Introduction
This case study explores how a public health county in Virginia transformed its healthcare operations with expEDIum Medical Billing. Facing challenges with a legacy Electronic Health Record (HER) and disparate PMS/RCM systems, the county sought an integrated solution to enhance their Patient and RCM workflow, improve financial controls and collections, and ultimately, better serve their patients.
They wanted a solution that addressed multiple Health Department areas, including:
- Coordination of health care services
- Documentation of healthcare encounters
- Practice management, including event scheduling.
- Workflow management and workload management
- Revenue cycle management, including registration, payer information, invoicing/billing based on encounter documentation, and resource use.
- Maintenance of paper records for processes for many clinical services; usage of legacy PMS for some limited functionality, age and limitations of these legacy systems and concerns about long term maintenance of such systems and the data it contained.
Customer Story
A public health county from Virginia which was using a legacy Electronic Medical Records (EMR) and billing system has migrated from their legacy systems, to the integrated EHR with expEDIum Medical Billing Software for their PMS/RCM needs across all specialties, which is white-labeled and seamlessly integrated with Public Health EHR from a North Carolina based EHR Vendor.
The public county's workflows, previously handled manually using legacy systems that mirrored the Fairfax County Health Department's initial goals, now benefit from an integrated solution with a customized expEDIum PMS/RCM built in. This integration aligns with the Fairfax County project's aim to improve coordination of services and streamline documentation.
By implementing a similar solution to the Fairfax County Health Department's project goals, the Virginia public health county achieved significant improvements in their healthcare operations. This demonstrates the effectiveness of integrated EHR+PMS platforms in streamlining workflows and enhancing patient care.
Challenges Customers Faced
Prior to implementing expEDIum Medical Billing Software, the Virginia public health county grappled with inefficiencies stemming from their legacy systems. Their existing EMR and separate PMS/RCM system lacked integration, creating data silos and manual workflows that burdened staff and hindered financial performance.
Specifically, the county faced the following challenges:
- Disparate Systems: The lack of integration between the EHR and PMS/RCM system forced staff to re-enter data manually, leading to errors and delays.
- Manual Processes: Many critical tasks, such as insurance posting and late payment handling, were handled manually, consuming valuable staff time and resources.
- Limited Reporting: The legacy systems offered limited reporting capabilities, making it difficult for the county to gain insights into their financial performance and identify areas for improvement.
- Inefficient Revenue Cycle Management: The disconnected systems hindered the county's ability to track and collect payments efficiently.
- Scheduled Daily Report Inefficiency: They lacked an automated system to transfer daily payment data from RCM/Billing to FOCUS (County’s Enterprise ERP Solution) and it was time-consuming and error prone.
These challenges not only impacted the county's operational efficiency but also limited their ability to deliver optimal patient care.
Reasons to choose expEDIum Medical Billing
The Virginia public health county embarked on a thorough evaluation process to identify a solution that could streamline their healthcare operations and improve financial efficiency. Their outdated EHR and separate PMS/RCM system created significant challenges, and they sought a unified platform to address these issues.
Exploring Options:
The county explored various solutions in the market, including both standalone options and integrated EHR+PMS offerings. However, expEDIum stood out due to its unique set of public health features and functionalities:
- Seamless EHR Integration: Unlike other options that might require complex integrations, expEDIum offered a white-labeled solution that seamlessly integrated with their existing Public Health EHR. This eliminated data silos and ensured real-time data flow between systems.
- Comprehensive Functionality: expEDIum offered a robust set of features beyond basic billing functionalities. The ability to customize patient and claim ledgers, track payments across facilities, and automate late payment handling addressed their specific needs and streamlined workflows.
- Enhanced Reporting: The custom financial reports provided valuable insights into their financial performance, empowering the county to make data-driven decisions and optimize revenue cycle management.
- Improved Efficiency: The automation of manual tasks freed up staff time, allowing them to focus on delivering quality patient care.
The expEDIum Advantage:
Through its comprehensive off the shelf public health clinic features, seamless integration capabilities, and commitment to streamlining revenue cycle & medical billing workflows, expEDIum emerged as the clear choice for the Virginia public health county. They were confident that expEDIum would not only improve their financial performance but also enhance their overall healthcare delivery experience.
Customizations done for Fairfax County Health Department
Here are the additional customizations done in expEDIum to transition the customer from their legacy system:
- Customizations on Patient and Claim Ledger: This included facility-based receipt numbers and multi-dimensional Procedure Code/Transaction/Payer Type specific GL (General Ledger) Codes. Service Line split of patient payments.
- Customization on Insurance Posting Module: This enabled tracking of various types of payments and the facilities from where the payment is collected.
- Various Custom Financial Reports These reports were based on the customizations added in the accounting ledger.
- New Late/Pending Payment Module: This module automates finding pending payments and applying fines, interests, and other charges.
- Custom Reports on Pending Patient Payments: This allowed for generation of late notices and final notices to patients.
- DTA Collection Reports: Department of Tax Administration collection report. In the future, we are expected to take up a seamless Interface to County Department of Tax Administration (DTA) for collections.
- Scheduled daily report: A Daily Data dump from RCM/Billing to FOCUS (County’s Enterprise ERP Solution) to report payments received across GL (General ledger) Accounts & Cost Centers by each office location end of each day.
- Data Migration: Patient demographics and financial data were migrated from their legacy system.
Benefits to the County by Using expEDIum (features other than customizations)
Beyond the customizations implemented, expEDIum offered the Virginia public health county a range of benefits that improved their healthcare operations:
- Improved Claims Submission and Reimbursement Rates: expEDIum's automated claims scrubbing and submission features ensured cleaner claims and reduced denials, leading to faster reimbursements and improved cash flow.
- Enhanced Patient Engagement: This enabled tracking of various types of payments and the facilities from where the payment is collected.
- Strengthened Security and Compliance: These reports were based on the customizations added in the accounting ledger.
- Scalability and Flexibility: This module automates finding pending payments and applying fines, interests, and other charges.
Results
The implementation of expEDIum Medical Billing with a customized EHR integration yielded good results for the Virginia public health county. After going live in April 2023, the solution has yielded good results across the organization.
- Increased Efficiency: Automating manual tasks freed up valuable time for the 16 providers and 90 users across 9 facilities (including district offices, health centers, pharmacy, and lab). This allows them to focus on delivering exceptional patient care and core competencies.
- Improved Financial Performance: Reduced claim denials, faster reimbursements, and optimized revenue cycle management led to a substantial financial boost. They processed over 40K claims valued at $5.6 million for 40,000 patients across 100+ payers, along with handling 60K patient transactions over the same period. Notably, the system effectively supports 24 Sliding Fee Schedule (SFS) programs, ensuring proper billing for patients who qualify for financial assistance.
- Improved Patient Satisfaction: Streamlined workflows, online appointment scheduling, and better communication resulted in a more positive patient experience.
- Data-Driven Decision Making: On-demand custom reporting capabilities provided valuable insights into financial performance and operational efficiency, empowering data-driven decision-making.
It is anticipated that implementation of a true EHR for the public health clinic would lead to improved billing practices, increased efficiency of operations and increased provider productivity.
We believe this successful partnership between a public health county and expEDIum paves the way for similar healthcare organizations to leverage integrated EHR+PMS platforms to optimize their operations and deliver exceptional patient care. Ready to streamline your healthcare operations and improve financial performance? Schedule a free demo to see how our integrated platform can optimize your operations and improve patient care.
Start your free 60-day trial today and see the results for yourself.
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