After working with Circle of Health Family Practice in Palm Coast, FL for about 4 years, nurse practitioner Christina Fernandes purchased the business in 2019. The practice provides a wide range of services for children 6 years of age and older to adults, including primary care, annual visits, preventive health care, chronic disease management, and adult and sports physicals. In addition to Christina, Dr. Jonathan Treece, MD, works part-time, and the practice recently hired another nurse practitioner, Jennifer Dopp. The practice also employs 2 medical assistants and a medical receptionist. 20-30 patients are served per day, and about 50% of patients are on Medicare.

Challenge

Although Circle of Health Family Practice had been in operation for about 12 years, growth had declined by the time the previous owner decided to sell it. An internal biller worked with an outside vendor, but there was little accountability and billing was only taking place every 6 months, not monthly. Billing codes were not consistently updated when claims were denied, which often resulted in charges being written off, and sometimes patients would receive bills after they self-paid. Group Medicaid had expired, and an office move years prior resulted in a wrong address on IRS forms that had not been corrected.

It was clear a new billing solution was needed. The team was happy with Quanum Electronic Health Record (EHR), which had been in place since 2012. Additionally, approximately 85% of patients were using Quest Diagnostics for lab services, and the staff valued the integration that Quanum EHR provides with ordering and receiving lab results.

As the ownership transitioned to Christina, she wanted to maintain focus on seeing patients and growing the practice through superior service. She charged office manager Misty Miraballes, who has been with the practice 5 years, with determining how to resolve the billing issues.

Solution

Misty called Quest Diagnostics to learn more about Quanum Practice Management (PM) and Quanum Revenue Cycle Management (RCM).

“Our system integrates with Quest Diagnostics lab services, which is amazing for us because then we don’t have to search for labs,” said Misty. “It was a big selling point for us that we can send orders and receive results directly and the integration is so smooth with a single login.”

The office implemented Quanum PM and Quanum RCM in June 2019 and the ownership transition to Christina was completed in December 2019.

Results

Since utilizing Quanum PM and Quanum RCM, Circle of Health Family Practice is now getting paid much more than before. In the 2nd quarter of 2020, gross revenue increased by 27% compared to the 1st quarter, despite the challenges at the onset of the COVID-19 pandemic. Monthly financial reports generated through the integrated EHR system confirm that target billing numbers are being achieved.

“Our practice is growing, and we continue to see progress in the right direction in terms of financial, workflow, and in more open lines of communication between our staff and with our patients,” said Christina. “Many new businesses don’t really see any growth in the first year, yet we’re still seeing growth, and that speaks volumes to our success.”

Thanks to workflow improvements, tasks are much less time-consuming. Previously, staff would spend one full day a week making telephone calls to verify all insurances individually. With the majority of verifications now managed through Quanum PM, workflow has improved dramatically. Instead of spending 8 hours, the front desk time spent verifying insurance has been reduced to 2 hours a week, including checks for insurance for patients not in-network.

In addition to finalizing transactions in the EHR and sending notes to PM, Misty handles any RCM-related issues for the office, such as denials needing a different billing code. Patients appreciate being able to contact a knowledgeable outside billing expert, and Misty is able to obtain information and respond with answers to their questions.

As a result of communicating quickly and regularly about patient statements, there have been very few issues. Patients are paying their bills rather than questioning charges and have a better understanding of their insurance, when deductibles apply, and how co-insurance works. In fact, the number of days in accounts receivable (AR) to collect payment improved by 14 days at the end of the 2nd quarter of 2020 compared to the end of the 1st quarter.

“We are getting bills out on time and providing the correct information to insurance more frequently, and the follow-through on AR has been a huge benefit to us,” said Misty. “There used to not be a single day that we wouldn’t get a billing complaint, and in the past year, we have only had 2 circumstances where patients have indicated a billing issue. The communication and responsiveness is better than I ever imagined, and the monthly billing reports easily allow us to see what’s going on behind the scenes without having to be an expert at billing.”

“A practice can see as many patients as they want, but without accurate billing they’re never going to see maximum revenue. It is important to get claims in time, fix rejections, and fix AR. This is how we’re going to keep seeing positive and continued growth.” said Misty.

Christina, Misty, and the entire office are appreciative of this great business partnership.

“My advice and recommendation to any practice, wholeheartedly, is to outsource billing,” said Misty. “I wasn’t sure about outsourcing initially, but I couldn’t ask for a better support system. We never would have known all of the revenue that we were missing out on, and it is such a benefit to have someone outside of the office as an expert to answer questions. These solutions have helped us grow tremendously, and not just financially, but also in terms of staffing, which is why we hired another nurse practitioner. It is one of the best decisions we made throughout the transition. I would never have an inside biller again.”