Universal Home Health & Hospice Care specializes in providing a full continuum of in-home services to meet the needs of patients. However, while it was caring for patients, the organization found itself in the unenviable position of losing money because insurance companies were losing track of its claims. But since Universal began using eSolutions’ Medicare File Transfer, Medicare Claims Editor, ClaimRemedi clearinghouse, it has improved its revenue cycle and claims tracking.
Reduction in RTPs
Clearinghouse payer acceptance rate
of claims are paid within 60 days
With its home office in Bellefontaine, Ohio, and offices in Kenton and Urbana, Universal Home Health & Hospice Care has been serving patients since 2006. Its mission is to help individuals improve function and live with greater independence; to promote a patient’s optimal level of well-being; and to help a patient remain at home, avoiding hospitalization or admission to long-term care institutions.
Universal Home Health & Hospice Care has approximately 50 employees and processes about 175-200 claims a month, according to Deborah Farrington, billing reimbursement specialist.
Universal Home Health & Hospice Care was losing money because insurance companies were losing its claims and it had no way of knowing what happened after the claims were submitted. Because some insurance companies have a timely filing deadline of 90 days and don’t process claims for 45-60 days, Farrington said Universal’s bottom line was suffering.
“I would send the claims [to an insurance company] with a cover sheet listing who was in the envelope, and they would say there were some missing on a regular basis,” she explained.
The third-party insurance provider would allow 90 days for Universal to file a claim, and they would take 60-plus days to process. Many times, it took them longer than that, Farrington said.
The Solution – Medicare File Transfer, Claims Editor & ClaimRemedi
All that changed when Universal began using eSolutions’ products: Medicare File Transfer, Medicare Claims Editor and ClaimRemedi clearinghouse. Farrington said Universal has seen definite improvements in its revenue cycle and workflows. The biggest benefit, she said, is being able to see whether an insurance company has received the claims submitted by Universal. Farrington said ClaimRemedi has remedied that problem. She now can see whether the insurance companies accept the claims she submits, and 91% of Universal’s claims are paid within 60 days.
“One claim not being received is more than what we pay eSolutions for a year,” she noted. “I LOVE ClaimRemedi, it is the bomb. I am very excited to be using ClaimRemedi!”
Besides solving the biggest problem of finding out whether and when claims are accepted, Farrington also said her organization now spends less time sending claims to insurance companies, which allows more time for follow-up.
With eSolutions, Universal can send claims to insurance companies that other vendors were not able to send to, and Farrington said that makes a big difference for her organization.
Now, there are no more cases of missing claims for Universal. Since using eSolutions’ tools, Farrington said she has seen a huge reduction in claims being denied by insurance companies because they say they never received the claims. Universal’s denial rate is now less than 1%.
In addition, she said eSolutions offers a host of helpful reports and the reporting makes her job much easier.
“When the CFO calls and wants a projected payment, I just go to eSolutions and pull a projected payment report in a matter of seconds,” she said. “There is a report that shows cancelled claims, which then gives you an opportunity to follow up and see why.”
And knowing why claims are denied or returned allows an organization to fix problems and improve its claim stats, thus boosting its entire revenue cycle.