The United States comprises about 50 states and more than 3100 counties. Many of the Public Health clinics across these counties have relied on legacy systems to manage their Electronic Health Record (EHR), Practice Management System/Revenue Cycle Management (PMS/RCM) needs, and a few clinics still use paper-based systems. To efficiently manage the public health workflow, it was necessary to implement a secure, state-of-the-art, HIPAA-compliant cloud-based system that can handle clinical workflow PMS, RCM, Claim Life Cycle Management, and Payment Postings.
The workflow and modules of public health clinics are distinct from those of private clinics and hospitals. Thus, to meet the requirements of public health clinics and accommodate various state-specific needs, an integrated system of EHR+PMS (expEDIum Medical Billing® + Patagonia Health® EHR) was developed. This combined platform successfully migrated public health clinics from legacy software to modern platforms.
expEDIum Medical Billing® has exhaustive PMS features with a proven track record in improving the payment reimbursement cycle from various insurance companies (both Government and Commercial) with transparency that helped the public health clinics manage the revenue much better than their legacy and paper-based systems.
Customer Story
expEDIum is currently being used by Public Health Departments/Counties across various states in the United States of America. As most EHR+PMS systems were designed for private clinic/hospital workflows, public health clinics were searching for secure, cloud-based systems that could accommodate their specific workflows, the nuances involved in various claim billing lifecycles, and at an optimal cost of ownership. They required a system that could handle more patients and process claims more efficiently, ultimately speeding up their revenue generation.
Our integrated Product offered the relevant public clinic features with exceptional support. It is open to making the necessary modifications to meet the requirements of public health clinics, even if it is not available off the shelf.
Challenges Customers Faced
The legacy system required improvement in various features that either needed to be present or inadequately implemented, resulting in partial or poor functionality. These features were entirely covered in Patagonia Health's EHR, coupled with expEDIum PMS/RCM integration.
- Support for sliding fee scales and associating with state-specific public health programs across multiple modules. This is one of the most important features in Public Health, where the system should be able to configure state-specific programs used by various counties for a given state.
- Support configuring patient-specific sliding fees (SFS) with programs and the program-specific waive-offs applied on service charges. The system should support configuring various programs and the percentage of charges that can be waived off (SFS %)
- Support for sliding fees in claims. When a super bill is created, these programs and waivers should be applied so that they are reflected in the claim.
- Support for billing and reimbursement of claims for Medicaid, Private/Commercial Payers, and Contract Payers with special handling of confidential and non-confidential claims and support for secondary identifiers (legacy identifiers used before NPI) in the 837P and 837I claim transactions to communicate with legacy MCO adjudication software.
- Various Public Health specific reports for aging and billing. Insurance Payments, Cash Postings, remittance reports, etc., can be filtered and grouped by SFS Programs and other SFS-related fields.
- Real-time Insurance Eligibility Verification (IEV) – The system should be able to verify insurance eligibility in real-time (in addition to batch eligibility) to increase the efficiency of the staff and avoid rejections/denials at a later stage.
- Transparent Error, Rejection, and Denial Management of Claims.
- Better secondary claim visibility and single button secondary billing. The system also supports cross-over payment posting by auto-generating secondary claims and posting adjudication details on secondary claims.
- Automation of EDI Claim Transactions and Auto-reconciliation of responses – The claims are bundled in HIPAA X12N ready 837P, 837I EDI transactions and transmitted to clearinghouses (even if the payer supports paper claims) in a scheduled automated mechanism, thereby reducing manual efforts and overheads.
- Support for outsourced Paper claims printing and in-house printing as well.
- Support for posting manual and automated remittance advice (ERAs using HIPAA X12N 835 and EOBs).
- Invoicing Contract Payers – Feature to generate contracted payer invoices and payment posting.
- Support for Self-Pay claims.
- Configuring and using customized Ledger Transactions, standard transactions, and receipt generation.
- Support for state-specific (NC and MD states) Debt Set Off/Patient Collection Modules.
- Friendly Patient Data Migration with Balance due and financial data migration.
- Transparent Patient Billing/Statements.
Reasons to Choose Patagonia Health®’s Public Health EHR + expEDIum PMS/RCM
The decision made by public health clinics to choose our Product is based on the response to the RFPs with the details on the existing features, questions on the various standard requirements, custom requirements, and other details, including pricing of the combined EHR+PMS integrated product. Only a few products in the market are compatible with public health clinic needs, making Patagonia Health® EHR and expEDIum PMS integrated products one of the popular products in the market for public counties across the USA.
