Since choosing eSolutions, Faulkton Area Medical Center has streamlined its entire claims submission process, resulting in decreased rejections and denials and improved cash flow.
Claims per month
Decrease in denied & rejected claims rate
Clean Claim Rate
Faulkton Area Medical Center’s story will ring true to most critical access hospitals. Like many rural areas across the country, Faulkton, South Dakota, has a shrinking population that’s growing older, and it’s the only hospital within a 60-mile radius. As its population ages, the busy 12-bed hospital strives to provide quality specialty, acute and rehab services.
The hospital processes up to 1300 claims per month, billing half of those claims to Medicare. Prior to eSolutions, the business office team hand keyed hundreds of claims into the FISS. This left them with little time to check RTP claims – money left on the table. Heather Bode, Faulkton Area Medical Center Business Office Manager, said the process of manual entry was inefficient and time consuming.
The Solution – Medicare Enterprise
In 2012, eSolutions gave Heather a Medicare Enterprise package demo, and she’s never looked back. With Enterprise’s eligibility verification capabilities, the hospital began catching claims that should have been first billed to an Advantage Plan, saving them claim rejections and rebills. The tool also helped the billing team check preventative exam coverage.
Enterprise’s unique claims editor is a priceless feature for the hospital’s team. “It tells you what claims need to be fixed, the whole claim is right there from top to bottom, and it looks like a paper claim so it’s simple to read and follow,” Heather said.
The reporting features included in Enterprise make it easy for the business office to effortlessly share information with administrators. “Our CFO really likes the reporting features because she can see incoming cash flow, which allows her to better forecast,” Heather said.
The hospital couldn’t be happier with the improvements to their revenue cycle and work flow since implementing Enterprise. Heather said the ability to fix claims easily and quickly saves her team significant time, and the hospital is getting paid faster. In fact, since choosing eSolutions, the hospital’s claims paid within 60 days has improved nearly 60 percent. Additionally, they’ve achieved a 95 percent clean claim rate.
Denied and rejected claim rates have decreased thanks to a combination of Enterprise’s features. “Before Enterprise, I didn’t want to go into the FISS and check RTP claims and get them cleaned up,” Heather said. “Now it’s part of our morning routine to check RTP claims in Enterprise to make sure no claims are sitting out there and that we’re getting paid faster.”
The hospital’s business office also counts on eSolutions’ customer service. “Your service is super easy, very user friendly and I can call and get a question answered,” Heather said. “eSolutions is great at educating users and touching base when there are new features or reports.”