Fewer Claims Denials, Greater Reimbursement: How Inovalon Tech Benefits a Billing Services Partner

In addition to these traditional RCM focal areas, Health Care Professional Consulting Services also provides training to address the “erosion of knowledge” that threatens many organizations, according to Julie Ann Kemman, the firm’s President.

Cloud-based software from Inovalon plays a key role in helping Kemman’s clients overcome common roadblocks. Medicare as Secondary Payer (MSP) claims are a challenge of their own, for example, often ending up being bad debt for many companies due to their complexities. The MSP claims must be billed to the primary payer with advanced coding requirements for Medicare to process and potentially reimburse claims. At the same time, 90% of Medicare claims automatically cross over from Medicare to the coinsurance payer, and may have patient responsibility included for the full reimbursement of Medicare co-pays (which some big payers still process manually).

“So that’s where Inovalon’s automated secondary claims tool is fantastic because it’s built into the application and is being handled on the back end to capture those reimbursements,” she said.

Software integration with PointClickCare (PCC) is what really makes Inovalon solutions the go-to choice in the post-acute market, Kemman explained. “It’s very intuitive and efficient. You can hit a button and export. As quick as you can log in, your claim files are there. Having the remits and automatic import going to cash batch in PCC is another huge benefit.”

One of Kemman’s staff members is a certified PCC implementation, training, and configuration specialist who has personally completed more than 1,000 Inovalon implementations with PCC. “We really like the Inovalon clearinghouse functionality and know how to make it work inside and out to efficiently manage and improve the revenue cycle,” she said.

With that type of expertise, it’s no wonder Health Care Professional Consulting Services was recently named one of the top 10 revenue cycle companies in the U.S. by HealthcareTech Outlook.

What stands out for users of Inovalon applications is the logical flow and multiple ways to get to desired information, which greatly boosts efficiency. Kemman noted that with just a few clicks, she can see every claim and every payment for the history of that person tied to a provider. “That’s the efficiency that I love. It’s great when you have an accounts receivable aging report that shows every outstanding balance, you can easily see the various transactions.”

The denial management abilities in Inovalon’s claims software are extremely helpful, she said. “The software allows users to upload and attach documents for denials, so that’s really important. This helps ensure that more reimbursements are hitting the bank accounts of providers, especially skilled nursing facilities, for their survival and to be able to make payroll.”

With Inovalon software, Kemman has been able to help her customers lower their denial rates by catching first- and second-level edits before being submitted to the payer. This type of proactive revenue cycle management regularly results in “tens of thousands of dollars” in collections that would otherwise have been written off, Kemman shared. Many potential write-offs are related to Medicare as Secondary Payer (MSP) claims and other challenges with benefits, which can be overcome with the right technology and knowledge.

“There’s so much that Inovalon has brought to the provider community with automation efficiency that has made a huge difference. Inovalon has the best clearinghouse and functionality that exists.”