Like a business organization, a medical practice also operates due to the integration and coordination of numerous departments and teams to ensure seamless workflow and completion of tasks. The owner/practitioner of medical practice knows the importance of employing qualified and skilled individuals to ensure necessary healthcare assessments and services are timely given to the patients.
A wide range of individuals are needed to successfully run a medical practice and include doctors, physicians, surgeons, nurses, pharmacists, lab technicians, lab workers, medical coders and billers, Information technology (IT) experts, and customer support representatives.
Medical Business Office
A typical medical practice depends on efficient financial management to ensure compensation to health care workers and staff, and payment of rent, overheads, medical equipment, and other utilities.
As most people have health insurance coverage, a major portion of the revenue comes from the medical claims submitted to insurance companies for proper reimbursement for the services rendered to the patients.
Without proper financial maintenance, it can be quite difficult for a medical practice to function and sustain. The drastic impact of Covid-19 has also given numerous challenges as the revenue cycle is affected due absence of patients coming for regular or emergency medical services.
It is also commonly seen that more than 50% of medical claims are rejected or denied by insurance companies based on incorrect medical coding and billing. The medical coder plays a crucial role in making the medical claim to allow the medical practice to receive full payment from insurance companies.
The medical coder translates patient information (diagnosis, treatment, medications) into standardized codes. The three common types of codes the medical coder must be familiar with are Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases (ICD), and Current Procedural Terminology (CPT). The responsibilities of a medical coder are
- Extracting relevant and accurate patient information from the health records
- Clarifying the information and communicate with the physicians
- Examining the documents and looking for any information that may be missing
- Assigning correct ICD, CPT, and HCPCS codes
- Ensuring correct selection of codes and removing any grammatical or typographical errors from the documents
- Advising and training the medical and support staff on key medical codes
- Making sure that the medical coding complies with industry-standard policies and guidelines
Medical Billing Specialist
The medical billing specialist is involved in maintaining a regular revenue stream of medical practice by ensuring that insurance providers make full payments. The numerous tasks performed by a billing expert include
- Create invoices or medical claim based on the medical codes
- Check for any inaccuracies and perform corrections
- Managing the electronic claim processing
- Submission of medical bills and claims to the insurance companies
- Submission and follow up of private invoices to patients
- Check the claim history to ensure all the rejected or ignored claims are managed effectively
- Tracking for any unpaid bills from the insurance company
Information technology or more popularly known as IT, is considered the backbone of almost all businesses and services. In the healthcare industry, IT plays a crucial and essential part in ensuring accurate delivery of services, patient safety, integration of modern systems and solutions, and improving the overall relationship between healthcare providers and patients.
The most important aspect of IT is the management from generation, collection, analysis, and storage of valuable data that includes patients’ medical history and assessments, diagnosis, treatments, and notes of the doctors and physicians.
The second significant advantage of integrating innovative IT solutions is the automation of key processes and relief from time-consuming, challenging, and stressful manual work. Traditionally, medical practices used to be filled with loads and loads of paperwork. The cabinets and shelves were filled with documents, files, charts, and X-rays.
Due to the extent of paperwork, there was a clear possibility that vital patients’ information can be lost, misplaced, or get damaged. Incorporating IT has led to the use of custom software and applications that allow easy input of patient data and fast transfer to reporting doctor or physician who can make quick prognosis and deliver immediate care.
The advancements of technology have also given way to smart applications installed on mobile devices and help in the fast transfer of test results, diagnosis, and treatment plans for the patients.
IT Network Manager
The Network Manager employed in a medical practice is responsible for establishing and maintaining systems and processes. The manager has to form a team of skilled and trained IT experts who can help devise efficient and effective network strategy within the given budget. The database and management system is designed and implemented to streamline and automate daily tasks.
The role and responsibility of the IT Network Manager include
- Making sure the internal computers and systems work efficiently and receive constant updates
- The website of medical practice is user friendly and credible
- Ensure that the patient portal is working seamlessly so the patients can book an appointment, view their test results, or send an online message
- Devise a strategy to include and display blogs on the website as more than 80% of online users search for illness and symptoms through the health-related blog
- Introducing cloud-based software solution that allows easy access and secures the valuable information
- Looking for better and cost-effective solutions and applications that can increase productivity and help attain the goals.
Traditionally, medical practices and hospitals used to install one particular software to manage the clinical and administrative tasks, but the advent of modern technology has led to the development of custom software according to the need and requirements of a medical practice.
An experienced and skilled software developer can help design and develop custom medical and billing software to allow efficient revenue cycle management. The valuable functions of a software developer are to develop software based in conjunction with needs of the medical practice and industry standards and that supports
- Instant checking and verification of patient insurance plan and status
- Integration with Electronic Health Records (EHR) that holds complete patient information from history, diagnosis, lab test results, medication, and previous treatment plans.
