CUSTOMER STORY:
End-to-End RCM Efficiency:
How Paramount Healthcare Transformed Their Billing Processes
Managing patient coverage and billing needs is complicated for many skilled nursing facilities. For Paramount Healthcare, keeping up with the billing demands of their 12 facilities was becoming overwhelming and inefficient. Between confirming active coverage, reverifying Medicare coverage, creating and tracking claims, and posting payments – and doing all these steps in different systems – the billing team had a mountain of challenges affecting their revenue cycle.
Fortunately, an end-to-end approach to revenue cycle management (RCM) transformed Paramount Healthcare’s billing success. With Inovalon’s integrated software, the billing team can now complete eligibility inquiries, stay on top of coverage changes, manage their claims from start to finish, and more.
The following describes how an integrated workflow has helped Paramount Healthcare make significant improvements to their RCM.
Eligibility Made Easy
Compared to other revenue cycle vendors, Inovalon’s eligibility solution is “so much easier to read and more robust,” according to Shasta McClary-Brocious, Director of Billing at Paramount Healthcare. For her, the software “is more reliable and has less glitches. It has less issues than other systems I’ve used in the past.”
This makes a world of a difference when managing coverage for hundreds of residents, many of whose coverage can change as their covered stays expire. Inovalon’s Eligibility Verification Pro and Insurance Discovery work together to ensure Paramount Healthcare can easily confirm residents’ coverage, find active secondary or tertiary payers, and identify changes in coverage.
For McClary-Brocious, an easier eligibility verification process has instilled more trust that claims are set up for success from the start.
Quick and Clear Claims Management
On the claims management side of the revenue cycle, Paramount Healthcare has gained greater efficiency and more visibility to where their claims are as they progress from submission to payment – and they credit much of this to “having everything in the same place.”
Previously, the billing team was using multiple systems to submit claims, and their claims were split with about 60% being electronic and 40% were paper-based submissions. Now, 90% of their claims are electronic, and the only remaining paper-based claims are for small plans that don’t accept electronic submissions.
In McClary-Brocious’ words, “Our payments are like night and day.” This is most notable for her in the areas of managing enrollments, tracking claims, and payment posting.
Fast Enrollments
Managing enrollments can be time-consuming and confusing when submitting manually. For Paramount Healthcare, it’s now a much easier process thanks to Inovalon’s connectivity.
“It’s so much easier. Even if we want to do a quick ERA EFT enrollment, it’s a one-stop shop. We can go in the same system to initiate those enrollments, fill out the paperwork, and then we get an email when we need to do something,” said McClary-Brocious.
90% of claims are now submitted electronically
”“Our payments are like night and day.”
Shasta McClary‑BrociousDirector of Billing, Paramount Healthcare
Understanding Claims Status
Prior to using Inovalon’s Claims Management Pro and Claims Management Medicare Pro, the billing team’s biggest challenge was inefficiency. It was hard to streamline work and get through the necessary tasks of the day, as much of it was manual or operating in different systems.
“Now, we’re so used to how fast our claims can process that we’re quick to notice and correct something when we’re just a few days behind in payment,” noted McClary-Brocious.
Automated Payment Posting with PointClickCare
As part of the PointClickCare marketplace, Inovalon offers integrated revenue cycle solutions, which for SNFs like Paramount Healthcare means that billers no longer have to key in payments.
As McClary-Brocious shares, “We receive the 999s and 277s and claims are paid pretty instantaneously – once that payment actually hits the bank, then it flows in on the overnight cycle in PointClickCare.” This integration offers peace of mind and significant time savings. She added, “A process that would literally take a whole day for each of our 12 facilities can now all be completed in one day.”
From 12 days to just1 DAY
Trusted Audit Readiness
In addition to the enhanced efficiency and visibility to the day-to-day operations of their revenue cycle, Paramount Healthcare has also benefited from better audit readiness.
After the COVID-19 pandemic, every SNF was audited with a 5-claim probe. Medicare Administrative Contractors (MACs) selected five claims, at random, from every facility for auditing. Passing the audit confirmed that claims were being submitted accurately, while not passing would mean the SNF would receive education on the mistakes, following the “target, probe, and educate” approach of the audit.
The real challenge: audits can take 90-120 days to process when submitted on paper, and the impact for Medicare claims can be a hault to receiving payments. This is because Medicare payments have to be processed in order, so if a claim from “month 1” is going through the audit process, claims for “month 2” and “month 3” cannot be paid until the first claim selected for the probe is completed.
It was a time of many unknown and cash flow concerns for SNFs. For Paramount Healthcare, having Inovalon’s esMD Management to address auditing needs made all the difference.
“It was huge. We were so concerned; we were prepared for the 5-claim probes to mess up our cash flow. But because of esMD Management, we were only a little behind. Once those claims processed, we were able to get everything back up again.” – Shasta McClary-Brocious, Director of Billing, Paramount Healthcare
Even now, esMD Management gives Paramount Healthcare billers peace of mind that they’re ready for any future audits, which are an ongoing challenge for SNFs. Whether from Medicare or other payers, the software maintains good processes in place to address audit requests as they come up. The team shared, “It allows us to be accurate, save time, and see claims status. We can make sure our documentation is good documentation – that it truly supports the clinical need of our residents.”
”It was huge. We were so concerned; we were prepared for the 5-claim probes to mess up our cash flow. But because of esMD Management, we were only a little behind. Once those claims processed, we were able to get everything back up again.
Shasta McClary‑BrociousDirector of Billing, Paramount Healthcare
Enjoy End-to-End RCM Efficiency and Peace of Mind
Paramount Healthcare transformed their revenue cycle efficiencies and, along the way, gained greater peace of mind that their billing was on track and accurate. Your organization can do the same. Contact us today to learn how our revenue cycle management solutions can support your organization.
