PBOI Improves Revenue Cycles through Front-End Management

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In our last article on Palm Beach Orthopaedic Institute (PBOI), which is located in Palm Beach Gardens, Fla., Brian Bizub, chief executive officer, discussed two groundbreaking initiatives: implementing a post-surgical DME program and opening commercial pharmacies in physician group practices.

PBOI is the top orthopedic institute in the southeast and is spread across four locations in Florida. Recently, a new medical complex was unveiled at 4215 Burns Road in Palm Beach Gardens. This complex will house an MRI facility, a D1 sports training athletic complex, the online portal NextMD, a rehabilitation center, and an on-site pharmacy.

Bizub said this complex continues to advance PBOI’s mission of high-quality, cost-efficient customer service and orthopedic care.

The organization’s continued growth is largely the result of innovative, daring initiatives, such as the ones we discussed in our previous article, as well as Bizub’s process-oriented approach to improving PBOI’s revenue cycle through front-desk management.

Looking beyond accounts receivable

Smaller practices are often unable to verify patient benefits prior to the patients coming in for an appointment, mainly because they lack the resources to do so. Unfortunately, practices then end up only collecting the co-pay at the time of the appointment and chasing any co-insurance and deductibles after the fact.

Medicare used to have an annual deductible 10 years ago, Bizub said. A practice would collect 20 percent, which was balance billed to the patient. For HMO plans, it was simply a co-pay with no deductible, and HSAs were like HRAs in that they were credit card-based. Patients self-funded HSAs through their employer and used a credit card for health-related expenses.

With rising insurance premiums and higher deductibles under the Affordable Care Act, it has become more important for practices to know what the deductible is so they can collect it from the patient on the front end.

This is especially true in orthopedics, Bizub said, which is an events-based practice. “We’re a subspecialty, so you may see the patient only once.”

Subspecialty practices like PBOI end up expending a great deal of time and resources pursuing patients who owe $20 for services received or for a deductible that hasn’t been paid yet.

“Unless you’re a process-driven person, you really need to look at the front end, because that’s where it starts,” Bizub said. “We’ve all been trained to manage our accounts receivable because that’s money in the bank.”

Understanding the payment type before the visit

Recently, Bizub renegotiated his outsource-billing contract since he’s collecting more allowables on the front end, amounting to hundreds of thousands of dollars in revenue every month because volume on the front end reduces billing expenses on the back end. Why should he pay the billing company a percentage? he asked.

Instead, PBOI has partnered with ezVerify, an automated healthcare solutions company that conducts real-time verifications.

Bizub and his team check their patient schedules two days in advance. They enter the patients’ names, their insurance plans, and ID numbers into ezVerify, and the software sends the information out to the individual insurance companies. An electronic file containing a 10-page document for each patient is then returned to them.

PBOI has interfaced ezVerify with its NextGen EMR to extract the pertinent orthopedics information from the documents. This information is automatically placed in the appointment book, and when Bizub’s team looks at the patient profile, they see only the relevant information needed for each patient’s visit.

The staff then calls those patients two days in advance, so they are aware of their payment obligations before they arrive at the office. Bizub said this not only weeds out those who are unable to pay, but it also saves patients from the embarrassment of realizing they don’t have the money while standing in the waiting room.

For those patients who need care but can’t afford it, the two days also gives his staff time to help them find alternative avenues for payment. Bizub said they still take a patient’s situation into account and will balance bill on occasion.

The 10-page document is kept in the system just in case a patient ever requests print verification of their information. According to Bizub, the convenience of this software cannot be overstated. Since installing it, he has saved $100,000 by reducing his full-time FTE staff from four to one.

He also emphasized the educational component to this software for everyone involved–the patients, physicians, and staff—since each party is learning to appreciate the cost and value of healthcare. After all, not collecting on the front end can cost a practice three times the original amount for a service.

Remembering change is a process

Bizub said he has increased front-end collections over the past six years by 53 percent, and he has saved tens of thousands of dollars in labor and resources. But it has taken time to attain these levels of savings.

“It’s a process,” he said. “If your practice is not used to collecting on the front desk, there needs to be some education to the patients prior to implementing this service. So you want to make sure the patients understand that. Once the program is up and running, the problems seem to go away because the patient’s expectations are changed. It’s definitely a mindset change.”

It’s also important to remember that physicians would rather avoid the financial end of healthcare.

“This helps to relieve that pressure from them when the patient comes in and asks about billing,” Bizub said. “I think that breaking down each thing that we do into a process and trying to make it as efficient as possible is important for the success of both hospitals and practices. The more we can do to help our patients understand their part of healthcare and the physicians to understand what they need to do to make it a more efficient process, I think the more successful healthcare will be. And we can help reduce healthcare costs through efficiencies.”

-by Pete Fernbaugh

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