Urgent Care Management Companies
“Our company is called Insight Practice Partners, and we have an entire menu of management services,” Max Lebow, MD and Medical Director of Reliant Immediate Care Medical Group, says. “We help practices move from either paper to electronic medical record, and help practices that have chosen an EMR that’s just not working for them.”
Lebow says a lot of clinics, both large and small, have chosen EMRs that just aren’t doing the right job.
“It’s slowing them down, decreasing productivity and decreasing their income,” Lebow says. “We will go in and switch them to an EMR that we like better, and that we think better fits their needs.”
Lebow also says that at the same time that the company is establishing a new EMR, it will also take control of the practice’s billing.
“In today’s data intensive world, it doesn’t make sense for an urgent care practice to have two vendors: one for their EMR and one for billing,” Lebow explains. “Because the billing and the EMR functions are so closely related, having to transfer the data out of one company to another is always going to be time consuming, expensive and cause a glitch.”
“EMRs and billing services are really all tied together, and that’s the part that most people miss,” Gene Howell, CEO of Insight Practice Partners, says. “They install the EMR and just expect it to work with their flow, but they’re not tying it to the revenue on the back end.”
Howell says that his management company looks at the whole process, from beginning to end.
“We bring in the EMR, forms, protocols and work flow, and then coach them on the highest and most appropriate billing level that the practice can get,” Howell says. “We’re the ones actually installing the EMR, we take over the revenue cycle management and billing and we’re with the practice long term.”
Howell says that the key to success and assuring the best quality is working with an urgent care practice from the very beginning.
“A typical billing and collections company is just gloried data entry; they’re simply entering whatever super bill lands on their desk,” Howell says. “We’re taking it back to when the patient first walks in the door – what can we do to optimize and follow the best practices?”
“The theory behind revenue cycle management is that the revenue of the clinic begins when the patient walks in the front door, and ends when the money is in the bank,” Lebow says. “We help the clinic manage everything from making sure the patient is registered correctly and efficiently, and not put in the wrong plan.”
Lebow says that his management company works closely with the front desk to ensure efficiency.
“We make sure that they know the best methods to ensure that the patient’s information is correct the first time, and that they ask the right questions and collect the right co-pay,” Lebow says. “In addition, we make sure that everything is booked the right way, patients are taken to the correct exam room and the right medications are given when the patient is discharged that fits into the formulary.”
Getting information right the first time is crucial to increasing efficiency and reducing the number of denied and appealed claims.
“Making sure the documentation is right the first time can help ensure that the doctor is getting paid the first time bills go out,” Lebow says. “When you can avoid the long appeals process, you can improve your cash flow.”
Incorporating proper documentation methods can also help improve work flow in an urgent care center.
“One of the things that we’ve seen with work flow is that doctors have a tendency to keep going back and forth to the EMR, entering and ordering, and just spending way too much time on the EMR in general,” Lebow says. “We try to teach providers that they should be touching the computer no more than twice for each patient visit.”
Lebow says that if they can do it with one entry per session, that’s fine as well.
“If someone comes in with a sprained ankle or a possible fracture, we want the doctor to put in as much data as they can when they order an x-ray, and then finish the chart as soon as the x-ray comes back,” Lebow says.
Howell says that typing in medical justifications and necessity when placing orders can also help with documentation.
“If I want to assure a provider that they will be paid for a test that they ordered like a lab or an x-ray, I need to make sure that the documentation in the EMR supports that,” Howell says. “We build in guidelines to the EMR that supports the fact that the doctor placed the order based on the presenting problems. This goes all the way to the end of the process because we’re assuring that we’re reducing the appeals, and that we’re getting paid on the first round of billing.”
Howell says that at the end of the day, if you have correct and proper documentation in your EMR, then you reduce your risk of being down-coded at the office level.
“All of those pieces, whether you’re paid for them or not, contribute to supporting the level that you billed out,” Howell says. “I’m not interested in hearing what you bill out, I’m interested in what you’re getting paid. You can bill out whatever you want, but if you’re not supporting your levels then you will be down-coded by carriers.”
In addition to helping practices code more efficiently, Lebow says that his management company also takes a leading role in negotiating payor contracts.
“Many small and medium-sized urgent care clinics are sometimes ill-equipped to deal with the insurance companies or large organizations that have very sophisticated negotiating people,” Lebow says. “We can come up with all sorts of plans – everything from modified fee for service to case rates, case rates with carve-outs and even capitated contracts. We help them get the best rates.”
Lebow says his management company also links its clients together, which allows them all to receive discounts on medical equipment.
“Our clients get a 20% discount with certain medical equipment vendors because we can go to them as a large urgent care system, even though we’re not owners of any of the clinics,” Lebow says. “Since we’re buying three or four x-ray machines, we can get a better price than if we were to just buy one. By using the power of numbers, and linking our clients, we can negotiate better rates for medications, medical equipment and just about anything else you can name.”
If urgent care owners and operators are interested in expanding their services to occupational medicine or workers’ compensation cases, Lebow says that a management company can also help with that.
“We have a whole menu to help improve not only the current urgent care clinic, but additional services as well,” Lebow says. “We’ll also help in everything from marketing and PR, to new clinical procedures and protocol.”
Lebow also says he doesn’t charge a fee for these services.
“What we’re really about as a management company is becoming a strategic partner with that urgent care center,” Lebow says. “We are percentage-based, so if the clinic does well, then we do well. If it doesn’t do well, then we don’t either.”
Even though these types of urgent care management companies hold no ownership in the practice, they can still help owners and operators get their centers on the track to success.
“It’s not a choice of whether we want ownership or not; they are two completely different lines of business,” Howell says. “When other clinics ask us how we’re so successful, and how our clients are so successful, instead of just giving them an answer, we offer to come in and install our software and take over the revenue cycle and billing. Creating these strategic partnerships with our clients, EMR vendor and other services has allowed us, and our clients, to really grow.”
If you have an interest in learning more about the subject matter covered in this article, the M&A process or desire to discuss your current situation, please contact Blayne Rush, Investment Banker at 469-385-7792 or Blayne@AmbulatoryAlliances.com
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