Business Situation 

Mid-sized CA hospital-based physician group 65k patient visits/year 

Challenges 

- Unexplained collections drop in biggest payer group – accounting for 30% of income 
- Looking for billing company with good reputation on collections and customer service 

Phycon Results 

- 15% increase in revenue in less than 9 months with PhyCon 
- Over 40% increase in collections over transition year after two years 
- No shortfall during billing system transition 
- Exceptional customer service 
- Expertise from company founded by emergency physicians 

Client Quote:

 “PhyCon stays on top of the billing and works the accounts. If something isn’t paid, they figure out why. They contact potential payers – either patient or payer – to work on resolving the issue. As part of the value-add to their service, they put more effort into employee time to collect all that’s possible, to get that last 10-15%.” 

-- Emergency Physician Group Medical Director

Billing Challenges 

A mid-sized California hospital-based emergency physician group needed answers to an unexplained drop in collections for one of their largest payers – an IPA accounting for 30% of group income. After six months with no resolution, and several hundred thousand behind in collections, they discovered the billing system was extremely log-jammed with misplaced paper charts, missing patient information and unsent bills. An unannounced change in account managers added to the confusion and the physician group decided to explore other options. 

The medical director of the emergency physician group, in charge of replacing their billing system, looked to peer references as a major indicator of success with a new billing company. “We often ask around to see which billing companies enjoy a strong reputation among physician groups like ours. We heard of a small billing company with a growing reputation for a lower billing rate but higher collections percentage.” The executive contacted PhyCon, Inc. for a consultation. 

PhyCon is a billing and consulting company specializing in emergency medicine billing. They initiated an audit to evaluate current patient charts and billing for accuracy and collection rates. PhyCon worked with the hospital to electronically collect charts and assess the current billing situation. The audit resulted in a projected 12% increase in revenue with a more efficient billing system and more personal attention paid to collections, especially to customize a system that would work for the largest and more complex payer groups. 

To verify these numbers, they contacted five of PhyCon’s current customers to ask if their billing experience match the audit projections. 

“Every client we contacted had the same experience – PhyCon collections were actually higher than the audit projection. So we agreed to give PhyCon a try, and they did indeed live up to their projections and more.” 

PhyCon’s Solution 

Knowing a change in billing systems is a major operational transition, they prepared for the switch with a back-up line of credit for $1million to cover lost revenue during the change in billing systems. However, as PhyCon collections ramped up and the previous billing solution was phased out, there was no shortfall in collections. In fact, within the first 9 months they experienced a 15% increase in revenue. This accounted for more than $30k more per physician in income! “Our physicians thought this was the most brilliant administrative move we’d ever made. And we couldn’t have been more pleased with their impressions and the overall bottom line.” 

PhyCon combines their propriety software billing service with specialized customer service to develop specific strategies for each physician group to get the highest reimbursement rate in the shortest amount of time. Prior to the implementation, PhyCon sends out an advance team of personnel to contact each customer’s major payers, especially those that comprised the highest volume of patient population, including the most restrictive contracts or those with lower collections. They work with both customers and payers to create a unique and efficient billing process for both, to better facilitate earlier and accurate payment. With California payers on the leading edge of specialized payer system, PhyCon has built an intimate knowledge of the different regional payer groups and how best to work with them for optimal billing. 

Another component to their service is an on-site employee to coordinate the billing process, in particular, to make sure the charts are complete and improve the efficiency of pre-billing process. They are also able to create customized reports specific to each physician group. 

“The biggest difference is their work philosophy. Our previous company would send a bill – and if it was paid, not paid, or partially paid, they didn’t go further than first couple of notices. It wasn’t worth the labor cost to them – if they worked harder for the last percentage of collections, they didn’t get paid more. And that also meant we didn’t collect what was billed. PhyCon stays on top of the billing and works the accounts. If something isn’t paid, they figure out why. They contact potential payers – either patient or payer – to work on resolving the issue. As part of the value-add to their service, they put more effort into employee time to collect all that’s possible, to get that last 10-15%.” 

Bottom Line Results 

After the initial 15% increase in the first nine months of transition, PhyCon was able to bring the physician group over 40% more in collections after just two years. 

“PhyCon returns a higher percentage of billing than other billing companies we’ve surveyed. In particular, customer service was an enormous improvement for us. PhyCon was established by emergency physicians – they are extremely knowledge about the emergency medicine business. The leadership includes very bright, intelligent people who understand our business completely.“