A focus on administrative efficiency can positively impact both revenue and patient satisfaction in growing organizations.

Orthopedic practices have been expanding, and administrative complexity has grown with them. In 2006, nearly one-quarter of physicians were solo practitioners. The latest statistics from the American Academy of Orthopaedic Surgeons (AAOS) estimates the current number to be 12%. More providers mean more administrative work to manage and bill patients. And, administrative requirements seem to increase every year, culminating in an average expenditure toward billing and insurance-related activities of up to 25% of professional revenue. Anecdotal evidence suggests that orthopedics administrative costs are on the higher end of the spectrum due to the large percentage of pre-authorizations (PAs) required for many procedures and treatments.

The ‘name of the game’ in healthcare administration is accuracy and efficiency. However, they can be challenging to achieve with staff turnover and constantly changing payer requirements. The price when processes go wrong can be high, and practices pay with decreases in revenue as well as reputation loss.

Focus on accuracy and efficiency

Two of the most common administrative hurdles cited by ortho organizations are claim denials and increased labor costs due to arduous pre-authorization protocols. Fortunately, denials due to inaccurate patient demographics and insurance verification (which are usually the majority of denials) are avoidable. In addition, options are available to mitigate the expense and frustration of pre-authorization processes if you know what to look for.

Top strategies for creating a healthy ortho practice

Focus on administrative workflows

1.  Change front-desk culture

If your organization has not done so already, consider using available EHR technology to streamline the check-in process. Patients who verify their address and insurance information are more likely to see and correct errors, especially if they understand that errors may lead to denials. Accurate patient information significantly decreases clearinghouse rejections and the resulting administrative labor to correct claims and appeal denials.

2.  Verify eligibility electronically whenever possible

Verifying eligibility is an administrative task that is best done electronically. Most large payers allow access to information through their provider portal, and many cloud-based applications specialize in insurance verification. In cases when a phone call is needed, develop workflows that encourage completing other administrative tasks while on hold.

3.  Don’t overlook small efficiency changes

Something as simple as supplying administrative personnel with two computer monitors can greatly decrease time spent on tasks and increase accuracy. Billing software updates built to improve efficiency are commonly overlooked by busy billing staff. Consider assigning an administrative team member to attend all software training, distribute learned shortcuts, and educate staff about new software capabilities. The money spent on training will soon pay for itself with labor savings.

Streamline prior authorizations

Although great strides have been made to increase efficiency in the billing workflow, one area that lags is the Prior Authorization (PA) process. The latest American Medical Association (AMA) survey on PAs reports that 94% of physicians experience care delays, and 79% have had patients abandon treatment due to process issues. Nearly one in five orthopedic surgery orders require prior authorization1 and many orthos report that PAs are one of their most significant segments of administrative expense.  As a result, many ortho organizations are turning to revenue cycle partners to limit administrative burdens and decrease turn-around time. Virtual OfficeWare Healthcare Solutions recommends looking for a partner that can manage all aspects of the complex PA process. A comprehensive solution should include:

  • Insight into payer requirements
  • Cutting-edge technology poised to keep up with advances
  • Comprehensive communication with payers
  • Visibility from start to finish into the PA process
  • The ability to take the work off your plate by securing the authorization

A smooth billing journey with streamlined PA procedures is a win-win for providers and patients. Resulting decreases in administrative labor, increases in revenue, and positive patient outcomes create healthy ortho organizations positioned for continued success.

Staying at the forefront ortho revenue cycle management and PA processes can be challenging – using the right partner for practice management software and billing makes it easy. Contact us today at (412) 424-2260 or visit vowhs.com to learn how we can help you optimize workflows, streamline claims, and maximize revenue.

1 athenahealth. (2020). 3 ways to take the pain out of prior authorizations.