CUSTOMER STORY:
Decreasing Costly Errors and Improving RCM Success for Tribal Health Organizations
Tribal health organizations are funded about 40% of their cost to render care, which makes every claims dollar paid even more valuable compared to other care settings. These groups are often working on slim margins and need to collect all third-party revenue for services rendered to continue providing care to their community.
Face Rock Enterprises helps tribal health organizations collect more by improving their front- and back-end revenue cycle management processes. They train employees, review RCM analytics with leaders, and offer years of healthcare experience to support their clients’ ongoing claims management education and success.
For this consulting firm, Inovalon solutions are an essential part of their approach. Karen Knight, Partner and Consultant, states, “We cannot get the same results unless we use the right tools. Inovalon provides the right tools for Tribes. With most programs or software, you must modify and create workarounds to accommodate Tribes, which in turn creates incorrect reporting. Inovalon doesn’t require workarounds. They produce good, clean tribal data and results.”
Navigating the unique needs of tribal health billing
Many IHS/Tribal/Urban (I/T/U)s use the Resource and Patient Management System (RPMS) to manage clinical and administrative information. This system helps with claims management, but often, it also adds another step in the billing process as billers bounce between RPMS, their electronic health records, and various payer portals to submit claims. Whether Tribes are using RPMS or another software program, billing processes are different, and Tribes require a system that works with them and not against them.
The added complexity creates unique challenges. “It’s not easy,” shares Knight, “they have to be able to write custom mini programs to keep up with their billing. For example, a claim that may have been on an HCFA 1500 claim form, then rolls into a UB-04 claim form, which requires a rev code that you would normally find only on a hospital claim rather than a clinical claim.
Inovalon’s Insurance Discovery™ and Claims Management Pro™ solutions seamlessly integrate with tribal health organizations’ systems, simplifying their claims management and empowering them to sharpen their RCM skills, improve accuracy, and reduce rejections and denials.
Our solutions help Face Rock Enterprise’s clients navigate the unique rules of tribal health billing. Clients can write custom rules within our cloud-based software to meet their billing needs, without having to juggle multiple portals or keep up with the latest requirements on their own. Rules are written right into the software which helps billers ensure accuracy in every step of the claims lifecycle, starting with finding and verifying patient insurance coverage.
Once a tribal health organization is up and running with Inovalon software, Face Rock Enterprises can further improve their clients’ billing success. They work closely with clients to get them fully trained on the software and to continue sharpening their claims management skills.
”We’ve written rules where no one else could. Inovalon is key in that they write the rules well, which helps take care of all the issues so clients can work through claims quickly and efficiently. Everything is going through very seamlessly and much faster than if billers were having to look things up on their own."
Karen KnightPartner and Consultant
Improving staff skills for ongoing RCM success
Once a tribal health organization is up and running with Inovalon software, Face Rock Enterprises can further improve their clients’ billing success. They work closely with clients to get them fully trained on the software and to continue sharpening their claims management skills.
Better patient access
On the front-end, registration staff can ensure they’re capturing accurate patient details, in full. Instead of stumbling through the limited capabilities of the RPMS system, staff can fully leverage the benefits of Insurance Discovery. With this software, registration staff can capture coverage details for “about 40% of patients who said they had no insurance,” says Knight. That’s 40% more patients that clients can properly bill payers for.
Additionally, the software catches any insurance mistakes before a claim is even created. Knight adds, “this is key because we’re able to check eligibility. Billers basically get a message saying, ‘do you want to use the correct or incorrect insurance?’ and they can easily see their error and use the correct insurance, preventing unnecessary delays in payment and appeals if caught after the claim is submitted. This also reduces timely filing write-offs. Additionally, the staff become subject matter experts, producing excellent work.
These corrections significantly add up. Face Rock Enterprises typically sees an average of 70-80% error rate in new clients’ eligibility verification. “Within one month [of working with us and using Inovalon software], that drops to 20%. And then in three months, we’re down to about 2-6% errors.”
Decreasing back-end errors
With faster, more accurate eligibility verification, tribal health organizations can better manage claims on the back-end. In fact, after their initial success within the first three months of reducing eligibility errors, “usually, revenue comes up and nearly triples within a six-month period,” shares Knight.
This is true for even the most complex billing scenarios, such as keeping up with ever-changing Medicare requirements and retrospective timing. Inovalon solutions are constantly updated with the latest payer rules, which helps reduce claims errors as rules change – decreasing the backlog of claims that billers across all settings often have to go back and fix to align with new requirements. Considering the changes coming with value-based payments/quality initiatives with HEDIS measures, health systems cannot afford to miss any revenue. Inovalon takes care of those solutions, almost like an extension of your own staff.
From Knight’s perspective, “with Inovalon, you have the rules in real-time, which is excellent. I like that Inovalon works with both CMS and payers so we get the most updated rules.”
At-a-Glance Results
20% Error Rate Within One Month
2-6% Error Rate in Three Months
The value of a “complete product”
When added together, the benefits of front- and back-end success can be summed up as the value of one complete, end-to-end solution. Knight says, “Inovalon has the most complete product. You get the insurance discovery on the front-end, updated rules on the back-end, and reporting to keep improving.”
This end-to-end workflow and reporting helps Face Rock Enterprises further support their clients’ success, going beyond simplifying work streams and improving individual tasks to enhancing how their entire revenue cycle works.
”Inovalon has the most complete product. You get the insurance discovery on the front-end and updated rules on the back-end, and reporting to keep improving."
Karen KnightPartner and Consultant
Real-time reporting
Built-in reporting within our solutions empowers Knight and her team to see when an individual biller or registration staff member are performing lower than their peers. They can then offer additional coaching to that individual and fix the mistakes they’re making, while helping them build lasting skills to support them in their healthcare career.
“We fix that error and then that person becomes a subject matter expert,” shares Knight. “It’s all about managing people. So, when you bring in managers who have this data to perform better and produce results as a team, it makes that manager look incredible. They have a handle on what’s going on and their staff really gains self-confidence and can develop a career path.”
Knight adds that this has been a game-changer for their clients. Our software enables them to keep an eye on the entire revenue cycle. Managers now have a measuring tool to gauge staff performance in real time – and with important details such as how many claims one person has completed that day, how many claims they completed in a week, and individual error rates. For her, “it’s invaluable.”
Easy onboarding
Not only do Face Rock Enterprises and their clients achieve significant success with one end-to-end solution, but they can quickly launch into action upon contracting with Inovalon.
Knight says, “the team that does the enrollment and onboarding is amazing.” Coupled with her team’s healthcare and consulting expertise, often, they’re able to train staff quickly. “We train them in just one session and they’re able to pick that back up.”
Experience the value of end-to-end RCM software
Our end-to-end solutions have greatly supported Face Rock Enterprises in helping their tribal health clients achieve better revenue results – and they can help your organization too, no matter your care setting. Discover how our RCM software helps acute, post-acute, and ambulatory providers achieve better front- and back-end billing success.
