US Eye Corrects 67% of Charges with Claim Automation
Manual claim production processes strained the US Eye team. They turned to NextGen Healthcare for a system that would help simplify and expedite workflows across their organization.
US Eye
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 Solutions:
- NextGen® Rules Engine
Simplified implementation
NextGen Rules Engine delivered a centralized knowledge base and charge posting process across locations, simplifying implementation
Increased automation
Implementing the NextGen Rules Engine eliminated US Eye's reliance on manual processes and integrated automation into their workflows
Impactful data
Operational and clinical teams have leveraged targeted data to improve the downstream revenue cycle and build provider confidence
Stronger outcomes
NextGen Rules Engine corrected 67% of issues automatically, avoiding high-level denials and strengthening US Eye's overall workflows
Slow, manual processes
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 EHR, manually pushed from EHR to the 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.
Standardized, automated technology
Technology that enables system and process standardization helps PE-backed medical groups scale their operations.
NextGen® Charge Review Rules Engine (NextGen 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.
Charges processed with rules
Decrease in denials
Reduction in charge lag
Better workflows. Better results.
As a result, 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.
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