Automated billing and coding: A case study on how eCareMD software helps in maximizing claim success ratio

Industry

Healthcare, CCM

Technologies

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

Client Background

The client is a well-known healthcare provider in the United States, offering chronic care management services to patients in the general medicine specialty. The client's medical team comprises a care manager, physicians, nurses, and administrative staff. The client is passionate about providing healthcare services and extensive use of digital telecommunications.

The client supports 3000 patients enrolled in CCM services by providing ongoing care and monitoring to manage their chronic diseases. This will be a big opportunity for the practice to increase its recurring revenue by providing virtual care to those patients enrolling in their CCM program.

Business challenges

In day-to-day operations, the client used CCM software to provide healthcare services to patients. While utilizing the software, the client realized the importance of accurate billing and coding inside the platform for the services offered to patients. Because the existing software lacked this functionality, the providers lost reimbursement opportunities from insurance payers due to inaccurate billing codes and spent additional time on manual billing and coding.

Below are some of the business challenges faced by the clients:

    1. Manual Billing Code Assignment

The client’s existing software was unable to accurately document and assign billing codes for services rendered, leading to errors, claim denials, and delays in reimbursement.

    2. Billing Status Tracking

With a large patient population, the client encountered difficulties in tracking the billing status for each patient, leading to confusion and delays in billing report submission.

    3. Incomplete Billing Reports

Manually generating comprehensive billing reports with all the necessary information for reimbursement processing was a labor-intensive task for the client. Incomplete or inaccurate billing reports could reduce reimbursement and compliance issues, impacting practice revenue and financial stability.

    4. Manual Time Tracking

The client further struggled with manual time-tracking, which was prone to errors and inefficiencies. Inaccurate time logging for patient activities could result in underbilling or missed revenue opportunities, affecting the practice's financial performance and billing accuracy.

To address this issue, the client approached Medarch Inc. for eCareMD software, which came with automatic billing capabilities based on the care provider's time spent on patient activities.

Apart from automatic billing, the client's major requirements include automated time monitoring, monthly billing reports, and the ability to submit, put bills on hold, or update the flag if required to seek quick attention.

Solution

To resolve the issue and meet the client's expectations, our team of business analysts and subject matter experts conducted many discussions and demonstrations with the client.

Upon understanding all the requirements, Medarch Inc. has implemented the eCareMD platform in the client’s practice.

It results in a better claim success ratio for the client and fewer claim denials. Thus, revenue has increased tremendously.

Solution Highlights

Medarch Inc.’s eCareMD platform consists of distinct features that streamline the practice workflow and ensure smoother and more accurate billing to avoid claim denials.

    1. Automated ICD-10 Standards-Compliant Billing

    The eCareMD software supports over 200 chronic conditions, aligning with ICD-10 (International Classification of Diseases, 10th Edition) codes and eligible CPT codes to ensure accurate documentation of the provided services.

    Based on the patient's chronic conditions, time spent, and services provided to the patient, the eCareMD software automatically suggests the qualified billing codes. These automated CPT code allocations improve billing accuracy and reduce claim denials.

    2. Log Status Billing Functionality

    The client constantly encountered confusion and delays in billing report submission while handling a large patient population and keeping track of each patient's billing status. The eCareMD software enabled the care providers to accurately categorize the patient billing by marking the status as ‘Submitted’ to the patient whose claim has been submitted, ‘Put on Hold’ if there is an issue in billing along with flagging or details to be edited and ready for billing for the patients who is ready to bill.

    3. Comprehensive Billing Report Generation

    To receive the maximum reimbursement, all services rendered must be carefully documented, and the report must include all necessary information. The eCareMD software allows care providers to generate monthly billing reports that include all of the necessary information, such as patient demographics, provider information, chronic conditions, service details, and date and time. This report could be downloaded in PDF, XLS, and CSV formats.

    This billing report can then be submitted to an EHR or medical billing software for reimbursement processing.

    4. Automated time tracking

    The eCareMD software enabled automated time tracking to ensure time is logged for each activity carried out on the patient profile, availing the maximum reimbursement from the payer. As the activity gets completed, the software provides time log functionality to log the time in an accurate category that results in evidence for billing and auditing purposes.

Value Delivered

    1. Compliance Adherence

    Accurate coding ensured compliance with regulatory standards and guidelines, reducing the risk of audits, penalties, and legal issues related to billing practices.

    2. Efficient Billing Tracking

    eCareMD simplified billing management by allowing providers to categorize patient billing statuses accurately, reducing confusion and delays in billing submissions.

    3. Increased Practice Revenue

    The accurate eligible billing code and reporting reduce the claim denials and improve the claim success ratio, resulting in increased reimbursement amounts for the practice.

    4. Improved Patient Care

    Reliable billing and coding functionality helps care providers spend more time on patient activities such as interaction with patients, daily, weekly, or monthly reviews, prescription refills, etc.