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I Clearinghouse_GEDI-RM.gif
(Top) Screen shot of the Contract Recovery Dashboard. Dashboard reporting identifies underpayments and/or denied claims, and initiates an automated appeal process letter so that the physician can retrieve payment on the claim. (Bottom) Screen shot of the SafetyNet Report, which shows any claim rejections that the practice hasn’t resolved to avoid “black-hole” claims.

AAOS Now

Published 4/1/2011
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Jackie Ryan

Add muscle to your revenue management

New member benefit can reduce rejections, help speed payments

What are your top three concerns about your practice? If you’re like most physicians and practice executives, financial performance will probably rank among them.

For most practices, pressures on reimbursement and increasing costs—particularly in the area of collections—are constantly straining their ability to cover practice expenses. Even though the economy is beginning to recover, increasing the effectiveness of your revenue management function will remain a major area of concern.

All too often, practices do not have resources to code correctly or the knowledge to comply with payer protocols. Additionally, most practices (even large group practices) lack information to recognize when payers do not pay, pay late, or make inadvertent or intentional reimbursement errors.

Help from AAOS
To help AAOS members control costs, submit clean claims faster, and get paid faster, the American Association of Orthopaedic Surgeons (AAOS) has signed an agreement with Gateway EDI for claims clearinghouse services.

“If you are in a solo or small practice, getting a handle on revenue can be challenging; the new AAOS Revenue Management Program powered by Gateway EDI helps you focus on your busy practice, while keeping cash flow running smoothly,” said Thomas J. Grogan, MD, chair of the Practice Management Committee.

Gateway EDI’s “Tools” and “Best Practices” will help you submit your claims faster and cleaner. The result will be increased revenue and decreased days in accounts receivable. For example, the average rejection rate for Gateway EDI clients is 5 percent or less. And, as you submit claims, proactive activity monitoring ensures that the information is accurate, helping you avoid delays in reimbursement due to edits and reducing the number of costly rejections.

Finally, participating in this new program can help you keep small payment errors from becoming big revenue problems. The difference between what is expected and what is paid can add up to significant revenue issues if left unchecked. Reimbursement Manager from Gateway EDI easily identifies denials and underpaid claims.

I Clearinghouse_GEDI-RM.gif
(Top) Screen shot of the Contract Recovery Dashboard. Dashboard reporting identifies underpayments and/or denied claims, and initiates an automated appeal process letter so that the physician can retrieve payment on the claim. (Bottom) Screen shot of the SafetyNet Report, which shows any claim rejections that the practice hasn’t resolved to avoid “black-hole” claims.

It works!
“Gateway EDI’s online revenue management tools help the business side of our office run smoothly. The day after claims are submitted, we receive notification of any potential errors. We can easily review the status of our claims and any remittances that have been received. My office staff also can instantly verify patient eligibility online to avoid long calls to insurance companies,” said Blaine L. Farless, MD, of Cleburne Orthopedics and Sports Medicine in Cleburne, Texas.

“As a result, we’ve had fewer claim rejections and quicker payments. In fact, since switching to their tools, our payment cycle went from an average of 30 to 60 days down to 2 weeks. Overall, Gateway EDI’s tools give me peace of mind, which enables me to focus on serving my patients,” said Dr. Farless.

Who’s behind the program?
Gateway EDI is based in St. Louis. Gateway EDI’s entry into medical office automation began in 1983 when a practicing physician began to search for a computer system to meet the administrative challenge of delivering high-quality care at a reasonable cost. After much research and review, the doctor was still dissatisfied with the alternatives available and so he chose to develop, design, and write software from the perspective of the physician and office staff.

“For more than 20 years, Gateway EDI has helped orthopaedic practices manage their revenue cycles and get paid quickly,” said Charlotte A. Martin, Gateway EDI’s president and chief operating officer. “We understand the challenges that face orthopaedic practices today, including administrative costs that consume 15 percent of every dollar spent on health care and the hassle of collecting from patients who are now taking on more responsibility for healthcare payments. That is why we are proud to partner with the AAOS to provide members with discounted pricing and advanced tools to address the revenue management challenges.”

Additional information about the Revenue Management Program is available from Steven Fisher, manager of the AAOS Practice Management Group, at sfisher@aaos.org or (847) 384-4331.

Jackie Ryan is a program coordinator in the AAOS practice management group. She can be reached at ryan@aaos.org

Filling members’ needs
Gateway EDI representatives helped staff the Practice Management Center booth in Academy Row at the recent AAOS Annual Meeting in San Diego.

Nick Challen, Gateway EDI’s dedicated sales representative to the AAOS, met with many members who recognized that they were not collecting revenue due to them under their payer contracts. “Members know they are leaving revenue on the table,” said Mr. Challen. “They want a better handle on their claims process. This program accomplishes that with minimal effort from a practice’s staff.”

Find out how the AAOS Revenue Management Program, powered by Gateway EDI, can help your practice reduce claims rejections, recover missed reimbursements, increase revenue, and save time. Visit www.gatewayedi.com/aaos and schedule a personal demonstration.