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

Industry

Healthcare , EMR

Technologies

Python ,Angular, TypeScript,REST ,SOAP,Web Services

Overview

The renowned ophthalmology organization, 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 load ranging from 650 to 700 individuals. However, facing challenges with their charge-based EHR system, which struggled to cope with their increasing patient count and billing inefficiencies, the client seeks a new EHR solution.

Additionally, lacking 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 charge-based 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, impacting the organization's revenue stream and financial viability. Manual billing processes may have contributed to errors, delays, and missed opportunities for maximizing 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.

image showing typical workflow of dermatology emr software

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.

-  Database Integration

-  Auto-populated CPT codes with a description

    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.

-  Real-time Verification

-  coverage details

-  co-payments prior to appointments

-  Automated Claim Submission

-  Status Tracking

    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 have developed a mechanism that helps to translate and map data from the EHR system to the required format for clearing house claim submission. Getting feedback from the clearing house regarding claim acceptance, rejection, and required modifications is possible.

-  API Integration

-  Data Mapping and Translation

-  Error Handling and Feedback

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.