- Compliance with HIPAA (Health Insurance Portability and Accountability Act)
- Automatic patient appointment scheduling
- Electronic claims processing
- Regular update of numerous medical codes
- Remote access of patients database and submission of medical claims
- Ensuring medical bills and claims follow particular payer regulations
- Improved workflow, turnaround time, and cash flow
- Generation of reports that allows analysis of patient data, productivity, and finances of the medical practice
The role of IT has increased significantly due to the ongoing Covid-19 pandemic that has left the majority of the population seeking quality care, getting vaccinated, and getting insured. The innovative IT solutions can help track patients and improve the delivery of healthcare.
As the healthcare system seems to evolve and change with the Coronavirus, the key focus will be on increasing the speed, volume, and quality of healthcare services and the role of medical coding and billing specialists, medical transcriptionist, IT systems analysts, and healthcare information engineers.
Customer Contact Center
The significance of customer services has grown rapidly in the past decade or so, and now CRM (Customer Relationship Management) is an essential function of nearly every business organization. Today, people have access to smartphones and fast internet connectivity and want to find a solution to their queries and problems within minutes.
A dedicated contact center for a medical practice means that patients can easily reach out, contact a healthcare provider and feel satisfied. In these testing times due to Covid-19, it can be difficult for a medical practice to manage all the calls coming from people to either book an appointment, know about lab test results, or schedule a treatment.
Due to budget limitations, it can also be difficult for newly established medical practices to spend money to buy equipment, train personnel, and pay for the salaries and communication services.
Busy phone lines are not good for business does not matter if it’s a big or small medical practice. The main purpose of a contact center is to improve communication between the healthcare provider and patients.
Contact Center Agent
Having a professional contact center means that the staff can rely on the customer agents to handle all the scheduling of appointments, billing questions, lab results, and any change of schedules. The medical staff also gets to focus on providing better care to the patients administered in practice. The responsibilities of the contact center agent include
- Professionally answer the patient inquiry
- Provide with the details of services available in the medical practice
- Manage appointment scheduling
- Provide pre-admission help
- Answer billing related questions
- Make follow-up calls and ask for any post-appointment and consultation
A quality contact center can help retain patients as those patients helped in need and time of hour will return due to quality of service, which will help improve ROI (Return on Investment). The medical practice can be reached anytime of the day and even on holidays. A well-managed contact center can easily result in improved patient satisfaction, excellent response time, and increased revenues.
Health Care Professional
Time is of the essence in the healthcare system, not only for the patients’ bus also for the corresponding doctors and physicians. Medical practice has to employ the best medical methods according to industry standards, incorporate the latest technological solutions, and also ease the workload of doctors, physicians, and surgeons.
The pressure and challenge for healthcare practitioners keeps on increasing with the demand for better health care services. Studies show that face to face diagnosis, treatment, and filing paperwork can be quite tiring for the physicians and may decrease the quality of care due to work-related stress.
One of the best solutions is the employment of a ‘Medical Scribe’ that can ensure quality care and increase revenue for the medical practice. Medical scribes are also called ‘documentation assistants’ who transcribe or translate the patient information in EHR following the instructions of the supervisor. Scribing or documenting the patient information allows the physician to be free and focus on the patient.
Medical scribes were previously used in Emergency departments but are now required in outpatient facilities and clinics as well. As the tenure of most scribes is less than a year, a medical practice should look for virtual scribes and save the time, effort, and cost required to find, train and manage an in-house scribe.
A virtual scribe is mostly connected with the medical practice using a HIPAA secure VOIP (Voice over Internet Protocol) and remote access to the EMR (Electronic Medical Records). The tasks performed by a virtual medical scribe are
- Manage all the administrative tasks that the medical practice requires
- Help with accurate coding with correct input of patient’s diagnosis, treatment, and medication
- Allows physician to focus on the patients and leave the time-consuming paperwork
- Assist the doctor or physician in filling data and charts
- Responding to the messages and questions sent to the doctor
- Decrease burnout
- Improves patient satisfaction
- Fill notes to speed up payments from insurance companies
Employing a virtual scribe helps ease the documentation burden of numerous patients, improve workflow and interaction between physician and patient. EMR and EHR have provided a platform to store and retrieve patient data easily, but it still takes time to enter the system. A virtual scribe can handle all the necessary paperwork and documentation.
PETTIGREW is an established company in the healthcare industry that can help your medical practice by providing valuable staffing solutions and developing medical software based on your needs and which can improve productivity and revenue.
We have a team of creative and expert software developers who can design software that is user-friendly and easy to navigate. Our team can also assist in training your staff, who can then use the features of software efficiently.