The client is a leading US-based organization dedicated to providing top-tier aesthetic care services. They have cultivated a team of skilled aesthetic care specialists with a strong presence in the Southeast region and over a decade of experience. They operate with a significant intake of 200-300 patients weekly. Recognizing the need for advanced technology to support their expanding practice, the client actively seeks an Electronic Medical Record (EMR) solution.
This organization's primary issues were payment processing and medical billing procedures, such as complex billing requirements, reimbursement issues, and compliance and regulations. The client wants to streamline billing processes, improve revenue cycle management, and ensure compliance with complex healthcare billing regulations.
To obtain all of the requirements, a group of SMEs and business analysts connected with the clients multiple times. The team has created a feature list that outlines the project scope based on the information acquired about the client's requirements. The client was shown that feature list, and after a few modifications, we received their approval.
After all the required procedures, our team has come up with a solution that carries essential key features-
- Aesthetic-specific CPT Codes
- Seamless Clearinghouse integration
- Streamlined payment process
1. Aesthetic-specific CPT Codes
Our team has developed a feature of that assists in customizing to include aesthetic-specific Current Procedural Terminology (CPT) codes. To ensure accurate coding for billing, we have implemented a dedicated section within the system for aesthetic treatments, procedures, and services.
Also, we have implemented a code lookup database, which helps ensure quick and accurate code selection. It will auto-populate the code as per the provided services.
2. Seamless Clearinghouse integration
To provide seamless service for communication between the EMR system and the healthcare clearinghouse, we have implemented Health Level Seven (HL7) standards. To make efficient exchange of billing information and to get claim status updates, we have implemented Electronic Data Interchange (EDI) transactions. It will be helpful in terms of getting clear updates on the claim status from the clearing house.
3. Claim Scrubbing
Our technical team has implemented a feature of scrubbing claim, which involves a combination of software, algorithms, and data validation processes. We have implemented a rules engine that contains a set of rules and logic based on insurance policies, regulatory requirements, and best practices. These rules define criteria for accurate coding, compliance, and other factors relevant to claim submission.
Also, we have integrated the existing system with relevant medical coding standards such as ICD-10 (International Classification of Diseases, 10th Edition) and CPT (Current Procedural Terminology). This integration ensures that the system recognizes and uses standardized codes for diagnoses and procedures.
4. Streamlined payment process
To offer a seamless online payment process, we have provided a tool that helps to integrate the EMR system with secure payment gateways. Using this feature, patients can make payments directly from the patient portal. Also, we have provided a feature that helps to store credit cards in the system for easy making of payments using encryption. We have provided patients with access to billing portals that allow them to view and pay bills online.
Streamlined Billing Procedures
The provided features helped providers streamline billing procedures with enhanced accuracy and efficiency in billing, reducing errors and delays in claim processing.
Improved Operational Efficiency
Implementation of delivered features of medical billing resulted in reduced administrative burden and improved workflow efficiency for the client's staff.
Enhanced Revenue Cycle
A specialized billing feature will assist in improving the revenue cycle by efficient charge capture; it assists in improved cash flow and reduced claim denials.
Seamless payment process
Using the provided features helps patients make payments seamlessly and securely. It is also beneficial for providers to send reminders for any pending payment.