CUSTOMER STORY:
Larry H. Miller Senior Health Achieves Better Billing and More Patient-Centric Care With RCM
Larry H. Miller Senior Health serves residents across 26 facilities, 16 home health and hospice teams, and one assisted living facility. All claims are managed by Tiffany McElheny, SVP of Revenue Cycle, and her team, who have been using Inovalon solutions for over 20 years – initially as a direct connection to Medicare for claims submission, to today: a complete front- and back-end revenue cycle management (RCM) workflow that’s integrated with their electronic health record (EHR) solution, MatrixCare.
For McElheny, the right software makes all the difference in her day-to-day, her team’s success, and peace of mind for the thousands of residents they serve and their families.
In sharing her experience using Inovalon’s solutions for the past two decades, McElheny reflects that what initially made Inovalon stand out is, “There were a lot of companies out there that offered the user-friendly interface, but nothing was as robust as this; nothing ever really checked all the boxes for me.”
The Need
A clear view of the entire revenue cycle across all locations
Reliable and accurate Medicare claims submission
Software that’s easy to use and train new staff on
One Clear View, Across All Locations
McElheny starts every day by checking the overnight report in her email that’s delivered automatically from Claims Management Medicare Pro. As the senior leader for all billing across multiple locations, she credits this report for guiding her focus to the most important needs of the day. The report takes thousands of claims, any denials, and expected revenue and turns it into one clear, comprehensive update.
“I don’t have time to manage each individual location, but I know I’m not missing anything. I can look at the report from an enterprise level, then plan my day. And having that at my fingertips is fantastic because we can all have the day get away from us.”
Her staff also gets the overnight report, so everyone knows what they have to accomplish that day before they even log in to their billing systems – and they can refer to the report if they do encounter surprises or pressing needs throughout their day.
”The report tells me exactly where my focus needs to be on any given day. Across all my lines of business, I can go there and see what needs my attention."
Tiffany McElhenySVP, Revenue Cycle
Medicare Claims Submission, Made Simple
The team at Larry H. Miller manages commercial, Medicaid, and Medicare claims all within Inovalon’s claims management software. For Medicare specifically, this has helped the team improve accuracy and speed in submitting claims, and speed has recently become more important.
Since claims are linked to a resident’s benefit period, if McElheny’s team submits a claim after another organization who also treated the individual, that organization could collect the payment on their services. To realize the revenue of the care provided during days 1-50 (for example, out of 100 days), McElheny’s billers have to get their claim submitted before the organization who administered care on day 51 and after.
In McElheny’s eyes, this is about more than revenue – it’s also to best serve residents. For any claims her team is delayed on submitting, that could mean the services become out-of-pocket expenses for the resident if another organization captures the payment. This means greater financial burden and more stress during an already difficult time for the resident and their family
Easy to Use and Onboard
Across all claims, eligibility checks, and RCM analytics, McElheny notes that Inovalon software is so easy to use that it has improved staff satisfaction and productivity while shortening the time it takes to train new staff.
She goes on to explain that beyond initial onboarding, the ease of use means more confidence that claims are correct. “Our jobs are getting harder, so we need technology to make it easier. Knowing a claim is clean or getting a 277 back and reading it in an easy format means we can do our jobs well. And it’s kind of hard to make mistakes because the software lays everything out for you.
”It’s kind of hard to make mistakes because the software lays everything out for you."
Tiffany McElhenySVP, Revenue Cycle
Greater satisfaction
“I love how this has increased our employee satisfaction, because it’s not ‘you have to go here, here, then here.’ Instead, it’s ‘go to this one place’ and it’s so much easier being able to use one product for everything,” shares McElheny.
Her team doesn’t have to try to remember different logins for different payer portals or bounce between separate tabs and systems. They can work all their claims and see relevant eligibility or claims tracking information in the same system, too.
This makes a notable difference. Employees are happier, their productivity is better, and the entire revenue cycle is running more smoothly.
Better onboarding
At Larry H. Miller, expanding from using Inovalon for just a Medicare connection to an end-to-end approach has cut onboarding time in half. It’s easier for new billers to understand the software and complete their tasks, whether to verify eligibility, create a new claim, track existing claims, or edit a denial.
This is true even for staff who haven’t done healthcare billing before, which can be a daunting skill to learn for the first time. McElheny says, “Our new billers can easily learn in the software and through the webinar classes Inovalon hosts. We’re seeing so many new employees in this space who may not really know or understand claims when they come into the job, so this is huge for us.”
Keeping Patients and Residents at the Heart of Healthcare
McElheny’s philosophy on successful healthcare billing is about much more than claims and revenue. She shares, “When a patient comes in, no matter what facility they’re at, they’re our job now. It’s our responsibility to educate them on all the services and benefits available and to cover as much of their care as we can by billing the appropriate health plan(s).”
They do this with the help of Inovalon’s Eligibility Verification Standard. Using the software to find clear eligibility information, her team can have a dedicated resident conversation that may look like, “Hi, I see you came in for a recent fall, but you can also get your flu shot, your vaccine, and your checkup.” McElheny states that this may be the first time a resident or their caregiver has had that level of conversation about their coverage, and it can be incredibly meaningful for them.
This humanizes the experience and improves the care journey for the resident and their family – they’re not just another person coming into Larry H. Miller, they’re someone who knows they need care, but is also likely unaware of all the treatments available to them.
She adds, “What elderly person have you met that doesn’t need more help when they get home? With clear coverage information, we can explain their skilled nursing coverage and also transition them to home health, should they choose to do that.”
Put simply, McElheny and her team are committed to taking care of the whole resident. She even takes the centralized billing staff on “field trips” to one of their organization’s various care facilities so they can see that there are real people attached to the other side of a claim – people who benefit greatly from accurate billing so that they don’t have to worry about paying out of pocket.
Additionally, if a resident is not covered for care at Larry H. Miller, her team guides them to other organizations where they may be covered based on their eligibility information. They go beyond billing to do whatever they can to help the person in front of them.
Accurate Billing, Staff Satisfaction, and a Better Care Experience
… all powered by Inovalon. For McElheny and her team, Inovalon’s end-to-end RCM solutions and MatrixCare integration are more than a means to an end. The software helps them accomplish important work faster and with fewer mistakes to make a real impact in patients’ and residents’ lives.
When asked to summarize her 20 years of using Inovalon software and why Larry H. Miller has never switched, McElheny stated:
“I love that Inovalon really is a one-stop shop. Anything you can really think of from an RCM perspective, anything you need is there. And we have a great relationship with them; it’s like a colleague that you trust and you can just call. When we lost connections [earlier this year], we billed again eight days later, and that took an army. That is mind-blowing to me.”
”We have a great relationship [with Inovalon]. It’s like a colleague that you trust and you can just call."
Tiffany McElhenySVP, Revenue Cycle
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