FPs Can Take Steps to Cut Paperwork, Costs

By Leslie Champlin
http://www.aafp.org

Diversity may be good in many circumstances. But in issues related to health care administration — such as credentialing requirements, health plan contracts, coverage, copayments and deductibles, and prior authorizations within and among insurance plans — can be crippling.

According to the Medical Group Management Association, or MGMA, the annual cost for administrative paperwork in a health care practice averages $24,713 per full-time physician in a 10-physician practice. Much of that cost results from the complexity of credentialing requirements for health plans and hospitals, claims denials and other billing and collection issues, and insurance formulary denials or demands for prescription substitutions.

The best way to simplify?

“Don’t take any insurance at all,” said FP Andrew Merritt, M.D., of Marcellus, N.Y., a member of the AAFP Commission on Practice Enhancement.

Merritt doesn’t subscribe to that approach, “but there are a number of doctors who do that,” he said. “The simplest way to reduce administrative paperwork is to make the patient responsible for the interaction with the insurance company on the claim, on pharmacy issues and the prior authorizations.”

Short of that, family physicians can — with some attention to detail — reduce the number of hoops through which they must jump to get credentialed and paid.
Know the Contract
First, advised Merritt, “Don’t accept bad contracts,” and know the details of the contracts you do sign.

“Know the rules and use them,” he said. “Know what is in the contract. Will it cover well-adult visits? If you have an adult patient with a chronic condition or two, and she says she’s coming in for a well-adult visit, you need to check on (her) chronic conditions and code appropriately.”

Likewise, know when an insurer requires stepped therapy and diagnosis. “If Company A will deny an MRI unless the patient has had physical therapy, send the patient to physical therapy first, and when that doesn’t work, go to the MRI,” he said.
Give Responsibility to Patients
In addition, many physician offices can eliminate or streamline costs by asking patients to accept responsibility for part of their care, said Merritt.

For example, according to MGMA, prescription refills comprise more than 63 percent of pharmacy-related interactions in a physician’s practice. No longer calling in refills would cut an average of $29,291 in staff time and $80,833 in physician time each year for an average 10-physician practice.

“We put as much responsibility as possible on the patient,” said Merritt. His office has slashed the number of pharmacy-related interactions because he doesn’t accept telephone requests for prescription renewals.

“We do not call in, fax or deal with prescription refills until the time of the follow-up visit,” said Merritt. “If a patient needs a prescription for a chronic condition, he needs to come in for a chronic care management follow-up to ensure quality of care, and he also needs to be responsible enough to remember that he needs a refill and tell the doctor about it at the time of the visit. It’s a patient responsibility issue.”
Cut Credentialing Hassles
MGMA data also indicate that credentialing applications soak up more than $7,600 a year in the average 10-physician practice. Here, duplication is the culprit.

“The process of going through the credentialing process is a significant cost and a huge amount of duplication,” said William Jessee, M.D., president and CEO of MGMA. “It’s the same information that goes to each health plan, and if you participate in 20 plans, it gets verified 20 times.”

FPs can save significant time and money by using the Provider Credentialing Application, a universal form the Council for Affordable Quality Healthcare, or CAQH, created for all health plans or hospital credentialing requests. Physicians can complete the form by visiting the Universal Credentialing DataSource secure Web site. CAQH is urging all states to adopt the form for their physician credentialing requirements.

“It covers most managed care plans,” said Merritt. “We’ve seen a significant reduction in our paperwork and administrative time (by using it). Even the updates take only a little time.”
Streamline Your Front Office
Jessee and Merritt also advise physicians to implement policies to minimize human error.

“An incorrect patient identification is the leading cause of claims denials,” said Jessee. “Look at your office procedures, and find easy ways to minimize the likelihood of errors on claims (before they are submitted). Put in place a quality control system, even if that means you have to copy numbers from insurance cards and have a second person review (them) to ensure there isn’t a transposition error.”

Take extra steps when dealing with insurance cards with decorative backgrounds that could obscure identification numbers, interfere with a photocopy’s clarity and increase the likelihood of errors, he added.

Merritt’s staff members avoid potential errors by scanning insurance cards into their practice management system. “This prevents copying errors and allows everyone to see the card when they’re working on something for the patient,” he said.

Jessee also recommends collecting copayments and, if possible, deductibles when the patient checks in.

“Practices that collect copayments and deductibles when the patient is there are doing much better financially than practices that don’t,” he said. “The cost of generating a patient bill is three, four, even five dollars when you account for labor costs, postage” and other paperwork-associated expenses.

Also vital to smooth claims payment is verifying the patient’s address. If the patient has moved recently, ask whether his or her insurance company has the new address. If not, Jessee advises submitting the old address with the claim. “Sometimes, it’s better to be paid than to be right,” he said.

And finally, when the physician and staff members have done everything right and a claim is still denied, keep track of that information. The practice can save time and money by identifying insurance companies with the most claims denial problems. Then limit coverage verification to just those companies, said Merritt.
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