Medical Billing Unlimited (MBU) provides a full menu of RCM, billing and practice management services to 260 providers in the El Paso area. With a client roster of 60% solo practitioners and 40% group practices, as well as all the major hospitals in the city, MBU is ideally positioned to help independent medical practices implement efficient processes for financial success.
“We have a process for everything,” says Josh Santillan, MBU’s Chief Operations Officer and part owner. “We help providers adopt a process for everything from charge capture, to data entry, to posting payments, to A/R reconciliation. When this happens, things run smoothly.”
The Challenge: Complex and Error-Prone Billing Process
Medical billing continues to get more complex. “When I first started out, you could mail out a bill and payers would cover 80% to 100% of what you billed,” says Josh. “It was pretty straight forward. You didn’t have any denials.”
Now claim rejections and denials can happen at any turn. “You have denials for CCI edits, LCDs, specific CPT codes for each payer,” says Josh. “And fixing claims is a lot of work on the backend. Claim denials can cause payments to be delayed for 6-8 weeks or more.”
Complexities with payer reimbursements was only half the challenge. With patient financial responsibility on the rise, improving patient collections became as much of a priority as payer reimbursements. “One of the things we’re seeing across the board are large patient deductibles,” says Josh. “Most people now have a deductible of no less than $2,500.”
In the past, practices could send patients on their way after a visit and mail a bill some time afterward. But with patient payments making up 30% of practice revenue by some estimates, that’s not possible anymore. “Once the patient leaves your office, good luck. It’s going to be very hard for you to collect that money,” says Josh.
As a result of higher deductibles coupled with the increased complexity with payer reimbursements, MBU started to notice an increase in bad debt (more than 120 days past due) on patient statements. Helping staff successfully and efficiently collect on patients became a priority at MBU.
The Solution: Streamlining the Billing and Reporting Process
MBU set the goal to streamline their billing and reporting in order to reduce the time and effort it takes to collect and manage revenue. To serve this goal, Josh saw the need to migrate all of their clients and his billing staff into a single software platform. He chose the Kareo integrated billing and EHR platform, with additional modules for practice marketing, telemedicine video visits and robust analytics.
With their new software solution chosen, Josh then worked with Kareo to migrate all of their existing clients onto the Kareo platform. “I have a science background, so I like to analyze data and take a very systematic approach,” says Josh. He started by segmenting his client population and setting dates for migration. Within six months, MBU clients had been migrated to Kareo and were meeting and exceeding their transaction goals.
As a growing billing company, MBU wanted uniformity in their reporting. Josh created customized monthly reports to easily push that information out to clients and gather feedback about any further customizations needed.
At the end of each month, MBU sends clients these standard reports, and if they want something more specific, Josh's team can now drill down into more detail, such as looking at accounts receivable by CPT code, payer, payer scenario, date of service, payment posting, and other filtering options. They can easily identify unrealized revenue opportunities and prioritize activities based on the greatest financial impact.
The Results: Time Savings, Reduced Rejections and Improved Patient Collections
Josh uses the reporting and analytics tools to help identify the cause of rejections and denials: “I can see what my denials and rejection rates are. I can see our most frequent denials as a company, and I can drill that down to the individual practice. That will let me know if the problem is on our end or at the practice location.”
A metric that MBU looks at each month to determine overall performance for the billing company is the days out in A/R, which determines how quickly they are turning around reimbursement on claims. “We have squeezed that window down from 40 days to 35 days and are working to get it closer to 30 days for all our clients,” Josh reports.
One Kareo feature the MBU team can’t get enough of is the auto-posting of the ERA remittance. “Our staff loves it,” says Josh. “We get the remittance in our billing system from the payer as they’re processing and sending claims and payments. It saves a lot of time.”
For MBU, improving patient collections means educating and providing tools to their clients. They remind practices to verify eligibility benefits using the one-button verification function in Kareo. They also help clients estimate the allowables for different payers. “Let’s say Aetna allows $150 for a new patient visit, CPT code 99203,” Josh explains. “If the patient hasn’t met the deductible, they should collect that whole $150 from the patient at the time of service.”
Josh and his team are working to set up these insurance allowables using the contracts management functionality in Kareo, in order to make that information available for practices to collect. Even before the visit, as a best practice, the scheduling staff could inform patients of their estimated amount due for the service.
MBU staff also reminds practices to collect email addresses so that they can take advantage of the software's electronic patient statements. Then patients can have the convenience to pay their bill by credit card online. “It’s so much easier than patients having to find a check or write their credit card information on a piece of paper and mail it in. I don’t even know where my checkbook is,” says Josh. “Making it easier for patients to pay their medical bills is a great benefit.”
In fact, they have seen an increase in POS (point of service) transactions from their clients. This makes it easier for MBU to track those copays and payments made on the patient account when in the client’s office.
Conclusion: Ready for Growth
“Now we have all our staff and our clients on this great tool, and we’re seeing how we can do our processes more efficiently,” says Josh. “I’m focused on looking at metrics to measure performance on our end—looking at our productivity, how staff measures up to their peers doing the same work.”
All of this efficiency improvement is for the purpose of allowing MBU to grow and expand beyond El Paso. “Before, if I wanted to look at the performance of our company at a global level, I was never able to do it,” says Josh. “I had to log into different systems, run different reports, it was very time consuming and inconvenient. Now, I have that ability to see the big picture in a quick snapshot, and then I can drill down into a specific practice and see what’s going on with their A/R. Kareo has given me a way to look at all my clients at an enterprise level and to provide our independent practices the stability and accountability they need to succeed.”