Improving Medicare Claims Management for Multiple Clients, with One Solution

Claims Management Medicare Pro helped Careficient reduce denials by 20% across their 50 clients, streamlining their work so much that the billing team was able to eliminate two full-time positions. This partnership transformed Careficient’s claims management. In sharing their success, the billing team credits three key benefits of Inovalon’s software.

1. Eliminating the need for multiple portals

“Being able to manage all payers was something that we struggled with in the past. We were using multiple clearinghouses. Now, we have one place.” – Allendys Gonell, Billing and EDI Manager, Careficient Claims Management Medicare Pro gives Careficient single-sign-on access to all the payers they need to work with.

The team no longer has to remember multiple logins or spend their day bouncing between browser tabs – or in the DDE system. They can work all their clients’ claims in one place, with greater speed and accuracy.

2. Enhanced claims accuracy

Inovalon software delivers more than clarity; it gives Careficient confidence that their claims are ready for payment. The solution is built with payer rules in mind and constantly updated as payer rules change. These rules inform claims scrubbers, which check claims prior to submission to catch errors such as missing data, incorrect demographics, and coding mistakes. This process happens automatically as claims are created, helping Careficient and their clients work claims faster and with greater accuracy.

3. Detailed reporting, ready for the team every day

Prior to using Inovalon software, Careficient was manually tracking claims. Their team spent hours understanding claims status and managing denials, as well as on custom client reports ranging from changes in patient coverage to a summary of common denial reason codes. Regardless of the focus, each new report meant hours sorting through data and organizing it for their internal team or respective client.

These hours are now a matter of minutes, and often, the reporting is already done for the Careficient team, like in the automated daily email Gonell receives on expected revenue. The software can also notify the team when patient eligibility has changed, which is important for Medicare timely filing. Notice of admission and notice of election for home health must accurately reflect the claim details and submission timing. With built-in reporting, the Careficient team can stay on top of coverage changes and any necessary action needed on their claims.

With the added power of RCM Intelligence, Careficient’s newfound reporting capabilities are a significant upgrade from the manual work they were doing prior, and the analytics have benefited their internal team as well as their clients.

RCM Intelligence has armed Careficient with the claims management details they need to consult clients as best as possible. This solution helps the team understand how many dollars are expected from a particular payer, what their organization’s most common claims errors are, and more. They can deliver more timely, accurate revenue projections – as often as daily, if clients prefer.

Internally, the team can leverage their data across clients to understand where they may need to educate billers on a particular error or how certain departments can better align on a particular claims management challenge. The analytics help guide their reeducation and support them working together for their clients. “And that’s how I can identify it, with those analytics,” says Gonell.

Our integrated capabilities with Careficient’s EMR software empower the organization to better serve their clients, improve their workflows, and continuously improve their claims management success.

But, the one thing there’s no substitute for is our relationship with them every step of the way.