CUSTOMER STORY
Automation Helps California
Hospital Control the Chaos of
Medicare Billing
Background
Marshall Medical Center comprises several facilities, including a community hospital, several primary and specialty care clinics, as well as labs and diagnostic imaging centers.
Marcie San Vicente is an acute care biller at Marshall Hospital, an independent, locally owned and operated facility and one of the only hospitals in Western El Dorado County near Sacramento.
She was brand new to medical billing when she joined the hospital as a commercial biller. She was later moved into higher-volume Medicare billing at the hospital, which outnumbers commercial claims for surgical procedures and other services.
Placerville
California
Success
Improved efficiency and visibility of Medicare claims
Making Sense of Medicare Billing
“It’s a whole different ballgame,” San Vicente said. “Medicare has a lot of rules and its own little quirks about how you can bill.”
To help navigate those quirks and access Medicare’s DDE system, the hospital uses Inovalon’s Claims Management Medicare ProTM.
She appreciates how the application helps her navigate the site and increase her efficiency. For instance, it clearly shows the difference between hospital claims and physician claims, whereas in DDE, they are all grouped together. San Vicente only works on hospital claims, so she saves a lot of time by not having to open each individual claim to see what it is.
“It’s also a lot easier to switch back and forth between National Provider Identifiers (NPIs),” she said. “I don’t have to log all the way out and log back in to look at different types of claims.”
“DDE is so archaic that it takes a while to figure out where things are,” explained San Vicente. “In [Inovalon’s software], it’s all in columns – so it’s a lot easier and cleaner to look at versus DDE.”
Setting Priorities for the Day
Medicare billers know firsthand how complex the claims can be. Having a tool to clear away the clutter and set priorities can make a big difference.
The application sends two important emails each day. One details payments received from individual NPIs; the other lists how many claims have been returned to provider, rejected, denied, or cancelled.
“It gives us a good idea of what’s out there to be worked, what’s getting paid, and what we’re waiting for payment on,” said San Vicente. “It’s really helpful to keep us on track.” She also noted the value in being able to access and review claims in the software when DDE has a dark day.
Inovalon takes pride in simplifying healthcare’s complexities, and there are few things more complex than Medicare billing. Claims Management Medicare Pro may not eliminate the need to access DDE, but it certainly makes for an easier journey.
Save Time and Money with Claims Management Medicare Pro
If your organization is looking to simplify revenue cycle management, our cloud-based tools may be the answer.
