What is Agility RCM?
Gene Howell has developed industry-leading best practices to consistently boost revenue, improve workflow efficiency, and mitigate legal risk. He is going to explain the difference between Revenue Cycle Management (RCM) and billing, why it matters, and then share a demo of the Agility Dashboard - a tool that measures your OM data daily in time for a recovery.
Ask yourself a few questions:
- Do you know how your first aide visits are trending?
- What percentages of visits are coming from new injuries?
- Do you measure your average billing by provider and visit type?
- Are you confident your coding, billing, invoicing, and claims processes create a healthy Occupational Medicine revenue cycle?
If even ONE of these points piques your interest, click here to hear the entire on-demand recording!
Learn how a specialized Occ Med EHR, integrated billing and documentation, revenue cycle management (RCM), KPIs, and expert coaching give you the tools to take control of your Occ Med practice and see real results.
A complete solution takes you all the way from visits and claims through dashboard business metrics—enabling you to spot gaps in your workflow and documentation processes before they impact compliance or your bottom line.
- [Gene] Lets talk billing. Lets talk money, everybody's favorite subject, right?
First of all, what is Agility RCM? And really it goes back to what is RCM compared to billing? And I always like of give this definition, because many people think it's one in the same, and it's actually not. Revenue cycle management is really door to bank. So you're partnering with a group that's gonna help you with everything from the patient walking in the door, to charting, medical justification necessity, everything leading up to the actual billing process, which would be the coding, the billing, and collection, and obviously the deposit. And typically a billing company, or a billing office, really takes over at the point at which the charting has been done.
So, really what we're doing is focusing on a specialization of, in this case Occ Med and urgent care, to get the best performance, best dollars. We're doing that by working with you all the way from the beginning of the process. The secret sauce is people that are experts in Occ Med, the process, and technology. I'm gonna talk about the technology in a bit. Really when I say technology, part of that's the EMR. The other part of that is giving you the metrics and financials you need to be able to run your practice. In many cases, and in most cases, either billing company, or even RCM companies are giving you reports at the end of the process, end of the month, maybe weekly. What I found, and we have a wide variety of clients to compare, is that you need this information on a daily basis, you really need this information on a daily basis to be able to properly manage your clinic and take care of issues before it's too late.
So, why does it matter? Why dies it matter to partner with an RCM group? Let's talk about hospital challenges. I'm gonna first talk about hospital, then I'll talk about private practice.
I call the 3% challenge. So, generally in a hospital, 3% of your revenue is OccMed urgent care, versus 97% of your revenue, which is handling the 25 other specialties that you're doing. So, where's your focus? Your CBO is focused on the 97%. So there's a growth opportunity here given the correct information, being able to partner with the right group. You can definitely grow that business. That 3%, I should say, it's not only about that 3% - it's also about the downstream revenue. Because what people overlook often is out of that 3% is CTs, MRIs, surgeries, referrals, et cetera. Even in come cases, a practice within a hospital organization is a loss leader for the downstream revenue.
Second would be the EHR challenge. You're using a patient centric system, which is great, EPIC, Cerner, Meditech. Beautiful for what you guys are doing in the hospital. The problem is occupational medical billing. They are musts that I say. You must handle split billing. You must attach notes to the claim, gotta handle multiple fee schedules, automate protocols and forms, handle invoices, and the one I really focus on again is the reporting of the financials, and the metrics specific to Occ Med. I challenge you with a patient centric system to find the reports you need in order to properly manage your clinic as it relates to Occ Med. It's more than just how much did we bill? How many patients did we see? There's a lot of variable factors, and I'm gonna go into those shortly.
Finally, I've already really talked about it, but the OM knowledge challenge. So, if 3% of your business is OccMed and the rest is 97, chances are there's a lack of knowledge. Probably very good billers, but again, if that's only 3% of the business, then you're not able to get those details which are staying current on industry specifics, billing and claim best practices. And also, something that we found is serving RCM clients nationwide, they really provide us the ability to compare metrics.
So, why does it matter in private practice? Well, technology I'm not going to go into. It's essentially the same. You know, only difference is you might be on paper, which obviously has inefficiencies. But really the issue is that you're team's wearing so many hats in private practice. They get squeezed as I say. They're generally not OM experts because they're just trying to get the bills out the door. And partnerships here are key. Really, in a private practice situation, the RCM relationships become even more important, because we want to work with them to help them establish workflows, educate the clinic staff ongoing on issues that we're seeing up front. And the big one that I always see is the money left on the table. And you know, I have the same experience back in the day when I was running a small billing office is that we were limited. We were running the front office, running the office, et cetera. The money that was always left on the table was the appeals. Go into any billing office, look for the largest stack, probably in the corner. I can guarantee you it's gonna be the appeals. I always say there's rings around them from aging. It's sort of like the rings around a tree. You can see how old they are. But, here's the issue, those are probably where your profit margin lies. So, appeals are huge, and in all probability, you're staff's not really getting to them. And then finally, just that we're able to give you real time dashboard reporting.
