CASE STUDY / FINANCIAL MANAGEMENT / OPHTHALMOLOGY
US Eye Corrects 67% of Charges with Claim Automation
THE CHALLENGE
US Eye relied on a manual, four-step process to produce claims. This resulted in thousands of charges that had to be reviewed by the charge poster in the electronic health record (EHR), manually pushed from EHR to the practice management (PM) system, scrubbed through the limited PM edits, and finally run through custom edit reports to produce the cleanest claims possible. This daily process took their 22 charge posters an average of 17 hours per day.
As a private equity-backed medical group, bringing on new practices required staff to be trained to use US Eye’s processes; many times, these processes varied greatly from how they had posted charges before.
Coupled with the fact that implementation mainly consisted of sharing the charge poster’s knowledge and undocumented processes, transitions were difficult and created a steep learning curve. US Eye needed to simplify their charge processes and create a central knowledge repository where everyone, including new staff, had access to best practice coding and billing procedures.
CLIENT PROFILE
US Eye
Background: US Eye is a multi-specialty eye care practice focused on providing an unparalleled patient experience. As a physician-led entity, they look to partner with practices with similar goals for patient outcomes. With over 50 locations and more than 100 providers across four states, they aim to streamline workflows and improve overall services across their practices.
NextGen Healthcare Solution:
NextGen® Charge Review Rules Engine
HIGHLIGHTS
- Reduced charge lag from 2.56 days to 1.5 days
- 11% decrease in denials in one calendar year
- Streamlined and automated claim processes across practices
THE SOLUTION
Technology that enables system and process standardization helps PE-backed medical groups scale their operations.
NextGen Charge Review Rules Engine fused the US Eye team’s billing and coding expertise. The rules engine allowed them to automate their manual processes while also serving as a collective knowledge base for the charge posters. This eliminated the learning curve for new staff and minimized their reliance on word-of-mouth training and implementation.
THE IMPACT
US Eye was able to process 94% of their total charge volume with rules, with 67% of those issues being automatically corrected by the system. By avoiding high-level denials, they reduced the workload for their collectors and increased engagement through feedback systems with collectors and charge entry teams. This has led to the creation of new rules that continue to improve workflows.
These changes also improved operations for clinical and operational teams. By using data to provide feedback, they have positively impacted their revenue cycle downstream. The confidence and trust gained with providers through the use of a tool that validates encounters before they are submitted has led to more timely payments, improving operations and outcomes across their organization.
“I have over 30 years’ experience in healthcare, with approximately 25 of those being in a revenue cycle role. During this time, I’ve worked for large and small companies, having had the opportunity to take part in a variety of improvement projects. Our team at US Eye agrees that the Charge Review Rules Engine implementation was easily the best we’ve ever experienced. We are thankful for our ongoing partnership.”
Ellen Grasso
VP of Revenue Cycle
US EyeFM_041526_USEye