When it Comes to Healthcare IT Success Stories, Don’t Count out the Little Guy

Tom GuillaniToday’s healthcare information technology headlines are littered with how large delivery networks are scaling up and successfully building and using IT infrastructure. But the real success story is hiding in the shadows of these large enterprise deployments, in the small and independent practices across the US. The recent ICD-10 transition, that had been foretold to drive small enterprise into financial despair due to their lack of IT savvy and infrastructure, has shown just the opposite. A report from a leading provider of billing software that was based on government and private payer claims analysis for the past 30 days shows a different story.

Small independent practices have few rejected claims and are getting paid quickly. The software vendor’s report, using data from over 13,000 small practices, showed that in October:

  • 99% of customers submitted at least one ICD-10 claim
  • 87% of customers received payment for at least one ICD-10 claim
  • 4 million claims submitted in October were already paid
  • 11 days was the average time to payment for ICD-10 claims
  • The payer rejection rate through one clearinghouse was 1.6%

These results are in line with announcements from large payers and clearinghouses like Humana, UnitedHealthcare, and Emdeon that reported no significant increase in denials during a panel at MGMA. However, the results do show small practices out-performing the industry average provided by CMS where total claim rejections were estimated at two percent.

The report clearly shows that small and independent practices that utilize an ICD-10 ready billing system designed for their needs to submit and process claims, have a lower denial rate thanthe average. “In preparing for the ICD-10 transition, [the right software] was of great importance for us to improve, and most importantly, have an EHR that effectively and accurately communicates data to our PM system, seamlessly bridging the gap between treatment records, scheduling, and billing requirements,” said Dr. Rebecca Pearson, an independent chiropractor in private practice.

This is a victory for the independent practice that is clearly out gunned when it comes to large scale IT resources and budgets. Practices of all sizes can learn that the right solutions for a small practice can allow them to operate much like their larger counterparts, and efficiently manage clinical charts, quality reports, and claims management.

Technology can level the playing field in many ways in healthcare and the future is bright for those practices that want to stay independent and leverage technology to ensure their success.

Tom Giannulli, MD is a clinical advisor to Kareo

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