Revolutionizing Primary Care: eCareMD's Impact on Efficiency and Revenue Growth

Client Background

A primary healthcare practice based in Michigan, United States, specializes in providing care for patients discharged from hospitals who require ongoing treatment to stabilize their health. The practice primarily focuses on enrolling patients in the PCM (Principal Care Management) program if they have been discharged for over a month. On average, the practice manages approximately 10,000 patients annually and aims to expand its services further.

The healthcare team comprises highly qualified professionals, including care coordinators, physicians, nurse practitioners, clinical social workers, and other skilled staff dedicated to delivering exceptional care and improving patient outcomes.

Business Challenges

The client wanted to expand their services and increase revenue, but faced some difficulties in managing day-to-day operations that restricted them. Some of the challenges the client has faced are:

1. Manual time tracking and errors

While performing the activities over the patient profiles, the client’s existing system lacked the automated time-tracking capability, which led to manual time tracking by healthcare providers and increased the margin of errors.

2. Inefficient care management

Assigning a care plan that fits the patient's health needs is a crucial step in obtaining expected patient health outcomes. The client’s existing software had a care plan assignment functionality, but it required the creation of each care plan in real-time, which consumed a significant amount of time and effort. Also, the software won't allow the review of the care plan at regular intervals.

3. Increased claim denials and reduced revenue

The healthcare providers manually track the time for the activities carried out and assign the CPT codes, respectively. This manual assignment of CPT codes leads to claim denials in audits by Medicare or during the reimbursement process. The increased count of claim denials has affected the practice revenue.

Solution

The client aimed to overcome these challenges to improve the efficiency of healthcare professionals and, ultimately, the revenue from Medicare. Hence, the client approached Medarch Inc. for the eCareMD software that supported the PCM (Principal Care Management) program and leveraged the advanced cutting-edge technological features to streamline the practice workflow and maximize efficiency.

Our team of business analysts took multiple calls with the client to understand the requirements and demonstrated how the eCareMD software addressed their requirements. After receiving the approval, our team implemented the software in their practice.

Solution Highlights

The eCareMD software comprises various advanced technological features. Some of the key features that addressed the client’s challenges include:

1. Automated time tracking



The eCareMD software tracks the time for activities done over the patient automatically. Due to this, healthcare professionals were able to deliver more enhanced care and be involved with patients. This automated time tracking eliminated the missing time tracking for activities and increased the revenue for the practice.

2. Efficient care management

The eCareMD software comprises built-in templates for each chronic condition and suggests the best-suited care plan based on the patient’s chronic conditions. Hence, the healthcare provider only needs to submit the responses, review the care plan at regular intervals, and make the necessary modifications as required. This allowed healthcare providers to modify the care plan, track the care plan progress, and get it reviewed by physicians, etc., quickly and efficiently.

3. Automated CPT code assignment

The PCM program's reimbursement is based on the CPT (Current Procedural Terminlogies) codes 99424, 99425, 99426, and 99427. Based on the activity performed and the time logged, the eCareMD software automatically and accurately assigns the CPT code for billing purposes. This increased accuracy resulted in a reduction in claim denials and increased the revenue for the practice.

Value Delivered

Let’s have a look at some of the key value deliverables of eCareMD software:

1. Enhanced Practice Efficiency

Automated time-tracking capabilities significantly reduced manual errors, allowing healthcare providers to focus more on patient care rather than administrative tasks.

2. Reduced Claim Denials by 30%

The software’s automated CPT code assignment feature ensured accurate billing and minimized errors during audits and reimbursements, leading to a substantial reduction in claim denials.

3. Increased Practice Revenue by 50%

Accurate time tracking and automated CPT code assignment led to maximized Medicare reimbursements, increasing practice revenue.

4. Improved Patient Outcomes

Efficient care plan management allows healthcare providers to customize and review care plans regularly, ensuring better alignment with patients’ health needs and outcomes.