CUSTOMER STORY
Medicare Billing, Streamlined:
How MGM Healthcare Transformed Their RCM Workflows With Inovalon
Background
Like many providers, MGM Healthcare used to manage their Medicare claims through the Direct Data Entry (DDE) system – an antiquated, tedious workflow where billers have to key in claims one by one. This process often led to delays in submissions, corrections, and payment, but at the time, was the only way to submit claims to Medicare.
That is, until the organization implemented Inovalon’s Claims Management Medicare Pro™. Revered by A/R Manager, Marco Ochoa, as “an amazing system,” this software transformed MGM’s Medicare revenue cycle management from slow and error-prone to quick, efficient, and more accurate.
Better Software, Easier Billing
Claims Management Medicare Pro delivers a modern, easy-to-use alternative to the DDE FISS system. This software gives providers one place to create, submit, correct, and track all their Medicare claims, with intuitive claims correction guidance and an industry-leading rules engine that ensures billers are always working claims in accordance with the latest Medicare guidance.
For MGM, this solution has led to greater efficiency, staff engagement, and visibility. In Marco’s words: “I’ve been working in this business for over 20 years, and Medicare is still using the DDE FISS system, which is very challenging for the new generation to learn. I’ve never found another system to get claims to Medicare. Claims Management Medicare Pro is amazing – we can do the same thing, but in a better way.”
“I’ve been working in this business for over 20 years, and Medicare is still using the DDE FISS system, which is very challenging for the new generation to learn. I’ve never found another system to get claims to Medicare. Claims Management Medicare Pro is amazing – we can do the same thing, but in a better way.”
— Marco OchoaA/R Manager
At MGM, “Better” Means:
- No more manual data entry. Billers can now work claims with clear guidance, in a system that is easier to understand than the traditional “Medicare green screen.”
- Easier onboarding. Rather than learning an outdated system, billers are equipped with a modern, intuitive alternative to learn how to manage Medicare billing from start to finish.
- Enhanced claims tracking. MGM can easily see what is happening with every single claim, such as whether it’s been paid, denied, or rejected. This enhanced visibility to claims status and predicted payments mean greater opportunity to adjust Medicare billing processes to address areas of leakage, and to capitalize on the successful parts of their billing process even more.
PointClickCare and Inovalon Integration
Through our integrated capabilities with PointClickCare, MGM is able to extend their Medicare claims management success even further. This relationship allows MGM to export claims directly from PointClickCare in to Claims Management Medicare Pro, where billers can then manage all claims and submit directly to the appropriate clearinghouses and payers. And when claims are paid, payments are reflected in PointClickCare – giving MGM one source of truth to understand their Medicare revenue performance.
“The best customer service”
In addition to being an amazing alternative to DDE FISS, Claims Management Medicare Pro is backed by a team of industry experts and leaders in customer service. Ochoa shared, “Anything I need is right there and we get responses right away. That’s really great customer service. I’d say it’s the best.”
Transform Your Medicare Claims Management
Get out of the Medicare green screen and into a solution that simplifies submission, increases accuracy, and delivers greater visibility to claims status through payment. Discover the power of Claims Management Medicare Pro.
