medical accounting margins

 If you’re operating your practice under the “buy-and-bill” model, you’re intimately familiar with the financial risks that come along with it. Not only is your staff responsible for ordering the medication, managing the inventory, securing the necessary authorizations, and administering it, you’re also responsible for billing directly to the payer to ensure that you receive reimbursement. This can be a really difficult process if you don’t have smooth workflows in place to manage all the different pieces. If you’re relying on paper and pencil to manage the process, your financial risk becomes even…well…. riskier.  Implementing and utilizing an electronic / digital workflow into your practice can take a lot of the financial burden off your practice so you can focus on what matters most – the patient care experience and positive outcomes. 

But how? 

It seems like a nearly impossible task, doesn’t it? To change up the way you have been running your practice for years can almost seem like a burden. You must pick the solution, figure out what it costs (here’s a hint: some are no cost at all to you), train your staff, fully implement, and get rolling without causing any disruption in your patient’s therapy. You find yourself asking, “is it worth it”? 

The answer is yes. You can achieve more with less by adopting a streamlined workflow.  

Manage practice inefficiencies 

Human behavior can negatively affect your specialty practice’s bottom line. If your internal processes are too cumbersome and complicated, your staff is likely to unknowingly drop the ball somewhere along the line. For buy-and-bill specialty practices, obtaining medical benefit information can be a difficult process due to the expensive cost of the drugs.  

By streamlining your processes with cloud-based, digital workflows (and with some additional support from a solution like eBlu), you can nix the paper for good. Moving your insurance benefits investigations, benefits verifications and prior authorizations to an electronic format will save time on data entry, filing, faxing, the works. More efficiencies internally means more margin in your bottom line. 

Software solutions should, in theory, prompt you for the exact information you need from the get-go. There’s no going back and forth with missing information – the information needed for investigations is collected accurately the first time, every time. Using a BI workflow solution like eBlu that can return highly accurate BI information much faster than manual processes. In fact, so far in 2022, eBlu Solutions has returned nearly 70% of the BI’s submitted within 60 seconds. How great would it be to know all about your patient’s benefits and what their out-of-pocket cost will be before they even walk out the door? From the time saved, you can shift your focus to better patient care and furthermore, the quality of that care.  

But let’s face it, when it comes to insurance benefit investigations and prior authorization, not everything can be managed on a computer. Sometimes you need a human to do the heavy lifting for you. That’s why it’s important to find a hybrid workflow solution that works for you. Here, let me explain. 

By using a digital workflow solution like eBlu Solutions, you are empowering your practice users to perform benefits investigation in a timely fashion. For more complicated cases, the responsibility is passed on to a team of support specialists to gather the correct information for you.  We train our staff thoroughly in the nuances of insurance benefits. We know how to obtain correct benefits, jump through hoops when needed and are fluent in all insurance terminology. Through this hybrid software/support solution, your practice is more likely to get accurate benefits up front before the treatment even starts so there are no surprises to anyone. Additionally, we have a working knowledge of payer groups and plans, and we understand how they work together. We get the info returned to you once it is gathered so you can go back to focusing on your business and your other patients. 

The power of data 

The tools you implement internally should also provide some transparency into what is going on with your patients. A strong suite of reporting tools will let them know when authorizations are about to expire or if patient plans are about to expire. This will provide an additional layer of efficiencies for your staff as they won’t have to spend their time leafing through paper notes and tracking down information. Data can also give some insights into patient adherence and where they tend to struggle in their therapy timeline. Examples of reporting might include:  

  1. The amount of time it takes from Benefits Investigation to Approved Prior Authorization. This information can help you better determine when IV therapy might begin so you can purchase stock on a tighter “just-in-time” timeline and help with inventory projections. 
  2. Practice-wide reporting on your patients regarding length on drugs and if they switch treatment plans. This should make forecasting revenue on buy-and-bill inventory easier. 
  3. Breaks in treatment can upset margins significantly. Upcoming expiring authorizations can help a practice proactively renew a patient’s PA so there is no break in treatment continuity.  
  4. Reporting on active PA’s can also lessen financial risk considerably. If treatment is given when there is not an active PA on file, your practice will not be paid for that treatment and that could mean thousands of dollars in medication cost.

These are just a few ideas of how establishing a workflow tailored to your specialty practice can positively affect your margins. We can help support your mission of providing exceptional specialty care by streamlining the process which can greatly affect your practice’s bottom line. You can spend more time focusing on what matters: the patient care experience and positive outcomes, while the workflow does the rest. Contact us today for a demo and let us show you how.