CUSTOMER STORY
Phelps Memorial Health Center Optimizes Revenue Cycle with Automation and Data Insights
The Challenge
A small hospital strives to provide holistic care to the community.
As a small, 25-bed critical access hospital in rural Nebraska, Phelps Memorial Health Center prides itself on caring for patients where they are – reducing the need for patients to travel. The center provides over 100 services to patients and employs dozens of physicians across multiple specialties.
“We’re very progressive, and we’re constantly looking at the needs in our community so we can meet those needs, and patients don’t have to go elsewhere for care,” said Rachel Dallmann, Senior Vice President of Clinical Operations. “Our outpatient services have grown exponentially in recent years. We’ve recently added a large number of specialists that are coming to our area.”
That level of care demands a robust claims management program to keep things running smoothly. Even as Phelps Memorial manages a multitude of payers across a variety of providers, they are able to maintain optimal KPIs efficiently with SaaS-based workflow solutions powered by Inovalon.
The Solution
An automated workflow improves efficiency and accelerates payments.
When Phelps Memorial adopted Inovalon’s Claims Management Pro™ software several years ago – to move from print image claims to automated claims – they saw an immediate improvement in workflow.
“It contributes a lot to our success,” Dallmann said. “It helps us identify areas of concern and get ahead of those before they become huge issues.”
Using a complementary application, the staff was able to submit, process, and monitor Medicare claims without having to use the FISS (Fiscal Intermediary Shared System). With Inovalon’s Claims Management Medicare Pro™, the claims are processed and paid much faster, saving them time and frustration. Using the application, Phelps Memorial was able to reduce their manual re-mittance from 100% to 25%, and they can get 90% of claims out the door without biller intervention.
Another major benefit Phelps Memorial has found with Claims Management Pro is the ability to customize the software to meet the organization’s needs. The application allows custom edits to be put in place for local payers, Medicare maximums, and national coding. Additionally, providers can identify upcoming coverage changes and put edits in place so the claims system is ready.
The efficiency gained by implementing Inovalon automation throughout the patient financial journey has allowed billers to focus their attention on delinquent accounts, bring in more revenue, and decrease overall A/R days.
“My billers are no longer touching every single claim, and we have increased our clean claims rate, so that was a huge win,” Dallmann said.
“The customizability has always been a game changer – to be able to put the edits into place as we need them. Claims Management Pro also helps us identify issues before they become a serious problem, allowing us to be proactive instead of reactive.”
Rachel DallmannSenior Vice President of Clinical Operations, Phelps Memorial Health Center
The Future
Phelps Memorial uses data analytics to take revenue cycle management to the next level.
Following the success they saw in their revenue cycle with Claims Management Pro, Phelps Memorial was quick to adopt Inovalon’s RCM Intelligence™ solution. Previously, the company’s billing department put significant time into pulling reports to see what was causing denials. With RCM Intelligence, they are now able to track denials
at a glance.
According to Dallmann, “The RCM Intelligence has been a complete game changer for us here at Phelps. We’ve gotten to the point where our KPIs are at best in class. We’re really able to pull back the curtain and see how we can make ourselves even better.”
With RCM Intelligence has come a new focus on first pass yield as a KPI. That has Phelps tracking how many claims are paid on first submission, with clear insights into what is causing initial denials.
“The clean claims rate didn’t really show the full picture. First pass yield helps us understand the claim as a whole, without limiting our outlook to when it hits the payer,” said Dallmann.
That insight, backed by easily shareable data, allows Phelps to communicate across the organization to help staff members understand their role in the revenue cycle. Dallmann said it’s helped bridge the gap to the clinical side of the organization so staff members understand the positive impact they can have on RCM.
The data insights gained through RCM Intelligence have proven invaluable to the organization.
“That transparency of that product, I would highly suggest every hospital have that product so they can keep looking to improve.”
Rachel DallmannSenior Vice President of Clinical Operations, Phelps Memorial Health Center
Solutions That Will Bolster Your RCM
When providers are looking for ways to ease staff workflows and increase revenue, Inovalon offers meaningful cloud-based software solutions. Discover how your organization can take its RCM to the next level.