Our fully integrated system includes Electronic Health Records (EHR), Practice Management (PMS), and Billing systems (RCM). expEDIum Medical Billing® is a PMS, RCM, and Medical Billing system that supports many specialties across the healthcare industry and can connect to multiple clearinghouses and MCOs for claims and insurance eligibility inquiries. However, we are currently using Office Ally® as our preferred Clearinghouse. It is seamlessly integrated with Patagonia Health® EHR to offer a complete end-to-end product with standards-based clearinghouse access built-in. This system (EHR side) is federally certified through Meaningful Use Stage 3 and promotes interoperability functionalities where it has interfaces with other healthcare applications and vendors, including labs and immunization registries.
How do the Public Clinics use the expEDIum Product?
As a healthcare technology and RCM company, expEDIum has a wealth of experience in public health workflows spanning over a decade. This encompasses claim cycles with various payers (government, MCOs, and private payers), enrolment processes for EDI transmission and ERAs, claim payment and denial/rejection patterns, and check/EFT cut-off cycles. Additionally, our exceptional team offers 24/7 support for our Product and RCM services for specific clients. With a commitment to this objective, we created an integrated EHR+PMS/RCM system that prioritizes public health, adheres to industry standards, is user-friendly, easy to train, and customizable based on user roles/staff. Also, our EHR Partner, Patagonia Health®, has received the Stevie Award for Best Sales and Customer Service for several years.
Initially, we faced challenges customizing our existing EHR+PMS to handle complex public health workflows. We also encountered difficulties obtaining approval for claim transactions from MCOs/Payers as they required support for specific secondary identifiers included in the claims. However, we overcame these obstacles and delivered a product suitable for many counties in the US, including specific state and county-specific customizations.
.... It certainly has helped us as far as our reimbursements. In six months, we've increased our reimbursements by 13% because of our ease with electronic billing. We can go in, review the claims, send them through immediately with a click of a button, and they go out that quickly. Prior to Patagonia + expEDIum, we did what was called batch billing. It was very time-consuming. With Patagonia, we can send the claims through more efficiently and quickly. It's not unusual for us to send a couple of hundred claims through in a day. Last year, we added our behavioral health department to Patagonia + expEDIum for billing, encounters, and progress notes. Once we started doing that, we estimated within a year that we've probably increased our reimbursements by $102,000...
-Sarah Petr, Revenue Cycle Manager, Harford County Health Department
.... One of the biggest advantages has been the Clearinghouse and funneling all the claims to one location. With our previous system, we could do electronic billing, but we had to funnel our claims to the different pay sources in different ways...
-Tammy Griffin, Billing Specialist, Cleveland County Health Department
.... Before Patagonia + expEDIum, our clinic struggled particularly with billing. We did not have a robust system. We received quite a few denials. Patagonia + expEDIum has a mechanism for checking those errors...
-Ann Absher, Health Director, Wilkes County Health Department
Results
The Product is designed generically, covering several public health counties across the USA, with specific modifications for a few counties. It has been instrumental in facilitating the migration of customers from legacy systems that are less user-friendly and require more manual intervention to a modern, secure, transparent, user-friendly, and feature-rich system that offers faster payment reimbursements and better productivity and revenue management. Additionally, the system provides a lower total cost of ownership (TCO) than other systems.
As a result of continued success with several public health clinics, expEDIum Medical Billing for Public Health integrated with Patagonia Health's Public Health EHR has been adopted by over 220 Public Health clinics across 29 states. These clinics are processing 1.2 million claims and around 4M HIPAA transactions annually with around 5500 active users and 2000 providers. Over the past several years, these clinics processed around 8M claims, with $830M as total claim charges and about $372M reimbursed. These statistics demonstrate the impact of expEDIum, along with Patagonian Health®’s EHR, on public health counties, providing crucial services to many users and providers in the healthcare industry.
.... In the past, you were lucky to get your payments back within three weeks to four weeks. Now, it's one, no longer than two. These are true patient statements. We have no patients calling to question what this means, what that means. We can print a batch of statements and tell exactly which ones go to debt set off. Patagonia's reports are straightforward to understand, efficient, and trustworthy. Patagonia is Meaningful Use compliant. We've taken advantage of the federal incentive money to help pay for our system and upgrade some of our system components to meet Meaningful Use requirements....
-Cindy Evans, Central Billing Manager, Appalachian Dist. Health Department
.... Our previous system had separate software for billing processes, and we had a separate system altogether for clinical charting. Clinical charting was cumbersome and very clunky. The key highlights with Patagonia Health are that it is an all-in-one system, all-inclusive- no more duplicate entry, and no piece-mealing it all together...
-Patricia Artis, RN, Nursing Director, Nash County Health Department
The following infographics show the states, the count of counties using Patagonia EHR, and expEDIum PMS/RCM.
