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ZirMed/Harmony Healthcare IT Case Study: Claims Efficiency Improved for 13-Location Medical Network

09.28.2010

Medical Specialists Centers of Indiana (MSCI) is one of the Midwest’s largest healthcare clinical groups, with 60 physicians deployed at 13 locations across all of northern Indiana. The practice averages 16,000 patient encounters per month, encompassing specialties from pediatrics and dermatology to endocrinology, pulmonary medicine and even sleep diagnostics. Such a diverse network requires a substantial billing department. Over 30 billing agents work at the MSCIs’ central office in Munster, processing hundreds of thousands of claims and payments each year.

The Problem

Two years ago MSCI wanted to improve its claims clearinghouse performance, since it was often operating in the dark regarding payments from insurance companies. “Most of the time we never knew if our claims were getting to the payer,” stated Annette Kopp, Revenue Cycle Manager for MSCI. “The only way we knew for certain was if we were paid. There was no mechanism for regular status updates, and very little feedback regarding errors or rejected claims.”

The Solution

To improve service and performance on all of its business software, MSCI initiated a relationship with Harmony Healthcare IT, a healthcare IT support company based in Mishawaka, Indiana. In addition to its strategic planning, programming and hardware/software install capabilities, Harmony offers service and support for Practice Management Systems (PMS) including MSCIs’ Sage Medical Manager.

“Harmony proved very responsive to our needs for better overall technical performance. It quickly understood how all our parts work together,” recalled Kopp. Within weeks, Kopp and her team was in discussion with the Harmony Healthcare IT team on how to improve its Accounts Receivable—not only insurance claims, but other revenue streams as well.

“Harmony put ZirMed at the top of the list,” Kopp said. “We looked at some other options, but pretty quickly it became evident that ZirMed was the best choice. We realized that ZirMed’s realtime claims management could put us in front of most of the submission problems we were experiencing. It also has established EDI [Electronic Data Interchange] with virtually every payer in the U.S.—well over a thousand, I believe.”

MSCI experienced a seamless switchover from its previous clearinghouse to ZirMed. Kopp noted the easy training process as well. “Harmony helped us every step along the way, and the ZirMed technical staff was terrific. The online interface is easy to learn, and very little retraining was required for our billing folks. ZirMed conducted weekly teleconferences with us, just to make sure all our questions were answered,” she stated.

The Benefits

One of the first things MSCI noticed was how ZirMed accelerated the group’s claims workflow. “Our staff was surprised at how quick everything happened. We immediately got feedback regarding incorrect or missing information. Instead of finding out weeks after a claim was submitted that there was an error, ZirMed flagged the problem instantly,” noted Kopp, adding that ongoing payment status was a point-and-click affair. “ZirMed lets us see when a claim is sent, when it is received and, if it’s denied or rejected, what the reason is,” she stated. “All we have to do is click on the specific claim to see the particulars.”

On the management front, ZirMed’s dashboard gives Kopp access to a variety of strategic reports. “I never had a tool like this before. Now I can find the underlying problem if we have a string of denials or claim reversals,” she commented. “What’s more, our physicians can use the dashboard to better manage their PQRI [Physician’s Quality Reporting Initiative] reports.”

Since moving to ZirMed, MSCI has expanded its use to include patient eligibility and Z-Pay, ZirMed’s Web-based credit and debit card solution for patient payment, at the point of care. Z-Pay reduces the number of edicated phone lines and allows card payments to be made from any PC.

In the roughly 18 months since MSCI began using ZirMed, it has realized some significant operational and financial improvements. Where in the past there was no way to accurately know the age of the practice’s rejected claims, ZirMed routinely keeps them under seven days. What’s more, Kopp estimates that revenue has jumped at least 5%–a significant amount in such a large practice. She believes ZirMed has had much to do with that increase.