Claimocity
Medical Billing Veterans

According to 2021 provider survey data by In4Research, the top three answers that hospital and facility-based physicians listed as the main reason for switching medical billing and coding services were:

1. Lower revenue than their peers
2. A lack of transparency
3. Poor coding benchmarks

A follow-up set of questions revealed that poor medical billing data visibility left providers and practice managers feeling intensely frustrated and that a lack of transparency made it difficult to get clear answers on their A/R process.

This went hand in hand with self-reported feelings of collecting less revenue than they felt they should and lower than expected month-over-month and year-over-year bottom-line growth when compared to their peers.

This dissatisfying sentiment was followed closely by reported long-term concerns about the risks of an audit due to an overall or partial lack of confidence in their level of coding efficiency during the charge capture process.

“It’s hard to make good decisions when you are kept in the dark,” says Jim Jensen, COO of Claimocity, “Which is why we offer unparalleled transparency for doctors. And not just for our clients as we offer free coding analysis and high-level process audits for non-customer practices so they can get properly evaluate how their in-house team or outside medical billing and coding service is really doing.” By giving our clients full insight into their end-to-end cycle, we enable a greater level of informed decision-making and cooperative improvement.

This level of micro and macro shared intelligence not only helps to track what they are owed and when they will be paid from the point of care (primarily via mobile charge capture) to the point of claim reimbursement but gives complete access to hundreds of in-process quality control metrics that the smart software and quality control teams are using to proactively identify gaps, inefficiency patterns, and revenue opportunities. “While transparency is key for accountability and practical decision making, coding efficiency is one of the most impactful opportunities for improvement in the revenue cycle,” states Jensen.

According to internally collected data across multiple peer-reviewed case studies, 68.2 percent of hospitalists (including physicians who see over 45 percent of their encounters outside the office) lose an average of 11K in annual revenue to under coding. And just over 37.8 percent face increased risk of an audit by repeatedly over coding encounters, most often by mistake.

Simply put, there is no good audit except the one that is avoided. Even audits that a practice or provider passes are time and energy sinkholes with significant opportunity costs, and failed audits can have crippling legal and financial ramifications. Claimocity offers two solutions to help clients with these issues.

If doctors prefer to do their own coding, then our AIenhanced software and quality control teams monitor the coding efficiency levels on a provider-by-provider basis, and proprietary feedback loops funnel the pattern back to the practice as an opportunity for improvement with a breakdown of incorrectly or under-efficiently coded encounters contributing to the coding efficiency levels that fall into audit risk ranges. We also provide our Practice IQ real-time benchmarking reports that show daily, monthly, and yearly deviations from optimal coding levels, as well as the projected impact this has on revenue.

If doctors prefer to allocate more time to patient interactions or increasing the number of patients they can see, then we offer a full-service automated coding service that enables physicians to outsource the coding to our certified coder team so that they can simply move on to the next encounter.

While transparency is key for accountability and practical decision making, coding efficiency is one of the most impactful opportunities for improvement in the revenue cycle

Our professional billing team reviews the encounter and handles the busy work, ensuring optimal compliance levels, which results in better audit protections and no under coding revenue losses.

There is even an option for providers to toggle the automation on for particularly complicated encounters or when they are strapped for time, allowing doctors to cherrypick which encounters they want to complete and which they prefer the professionals to handle for them.

When asked about what Claimocity is doing to ensure revenue growth, Jensen replied, “Our business model is built on growing with our clients.”

It would be safe to say that 99 percent of medical billing services draw a line that they won’t go beyond. Either they lack the ability, or it’s not profitable to go after every claim, to rework complex denials, to have their teams make dozens of calls (on a single claim), to allocate every resource available, and do whatever it takes to collect everything possible. There is a line where a claim becomes not only financially unprofitable but exceedingly costly to the medical billing services in terms of time and effort.

This line is a key differentiator for evaluating billing services. A big part of the lack of transparency in the industry revolves around an unwillingness by RCM companies and inhouse billing and coding teams to reveal where they draw the line and what revenue is being left on the table.

At Claimocity, we don’t separate profitable claims from unprofitable ones, so there is no line. We believe that doctors should get paid for every single encounter they perform, and we make a point of pride to collect everything.

To that end, we have over 4500 certified coders and RCM specialists on staff working around the clock. This blend of advanced technological infrastructure and a highly proficient array of experts ensures that we have the processing power to get the most claims collected at the highest levels in the shortest time possible.

For example, while the industry average is anywhere from 24-48 hours, our claims go out in an average of 10 minutes after the charge capture process is completed by the doctor.

Best of all, the machine learning algorithm and quality control oversight teams funnel all the data through a series of proprietary feedback loops, which are designed to reveal granular assessments of identified problem areas and realworld growth opportunities. This is only possible because of the high level of revenue intelligence data that comes from state-of-the-art end-to-end RCM analyses.

“We call it having the horsepower to do more,” says Jensen, “And it is a blend of well-designed systems, smart software, and highly experienced industry experts at every stage of the process.”

He goes on to explain that by not differentiating between claims that have financial value verse those that have a financial cost, Claimocity willingly reduces its own short-term profits in favour of maximized short and long-term revenue growth for the client.

“We believe in doing what is best for the doctors that work with us. Our clients see first-hand that we do everything possible to make their lives easier and get them what they are owed. Then when they inevitably grow, we grow.”

He went on to cite multiple internal case studies on hospitalist practices that showcased mutually beneficial revenue trend lines as well as ancillary variables studied such as added providers, expanded weekly encounter averages, improved coding efficiency levels, and increased revenue collection efficiency levels.

“When you tell people the truth, show them the data, and do everything you can to help them save time and make more money,” Jensen concludes, “you get well informed customers who understand how much you value them and can make informed decisions about what is best for their practice.”