Case study: End-to-end RCM services for ROC Orthopedics
How we have worked together over multiple years to support a thriving independent orthopedic practice
Over the last few years we have sustained and grown our partnership with ROC Orthopedics, a multispecialty private practice in Oregon, providing not only end-to-end revenue cycle services across coding, billing, and authorizations, but also a flexible approach that helps meet ROC’s evolving needs.
Kate Othus, CEO of ROC, helped architect the partnership with Orthos, initially focusing on critical business continuity support through a merger of two groups and expanding into new strategic areas.
Orthos leadership with Kate Othus, CEO of ROC Orthopedics at AAOE conference
In Kate’s words, “Although in the past I have struggled to find reliable partners for billing, Orthos has been different. We have gained much better data, visibility, and confidence in our billing operations than we have ever had, and our payments are flowing well.”
Orthos worked together with Kate to build a new culture, focusing on three main areas where we could bring unique value through a technology-driven approach. As a technology executive, Kate was able to articulate an ambitious vision and Orthos brought capabilities across technology, people, and process to deliver for the practice.
1. Having high-quality orthopedic-specific data and analytics to make operational decisions.
Orthos provided access to a live dashboard showing critical information as well as analysts who can run custom reports and help ROC engage effectively across the physician leadership, clinical staff, front office, and back office to maximize collections. Orthos also helped integrate data from prior systems from before the merger and eventual EMR switch to provide long-term trending and context.
“Orthos was able to show me how each ROC provider was doing in terms of volume, case mix, and payor mix going back years so I could have a fact-based conversation with each of the physicians about their growth,” according to Kate.
2. An appreciation for the root causes of billing issues and commitment to fixing them.
Knowing that many billing companies prefer to just do their specific part and have limited interaction and feedback with the practices, we both wanted to avoid that. So we intentionally set up a weekly rhythm of feedback that connects managers across the practice and Orthos. Orthos gained a better grounding in clinical operations throughout ROC and found areas to contribute billing expertise, including front desk training on insurance. We also conduct monthly deep dives into denial patterns with specific claim examples that we can all use to get better.
“Orthos’s team lead for ROC has a lot of experience working with our local payors and our monthly discussions about denial trends have led to important improvements in our practice. For example, one of our private payors was inappropriately processing our claims as out-of-network and I was able to get help from the provider rep to fix it,” Kate says.
3. Experienced team members providing additional capacity where needed.
After a year, ROC asked Orthos to provide more resources in certain situations to get caught up and to cover for staff vacations. This enabled ROC to avoid hiring for 2 additional full time roles. By drawing from across the country, Orthos provides a remote capability that complements the local staff who transferred over to Orthos full time.
Orthos team on site at ROC meeting with physicians and practice leaders to continuously improve RCM performance together.
The results of the new approach included:
Sustained high performance in payments, exceeding the collections goals set at the start of the partnership
5% cost savings for the practice versus internal staffing levels needed to deliver revenue cycle services
Improved audit capabilities, detecting over 100 underpayments versus allowable contracted rates
Elimination of backlogs for charge entry and procedure scheduling from 2+ weeks to <3 days, improving patient experience