Like many medical billing companies, Enhanced Revenue Solutions (ERS) struggled to keep up with changing regulations and payer reimbursement rules that often occur without notice. They turned to eSolutions’ TITAN to help them more efficiently work with healthcare providers. TITAN helped ERS quickly identify client problems with real-time, transparent insights. ERS has helped providers across many states and specialties pinpoint issues causing denied and rejected claims.
Enhanced Revenue Solutions (ERS) is a full-service revenue cycle management and billing company located in Houston, Texas, that serves multi-specialty practices across the country. As a boutique revenue cycle management service, ERS reduces the amount of time and energy physician specialty practices spend on submitting claims and chasing payments. ERS increases the effectiveness of physicians’ billing operations, enabling them to concentrate on the clinical aspects of their practices by significantly reducing the amount of administrative red tape usually required for medical billing and collection.
Payer reimbursement rules change frequently and often without much – or any – advanced notice. Providers often learn about the reimbursement rule changes when their claims are denied for no apparent reason. Researching why claims are denied, correcting them and resubmitting them is a tedious and costly process that ultimately increases accounts receivable days and impacts cash flow.
Although these payer rule changes can create challenges for a single physician practice, they become a large obstacle for an outsourced billing services company that may have dozens or hundreds of client practices. For ERS, these challenges prompted the outsourced billing service to seek a solution.
The Solution – TITAN Comparative Analytics
ERS selected TITAN as a revenue cycle management solution that provides their team with actionable reimbursement and compliance insights, proactive notifications, and analytics that offer a transparent view into essential business metrics. TITAN’s powerful system analyzes more than a decade of historical claims data from providers across the country. The solution is deployed via a software-as-a-service (SaaS) model, so no hardware or software installation is necessary. TITAN analyzes ANSI 835 Electronic Remittance Notices for benchmarking against regional peer practices, based on specialty and geography. The solution delivers crucial information to help refine day-to-day processes that reduce denial rates, accelerate cash flow, increase administrative efficiencies, and anticipate audits.
TITAN allows ERS to identify and correct its clients’ problems quickly. “We had one of our clients do a major computer conversion where they were responsible for the configuration of the system. After getting the system up and running, they experienced a huge number of rejections for a particular CPT code,” Kristeen said. “By using TITAN, we easily identified that they forgot to enter their CLIA code number during the system configuration, which caused the rejections. We input the CLIA code and got the claims resent right away.”
In addition to its real-time and historical analytic capabilities, TITAN arms practices with proactive information by providing physicians, administrators and staff with customized weekly or monthly insights. These electronic notifications target areas for improvement, ranging from financial performance to staff productivity.
“The insights that we get from TITAN help us focus in on potential problem areas that our clients may be experiencing. For example, we suspected that one of our clients was consistently underbilling, and we were able to use TITAN to see what the allowable billing was for that procedure by payer,” Kristeen said. “This type of proactive information allowed us to talk with the client and suggest to them that they should evaluate how they’re coding that procedure, since they might be leaving money on the table.”
“By using TITAN, we easily identified that they forgot to enter their CLIA code number during the system configuration, which caused the rejections. We input the CLIA code and got the claims resent right away.”
In another scenario, TITAN helped ERS quickly identify a payer rule change that was causing numerous rejections for a client. “The payer decided in mid-stream that — going forward — they would require a certain modifier on EKGs performed in the office,” Kristeen said. “So our client, a cardiology practice, started getting numerous rejected claims. This was a big problem because EKGs at a cardiology practice represent a lot of revenue. By using TITAN, we were able to quickly find out why the claims were rejected.”
Kristeen also added that TITAN is a valuable tool for a company like ERS that works with providers in multiple states. “We’re able to detect rule changes by state entities and all the payers across the nation,” she said.
“By using TITAN, we were able to quickly find out why the claims were rejected.”
ERS expanded its use of TITAN so client issues can be queued directly to TITAN. For example, ERS assigns specific client problems to employees, or sends work to specialists by claim denial type. “With TITAN we can approach our work from a global perspective and get issues resolved faster,” Kristeen said.