Acquiring a new practice is rarely easy. Not only is there a lot for a new owner to learn, but there may also be processes and staff habits that need to be addressed. Margie Recalde, OD, FAAO, faced some of that when she realized as the new owner of Lifetime Optometric in Fresno, California, that her years as an associate had not necessarily prepared her for billing and revenue collection.
“I initially just carried on what the previous owner had established,” Dr. Recalde notes. However, she soon discovered that the in-house biller was frequently pulled away to perform other essential tasks, leading to a backlog that had severe financial consequences.
THE HIDDEN COST OF INEFFICIENT BILLING
The depth of the problem did not become apparent until that employee left, and Dr. Recalde uncovered just how much revenue had gone uncollected and the critical gap in the practice’s previous billing process. “We’re talking about six-digit numbers of revenue that weren’t being collected or posted.” This alarming discovery prompted her to seek immediate solutions. She hired a third-party remote billing company, hoping they could help clean up the chaos left behind. This initial step helped some, but Dr. Recalde realized that it came with its own set of challenges.
First, the remote billing company was located overseas. “There were a lot of claims that were not being filed in a timely manner,” Dr. Recalde says. “I didn’t feel I could communicate well because there was a middle person between me and the billing team. Eventually, they decided to eliminate that intermediary, and all communication went directly to the overseas team.” Unfortunately, this made the conversations even less effective, leaving Dr. Recalde feeling detached from her revenue collection process.
FINDING THE RIGHT BILLING PARTNER
Frustrated, she eventually sought out revenue cycle management (RCM) services from what is now HELIX RCM and was then known as VisionWeb RCM. “The company said it would do a better job, so I thought, ‘Let’s try it out,’” she recalls. Now, after several years with HELIX RCM, Dr. Recalde appreciates the improved communication she now has with her account manager and the greater clarity over her RCM.
The use of HELIX RCM has streamlined the billing process significantly. “We use Crystal PM for electronic records, and it batches claims into a system that HELIX RCM reviews,” she explains. “If something isn’t billed properly, I receive a secure message with the items that need fixing.” This approach allows for timely corrections, decreases rejections and appeals and provides speedy reimbursements.
Dr. Recalde is particularly pleased with the transparency that comes with using HELIX RCM. “I can see what claims are past due and whether they’re actively being worked on,” she shares. The team has set up secure spreadsheets that help her keep track of outstanding balances, ensuring payment opportunities aren’t overlooked.
“I’ve also learned a lot from HELIX about proper coding,” Dr. Recalde says. “HELIX RCM flags us when a diagnosis code isn’t appropriate for a particular procedure or if there’s a conflict with medical and vision insurance billing. That attention to detail helps prevent those claims from being rejected or underpaid.”
MORE TIME ON PATIENTS, LESS TIME CHASING CLAIMS
The outsourcing of billing has freed Dr. Recalde to focus more on patient care than the complexities of billing. “I was responsible for claims during the transition period,” she reflects. It was a lot to manage. It meant keeping up with every nuance and change in the codes or payor policies. “Now I don’t have to worry about that as much. The electronic processes make everything easier and more efficient.”
That allows her to focus on the patients in the exam lane and reserve time for planning for the growth of her practice. For example, she says, “I’d love to expand my office and bring in new technologies, especially for treating dry eye conditions.” She can explore these dreams in part because she knows that she will have the support to ensure that she is paid for her services appropriately.
Instead of feeling trapped in a cycle of rejected claims and mounting accounts receivables, she can now envision how adding new services, coupled with correct and timely billing, will help her achieve her goals.
Want to learn more about HELIX’s RCM service? Schedule some time to talk with the team.
