The Challenge

Despite the vaccine administration program’s success, insurmountable issues regarding billing, and insurance reimbursement arose in the months that followed.

There were several inherent errors in the overall process, many of which sprung from intake software limitations. Of the 76,000 patients, Dr. Savage had served, information was either missing or incorrect for over 60% of this group; the remaining 40% required insurance verification. This placed a severe burden on his billers and administrative staff.

Dr. Savage's practice began to drown. His only option was to resolve these challenges. "I was definitely struggling; I was under a lot of pressure,” said Dr. Savage.

He began with several attempts to alleviate the problem. He initially had his in-house biller look at the problem. With 76,000 patients served, the task scale was huge, however. “A single biller had a tough time keeping up with seventy-some-thousand vaccinations," said Dr. Savage.

Seeing his previous attempts futile, he tried hiring multiple third-party billers hoping for a more streamlined claim processing approach. Still, traditional billing services were unable to find a solution that was feasible or efficient. Despite two months of effort, third-party billers had barely scratched the surface. There were multiple system errors and claim denials making the process exceedingly inefficient, expensive, and slow. After three months, Dr. Savage’s billing team had successfully addressed the needs of only 5,000/76,000 patients (6%)

He turned to CharmHealth billing tech team of his EHR Provider, CharmEHR for a deeper look. CharmHealth's audit revealed three main challenge areas.

The Solution

CharmHealth takes control

Amidst an increased turbulent COVID situation, Dr. Savage’s practice struggled to stay afloat. 6When the CharmHealth billing team first took control, the process began to move at an incredibly fast pace; Dr. Savage became hopeful and repositioned himself to expect a 60% recovery of revenue.

When results began to roll in after eight weeks, however, this initial recovery skyrocketed to 80%— 33% over initial expectations After two months, Dr. Savage became increasingly confident and turned to CharmHealth for all RCM-related needs.

Solution #1

CHALLENGE

Missing/incorrect patient demographics and insurance information collected at the point of service

1000s of errors in the system resulting in little or no reimbursement from payers. The two factors reasons for these inconsistencies-

✅1. Patients were allowed to enter insurance information themselves.

✅2. Intake process software featured open text fields with no error-checking capabilities, allowing patients to enter payer information in any manner they saw fit.

SOLUTION

TECH AND AUTOMATION GENERATE STABLE REVENUE STREAM

The billing tech team found the open data entry process resulted in thousands of payer information variations.

The solution included developing custom CharmHealth scripts to automate payer identifiers, merging duplicate data, identifying missing information, and preparing the claim for submission: software automation that finally drove results!

When errors were corrected and resubmitted, the results spoke for themselves. "Within the first two months, I was quite happy to see rapid results compared to my previous few months' experience,” Dr. Savage shares. After eight weeks, this initial recovery skyrocketed to 80%—33% over initial expectations.

"Bad data in leads to bad data out, but CharmHealth corrections ultimately pushed through those claims: resulting in reimbursement amounts much better than I expected!” Dr. Savage shares, pleasantly surprised by the results.

Solution #2

CHALLENGE

Poor outcomes due to fragmented and manual workflow.

✅Dr. Savage's billing staff manually transferred patient information from intake software into CharmEHR for claims processing—an extremely laborious, unprofitable task.

✅Dr. Savage also notes a lack of system integration was leading to information flow disruptions, stifling RCM performance.

SOLUTION

The billing tech team replaced the manual process with API integration between Dr. Savage's intake software and CharmEHR- automating the workflow

CUSTOM API INTEGRATION AUTOMATES EFFICIENT CLAIM SUBMISSION

The billing development team ultimately took over, quickly replacing the manual process with API integration between intake software and CharmEHR.

API Integration provided several advantages-- 

1. Automated data inflows related to vaccinations, insurance, and patient information

2. Automated CPT and Dx code entry per the vaccine administered (selecting payer HRSA for uninsured patients)

3. The ability to analyze payer information to resolve billing issues on demand

4. Optimized flow of information resulting in a stable revenue stream, with EHR and RCM in one system

Solution #3

BACKGROUND 

After two months, Dr. Savage became increasingly confident and turned to CharmHealth for all RCM-related needs.

CHALLENGE 

Obtaining reimbursement amidst new laws

✅A detailed look revealed many uninsured patient claims were not submitted to the HRSA: a brand-new program that provided reimbursement for testing and vaccine administration among the uninsured.

✅New laws and regulations were ambiguous and therefore bred confusion among healthcare providers.

SOLUTION

Timely payments start with intelligent inquiry and domain expertise.

The CharmHealth billing development team scrutinized all law details, identified the process for uninsured patients, and found success in federal program submissions.

For example, in the case of unemployed, uninsured patients, the billing development team was required to connect with the appropriate government agency, obtain a temporary ID, and execute direct HRSA submissions. Accordingly, addressing the crux of the problem required domain expertise, grit, and an investigative approach.

In addition, the CharmHealth billing team improved outcomes across a number of areas, including understanding clearinghouse guidelines, updating enrollment instructions, and addressing varied payer requirements related to ERAs. They also efficiently handled ERA setups

The Search for a Tech Partner

Solution success depended on vendor expertise in understanding billing process workflows as well as software development. Specifically, intelligent automation was critical to reduce the administrative load.

“A better claim submission method would be to automate the process rather than relying on manual procedures,” Dr. Savage shares.

THE MUST-HAVES

There were several must-haves for Dr. Savage's dire situation. He required a vendor who has a/an

1. in-depth understanding of billing process workflows, and
2. knowledge of software development-- applying intelligent automation was critical to reducing the administrative load.
3. The turnkey billing solution that is economical and within budget parameters
4. complete in a timely manner-- the practice needed to stay afloat.

Vitally, to ensure success and meet the changing needs, Dr. Savage's practice requested continuous consultation and support along the way.