Low Reimbursements? Streamline Ophthalmic Billing with Thinkitive's EHR System

Overview

The renowned ophthalmology practice, based in the United States, boasts a prestigious legacy spanning over a decade. With a robust presence across various locations, they are acknowledged as a leading provider of specialized ophthalmic care. Their extensive team of experienced ophthalmologists caters to a weekly patient population ranging from 650 to 700 individuals. However, facing challenges with their charge-based EHR system, the practice struggled to cope with their increasing patient count and billing inefficiencies, and the client sought to develop a new EHR solution.

Additionally, the lack of an efficient billing system led to issues with low reimbursement rates, prompting the client to explore an EHR solution with integrated clearing house and billing features to address these challenges effectively.

Business challenges

1. Scalability Issues:

The existing EHR system struggled to accommodate the growing patient load, resulting in inefficiencies in managing the increasing volume of patient data and appointments.

2. Billing Inefficiencies:

The lack of an efficient billing system led to issues with low reimbursement rates, which impacted the organization's revenue stream and financial viability. Manual billing processes may have contributed to errors, delays, and missed opportunities to maximize reimbursements.

3. Low Reimbursement Rates:

Due to billing inefficiencies and the lack of an efficient billing system, the client experienced challenges in maximizing reimbursement rates for services rendered, resulting in financial strain and reduced revenue.

Solution

As per the clients requirement we have developed a comprehensive EHR system with advance billing feature :

1. CPT codes tailored for ophthalmology

The provider encountered difficulties in determining the correct CPT codes for the treatment offered. To address this issue, we have created a secure database integrated within the EHR system, specifically designed to store ophthalmology-specific CPT codes along with detailed descriptions. This database comprises a comprehensive range of CPT codes covering a wide array of ophthalmic examinations, treatments, and surgical procedures.

2. Streamlined Insurance Verification and Claims Processing

To enhance reimbursement rates, it is crucial to confirm insurance coverage prior to proceeding. In the feature we have developed and implemented, real-time insurance verification functionality is integrated with the insurance database. This feature enables generating and submitting claims directly from patient records, ensuring accurate inclusion of claim information and selected CPT codes for submission. Additionally, we have incorporated a claim tracking system feature to provide updates on all claim-related activities.

3. Clearinghouse Integration

Integration with the clearing house will be beneficial in getting a higher reimbursement rate. Our team has delivered a feature that streamlines the clearing house integration process. Integration of the EHR system with a clearinghouse is possible using secure APIs.

We developed a mechanism that helped translate and map data from the EHR system into the required format for clearing house claim submission. This made it possible to get feedback from the clearing house regarding claim acceptance, rejection, and required modifications.

Value Delivered

• A 20% reduction in total expenses:

  It was observed following the implementation of the comprehensive EHR system, reflecting a notable decrease in costs for the client. This reduction encompassed subscription fees and operational overhead.

• Improved Billing Processes:

  The features provided will contribute to the streamlining of billing procedures, resulting in increased accuracy and efficiency in billing. This will lead to a reduction in errors and delays during claim processing, ultimately enhancing the clinic's ability to manage patient billing while ensuring compliance with regulatory standards.

• Increased Operational Efficiency:

  The implementation of the medical billing features delivered will alleviate administrative burdens and enhance workflow efficiency for the client's staff.