CUSTOMER STORY
Skilled Nursing Group Gets Paid Faster, Sees Fewer Denials With Inovalon
Background
Time is money. That’s something most healthcare providers will admit is clichéd but an undeniable reality of the business. More and more, insurance payers are slowing reimbursement timetables, which can disrupt cash flow for SNFs. HMG Healthcare, which operates 33 SNFs in Texas and Kansas, has found a way to ensure they’re getting paid as quickly as possible by getting clean claims out the door faster with software from Inovalon integrated into their PointClickCare (PCC) system.
Like many SNFs, HMG Healthcare long visited individual provider sites to find the information they needed to submit claims. That meant downloading claims from several places and uploading them into the PCC system. And when billing processes slow the rate at which claims are being sent, those processes ultimately slow the payment. In 2019, Dohn received a call from an Inovalon representative who demonstrated how software could be integrated into PCC to reduce the amount of time staff would need to compile claims information and get bills out the door.
By early 2020, HMG Healthcare was implementing Inovalon’s Claims Management Pro™, Claims Management Medicare Pro™, and Eligibility Verification™. The integrated software solutions helped HMG streamline its claims management process to get claims sent faster, with fewer error flags, and a reduced burden on billing staff.
”Cash flow is very important, obviously. It’s a cliché, but cash is king. If you don’t get your bills out and you don’t get paid in timely manner, you won’t have money to pay expenses, then you will have to draw from credit lines.”
Bill DohnVice President of Accounting, HMG Healthcare
Streamlined Claims for Faster Payments
An automated claims process – one that enables providers to submit claims from one system without needing to visit individual payer sites – has become increasingly important as more and more SNF residents subscribe to Medicare Advantage plans fulfilled by a host of providers. With Claims Management Pro and Claims Management Medicare Pro, HMG Healthcare has eliminated the need for billing staff to visit multiple sites and complete multiple form downloads to submit a claim. That means that the billing department spends less time getting claims out the door, leading to faster payments.
“We’ve reduced our billing timeframe by about a week, which allows insurance companies to receive bills faster. It ensures we can get our billing done and paid in the same month, which is ideally what we want to do,” Dohn said.
Previously, it took HMG’s billing department 15 calendar days, at best, to submit a claim. Now, HMG is able to submit claims in about nine calendar days. With governmental and managed care claims, HMG’s claims are submitted quicker and ready to be paid as soon as possible. That’s significant, considering 70-75% of HMG’s claims are covered by such plans.
”I’ve talked to my counterparts at other healthcare facilities, and from the time bills are generated in PCC, it can take them anywhere from two to three weeks to get their billing done. I’m seeing my staff completing the billing process in two to three days.”
Bill DohnVice President of Accounting, HMG Healthcare
Cleaner Claims for Reduced Denials
Since implementing Inovalon solutions in early 2020, HMG Healthcare has seen a dramatic increase in its clean claims rate, from around 90% to 98.5%.
The integration of Inovalon software has not only benefited HMG Healthcare with a faster billing process, but it’s also delivered cleaner claims that have saved staff time and reduced denials.
In addition to supporting faster billing times, cleaner claims save staff time because they don’t have to manually correct errors in flagged claims before they can be sent to the payer.
According to Dohn, the increase in clean claims is a result of the organization’s focus on improving documentation, as well as the ability to leverage Inovalon software to automatically address the errors that were resulting in flagged claims. With Inovalon software, HMG has seen denials decrease from 7% to 3%.
”One great thing about Inovalon is that if we have actions that billers were repeatedly having to go in and change, we can contact Inovalon support, and they will write a rule within the software so it’s customized to correct the error for us. That’s helped our efficiency, helped our acceptance rate go up, and helped our rejection rate to go down.”
Bill DohnVice President of Accounting, HMG Healthcare
Growing the Organization Without Adding Staff
The increased efficiency in the claims management process also has allowed HMG Healthcare to continue to expand without needing to add more staff to deal with the increase in claims.
When HMG integrated Inovalon software into PCC, the healthcare group had four members of the billing staff handling claims for 23 facilities. Now, the same number of staff members are managing billing for 33 facilities. Even with the increase in claims being handled by the staff, the organization still sees claims being submitted faster and staff completing key reports sooner.
Dohn credits the ease of use of the cloud-based SaaS solutions, as well as the support he and his team receive from Inovalon.
He adds that he’s seen similar enthusiasm from his staff. Those who were experienced in SNF billing were hesitant to take on a new system. But once they saw how easy Inovalon solutions were to use, they embraced the change and the efficiency it created.
”I tell people all the time: I’ve been at the CFO-type level since 1999. I’ve spent the majority of my healthcare career in acute care. When I walked in the door here, I could probably count on both of my hands the amount of times I’ve actually filed a claim. But Inovalon’s software is so easy to use, I’ve now filed hundreds of claims myself.”
Bill DohnVice President of Accounting, HMG Healthcare
Payment Solutions for Better Customer Service
Beyond claims management, HMG Healthcare also utilizes Inovalon technology to facilitate resident payments and enhance residents’ financial experience. With Inovalon’s Patient Payment Management™, HMG has been able to set up recurring payments for their residents, a service that was regularly being requested.
“Yes, they’re residents in our facilities, but they’re also our customers. Patient Payment Management has given us an added benefit to be able to offer them what we didn’t have previously,” Dohn said.
HMG recently added links to each of its facilities’ websites to allow residents and their families to easily make payments electronically. While the offering is too new to assess its impact on the revenue cycle, Dohn said he expects to see residents appreciate an easier, online payment opportunity.
Addressing SNF Challenges With the Right Technology
The obstacles facing skilled nursing facilities are ever-changing and unlikely to simply disappear. But HMG Healthcare has discovered how the right software can help them face the challenges head on.
Inovalon software has improved our efficiency while helping our acceptance rate go up and our rejection rate go down,” Dohn said. “And the technology – it’s such easy-to-use software.”
– Bill Dohn, Vice President of Accounting, HMG.
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