Hospital systems face enormous claims processing challenges when there is a lack of coding accuracy and inadequate documentation. Such problems make them easy prey for claim denials, which can cause financial losses amounting to millions of dollars a year. Healthcare facilities are therefore looking for solutions that can integrate the entire process to manage billing and automate claims. These solutions, built on technology, are poised to minimize human errors, process claims submissions quickly and optimize the overall efficiency of revenue cycle processes. This, in turn, allows hospitals to keep their reimbursements paid on time, optimize cash flow and ultimately bolster financial stability so they can go back to where the focus truly belongs — providing high quality care to patients.

Client Background:

An ambulatory care provider in Chicago was facing longer than necessary claims processing times and losing millions, slowing down their revenue cycle. These setbacks resulted from the manual processes and inefficiencies that plagued their revenue cycle. To solve these problems, their end client wanted an end-to-end solution that would make their claims workflow seamless and automated, with the intent to optimize both efficiency and precision, decrease processing times, and improve financial performance.

Key Challenges

• Delayed Claims Processing: The use of manual processes resulted in extended claim submission times, causing delays in reimbursements and affecting cash flow.
• Manual Data Entry, Leading to Errors: Heavy reliance on manual data entry heightened the risk of mistakes, leading to claim denials and additional delays in processing.
• Incomplete Billing Information: Inaccurate or missing billing information frequently resulted in claim rejections, leading to financial losses and increased administrative workload.

Project Goals

• Automate Claims Creation for Outpatient Services: Implement a system to automatically generate claims from patient visit data, minimizing manual involvement and accelerating the billing process.
• Enhance Integration with the Epic Electronic Medical Record (EMR) System: Strengthen interoperability by seamlessly connecting billing systems with Epic EMR, facilitating smoother data flow and optimizing the claims processing workflow.

ClinDCast's Solution

ClinDCast utilized the capability of Epic EMR to offer a comprehensive, end-to-end solution that integrated and automated the client's claims processing:

• Seamless Integration: used API access to link Epic EMR with pre-existing billing apps, guaranteeing smooth data transfer.
• Automated Claims Generation: enabled features that automatically created claims for outpatient services by reading diagnoses, patient histories, prescriptions, and check-in and check-out data. And created a widget in epic to display the application.
• Real-Time Alerts: Implemented alert systems to flag any missing information essential for claims processing, significantly reducing rejection rates.
• Automated Workflow: Established automated processes for claims submission after each outpatient visit, minimizing manual intervention.
• Standardized Processes: Developed streamlined workflows and standard operating procedures to support ongoing efficiency improvements.

Benefits and Results

• Faster Claims Processing: Accelerated the turnaround time for claim submissions, ensuring timely reimbursements.
• Error Reduction: Minimized manual entry errors, significantly improving claim accuracy.
• Operational Efficiency: Enhanced the overall efficiency of the billing process, allowing staff to focus on higher-value tasks.
• Financial Improvement: Reduced financial losses due to claim rejections, leading to improved revenue cycle performance.
• Increased Satisfaction: Boosted organizational satisfaction by providing a more streamlined, automated claims process.

Frequently Asked Questions (FAQ)

What challenges did the facility face before the solution?

Prior to the solution, the facility experienced sluggish claims processing, a high rate of errors from manual data entry, and insufficient billing information, which resulted in financial setbacks and claim denials.

How did ClinDCast’s solution address these challenges?

ClinDCast automated the creation of claims, decreased human error, and ensured more precise and effective claims processing by integrating the facility's billing system with Epic EMR.

In what ways did the solution improve operational efficiency?

The system improved workflow, sped up claims filing, and increased overall productivity by automating claims processing and reducing manual intervention, freeing up staff to concentrate on other important duties.

Contact Us

Learn how ClinDCast can transform your healthcare IT solutions.

🌐 Website: www.clindcast.com

📧 Email: contact@clindcast.com

📞 Phone: 813-279-5538