CLIENT SPOTLIGHT: CORE PHYSICIAN SERVICE

Diane Alburn, MBA
Director of Revenue Development
Core Physician Services
Exeter, NH
Multi-specialty practice with 17 specialty areas
77 providers (53 physicians, 24 mid-levels)

Core Physician Services is a New Hampshire-based, multi-specialty group practice affiliated with Exeter Health Resources. Its fundamental mission is to improve the health of individuals and families in the communities it serves. As a major provider of primary care services in the region, Core continues to develop diagnostic and surgical services to meet the increasing healthcare needs of a rapidly expanding population. In addition, specialty care services are being added to compliment the practice's community-based, patient-focused care. Established in 1994, Core has 23 offices in seven communities along the greater New Hampshire Seacoast.

Began using Navicure's RCM: January 2004

What claims processing technology had you been using prior to adopting Navicure's RCM?

We had relied upon a national clearinghouse, but were increasingly frustrated by the number of files the vendor lost - totaling hundreds of thousands of dollars - and by the fact that they offered no mechanism to track claims. HIPAA had just been implemented, so a lot of practices like ours were having problems. But we felt we were facing double trouble, because of the inherent flaws in this vendor's system.

How did you go about searching for a new partner?

Our approach was not very formal. We were in a bad place and had to move quickly. We called a number of colleagues we respected and asked for recommendations. Ultimately, we reviewed several vendors and called a lot of resources. We heard glowing reports about Navicure from everyone. In fact, we asked a couple references if they were on Navicure's payroll because they were such enthusiastic supporters! The deciding factor, however, was Navicure's Web access. When we saw how Navicure would allow us to track claims and see what was going on in real time, we knew we had found the right solution. It was like comparing space-age technology to the paper-and-fax world we had been living in.

What benefits have you realized since implementing Navicure?

Top of the list is our ability to see the claims submission forms online. After we send the claims to Navicure, we can log on and review their status. We can spot problems or rejections at the Navicure level and fix them before they are ever sent to the payer. This means we get paid faster and spend less time correcting errors down the line. Since implementing Navicure, our days in A/R have dropped from 70 to 29.

We also love the level of reporting Navicure provides. We have access to a wide range of information in real time, and can create reports on a monthly or quarterly basis. For instance, we can go onto the Navicure Website and request the top five reasons our claims are rejected. We have this information at our fingertips and that allows us to better understand how we need to improve our processes to get paid even more quickly.

We also can't say enough about Navicure's customer service. Their staff answers calls promptly and, if they don't have an immediate answer, they do their research and respond within 24 hours. They were extremely helpful during our initial set-up as well. We figured we would have to do all the up-front work of notifying our payers in writing about the change from our previous clearinghouse. But all we had to do was give Navicure the names of our payers and our providers, and they took care of everything.

Did you realize any unexpected benefits through Navicure?

Yes, in two areas:

1) Navicure provides electronic remittance advice (ERA) from payers, and this has saved us a great deal of time in our posting department. In the past, a 200-page remittance advice, processed manually, would take two to three days to post. ERA accomplishes all of this automatically and makes it easier to submit secondary claims. We had four full-time staff members working in the posting department and were primed to hire more before we started using Navicure. Now they have all been re-deployed to do follow-ups and collect on patient accounts.

2) We are now providing management services to a department in one of our local hospitals. This department needed billing services, and Core has now been contracted to take over all these tasks and functions. This generates additional revenue and enhances our bottom line. We were given this opportunity because the hospital's CFO saw that our days in A/R dropped after we implemented Navicure and that our financial performance has been steady for more than two years.

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