Ignorance is no excuse. Over the last few months, like me, I’m sure you’ve seen headlines and read articles about the federal crackdown on Medicare and Medicaid fraud. Millions of dollars have been identified as fraudulently paid for services either not rendered or with limited justification. I acknowledge that there are unscrupulous practitioners and providers out there who should be identified, indicted, convicted, and sentenced to the fullest extent the law allows. However, while I don’t have the numbers, I wonder to what extent “fraud” was committed by those who unwittingly engage in poor billing practices, such as miscoding and/or absence of support documentation for procedures provided. Ignoring the old adage that if you didn’t document it, it didn’t happen, may put providers and practitioners at risk of investigation and indictment with all the attendant negative results, such as loss of reputation, decline in confidence, and possibly business failure.

If this falls within the reasonable realm of plausible possibility, I have to scratch my head and wonder why. Why place your business and your future at risk, when you don’t have to? Once again, IT can come to the rescue. Imagine the peace of mind you could have while reducing your DSO, assuming you are at risk not for lack of integrity, but credibility, if your organization had a billing and claims management system that would file clean claims each and every time.

Such an automated revenue cycle management system exists, specifically designed for long term care providers. Imagine a system comprised of a comprehensive and configurable user-friendly web portal to manage claims throughout the submission process, with functions for loading, reviewing, editing, and tracking claims online. With this portal, providers can fully leverage enterprise-level security and permissions with user-definable roles to satisfy their specific claims processing practices. As part of a complete health care transaction solution, providers can submit, monitor, edit claims, and review their claims on-line.

Key benefits of the ProClaim Partner’s application:

• Increased revenue stream and reduced DSO through quick claims turn-around and real-time claims management reporting viewable through a user-defined digital dashboard

• Smoother claims flow through direct connections with providers, trading partners, and value-added networks

• Eliminating avoidable payment delays by increasing successful first-pass rates, tracking claims, and automatically checking claim status

• Reduced transaction fees and paper handling costs by enabling direct connection with providers and payers

• Decreased operations costs through automated handling of routine questions and documentation requests associated with eligibility, claims status, and referrals

• Preserving investments in existing systems by offering an off-the-shelf claims management application that easily interfaces with existing adjudication, financial, and membership systems

   

• Reduced risk through its robust user audit functionality

Providers would be well rewarded for looking into it. In times like these and under this “gotcha” environment of fraud crackdown, doing billing right certainly has its virtues. But a system is only as good as the workflow that leads to the filing of claims – preadmissions screening and documentation; admissions documentation; clinical documentation; therapy services documentation; proper coding; charges compiled; and claims created, scrubbed, triple checked, filed, and monitored. All are critical components of the workflow and are at risk of vital data and information leakage.

In the next blog, we’ll discuss some of these workflow components which are considered industry best practices.

Question: What solid claims management practices have you observed or implemented?

B2B e-Commerce or e-Procurement is here to stay. Vendors and buyers alike who leverage the power of e-Procurement receive numerous benefits including, among others:

• The elimination of manual processing and B2B processing cycles
• Elimination of Dual-Data Entry (DDE)
• Improved data quality and movement, data mining, and real-time reporting
• Improved demand and supply forecasting
• Management of complex logistics operations
• Improved cash flow
• Better management of contracts
• Improved communications between business partners

Acknowledging that B2B e-Procurement is the wave of today’s procurement practices, I’d like to revisit a topic mentioned in an earlier blog, the Patronizing Partnership, the best way to leverage B2B e-Procurement. The ideal relationship between vendor and buyer is a partnership that is mutually beneficial. In this kind of a relationship, both parties work to ensure that each financially benefits; the vendor makes money and the buyer saves money. In a Patronizing Partnership, buyers and vendors tie their procurement goals together based on economic outcome, coordination improvement, and process collaboration. These goals have energized the B2B eProcurement wave.

A key component of B2B eProcurement is information sharing in which both buyers and vendors alike can readily share information about the entire transaction process from the time the PO is created on line, the order is approved, placed, received, and acknowledged to the time when the item is shipped, received, invoiced, entered into the GL, and paid. During this process, feedback about product quality, contract consistency, and delivery, among others go both ways. In the book, The One-Minute Manager, Ken Blanchard writes that feedback is the breakfast of champions. By sharing information, vendors improve customer service and both parties improve the quality of their relationship and cooperation. Both are winners. Information sharing also champions a high level of trust and performance expectations, because it makes the entire procurement process transparent. 

Leveraging the power of information sharing through B2B e-Commerce, vendors and buyers are able effectively to create and strengthen a Patronizing Partnership which is financially mutually beneficial. 

How has B2B e-Commerce benefitted your company?

Procurement specialists have long been recognized as strategically key players in business, but their roles, like most others in the company, are changing with the advance of technology.

Where once procurement services were seen solely in terms of their role in controlling costs, managing inventory, and coordinating vendor services, a recent survey of financial officers has shown that procurement experts are in a position now to contribute to a company on many new fronts.

“Procurement has traditionally been recognized and rewarded solely on the basis of its cost-cutting ability. But through the productive use of automated systems, the function has been able to move beyond simply meeting savings targets to help address larger, more-complex issues such as managing cash and capital, managing risks to business performance, and expanding into new markets or business lines.” said Sam Knox, senior vice president and Director of Research at CFO Publishing, in a statement announcing the release of the latest survey.

The study attributes this new role for procurement to developing technology and envisions even greater roles for procurement experts if they continue developing their supplier networks, bring additional automation to their processes, and increase efficiencies.

Procurement experts have long served business interests in some very essential ways. Their impact on business can be even more significant.

Have you studied your procurement practices lately? Could your procurement operations do more for your business? If you’d like to find out more, Contact Us.