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Selecting & implementing a billing system

By Donna M. Sherwin, CPA

Selecting and implementing a physician billing/practice management system is one of the most critical choices a practice will make. Often it is an administrator who undertakes the task of selecting a system and outlining an implementation plan without considering all those who will be in some way impacted by the decisions made. Mistakes made during the process can lead to disastrous financial, operational and even public relations issues that are irreparable.

There are certain aspects of a system that will impact the entire organization and must be reviewed with the overall good of the company in mind. In order to achieve the desired results, one must be able to distinguish between short term and long term benefits when selecting and implementing a physician billing system. Further, priorities must be very clear to those who will be making the decisions.

One of the first things that must be decided from a global perspective is what level of sophistication will be necessary to ensure efficient and effective operations and reporting. Unfortunately, there are times when one will need to sacrifice one desired feature for another. For example, user-friendliness is a much sought after feature of any system, however, one must be very careful not to give up the long term benefit of increased functionality for a seemingly user-friendly system. While many systems have characteristics of both user-friendliness and sophistication, often times there is an inverse relationship between the two.

Another crucial aspect that must be analyzed carefully is the levels of reporting that will be necessary to make informed business decisions. If you are a one physician office, your needs will be quite different from someone who is selecting a system with several locations, multiple specialties and multiple programs within those specialties. Without the appropriate hierarchy of reporting, you may lose some significant reporting capability.

Levels of security, on-line data entry edits and the degree of support you’ll need should all be addressed from an organizational perspective. Without the proper security, edits and support, the power of the system will be greatly reduced no matter how well the specific functions are designed. Once the general issues have been resolved, you will want to consider specific features and functions from the various users’ perspectives. I offer the following as an example of features by user groups.

The Physician and Non-Physician Clinical Perspective

Some of the features a physician will desire might be high level reports including service analysis reports, clinical reports and financial and reimbursement analysis reports. A physician and other clinical personnel may also be interested in an electronic medical record and on-line access to medical results.

The Management Perspective

In addition to a fairly comprehensive set of “canned” reports, management might want the capability to develop their own reports through a user-friendly report writer. Management will also want financial balancing capability, i.e., what was posted to the system to cash deposits and the ability to have multiple fee schedules. In addition, supervisors and managers will benefit from individual and group productivity/statistical reports for the billing staff. Of course electronic billing capability, claim edits and claim edit reports as well as an encounter form generator would be considered beneficial for most management level individuals.

The Billing Staff Perspective

Since billing staff positions are largely data entry positions, features that minimize keystrokes such as easy pathways, “hot keys” and so on will be very desirable to billing personnel. Other time saving features such as easily understandable account history and responsible party transfer screens, as well as patient note screens that allow for extensive notes, will also be welcome features to the billing staff. Further, on-line help screens are a virtual necessity for the billing staff.

The Technical Person’s Perspective

The technical crew will be concerned with the compatibility of the platform on which the system runs, interface capability, hardware compatibility and security access. The level of technical support to be provided might also be a deciding factor for technical personnel.

The Patient’s Perspective

Patients are an often overlooked group that will be impacted by the decisions of those selecting and implementing a system. One should be careful to ensure the system will facilitate the flow of patients through the check-in and check-out processes rather than impair it. Patient inquiry screens should be easily understood so that patient representatives can provide timely responses to patient calls. And finally the system should provide for plain language statements and collection letters.

The Implementation

While most practice management/billing systems have imperfections, even the most complete and sophisticated system will be grossly limited if functionally and technically installed without proper forethought, particularly with respect to reporting. There are many large and small health care facilities today that are suffering from faulty installations of five or more years ago. The only recourse is to re-install the same system or to buy and install a new one. Either alternative is costly and time consuming.

Although you may have given a great deal of thought to developing the RFP (request for proposal), the functional installation/implementation phase of the project will require the most work and will be the most tedious. While you may be anxious to bring the system live, you should not cut this phase short. Time and effort expended at this point will pay off for years to come. It is at this juncture that you will begin to capitalize on the functions and features of the system.

The Plan

While every practice is different and the size of the practice will dictate the sophistication of the plan, it is nonetheless important to have a well thought out and documented selection and implementation plan. I offer the following ten step program as one alternative to the process of selecting and implementing a physician billing system.

Step 1. Form a committee to include each of the following:

• Physician representative.

• Non-physician clinical representative.

• Management representative.

• End-user representative.

• Technical representative.

• Patient liaison.

Step 2. Prepare a project management time-line in which you assign responsibilities and highlight critical paths.

Step3. Set standing meetings. Early morning meetings are suggested to provide for best attendance.

Step 4. Convene a” brainstorming” session in which each of the above representatives participates in developing a “wish list” of features and functions of the “ideal” system.

Step 5. Select three to four systems to be demonstrated to the committee. Have the “wish list” available for comparison as the systems are being demonstrated.

Step 6. Prepare an RFP to be sent to selected companies. The RFP should be all inclusive. (Functions, features, outcomes, delivery and support)

Step 7. Select the preferred vendor based on the RFP.

Step 8. Invite the vendor of choice to your standing meetings to review and agree on details of the RFP. Your “wish list” should be used for comparative purposes.

Step 9. Prepare an implementation plan, including a committee with a representative from each of the above areas as well as a vendor representative, a schedule of standing meetings and a project management time-line.

Step 10. Develop a training plan for all those impacted. In addition to training all end users, the plan should include the development of written documentation that explains reports as well as patient correspondence, i.e, statements and letters.

There are numerous practice management systems on the market. It is not a simple process to select and/or install a physician billing system. The vendor you choose should be one that you trust and that has the capability to become your partner during the process. While no system will meet all of your needs, with the proper planning and involvement of appropriate personnel your system can positively impact your business for many years to come.

Donna M. Sherwin, CPA, is president of Physician Billing Solutions, Inc. in Wayne, Pa.

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