CUSTOMER STORY
Lifesprk Cuts Biller Workloads in Half and Easily Transitions to PDGM With Inovalon
The Challenge
Significant time and resources spent manually managing claims
Medical billing is a challenging task for many home health agencies, particularly when it comes to devoting the time needed to manage billing and claims across multiple payers and patients. From ensuring the right payer(s) are billed, to scrubbing claims prior to submission, to correcting and tracking claims statuses, claims management can require a great deal of time and effort, especially if you’re doing it all manually.
With a current census of 500 home health clients, Staci Boehmer, a Home Health Billing Manager with Lifesprk, and her team of three, simply did not have time to manually check, correct, and resubmit claims. And, with a diverse payer mix that includes Medicare, Medicaid, and commercial claims, billing across multiple payers only compounded the time.
The Solution
Inovalon enables automation and efficiency
Boehmer first used Inovalon applications while in a previous position at Volunteers of America. There, it saved her the hassle of keying into DDE/FISS for claims tracking and status checks. For this reason, she was thrilled to hear that Lifesprk would be using Inovalon when she first started working there.
The deployment of Inovalon solutions and integration with Lifesprk’s Homecare Homebase practice management software was simple and the billing team was able to begin automating tasks and running reports right away.
With Inovalon, Boehmer and her team can easily automate and submit claims for all payers in a single portal. “Having everything automated has been great. If we need to make minor changes to a claim, it’s very easy to do so within the application.”
Aside from the easy-to-use interface, they have peace of mind knowing they will receive alerts if claims are returned or denied. “At the beginning of the year, one of our payers changed members’ ID numbers, which would have impacted us significantly,” says Boehmer. “But before the claims were submitted, our Inovalon solution immediately rejected the claims upfront, before they were submitted to the payer, which was a huge time saver!”
“One of the key areas of value for us is being able to get the EFT and RTP reports on a daily basis,” continues Boehmer. “You can assume all your claims are processing unless you see one come up on that report, which is great. And when my billers see one that goes to RTP or was denied, they can research it right away or reach out to me if they need help.”
”Before the claims were submitted, our Inovalon solution immediately rejected the claims upfront, before they were submitted to the payer, which was a huge time saver!”
Staci BoehmerHome Health Billing Manager, Lifesprk
The Impact
More efficient billing in half the time
By using Inovalon applications to easily verify eligibility, submit claims, make corrections, and track claims and reimbursements, Lifesprk billers are able to save an immense amount of time that they can use for other essential tasks.
In addition to cutting biller workloads in half, Lifesprk is also benefiting from:
Cleaner claims submissions.
With its industry-standard rules engine, Inovalon flags errors before claims are sent to the payer. When a mistake does occur, Lifesprk billers easily correct and resubmit claims.
Automatic eligibility updates.
Through regularly scheduled batch eligibility checks and pre-submission verification, Lifesprk has been able to avoid the beginning-of-the-year headaches caused by open enrollment and insurance changes.
Seamless transition to the Patient-Driven Groupings Model (PDGM).
With Inovalon, Lifesprk was fully prepared to meet the increased billing episodes (from 60 to 30 days) due to the transition to PDGM.
”I would say [Inovalon] at least cut the time in half by not having to log into the individual payer system, look up the claim, and fix it in your software, then rebill it again.”
Staci BoehmerHome Health Billing Manager, Lifesprk
Keeping Momentum Going After Seeing Stellar Results
The agency plans to use Inovalon for its expansion into hospice care, especially for batch filing of Notices of Election (NOEs). From checking eligibility and correcting complex Medicare claims to automated sequential billing, Inovalon will help to accelerate billing and reimbursements for Lifesprk’s new service line.
Discover the power of Inovalon’s claims management solutions
