Meet Revenue Cycle Director Tammy Sims
Learn how she decreased days in A/R and kept denied claims below 3%
The ModMedⓇ Practice HERO Award recognizes leaders in healthcare operations who harness our solutions to help improve their practice. Under her leadership, award winner Tammy Sims’ staff successfully improved practice profitability. Learn how she did it.
My staff has been able to drastically reduce our accounts receivable. We stay around 20 days on average.
Tammy’s Story
I started working in the billing field in 1996, handling coding and insurance. I transitioned to practice management in 2006. I was responsible for managing daily operations of all departments, and I helped three offices transition from paper to electronic health records, but I always loved billing the most. Eventually, I wanted to transition back, because my job turned into checking off boxes to satisfy government requirements and convincing doctors to do things they didn’t want to do.
In 2018, I became Billing Manager for Digestive Care Center, which has evolved into the Revenue Cycle Director position. Now, I manage billing, contracting, credentialing and accounts receivables. And I love my job and the people I work with.
Digestive Care Center was established by Gastroenterology Associates in 2013. The all-board-certified physicians have served the community for over 50 years, offering digestive disease diagnosis and management, preventative healthcare through advanced colonoscopy and screenings and the latest techniques and treatments.
Meeting Financial Challenges
The biggest challenge in my field is handling all types of different insurance companies who request records and supporting documentation on so many claims. It’s a constant upload of records to support what we’re doing as a practice. Also, you have to work on a lot of denials. Sometimes payers deny a claim for unclear reasons, but we make sure to investigate, appeal and turn them around quickly to get them paid.
Another challenge I’ve overcome is convincing the clinical team to embrace new technology. I started out with providers who were already willing to try to make it work, and we figured it out together. Then I would go to each subsequent doctor and was able to show them the new efficiency to convince them. In this way, I earned their respect, and they have confidence that I know what I’m doing when I suggest changes.
Finding the right people for the billing department was critical. I needed to have a lot of patience. I put the job posting out there, but didn’t hire unless I was certain I had found the right candidate. Sometimes the role would stay open for months, and if I had to take on the extra responsibilities to support my team, I was more than fine with that. Now we have a fantastic staff. I have a lot of faith in them and I’m proud to say they trust me. I got them in the door, but I give them all the credit in terms of the numbers we’ve been able to produce.
Bad debt stays around 1%, and denied claims stay around 2.5-3%. Our rates are all well below industry average.
The Numbers Say It All
To me, success is when the numbers look good and the money looks better! Sure, you can make your numbers look better than what they are by making adjustments, writing off claims and bills that don’t get paid. But then the money won’t be there to support your metrics and the practice as a whole. When your money continues to grow along with your patient volume, and you can prove your metrics line up, that’s success.
My staff has been able to drastically reduce our accounts receivable. We stay around 20 days on average. Bad debt stays around 1%, and denied claims stay around 2.5-3%. Our rates are all well below industry average. The consequence is that our doctors’ incomes have increased, and adjustments have substantially decreased.
Taking Advantage of Financial Software
We were already using gGastroⓇ when I started at Digestive Care Center, but I was tasked with moving us to gPM™. We made the transition in January 2019, and it’s been a major tool for us to maintain our numbers. With our previous system, we found tasks, charges and claims that slipped through the cracks. gPM makes it easy to find the outliers so they don’t go unpaid.
Our doctors’ incomes have increased, and adjustments have substantially decreased.
gAdvisor™ has also been a fantastic resource for us to help with MIPS reporting. We had lost some administrative staff, and realized too late in the year that we might take a big negative payment adjustment if we didn’t do something fast. I heard about the gAdvisor service at MOMENTUM, the ModMed annual users’ conference, and took it back to my boss as a solution to help us avoid taking the hit. We jumped on it, and have been able to get the highest possible payment adjustment, based on our submitted data, every year since. Darlene, our gAdvisor, is amazing!
Advice for Aspiring Award-Winning Revenue Cycle Directors
I was totally shocked to win! My boss tells me all the time that he appreciates me, but to win an award was wonderful because to me, I’m just doing my everyday job. To be recognized for doing it well was definitely a welcome surprise.
The best advice I could give would be to 1) put the right staff in place, and 2) trust them to do their jobs. I do not micromanage; I let my staff do their work and I focus on mine. Also, use all of the tools available to you! I go to MOMENTUM and I meet people every year who aren’t using all of the software features at their disposal. They’re not taking advantage of the full potential. Learn the software and it will make your life so much easier because you can set it up the way you need it, and then you can trust the system.
Learn more about our ModMed Practice HEROs.
The statements and conclusions contained herein reflect the opinions of Tammy Sims and not those of ModMed. ModMed makes no representations or warranties as to the accuracy of any such information. Results may vary depending on medical practice size, product usage and other variables.
