First-Time Healthcare Billers Achieve RCM Success with Cloud‑Based Software

Healthcare billing is its own beast, particularly for a finance team that doesn’t speak the language of revenue cycle management. For Roots Food Group, transitioning their standard invoicing process to healthcare claims meant learning new workflows and terminology such as “CMS 1500,” “EOB,” “diagnosis codes,” “modifier codes,” and more. Claims management was a brand-new world – one they had to get adjusted to quickly to keep their financials on track.

For the payers they work with, there was also a learning curve as they added community support codes. Plans and their community partners needed to learn how to effectively work together. As Kimelyn Coleman, Director of Revenue Cycle, explains, “this was all about helping people get well with food based on their social drivers of health – but no one knew how to bill it, and payers weren’t prepared for how voluminous the program would be. Invoicing manually was burdensome for us and for the plans we work with. We had to figure it out together.”

Enter: Inovalon’s revenue cycle management software. With our front-end and back-end solutions, Roots Food Group quickly learned the ropes of efficient, automated healthcare billing.

Prior to implementing Inovalon, Roots Food Group was manually entering data, manually converting invoices into claims, and working only one or two claims at a time to ensure they were approved by the payer.

The billing team had to type out an invoice for every box of meals shipped out, then convert that billing form into a CSV file, to again convert the CSV into a CMS 1500. At a rate of hundreds of meals delivered a day, the workload was quickly piling up and the clunky, manual process left a lot of room for human error.

Now, one CSV file converts hundreds of claims into the correct format in just one step, and the payer rules built into Claims Management Pro ensure the organization is always working with the latest payer requirements in mind.

Coleman shares that, “Inovalon has saved us time tremendously.” She adds, “Invoices for one of our larger payers kept getting denied. We needed a modifier code, then a diagnosis code, then a service date over a 14-day span. It was a lot of back and forth in the beginning just to learn this type of billing, so we were doing one or two at a time to make sure they got approved. Now, we do our billing in bulk and can trust the claims are correct.”

Inovalon’s software helped them navigate unique payer requirements and transform their claims submission – so much that Roots Food Group is now collecting five times more a month than before

On the back-end, Inovalon’s real-time RCM analytics make reports much easier to run, so that more time can be spent taking action on the organization’s billing performance. For Coleman, regularly sharing performance updates with her peers and leaders is as simple as pulling a report from RCM Intelligence. She states, “I can get the data that we need to provide our finance department and it’s ready to paint the picture with charts and graphs. I can just download and send, and it’s more accurate because everything is accounted for.”

Plus, reconciliation is easier as well. What was previously a manual accounting process because of one-by-one claims submission is now just a few quick steps. Billers can correct an error and reupload that to the original claim – no need to redo data entry on a new claim or to manually reconcile it later.

She adds, “We made the right decision. When we call the support line, they’re there. They explain what I need before they release the call. I’ve spoken to different people every time I call and have gotten the same level of service. You don’t get that all the time now.

Everyone seems to be happy and gets satisfaction out of supporting customers – you can’t ask for more than that.”

Empowered with the right tools and a team they could learn from, Roots Food Group quickly adapted to the world of healthcare revenue cycle management. Today, they manage every step of the claims lifecycle – from eligibility verification to claims creation, to denial management and reporting – with more speed, accuracy, and peace of mind.