C LI ENT STORY
One of a series of stories of our clients thriving…with ZirMed.
Orthopaedic Specialty Group
I’m with ZirMed!
“We’ve virtually eliminated the
problem of lost claims.”
Steve Fiore
CEO of Orthopaedic Specialty Group
Situation
Orthopaedic Speacialty
Group wanted to bring DME
billing in house
Results
Ongoing revenue
enhancement now accounts
for a 15% increase in
business
Increased collection rates for
patient responsibilities
Reduction in payer denials
For many medical practices today, providing quality services to
patients is the easy part; getting claims processed and getting
reimbursed is the hard part. As claims processing continues
to become more and more complicated, this problem is only
going to get worse.
Industry statistics show that denial rates and zero-pays can
range from 5% to as much as 15% or more of submitted
claims. This was certainly a sizable problem for Orthopaedic
Specialty Group (OSG) of Fairfield, CT, according to practice
CEO Steve Fiore. OSG is a full service orthopaedic practice
with an advanced ambulatory surgery facility, three locations,
three state of the art physical therapy facilities and seventeen
physicians and nine physician’s assistants on staff.
Thriving with ZirMed.
Like many orthopaedic practices, OSG used to
bill primarily for medical services, not for any
durable medical equipment (DME) like back braces,
prosthetics and orthotics provided to patients as
part of prescribed treatment. OSG started looking
for ways to enhance practice revenues with ancillary
revenue streams, Fiore decided to bring DME billing
“We can see when it was
received and paid! We can
check claim status on-line
which is a huge time saver! ”
in-house. But it was an ancillary revenue stream
with a catch: what he didn’t anticipate was the
complex labyrinth of insurance claims processing
and payment collection that would be involved.
OSG deals with 26 different payers, from large
national health benefits groups like Medicare, BCBS
and Cigna to small regional health plans. Each one
of them has different rules for claims submissions,
and those rules and requirements are constantly
changing, usually with no advance notice, and
often with no notification at all.
provider of revenue cycle and claims management
applications for healthcare providers.
What Success with ZirMed Looks Like
ZirMed’s filters and rule-based “scrubbers”
automatically verify and validate every claim,
making sure that the data meets the intended
payer’s current
rules, requirements and
reimbursement criteria prior to submission. If a
problem is detected, the claim is instantly flagged
for correction, avoiding the risk of denial and timeconsuming hassles of re-submission and delayed
payment.
ZirMed ensures that OSG’s claims are as clean and
perfect as possible so they’ll get paid on the first
pass through. A full service claims clearing house,
ZirMed submits the claims to the appropriate
payers, records when the claims are delivered,
received and accepted by payers, and pursues
reimbursement. ZirMed also ensures that claims
are in full compliance with Medicare requirements,
keeping a complete record of all transactional data
for audit purposes.
“We’ve virtually eliminated the problem of
lost claims because we have electronic proof
of exactly when a claim was received.”
“Lost and denied claims were soon averaging
about 7% of our business, representing a lot of
lost reimbursement revenue,” said Fiore. “The
reasons for denials could be anything – not using
a new submission form we didn’t know about,
a transposed number in a claim code, entering
an outdated modifier, using a married instead of
maiden name, even something as trivial as not
capitalizing a word or missing the period after
a middle initial. Trying to keep up with all of the
different rules, find and fix the problems and
resubmit claims was overwhelming.”
If a claim does get rejected, the ZirMed system has
tools that let us sort out the problem quickly and
re-submit right away. With ZirMed processing our
claims, our ongoing revenue enhancement now
accounts for a 15% increase in our business.”
The ZirMed system also helps OSG with the
collection
of
co-payments,
co-insurance,
deductibles and payments from uninsured patients
at the time of service. Through ZirMed, patients can
pay by credit card while they’re still in the office,
or schedule automatic payments from their credit
card or checking account. All payments are logged
into a ZirMed transaction report for easier posting,
reconciling, and end of the day balancing.
Fiore decided to find a subject matter expert to
help them. After evaluating several options, he
chose Reimbursement Economic Services (RES)
for their superior knowledge of the DME market
and the powerful combined solution they offer
in conjunction with ZirMed, a recognized leading
“Now that ZirMed records when our claims
are received by payers, we’ve virtually
eliminated the problem of lost claims
because we have electronic proof of exactly
when a claim was received.”
In addition to minimizing denials and lost claims,
Fiore also appreciates RES’ and ZirMed’s advanced
analytical reporting tools that help him better
understand his practice’s business and organize it to
more effectively deal with payer-related and patientrelated revenue issues. He uses their reporting
engines to track volumes, patient transaction
activity, reimbursement cycles, trends and practice
profitability.
“Their reports give me the business intelligence
I need to make informed decisions and run the
practice as a profitable business. The doctors can
see the financials whenever they want to, but not
have to worry about the day to day operation and
business processes.”
ZirMed Solutions
ZirMed provides a set of solutions for the entire
backend of the revenue cycle process. Much
more than a traditional clearinghouse, ZirMed’s
robust offerings cover all three major areas of the
revenue cycle including:
ZirMed Front Office Suite
Eligibility, Patient Estimation, Zpay Collect
ZirMed Claims Management Suite
Claims, Remittance, PQRS
ZirMed Payer Payment Suite
VeraFund Manager, Lockbox, EOB
ZirMed Patient Payment Suite
Statements, Notebook, Self Pay 360
“ZirMed allows me to keep
my timely reimbursement
promises to my clients.”
ZirMed Developer Suite
API toolkits, Developer’s Sandbox
ZirMed Analytics Suite
Dashboard, Comparisons, Charts
ZirMed University
CEU Accredited Training
“Running a medical practice is a very complex
business, and it was easy to lose sight of just how
complicated and convoluted it can be, especially
when payers are always changing things, making it
more difficult to get paid,” concluded Fiore. “Now,
with subject matter experts we can rely on, and
ZirMed’s billing, claim and payment processing
system and the combined analytical reports from
RES and ZirMed that help us make informed business
decisions, we have the ideal solution.”
With ZirMed, Orthopaedic Specialty Group
succesfully turned around their DME buisness to
internal managment.
A B OUT U S
We’re ZirMed and we’re one of the nation’s leading providers of healthcare revenue technology
and information solutions. Serving 113,000 healthcare providers across all care settings who in
turn provide services to more than 1 in every 10 Americans, we are a nationally recognized leader
in understanding the flow of money and information in healthcare. Offering eligibility verification,
claims management, patient payment estimation, patient payment processing, online bill pay, online
and offline statement delivery, innovative lockbox services, analytics, coding compliance and more,
our solutions simplify the complexities of payments for providers and patients. We resolve many
problems with one simple solution – and one great relationship.
For more about thriving with ZirMed, visit us at ZirMed.com or call 1.877.494.1032.