached by phone at 562-424-7899 or by e-mail at gchurch@acom.com.