Aligning Clinical & Financial Performance

April 26, 2019

To comply with value-based reimbursement models like the Merit-Based Incentive Payment System (MIPS), specialty medical practices are now required to track, measure and report out on a host of quality measures – all while driving sustainable cost improvements. To optimize performance, practices will be compelled to rethink workflows around clinical and financial documentation, which must now provide a more detailed view of a patient’s treatment as well as reflect care delivered across all settings and conditions. As one large, multi-specialty practice in Southeastern Michigan uncovered, insufficient documentation and corresponding workflow challenges related to chemotherapy orders were directly impacting authorization and billing, resulting in avoidable rejections.

With the help of Integra Connect, the practice introduced new three new workflows to proactively address both clinical and financial documentation gaps. The Integra Connect team:

  • Instituted an internal work queue system to document and track documentation gaps when they appeared;
  • Introduced a new, best-in-class workflow to optimize efficiencies as well as ensure payer-specific coding was followed; and
  • Put in place a more rigorous claim scrubbing process to flag documentation gaps prior to claim submission.

By shifting their end-to-end RCM processes to focus on optimizing performance across both clinical and financial documentation, the Integra Connect accelerated practice cash flows and facilitated increased control over their chemotherapy ordering and billing processes. After the first six months, the practice had increased net collection and reduced their denial rate by nearly 50 percent.