I want to leave you with this thought. We'll start out with this thought. If you can't measure it, you can't manage it. And generally when I do webinars, or I speak to groups, I actually like to bring real scenarios, just a couple of them, the thing that we're seeing the most. So that I can challenge you when you get off this call to see what it is that your billing office is doing. How they're handling these particular issues, and/or if you're even measuring them. And so, I want to share with you what we're finding to be the top issues right now within OccMed billing. Go back to your staff and ask for reports. Talk to them about these particular issues. Because I know if you address these three today you will walk away from this presentation being able to increase some income. And I think that's the goal of being here today.
So, first one is percentage of first aide. Do you know how your first aide visits are trending? I see it over and over again. New injuries keep increasing, but not the overall census. First problem is, most are are unable to even measure this. I guarantee you, first of all, if you're on a patient-centric system, you're not able to measure this at all. In all probability, even many OccMed systems are not looking at this particular issue. The downstream revenue is lost, obviously. Because if we end the case after the first visit, inappropriately, we're not getting of those follow ups, the PT. And then, of course, if you're in a hospital system you've lost the MRI, CT, you know, I could go on an on.
I'm gonna give you one example. We have a clinic that historically had seen about 17 to 20% first aids out of every new injury. The last three months when I looked was at 40%. So, the question is what happened? And the answer is, there were a lot of new providers, and the person training them didn't quite understand OccMed. And those providers came from the ED. So their idea was to close out these cases, and just get people back to work. The issue here is that on average, you're probably losing about $1300 for each visit. So, after the first visit, there's a remainder on average. If you factor in the follow ups and the PT, probably about $1300 that you've lost. It adds up quickly. And so, when we compared new injuries, and we're able to do this because we compare clinics to clinics by handling multiple clinics. We see clinics that are handling the same amount of new injuries walking in the door, but some are struggling, and the others are making money. They're making money because they're handling the follow ups and the PT properly. That's number one. Go back today and start asking for that information and do something about it.
And number two are the percentage of follow ups to PT. Now, obviously, the first one affects that greatly. You can't even get it past inappropriate first aide visit, then you're obviously gonna be effected. But, beyond that, the new injuries again keep increasing, but the followup and physical therapy visits are stagnant. So, there are industry standards that you can follow. Example, usually the follow ups to every new injury would be about 2.6 to 3.0. And on the physical therapy, at minimum, you should probably by seeing about six patients, if you're doing physical therapy as well. That's one thing to look at. The other is just remember, right now, without you measuring this, your providers and your staff are in control. And unless they're on some sort of incentive program, they're probably incentivized somewhat to get these cases closed. You want to make sure, obviously, that first and foremost, you're treating the patient properly, you're closing out these cases, that you're doing a service and not a disservice, to the employers, the adjusters, and the patient.
And the last one, which I think you're probably gonna say, "Well, average billing. That's obvious." but here's the deal, in OccMed, the ability to measure the average billing, not only by provider, but visit type, and this is huge. You've got to be able to break down that average bill going out the door, by the book of business. So, what I mean by that is, provider to provider, and a history going back, years if necessary, you've gotta look at what are we billing out for new injuries? What are we billing out for follow ups? What are we billing out for physical therapy, and so on? A good example of this is that in a clinic that we were working with, we saw that a year ago the more experienced providers were billing out on average for a new visit, about $350. Currently they were billing out about $215. Now, I don't even have to do the math. You can do the math on that. Again, you can also assume that they're under billing then for the follow ups and for the physical therapy. And generally, this is caused where the documentation is not being followed, and the billers just billing what they see. We work very hard, and I'll show you later, to return visits that have, we know you've done more too, or that may have additional billing. Maybe they didn't dispense meds, the MEs, et cetera.
These three items, data, data, data. You must be able to look at this data on a daily basis. Again, most billing companies are giving you reports at the end of the month. It's too late. You can not go back and fix a first aide, for example, or adjust the follow ups and get the patient back in at the end of the month, probably even the end of the week. So, can you measure your OM data daily in time for recovery? Ask yourself that. And I would suggest that you definitely work to do that if you're not already. I'm gonna show you how we do that.
This is a a dashboard, not just any dashboard. This is an OccMed dashboard. Meaning, generally a dashboard is related to financials only. We've put an emphasis here on reporting back to providers, also, occupational medical stats. And those three issues that I just told you about, we just added a brand new screen to capture that information. So, I'll show you that as well. But, I'm gonna give you a quick demo, and show you what it is you should be looking for in a dashboard to manage your practice properly, so that you're working smarter and not harder.
First, generally, this is just an overview of what's happening in the practice. Obviously, we have the previous days visits. This is huge, pending visits. What can we not bill out today because of charting issues? And then, what's been posted? Then a year-to-year comparison, so the question here is why do I need to see this on a daily basis? I'll tell you this, I've already talked about the metrics. I think on the financial side, obviously it's important that you know what's going on in the moment, every day. I think that it's very important to see trends, for example, if you see the money not coming in the first half of the month, to start questioning the work that was done previous. And, you can recover before it's too late.
