Eligibility Verification

Multi-specialty Physician Group Streamlines Patient Registration and Reduces Denials

Uses RelayClearance^™ EDI to Enhance Cash Flow

Situation Profile

Based in Quincy, Illinois, Quincy Medical Group is a growing multiple-specialty, physician-owned group practice with 125 providers serving patients in communities across Missouri, Illinois and Iowa. In 2007, claim denials at Quincy Medical were on the rise and they were experiencing high carrier rejections and administrative costs, low productivity and weak revenues. “We were not doing any verification on the front end, which led to significant denials on the back end for a broad range of coverage issues,” recalled Megan Liter, Senior Director of Business Services for Quincy Medical Group. “Not to mention the impact on administrative costs and the drain on productivity and cash flow.”

Challenge

“Patients may have six or seven insurance cards in their wallet and have no idea which one is current,” said Liter, recalling when the group practice relied on its patients for up-to-date information. Quincy’s billing staff had to manually dig through paper files and multiple web sites in an attempt to secure verification. Administrative costs were high, and so were claim denials and carrier rejections. Quincy needed a solution to simultaneously address these issues in a definitive and cost effective manner.

Solution

In June 2007, Quincy Medical Group implemented RelayClearance EDI, a web-based solution that delivers quick, online confirmation of patient insurance and benefit coverage directly from the payor’s database.

“RelayClearance EDI delivered immediate improvement in the number of denied claims and write-offs caused by uncovered patient services,” Liter said. “Initially we thought eligibility verification might increase patient check-in time, when in fact it has actually sped up registration and greatly enhanced our patient service,” explained Michele Clarke, Quincy’s Quality Assurance Coordinator and Trainer.

Quincy uses McKesson’s Horizon Practice Plus for their practice management, which also provides a simple interface with RelayHealth’s Eligibility Verification. “The system integration was easy and so was our verification solution choice,” Liter added. “McKesson and RelayHealth are valued partners with the IT know-how and expertise to help Quincy Medical Group take control of our claims process with confidence.”

Quincy Medical Group sends a nightly electronic batch file containing coverage-related data for thousands of patients to RelayHealth. Individual insurance records are automatically reviewed overnight and cleared or denied prior to patient appointments the next business day. Quincy also uses RelayHealth’s real-time verification capabilities for walk-in patients.

Quincy is directly linked to 43 payors using its automated eligibility confirmation service. “With RelayHealth’s Eligibility Verification, our scheduling, check-in and billing teams can review patient coverage status and details from anywhere across our group,” Clarke explained. “Having the confidence that we have accurate insurance information at our fingertips has forever improved the way we do business and serve our patients.”

Patient eligibility can be affected by a myriad of reasons. Everything from expired coverage to a misspelled name or an outdated co-pay lead to rejections. Carrier responses delivered to billing staff desktops clear up patient eligibility questions, alleviate back end denials and losses, and open the door to better productivity and ultimately improved patient satisfaction.

Running Clean

“With a carrier response in hand, we can open up a conversation with a patient about the status of their coverage that we might otherwise not engage in at check-in,” explained Liter. “Staffers and patients alike are benefiting tremendously from the accuracy of our eligibility data.”

Quincy’s staff is now capable of proactively prompting patients with tips and information aimed at keeping their coverage current. A comprehensive process overhaul, including the implementation of RelayClearance EDI reduced A/R days from the low 70s to 45, and dropped registration-related denials to an average of 1%.