He was spending so much energy on these functions that he couldn’t focus on improving treatment service for his patients. Michael’s once-thriving practice was in trouble: accounts weren’t being timeously paid, the medical schemes were rejecting claims from his patients and his medical supply costs were out of sync with market norms.
Michael’s story is not unique. In today’s complex environment, running a successful practice is a balancing act between financial outcomes and healthcare results. A well-managed practice frees up professionals and staff to spend their time and resources on improving healthcare results.
Straddling two distinct skill sets
With all the best intentions and ideas, many good healthcare practice owners simply don’t have the time to ensure that their practice is run as smoothly and profitably as possible.
Keeping abreast of ever-changing administrators and scheme agreements is complex and time-consuming. Yet well-designed technology solutions are available to take care of mundane tasks that are a necessary part of good practice management, from billing and claims submissions to calendars and record-keeping.
Each practice also has its own style and preferences, so a one-size-fits-all technology solution is not the answer. While some businesses like to handle their own accounts function manually, others prefer an automated system and there are those who prefer to outsource this aspect of practice management.
Having experienced first-hand how difficult it can be to keep abreast of the administration, accounts management and stakeholder liaison involved in running a busy practice, eMD was conceptualised by a medical professional to help improve efficiency and profitability. Since the software was developed over 20 years ago, it has been constantly improved, updated and refined. Today, eMD has evolved into a powerful business and efficiency tool used in over 3000 practices throughout South Africa, including 87 provider types, several group practices, clinics and doctor groupings.
Dr Dimitri Tzitzivacos, CEO of eMD, explains that clinicians work smarter and faster with configurable, role-based workflows that enable them to work in the way in which they are most comfortable. “Keeping abreast with the latest research and clinical studies drives better healthcare results. In much the same way, using technology to manage your practice, time and revenue reduces costs to achieve better financial outcomes,” he says.
The intuitive workflow design of healthcare practice technology enables automated pathology reports, electronic remittance advices and patient visit calendars. Specific medical aid-related functions allow practices to check member benefits and validate membership in real time, see what the medical aid will pay and deliver claims – even without internet access. Tariff coding and pricing is built into the technology which has built-in flexibility to provide cloud-based services as well as to operate both online and offline.
Agility and scaling your healthcare business
For most healthcare service providers, connecting with the right stakeholders in the medical aid industry is a struggle. Healthcare practice solutions should bridge the gap between healthcare professionals and private healthcare insurers.
- The communication process is streamlined using electronic billing software that switches medical billing.
- Real-time and electronic data interchange capability gives quick and easy visibility into the status of each transaction.
- Claims transactions are easy to understand, and billing rules are transparent and clear.
“With these in place, a good solution can precisely review the age of the debt, and the financial status of the debtor, providing the practice with the ability to make faster decisions and respond quickly to changing customer and market demand,” explains Dr. Tzitzivacos.
To further improve agility and keep abreast with the financial state of your business, you need to have access to your practice management system from any smart device using a cloud-based system. A good solution provides integrated data on one screen and can generate comprehensive reports.
Figuring out how to scale your healthcare business can be daunting. Personalised and consultative professional guidance enables you to review the revenue cycle performance of your practice, identify the drivers behind your performance and identify trends. These factors drive process improvements and system enhancements to help grow your business.
Submission of claims and data sharing
Says Dr. Tzitzivacos, “Data sharing is essential for care co-ordination and collaboration, but practices struggle to gain access to real-time and complete patient information, especially when technology system silos make it difficult to exchange data. For this reason, healthcare advisory and IT consulting services are increasingly required by growing practices.”
Should you prefer to submit claims and manage accounts on your own, a flexible technology solution provides an accurate and reliable basis to do so. This could be expanded to submit claims and automatically reconcile accounts, or you could submit claims and a healthcare solution provider like eMD will manage the medical aids. An outsourced model like the eBuro service ensures that capture, submission and management of all claims is handled outside of the practice. Modifications of submitted claims are simple and reliable.
According to Dr Tzitzivacos, claim rejections have been reduced by as much as 70% using an established healthcare management solution.
Addressing billing problems through technology
It is important to identify and address billing problems before they affect your profitability. Billing and debt management processes need to be optimised, which removes the need for expensive hardware, upgrades, and management. Staff training is another key aspect of billing success and by extension, profitability.
“Without using a centralised system, keeping track of all the dimensions that affect the viability of a healthcare practice is impossible. If your system has pre-defined parameters, adjustment rules, and claim resolution processes in place, you are well positioned to focus on patient care, safe in the knowledge that your practice is well managed.”
As an established name in the industry founded by a healthcare founder, eMD understands your specific needs and can tailor its solutions to fit your management style. With six regional offices throughout South Africa and 135 staff to help you improve clinical and administrative workflows and free up time to spend with patients.
“Our integrated software suite reshapes the way practices run their businesses, while the accuracy and extent of our end-to-end solution provides a holistic approach to practice management. eMD’s management team’s knowledge includes over 20 years of healthcare experience. We have a strong presence and actively participate in all the major South African industry forums such as the Private Healthcare Industry Standards Committee (PHISC) and the National ICD-10 Task Team in South Africa.
Participation in these forums ensures that we are always abreast of industry requirements and changes and that we play a vital part in decision-making processes. We have recently expanded to Botswana and Swaziland and we are extending our footprint into other African countries, actively providing healthcare solutions,” concludes Dr Tzitzivacos.
Perhaps Michael’s story would have ended very differently with the right solution partner. Are you ready to avoid the mistakes that cost him a thriving practice and grow your healthcare practice instead?
For more information, visit https://e-md.co.za/.