CUSTOMER STORY
BAYADA Boosts Claims Processing Speed, Accuracy & Payment
Background
Established in 1975, BAYADA Home Health Care is a leader in providing a full range of clinical care and support services at home for children and adults of all ages. With more than 360 offices in 23 states and six countries, it is committed to finding, training and supporting employees who take pride and joy in healing and helping others. Currently, the organization has 28,000 employees caring for an average of 31,900 clients per week.
As BAYADA’s culture and value propositions are central to the organization’s operations, company leaders seek not only employees but vendors and partners who share their values and are aligned with their culture.
23
states
6
countries
Challenge
Working with tight margins and income constrained by the limitations of third-party payments, BAYADA found it challenging to keep the cash flow necessary to maintain its commitment to high-quality care and ensure the provision of the best caregivers and service for each client. Specific challenges included:
“Having the visibility of where our
— Steve FlanneryDivision Director of Reimbursement Services, BAYADA
claims are at any given time is really
important. That is your biggest
risk – that your claim gets stuck
somewhere in the process, and it
isn’t caught due to lack of visibility.
This can be disastrous. Visibility
of where all our claims are at any
given time is huge.”
Solution
BAYADA increased the speed and efficiency of its claims management process by adding Inovalon’s Claims Management ProTM for comprehensive claims submission and remittance management. For a company like BAYADA, which prioritizes client service and satisfaction over everything else, working in a tight market requires discipline and efficiency. “We have to work to reduce overhead by finding efficiencies in everything we do. We’re always looking for ways to save time and improve our processes,” said Flannery.
Inovalon gave the team at BAYADA a one-stop way to address billing collections and application processing. “Ours is a big operation. We really need to be able to route claims quickly to the correct person in the operation. We are collaboratively working with Inovalon to achieve this. This is very exciting. It’s a big win,” said Flannery.
The BAYADA team upped its first-pass payer acceptance rates, got faster, clear correction guidance and increased the accuracy of revenue projections.
Almost immediately, the company realized the benefits of a system designed to reduce first-pass rejections — getting superior claim “scrubbing” and easily deployed custom business rules. In addition, Claims Management Pro provides visibility to all payer messages and user activity, eliminating the administrative burden of tracking down lost claims.
BAYADA was able to get more accurate rules validation, faster, easier corrections, integration with eligibility verification and more complete documentation. Not only did this mean more accurate claims that moved through the system faster, but also less staff time hunting down missing information and rejection causes, contacting payers, submitting appeals and monitoring “unique” payer rules. The BAYADA team upped its first-pass payer acceptance rates, got faster, clear correction guidance and increased the accuracy of revenue projections.
After partnering with Inovalon,
BAYADA is seeing a clean claims validation rate of
98%
In less than a year, the results were staggering, with an initial ROI of nearly $250,000. While the company previously had an impressive clean claims/validation percentage of 90%, after partnering with Inovalon, BAYADA is seeing a 98% rate with less work. Receivables are getting paid 15% faster with less work on the front end. The company is experiencing reduced FTEs and expects to redeploy more staff when they fully transition into claims denial management.
In the past, it was challenging to learn which payers offered electronic fund transfers and then set each one up. With Inovalon, the team at BAYADA is able to identify those payers quickly and convert to electronic payment.
Payments are received faster and more efficiently. The company increased the number of electronic remittances received and posted and increased the accuracy of postings as well.
The partnership with Inovalon not only improved processes and payments, but enhanced both employee and client satisfaction. Because the system is more intuitive and robust, it enables employees to train and get up to speed more quickly. At the same time, it is a selling point for younger team members, who want and expect to use the latest, most efficient technology. Flannery said, “Working with a modern, forward-looking product like Claims Management Pro has really engaged them a great deal.” He noted that employees were looking for a better way to do things, and they are excited about this application. BAYADA is more quickly and easily enrolling new clients, ensuring everyone gets the care they need.
BAYADA experienced an ROI of approximately $250K in the first year.
— Metrics prepared by Bryan Quinn, Manager, Reimbursement Systems Analyst, BAYADA
Receivables are getting paid 15 percent faster with less work on the front end.
Partnership
Working with a partner who shares its values and commitment to a culture of quality and customer service, BAYADA has established a system that enables it to maintain and strengthen its mission of excellence. “We were looking for a better solution; we needed to improve our processes. Inovalon has enabled some unique improvements to our processes, and the company’s culture was consistent with ours. They have helped us with some enhancements that have made a big difference,” said Flannery. He added, “We have a high level of trust and flexibility, and there is an easy collaboration between the two companies.”
BAYADA is free to be more strategic with contracts and how it does business. It can evaluate payers and identify issues as it renews contracts. Having real-time, accurate data enables the BAYADA team to have productive, informed conversations with payers as well.
Looking ahead, BAYADA hopes to grow its partnership with Inovalon. To start, the company is uploading paper claims into Claims Management Pro to have everything posted and available electronically. BAYADA implemented denial management processes, and the team is transitioning into this. At the same time, Inovalon is customizing enhancements to maximize its effectiveness and make the appeals management process more intuitive and expeditious.
Ultimately, BAYADA discovered that by implementing a system that streamlined its process, the organization can more easily function within tight margins, attract and keep quality caregivers, and provide clients with the best possible care and services.
“We were looking for a better solution; we needed to improve our processes. Inovalon has enabled some unique improvements to our processes, and the company’s culture was consistent with ours.”
– Steve Flannery, Division Director, Reimbursement Services, BAYADA
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