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Agnes Radz knew something was wrong. When she came three years ago to Ascend Billing Services, a physician-owned company that does billing and accounts receivable for about 60 emergency room physicians in Denver, the promise of the organization had yet to be fulfilled. That promise was to make billing and collecting easier for its physician clients.
"They were not doing that great [financially] and they had employee issues," says Radz, Ascend's CEO. "The system they were using was created for radiology billing, and as I learned what the system did, I knew it was not going to work with us."
Further, Ascend's clearinghouse offered no confirmation of the claims it received. There was a lot of faxing going on, which Radz, a former employee with Per-Se Technologies (now owned by McKesson Corp.) views as particularly unproductive in an era of electronic, automated communication.
"The only time we got a claim confirmation was after we settled with the insurance carrier and that was 30 days later," she says. "That's hard to manage because it wasn't like the claims wouldn't go through."
Not only is it hard to manage, but Radz says she was finding that claims she thought would be paid were being rejected—again—30 days later. Not only that, but she says some claims were being paid incorrectly—that is, at less than the contracted rate. Funny how errors didn't seem to happen in the physician's favor, either, she notes. The process of digging though old claims individually to rectify that situation was also costing her employees valuable time.
"Insurance companies will find the tiniest little detail to reject the claim," she says. "We just had to become better at the game."
Radz searched out a new vendor that would allow online submission of claims and real-time claims-tracking—that way she could discover rejected claims the next day and work to resolve them much more quickly.
She went with Navicure, a medical claims clearinghouse, because it allowed next-day online verification of claims submissions.
"Now they can't tell me that they didn't receive the claim," she says of the insurance carriers. "We don't fax the claim status sheet over. It's electronic and it stops delaying tactics."
Further, employees at Ascend can go online and see the claims moving from bucket to bucket in the process of getting paid, Radz says.
The move and the quick turnaround for physician payments has become a big selling point for Ascend, which is looking to attract new business from other specialty physicians, not only including ER docs but also in toxicology and neurology, for example.
"We increased by about eight new physicians in the past year and a half," she says. "We shifted responsibilities so a lot less energy was needed in tracking claims. That allows me to direct more employee resources toward self-pay patients, which our clients also like."
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