Vascular Specialists Should Streamline Office Efficiency

By Kerri Wachter 

NEW YORK -- Reviewing and optimizing scheduling, billing, and coding can lead to increased revenue for vascular surgeons and improved care for patients, said Dr. Sean P. Roddy at the Veith symposium on vascular medicine sponsored by the Cleveland Clinic.

In the 2 years since financial control of vascular surgical services was transferred from Albany (N.Y.) Medical College to a private practice limited liability company (better known as an LLC), collected cash rose 23%. When the practice's improved efficiency and volume was factored in, collected cash rose to 42% with the same number of physicians.

In all the preceding years, the vascular surgeons had "had no access to the details on reimbursement and no say in finances," said Dr. Roddy, a vascular surgeon at the Albany Medical Center Hospital.

The average number of days in accounts receivable was 53 days in the first year and 41 days the second. The practice's revenue realization rate is now 95%. In comparison, in a 2-year period prior to the transfer, the average number of days in accounts receivable was 103 days and the vascular surgery revenue realization rate was less than 70%.

To achieve similar results, a central coordinator for all procedures is invaluable. This person ensures that all procedures (angiograms, vascular treatments, open surgery, rounds) are all coded correctly. In Albany, the coordinator is a vascular surgeon.

"This allows for completeness of the registry--for both the procedures performed and the outcomes," said Dr. Roddy.

The coordinator should be updated frequently as to scheduled procedures, as well as emergent procedures. It's also important for surgeons to keep in mind time spent on hospital consults, admissions, and visits--time that is often overlooked.

Improved coding and correct submission of claims not only decrease the risk of insurance fraud but also may improve reimbursement. "Once a claim has been denied, the odds that it will ever be reimbursed begin to fall precipitously," said Dr. Roddy.

Another helpful tool is a computer system that integrates registration, billing, and scheduling. These systems allow users to set up scheduling templates for both the office and the vascular laboratory, improving patient throughput, patient satisfaction, and the number of patients seen.

Some systems allow access via the Internet. Many systems have interfaces with major insurance companies, allowing immediate eligibility verification.

"We also find electronic medical records to be vitally important," said Dr. Roddy. Templates speed processing and allow more time for patient care. The records let nurses more easily answer patient questions. Some records allow surgeons to automatically fax completed notes to referring physicians, decreasing the communication time from weeks to days.

Another necessity is a knowledgeable billing manager. This person routinely assesses billing staff to ensure quality work and also to determine whether staffing is adequate to handle the billing workload. "A decrease in the backlog of billing more than pays for an extra person in the billing office," said Dr. Roddy.

The billing manager also can identify insurance issues and audit charts for compliance.

"Lastly, we have a physician liaison to the billing manager," said Dr. Roddy, who performs this task for his practice. He assesses global issues, verifies problems, and calls medical directors when necessary.

Dr. Roddy disclosed that he has no potential conflicts of interest.

When asked to comment on this article, Dr. Robert M. Zwolak, professor of surgery, vascular, at Dartmouth Medical School, Hanover, N.H., stated: "Dr. Roddy's article demonstrates the ability of physicians knowledgeable in coding and billing details to influence the fiscal bottom line of their practice.

"This seems like a 'miracle story,' but it requires, hard work, attention to detail, willingness of all partners to work efficiently, and financial commitment to an EMR among other things.

"Extremely important from my perspective is the fact that the Albany group accomplished this while simultaneously noting improved patient satisfaction. It's a win-win."