Maximizing Reimbursement: A Case Study on How eCareMD Software Facilitates Maximum Reimbursement Through Remote Patient Monitoring

Industry

Healthcare, RPM

Technologies

Python, Angular, TypeScript, REST, SOAP, Web Services

Client Background

The client is a well-known healthcare provider based in Texas, recognized for delivering high-quality care services specializing in chronic care. With an experienced and passionate medical staff, the client effectively coordinates care for over 600 enrolled patients, utilizing EHR software to deliver healthcare services.

Business challenges

The client encountered a significant challenge in managing patients with chronic diseases using their existing EHR software. Despite identifying a potential remote patient monitoring-eligible population of 5000 patients, the EHR software lacked essential functionalities for effective management. This limitation resulted in missed revenue opportunities for the client, prompting them to seek assistance from Medarch Inc.

The client aimed to address this challenge by implementing the eCareMD software, aiming to efficiently manage a larger patient population and subsequently increase revenue. Furthermore, the client had specific requirements, including the need for automated time tracking, streamlined billing processes, and the capability for bulk onboarding and patient invitations.

    1. Limited insights and statistics

    While using the EHR software, the client lacked the functionality to view the vital real-time statistics of patient health, trends, and fluctuations. Due to this, the client was unaware of the abnormal changes in patient health that led to delayed interventions by the care providers and complications in patient health.

    2. Manual Patient onboarding

    For onboarding patients within the software, the client's administrative staff must create each patient manually, which consumes time and reduces productivity. Also, to enroll patients, the staff must select each patient and manually share the consent forms. These manual activities lead to delays in patient care and errors.

    3. Identification of eligible patients

    Once the patients were onboarded within the software, the client faced challenges in tracking eligible patients according to their chronic conditions, duration, and age. Hence, to do this, the client needed to interact with and check the data for each patient and then decide their eligibility for a suitable program.

    4. Inaccurate time tracking

    Using the EHR software, the client faces challenges in logging the exact time for the activities performed, like daily and weekly vital reviews, care plan assignments, addition of vitals and readings, sending educational material, assigning assessments, etc. As the software lacked the functionality to log time, the client needed to track and log time manually, resulting in manual activities and errors in time logged. Ultimately hampered the reimbursement amount.

    5. Manual billing code assignment

    The client faced challenges in manually assigning billing codes for completed RPM-related activities. This burdened care providers and led to inaccuracies and billing errors, hampered the reimbursement amount.

Solution

The client was looking to improve chronic care management for their patients while aiming for sustainable revenue growth. Recognizing the potential of remote patient monitoring (RPM), they approached us for guidance and implementation.

Our team of experienced business analysts and subject matter experts collaborated closely with the client, conducting in-depth consultations to understand their goals, existing workflows, and patient population.

Upon receiving confirmation from the client we successfully implemented the eCareMD software within the client's practice. With its robust features and secure data handling, eCareMD facilitates efficient patient management and data-driven care delivery.

After the implementation of eCareMD software client achieved significant revenue growth.

Solution Highlights

The eCareMD software consists of several features that support the management of more patients and ensure maximum reimbursement for practices. Some of the features are

    1. Informative statistical dashboard

    Implementing eCareMD software addressed the challenge of limited insights and statistics by providing real-time access to vital patient health data. The client gained comprehensive visibility into patient health metrics through the real-time tracking vital dashboard, including vital signs, trends, and fluctuations. This enabled timely detection of abnormal changes in patient health, facilitating proactive interventions by care providers to prevent complications.

    2. Bulk onboarding and invitation of patient

    Maximum reimbursement can be achieved by managing more patients and delivering services to them. The eCareMD software allows care providers to upload CSV files through which thousands of patients get created within the software in a second. Also, it provides bulk invitation functionality so that multiple patients can be invited to enroll in the RPsM program. This reduces the manual effort and time spent on enrollment activities.

    3. Automated eligibility tracking

    The eCareMD software automatically tracks the patient who has at least one chronic condition that is expected to last at least 3 months. Chronic conditions may include heart failure, chronic obstructive pulmonary disease (COPD), diabetes, hypertension, etc. This automated eligibility tracking helps care providers, send invitations to those patients and get enrolled in the RPM program.

    4. Automated time tracking

    To maximize reimbursement in remote patient monitoring, it is crucial to record the maximum time spent on activities within the patient profile. When a care provider initiates activities such as care plan assignment, care plan updates, monthly reviews, and communication with the patient through text, email, etc., the system automatically commences time tracking. This ensures that the system captures the maximum time spent on activities and reduces the risk of missing time logs. Additionally, the software allows care providers to manually log time for activities, further enhancing the accuracy of time tracking. The precise time log functionality plays a vital role in optimizing reimbursement for healthcare practices.

    5. Automated billing codes and report generation

    Based on the time logged and activity done over the patient profile the eCareMD software assigns the accurate CPT codes for billing. These codes help in earning maximum reimbursement amounts and reduce claim denials. Also using the software care providers can generate and download the monthly comprehensive billing reports which are further pushed to EHR or clearinghouse for reimbursement.

Value Delivered

    1. Improved health outcomes for the patient

    As the care provider can monitor the patient's health vitals in real-time for any abnormal changes in the patient’s health, the care provider can make interventions. These interventions helped patients reduce health complications and resulted in improved patient health outcomes.

    2. Improved operational efficiency

    Using the eCareMD software, care providers can manage more patients with fewer resources as the software facilitates easy and quick onboarding and enrollment of patients, remote communication capabilities, etc.

    3. Increased revenue for practice

    Features like automated time tracking helped care providers log the maximum time for reimbursement, ultimately increasing the practice's revenue.

    4. Reduction in claim denials

    As the software enables accurate CPT coding based on the time logged and activity done over patient profiles, it minimizes billing errors, reduces the number of claim denials, and leads to a higher claim success ratio.