Reimbursements in health care have gotten more complex with the growing importance of risk-based, value-based plans and behavior change. In this video interview, Tiffany Waltos, Director of Revenue and Analytics at Community Health Care in Northern Ohio, discusses today’s pressures on revenue cycle management and ways health care providers can respond.
Under value-based care, payers require providers to capture different information: not just procedures performed, but what they actually do for patients. Different payers specify their requirements in different ways which can make things challenging. Plus, differences in doctors’ documentation practices have to be reconciled with the requirements for each provider to be reimbursed.
Waltos points out that coding inconsistencies are noticed by patients as well as payers, because visiting one specialist might lead to a higher bill than visiting another for the same condition.
Community Health Care, with 19 offices and 65 providers with a focus on primary care, realized they needed to put clear rules in place for coding and billing and create consistency among doctors so that submissions would be approved the first time around. One of the big things that helped them do this was to contract for the RCM (Revenue Cycle Management) consulting services offered by their eClinicalWorks EHR vendor. Working together they were able to address some of the more complex issues they faced and improve their RCM efforts.
Waltos calls the contract with eClinicalWorks as “very collaborative.” Community Health Care provided a list of areas where they felt they could use improvement, such as in rules engines and eligibility testing, and eClinicalWorks independently made suggestions.
Community Health Care is employing AI as well. It can find out quickly why a submission was been denied, and even create a new rule engines to prevent the problem from re-occurin. Ambient voice recording can also suggest appropriate diagnostic and PT assessment codes.
Check out our interview with Community Health Care to learn more about their RCM efforts and how eClinicalWorks consulting services is helping them optimize their RCM.
Learn more about Community Health Care: https://www.chci.com/
Learn more about eCW: https://www.eclinicalworks.com/
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