Monday, September 11, 2006
Medical Billing and Collections Company Improves Client Services Through Acquisition
For more than 12 years, Loida Garcia's physician billing and collections service company, Med Billing Services, was growing and thriving. From its base of two employees and four clients, the company had grown to more than 20 employees, collecting millions of dollars each year for over 30 physicians, physician groups, clinics and other healthcare providers in the Miami area. But, when Garcia looked ahead to the future, she saw the need for changes within her company.
"By all accounts, Med Billing Services was thriving," says Garcia, who has more than 25 years' experience in medical management. "We were doing well financially. Our clients were happy, our employees were happy. But the medical field had changed, as had technology. Doctors were becoming increasingly frustrated by complex business functions -- such as billing, collections, and dealing with insurance carriers and managed care providers -- which took time away from patient care. As a result, they were becoming more and more dependent on us to provide immediate answers to problems, and instant access to information."
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 sought to resolve many of these problems by creating new standards for the electronic storage, management and transmittal of healthcare data. HIPAA requires the use of standardized coding for medical conditions and procedures, as well as the use of standardized electronic transactions between healthcare providers and payers to create a nearly paperless nationwide system. HIPAA mandates that all healthcare providers and payers conform to its transaction standards by October 16, 2003.
In April 2001, Albert Santalo, Ben Sardinas, Francisco H. "Frank" Recio, and Santiago Pique founded Avisena, Inc., to address the implications of HIPAA on healthcare organizations. The four also saw a tremendous opportunity to offer healthcare providers a wide range of services, ranging from the automation of basic front-office functions such as appointment scheduling and payment processing, to support for back-office functions such as billing, collections, and insurance claim follow-up.
Avisena centers on powerful, Web-based, proprietary software called Avisena Practice Manager, and combines it with highly effective support services. Through the use of Practice Manager and its many components, client-physicians are able to easily record and access real-time information regarding daily business activity; avoid entering information that would ultimately result in insurance claim denials; and self-generate reports on demand relating to patient billing, insurance claims, and payments. Offering convenience, safety and HIPAA compliance, all information is stored on a secure, centralized server. Avisena's unique Reimbursement Management System (RMS) enables the company to immediately address claim denials or incorrect or partial payments on a line-item basis, and to keep working until an acceptable response is achieved.
Rounding out Avisena's software and support services are its consulting services and document management services. Avisena professionals are available to consult on a wide range of business issues that will help client companies ensure smooth operations, increase revenues, enroll providers in managed care plans, and maintain HIPAA compliance. Further facilitating this compliance, and providing client companies with easy access to patient information, Avisena can scan existing paper documents, such as medical and financial records, and store them electronically.
Because Loida Garcia's company had focused on providing personalized customer service, much of its work was being performed on the telephone or in an off-line, paper-based manner. Billing claims were sent to insurance carriers by mail and electronically. Rejected claims were analyzed manually. Account status reports were printed out and sent to clients when requested. Med Billing Services and its clients lacked the electronic resources to meet the mandates set forth by HIPAA.
"Certainly, we were in need of an upgrade," says Garcia. "We needed to find an electronic solution that would enable us to more easily submit claims for clients, more quickly collect on those claims, and allow our clients to instantly assess the status of their collections activities. And with the quickly approaching HIPAA deadlines, we knew we had to do something right away.
"But," she adds, "it would have cost hundreds of thousands of dollars to license this technology."
About the same time that Garcia was searching for a solution to her company's problem, Avisena was looking for new opportunities to expand its business. Already providing software and support services to a large number of clients, Avisena had devised a strategy that would enable it to add more clients by acquiring successful medical billing and collections companies. Upon meeting Garcia, the principals became immediately interested in acquiring Med Billing Services, considering it a successful company that would enable Avisena to increase its portfolio of customers.
Subscribe to Posts [Atom]
