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Case Study
Revenue Cycle Management Services Help Emergency Group Create Operational Infrastructure
“We have been extremely happy. Not only have the services been comprehensive and top-notch, but their people have been engaged and committed to our success from the start. They’ve exceeded our expectations in all respects, and we’re looking forward to a long and continuing relationship with them.”
- Fernando G. Mendoza, M.D.
President
PedEM, PLLC
Customer
PedEM, PLLC
Miami, Florida
Challenge
Mission-critical tasks such as establishing a viable billing solution to optimize claims and collections, physician enrollment, and financial projections
Products
Revenue Management Services
Results
- Successful practice launch
- Long-term revenue cycle stability
- Ongoing process improvements
- Detailed reporting
The Customer:
PedEM, PLLC is a physician staffing group formed in 2012 to provide round-the-clock pediatric emergency care coverage for Baptist Children’s Hospital in Miami. The 16-physician group is responsible for about 30,000 emergency pediatric cases annually.
The Challenge: Establishing a Viable Billing Solution
PedEM was formed by longtime pediatric emergency medicine physician Fernando G. Mendoza, M.D., to bid for pediatric emergency coverage at Baptist Children’s Hospital. After winning the business from the incumbent physician practice, the startup needed to quickly execute a series of steps to become operational. Chief among these was setting up a revenue cycle process that would allow cash to begin flowing.
“It was essential that we get up and running so that we could get paid quickly,” says Dr. Mendoza, the group’s president. “It took us three or four months of planning before we could actually generate income. So we were running on fumes.”
Beyond billing, other necessary duties included physician enrollment and payer contracting. The group also needed to develop business models based on anticipated payer and patient mix.
The Solution: Turn-key Revenue Cycle Services
Dr. Mendoza began looking for a vendor who could help with the start-up-related tasks. A fellow Miami area emergency physician recommended Change Healthcare. Discussions with Change Healthcare representatives soon convinced Mendoza and other practice leaders that the company could meet the new organization’s needs.
“It was clear that they could help us quickly operationalize revenue cycle management, and also provide us with a variety of other services the group needed to get off the ground,” he states. “It was really a turn-key solution. That was very attractive for us, because it meant we would be dealing with just one company.”
Change Healthcare came on board several months prior to the launch. During the planning phase, the company helped practice leaders develop detailed revenue projections based on the previous group’s payer mix and projected emergency department volume. Establishing realistic financial assumptions is imperative for the success of both start-ups and seasoned practices alike. Change Healthcare also began the time-consuming but vital process of enrollment and on-boarding the group’s 16 physicians with a variety of payers, including the state Medicaid program.
Finally, Change Healthcare representatives worked quickly to set up a robust revenue cycle solution. These efforts included establishing necessary data feeds from the hospital for demographic and clinical information, implementing internal processes at the practice, and educating physicians on how to capture accurate and complete clinical documentation. According to Dr. Mendoza, all of the preliminary work was handled “efficiently and seamlessly” by Change Healthcare.
The Results: Accurate, Timely and Consistent Claims
The PedEM go-live in July 2012 went off without a hitch, thanks in part to Change Healthcare, and cash was soon flowing to the group. Today, the group’s coding, claims submission, and denial management continue to be handled through the Change Heatlhcare Emergency Medicine Center of Excellence in Jacksonville, Florida. According to Dr. Mendoza, one of the biggest benefits of working with Change Healthcare – beyond the efficacy of the revenue cycle management services – is the detailed business intelligence reports the company provides the practice. These customizable reports offer insight into multiple key performance indicators.
“The reports are extremely detailed and allow us to drill down to whatever level of information we want, whether it’s an individual provider or even a diagnosis code,” Dr. Mendoza says. Thanks to the reports, he noted that the group has been able to pinpoint areas in need of improvement. One of these included the reporting of critical care time.
“With the help of Change Healthcare, we provided feedback to our providers so they could improve their documentation of critical care time, and within a few months, we saw an immediate impact on revenues.”
Dr. Mendoza reports that Change Healthcare has continued to provide face-to-face workshops to help physicians and scribes improve documentation throughout the emergency care arena. These workshops were particularly important in the run-up to the ICD- 10 coding conversion, he states.
Separately, Change Healthcare conducted an analysis of the group’s use of scribes to capture clinical details in a near-real-time fashion. The study validated the expectation that scribes were improving physician productivity and helping increase revenue.
“We have been extremely happy,” Dr. Mendoza says. “Not only have the services been comprehensive and top-notch, but their people have been engaged and committed to our success from the start. They’ve exceeded our expectations in all respects, and we’re looking forward to a long and continuing relationship with them.”
