ORLANDO, FL - Every medical practice wants to cut administrative overhead and boost its cash flow. Not coincidentally, these are the goals of a new Web-based application spearheaded by Pennsylvania-based healthcare payor Highmark. In an effort to remove the paper glut associated with eligibility and benefits, the plan has bolstered patient and staff satisfaction while increasing profitability for a provider in its network.
In a presentation at the Healthcare Information and Management Systems Society (HIMSS) conference on Monday, Augusta Kairys, Highmark's vice president of provider relationships, shared her company’s efforts to establish its Web-based presence in its network of over 44,000 professionals and more than 1,000 facility and ancillary providers.
The payor had five goals behind its initiative:
- Strengthen relationships with healthcare providers.
- Reduce administrative hassles that providers associate with managed care.
- Increase provider office efficiency and decrease costs.
- Reduce administrative costs.
- Capture the desktop of providers.
Highmark devised a two-pronged solution to achieve its objective: A Web-based application that serves as a platform for administrative transactions between payors and healthcare providers. The application is payor-neutral to maximize the number of transactions and facilitate provider participation, she said.
The application, NaviNet, was developed and maintained by NaviMedix of Cambridge, MA. Highmark subsidized its development and offers it at no cost to providers.
"Early on we made the decision to have the portal developed by a third party because we didn’t want to add to the workload of our IT staff," Kairys said.
The payor-neutral platform fits into existing provider workflow routine, is accessed via an Internet-connected PC in providers' offices, and delivers real-time data to providers, ensuring that they receive the most current information.
The Blue Cross, Blue Shield administrator provides the following functions to its provider group through the NaviNet application, according to Kairys:
- Eligibility and benefits.
- Referral and authorization submission and inquiries.
- Diagnosis code, procedure code/modifier, and fee allowance inquiries.
- Professional provider, facility provider, and report inquiries.
- Recredentialing.
- Claims submission and claims status inquiries.
- Prescription management.
- A resource center that includes provider education and a searchable database of medical policy.
Since full implementation of the Web portal in June 2000, Highmark has been able to realize a savings of 92¢ per claim, $1.84 per referral, $15 per staff registered nurse conversation, $7.98 per front-line staff conversation with providers, and $7.90 per call to the provider service center. Highmark has also reduced its mail costs by putting information online, and has been able to shut down part of its IT infrastructure such as fax servers and dedicated lines, Kairys said.
"Overall, we’ve seen a 75% decrease in costs associated with claims management," she said.
Barbara Condit, practice administrator of women’s health center Moraca OB/GYN Associates in Moraca, PA, said the application has enabled her practice to increase patient and staff satisfaction and decrease the payment time of accounts receivable.
The center has six full-time physicians, 52 staff members, and sees 275 patients a day. It also has three part-time radiologists affiliated with the group who conduct 6,000 mammograms annually, in addition to some interventional procedures that are performed at the facility.
"NaviMedix staff came to our office to install the application and took two hours to train three of our staff members. Those staff members, in turn, trained the rest of the clerical staff on the job," Condit said.
Authorizations for outpatient surgeries, which used to take nine hours of staff time on the phone each week for an average of 65 procedures, are now resolved in an hour and a half.
"Patients now know before they leave the center whether or not authorization has been granted by the payor," added Condit.
Eligibility and benefits can be checked online so that the staff has accurate claims-submission data, she said.
"We’re able to provide a level of service that was previously unattainable," Condit said. "We can share benefit and authorizations with a managed care member at the time of their appointment, and we’re able to answer their questions on the spot instead of playing phone tag with the payor and the patient. It has led to much higher satisfaction with service, both on the part of the staff and the patients."
Accounts receivable has also seen a quicker turnaround time as a result of moving claims to Web-based filing.
"Our average time for accounts receivable prior to using the NaviNet application was 34 days. Since we shifted our work onto the Web, accounts receivable are taking from 20-24 days. We estimate that’s an increase in profitability of between 5%-7% annually," Condit said.
There is a thorn in the rose of payor-provided Web applications, in the form of a reluctance on the part of payors to provide information to practice management applications. This means that claims information needs to be keyed in twice by provider staff: once for a practice management application and again for the payor application.
"We’re working toward finding a solution to this issue," said Kairys in response to a question from the audience on dual-entry. "We’re currently looking at how we can be HIPAA-compliant and still share our data. One option we’re investigating is business-associate agreements."
By Jonathan S. BatchelorAuntMinnie.com staff writer
February 25, 2004
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