Moving down we have a visit analysis. So on the visit analysis every morning, what did we see? Who did we see? And so, this gives you a recap. I can just divide this up by employer services. I can know what I did for employer services. I can just choose my private practice, which would be urgent care. Or, I could choose work comp. And so, this divides those up evenly, or together. I'm sorry. And, you're able to view exactly what's happening in your clinic as it relates to the numbers walking in the door.
So, the question is, well, why is this important? I think it's important because generally we will staff in a clinic with a traditional dashboard, based on the total numbers. And here's the truth, other than physicals, it's not necessary in all probability that you would need to staff providers, for example, for employer services. So, when we look at patient flow, and this is how many patients are coming in the clinic per hour. This is huge, by the way, because you'll be shocked when you find out that your waiting room is not busy at 12 because it got busy then. It's because they started walking in at 10. You need to adjust your staffing back, or even reduce staffing, which is awesome when you're able to cut back on some provider hours.
But most important, I like to look at this information and say, "I'm not interested in employer services "when I'm scheduling providers. I just want to know about urgent care and work comp." And this gives you the stats to understand just with that book of business, we go back to that book of business again, exactly how many patients you're seeing per hour, so you can staff appropriately.
Another one would be error reports. We obviously, you're able to report back not using email with your staffing, I'm sorry, with you RCM, or your billing office, by visit, exactly what the issue is that we can't get this bill out the door. And that represented that number up front. We've got missing claim numbers, wouldn't be found in a typical dashboard. And then finally, unbilled visits, this is huge. Often times when going live with a client we find a huge amount of unbilled visits. In one scenario it was like 2500 visits. They'd completed the visits. They were mostly employer services, just hadn't dropped the chart. And by the way, this is a demo site. So don't be scared over those dates. And finally, a billing, obviously, it's self explanatory, collections, and aging.
And I want to show you the new report, which is what we're calling clinic performance. I'm just gonna go into the group that has it. So this is the new report that we're introducing. In this case, those three items that I talked about, this was the shocker here, talked about 40%, it was actually 43%. So in this we're talking about each section, which is colored. Hey, these are all of our new visits walking in the door. What's our average bill going out the door? Remember I talked about we're at 208, 261. It used to be in the 337 range back in '17, a year ago. What's the percentage of first aides that are going? It's just progressively risen over time up to 43%, which is shameful. Because in this particular clinic, we actually lost a thousand visits compared to the year before, same amount of first new injuries. And then obviously, follow up visits percentage visits that are becoming a follow up. And then here, percentage of visits that are going to PT. And in this case, this is actually, I think we've been in the 30. It's actually rising. And then, what that ratio is as well, so we've got that ratio. So, when I talk about, should be about six, there's work to be done here, many of them are current months. If I'm able to look at this information on a daily basis, I'm able to recover from this before it's too late.
So, I'm not gonna go any further on the dashboard. But, I do really challenge you to go back and start looking at this information. I guarantee you, you will see financial results from this, almost immediately.
- [Moderator] How easily does this interface with Cerner or other HIS systems?
- [Gene] If you're referring to the dashboard, currently it's built out to interface with Agility. It was a product we created to work with Agility.
- [Presenter] I think the question was in terms of Agility as an occ health platform, how does it interface with Cerner as in with Meditech the other hospital EHRs? Significant interoperability, we've got over 300 interfaces and as a company over 3000. We're also MU 2 certified EHR, which has built interoperability ramifications that are part of that definition. So if anybody has any specific questions about what they're looking for, lab, radiology chart, ADT interfaces, please let us know. We'll be more than happy to get back in touch with you. Any others?
- [Moderator] Yeah, there's one question about the dashboard here. This person says he loves the dashboard. And how much of the dashboard is compiled manually, versus automatically exported out of the Agility EMR data.
- [Gene] I can answer the question. Everything on that dashboard that you saw is uploaded to the dashboard at 2 a.m. So when you arrive every morning, or if you like to get up in the middle of the night, you can see all the stats. It's all there. There's nothing to manually upload. And what I didn't show you, just for sake of time, is that all of that information, if I was to right click in any of those fields, it instantly will output to excel if you would like to work with it, and also to print. For those of you who are Agility users, and build reports, you'll appreciate the fact that it's within seconds to generate the report you see on the screen to be able to work within Excel.
- [Presenter] Gene, thank you. I know that there are several other questions. We have reached our max time. So, first of all, I want to thank Gene, and also thank Eddie. I appreciate your guys time and preparation, and really a passion for what you do. And also want to thank all of you. I appreciate your time, appreciate you joining. I hope that this was informative. And again, if you have any questions, please reach out with us. We'll get back in touch with you. And if you'd like a copy of the recording, or any of the slides, let us know that too. Thanks so much. It's been great to spend time with you. Have a great rest of your day, and a great rest of your week. Thanks again.