Streamlining Healthcare: AdvancedMD CEO Eric Morgan (Part 6)

SM: What is driving your low medical billing rejection rate?

EM: There are a variety of things. We have a sophisticated process of taking the claims and scrubbing them before they go out to ensure they are encoded correctly.

SM: I know the coding process is very complicated and is definitely at the heart of many issues.

EM: Definitely. We also make sure the data is in the right format to ensure it is not rejected for technical reasons. We spent a rather large investment doing that. We are integrated with the leading clearinghouse, which is Relay Health. They do a great job managing the connection to payers.

A lot of our competitors will sell the practice management piece, but they will allow their clients to go out and decide who they will sign up for the clearinghouse. Our philosophy is that unless you provide an integrated solution front to back, you are not going to get the kind of results that really make an impact. We look at the entire problem holistically.

The other significant advantage of the SaaS model in this is that we have 10,000 doctors hitting this billing and collection system every day. When any one of them discovers a significant change that causes a rejection, we can develop new software to fix it and implement it on the system very quickly. That benefits all users of the system, whereas my physical therapist has four-year-old software for his billing and collections that he has never updated. As you can imagine his collections are horrendous.

SM: Those are the dynamics of a SaaS model hosted in a central location. There is no question it is a vastly superior model. Is there a reason you chose to integrate with Relay Health rather than anyone else?

EM: We like their breadth and scope in regards to their integration to payers. Small clearinghouses have difficulties handling those who are not in their area. We are in every state in the country. We have to have that kind of presense.

SM: They cover all the national players, but do they cover all the regional ones as well?

EM: They do.

SM: How many clearinghouses are there like them?

EM: You could probably find half a dozen who are viable.

SM: By working with your solution, does that mean physicians’ offices will also have to make the decision to switch to a particular clearinghouse?

EM: It is transparent to the physician’s office. Most of our clients don’t care. If they want to know we will give them further details. It is not an issue any more than I worry about what ISP my company uses when I go to access the Internet. Physicians are looking for the solution and to get paid.

When you have a national clearinghouse integrated with a web-based practice management software, three things happen. One is real-time denial tracking on which either the doctor or practice management can take appropriate action. They can develop collections list for your billing and collection people who are real-time based on interaction with the clearinghouse people. Each day someone can hit a button and see what 15 accounts they need to collect.

Finally, sometimes when there is a rejection and you want to resubmit it, there are many reasons that you may want to override the existing coding. Our software allows you to do that depending on the circumstance. There is fundamental power that becomes inherent by having the clearinghouse integrated with our solution.

This segment is part 6 in the series : Streamlining Healthcare: AdvancedMD CEO Eric Morgan
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