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    7 internists and a patient panel of 20,000, quite similar to Potomac Physician Associates (Donato, 2003), in Bethesda, MD, who in 2002 brought their claims submission and practice management services in-house. Assuming three FTE’s working the billing and using Vericle’s technology, the costs would be about $120,000 for personnel and $36,000 for technology. For referen
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    Internet-based technology has been applied effectively to reduce medical billing costs, especially at the stages of electronic submission and scrubbing. However, excess focus on reducing costs of individual process components while ignoring total billing quality exposes medical practice to significant financial downside. Quantification of billing quality and its inclusion into price-performance equation of billing service yields more comprehensive financial picture and better decisions about billing service selection and its management. Such an approach also results in substantially higher remittance and better regulatory compliance. It is effective, however, only subject to billing performance guarantees and transparency.

    Traditional sequence of management steps to rationalize medical practice billing and reduce its costs requires the physician to invest in processes, personnel, and technology:

    1. Study your denials to eliminate errors by using claims-scrubbing software
    2. Educate your front-end employees about the billing process and know how to be a part of it
    3. Investigate tools for electronic submission and take advantage of technology
    4. Set guidelines for which claims and which dollar amounts merit appeals
    5. Provide patients with clear payment policies up-front

    ROI in Claim Processing Technology

    For illustration, consider a case of a three-office practice with 17 internists and a patient panel of 20,000, quite similar to Potomac Physician Associates (Donato, 2003), in Bethesda, MD, who in 2002 brought their claims submission and practice management services in-house. Assuming three FTE’s working the billing and using Vericle’s technology, the costs would be about $120,000 for personnel and $36,000 for technology. For referenc

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    Traditional sequence of management steps to rationalize medical practice billing and reduce its costs requires the physician to invest in processes, personnel, and technology:

    1. Study your denials to eliminate errors by using claims-scrubbing software
    2. Educate your front-end employees about the billing process and know how to be a part of it
    3. Investigate tools for electronic submission and take advantage of technology
    4. Set guidelines for which claims and which dollar amounts merit appeals
    5. Provide patients with clear payment policies up-front

    ROI in Claim Processing Technology

    For illustration, consider a case of a three-office practice with 17 internists and a patient panel of 20,000, quite similar to Potomac Physician Associates (Donato, 2003), in Bethesda, MD, who in 2002 brought their claims submission and practice management services in-house. Assuming three FTE’s working the billing and using Vericle’s technology, the costs would be about $120,000 for personnel and $36,000 for technology. For referen

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    Traditional sequence of management steps to rationalize medical practice billing and reduce its costs requires the physician to invest in processes, personnel, and technology:

    1. Study your denials to eliminate errors by using claims-scrubbing software
    2. Educate your front-end employees about the billing process and know how to be a part of it
    3. Investigate tools for electronic submission and take advantage of technology
    4. Set guidelines for which claims and which dollar amounts merit appeals
    5. Provide patients with clear payment policies up-front

    ROI in Claim Processing Technology

    For illustration, consider a case of a three-office practice with 17 internists and a patient panel of 20,000, quite similar to Potomac Physician Associates (Donato, 2003), in Bethesda, MD, who in 2002 brought their claims submission and practice management services in-house. Assuming three FTE’s working the billing and using Vericle’s technology, the costs would be about $120,000 for personnel and $36,000 for technology. For referen

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  • Investigate tools for electronic submission and take advantage of technology
  • Set guidelines for which claims and which dollar amounts merit appeals
  • Provide patients with clear payment policies up-front
  • ROI in Claim Processing Technology

    For illustration, consider a case of a three-office practice with 17 internists and a patient panel of 20,000, quite similar to Potomac Physician Associates (Donato, 2003), in Bethesda, MD, who in 2002 brought their claims submission and practice management services in-house. Assuming three FTE’s working the billing and using Vericle’s technology, the costs would be about $120,000 for personnel and $36,000 for technology. For referen

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    7 internists and a patient panel of 20,000, quite similar to Potomac Physician Associates (Donato, 2003), in Bethesda, MD, who in 2002 brought their claims submission and practice management services in-house. Assuming three FTE’s working the billing and using Vericle’s technology, the costs would be about $120,000 for personnel and $36,000 for technology. For reference, Vericle technology performs comprehensive claim validation, patient demographics and eligibility test prior to visit, electronic claim submission, and comprehensive reporting for followup etc. Additionally, using Vericle technology, 98% of claims are now clean, adding further value for the investment in claims processing technology. In this case, billing costs add up to $156,000 annually. This is a significant accomplishment in terms of billing processing costs, because without advanced technology, the same practice may need at least seven FTE’s, at cost of $280,000.

    Accordingly, the previous arrangement prior to installing the Vericle technology costs at least $292,000 (assuming 1/3 of cost for an alternative albeit inferior billing package). Thus, an investment of $36,000 in superior technology saved at least $136,000, which is obviously an impressive ROI on $36,000.

    However, this approach does not account for the entire spectrum of costs associated with in-house billing approach. It ignores the total revenue aspect of the billing function, which is its ultimate purpose.

    Quantification of Losses Caused By Insufficient Billing Process Quality

    To receive a more comprehensive perspective, let us compute the total losses of this approach generated by uncollected payments. We will proceed by establishing a convenient baseline and figuring out a way to approximate the losses.

    In our experience, the likelihood of payment sh

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