The healthcare industry is among the fastest growing sectors in the U.S. because of today’s aging population. As the industry undergoes a significant transformation due to changing regulations, resolving the demand for superior Revenue Cycle Management (RCM) solutions has become a challenge. Aiming to improve patient services and efficiency while lowering costs, ABILITY Network provides RCM solutions and API services that simplify Medicare and all-payer claims and eligibility verification for home healthcare agencies, hospices, hospitals, skilled nursing facilities (SNFs), and ambulatory providers.
“With our RCM domain expertise, we work with healthcare providers and assist hospitals, Federally Qualified Health Centers (FQHCs), SNFs, and physicians across the country,” delineates Bud Meadows, EVP and Chief Revenue Officer, ABILITY Network. Using the ABILITY Network comprehensive suite of care coordination and workflow services, customers are able to reduce costs, increase cash flow, and more effectively manage the financial and clinical complexities of healthcare.
Because a large segment of the population is accustomed to working with XML, ABILITY takes providers’ information and converts it to standard transaction ANSI X12 formats, sends the data to CMS, and then returns the content to the provider in easy-to-access XML format through its easy-to-use ABILITY | ACCESS API. “By using this programmatic data retrieval system which allows partners to access CWF eligibility and FISS claims status, customers can be up and running in much less time while saving on the costs it would take to build such a system,” explains Meadows.
Recognizing the dynamic complexities affecting the RCM landscape, the company introduced ABILITY | EASE in 2011. The software service identifies and analyzes Medicare claims status and streamlines billing office workflow to find issues and report on reimbursement status— saving staff hours and increasing visibility to a healthcare agency’s overall financial picture. “EASE automates the time-consuming steps of managing Direct Data Entry (DDE)/ Fiscal Intermediary Standard System (FISS) tasks for Medicare submission and eligibility verification,” shares Meadows.
ABILITY services automate the time-consuming steps of managing the often-complex billing and workflow
processes of healthcare
EASE further manages the Medicare billing process for home healthcare and also alerts clients to possible delays in reimbursement. In one instance, a healthcare agency merged with another agency and needed to manage their business operations with a downsized number of billing staff. During this time, patients shifted from Medicare coverage to a Medicare Advantage program, and the smaller, merged billing staff needed to ensure the changes in eligibility were captured accurately. The agency then approached ABILITY for a solution to handle their revenue cycle and workflow operations. “With the existing staff, the agency had difficulties in processing payments and managing the revenue cycle,” says Meadows. Using EASE, the agency was able to manage the RCM and was alerted to patients who shifted from Medicare coverage to Medicare Advantage. The service saved them considerable staff time. More important, the agency no longer had to deal with delayed reimbursement of claims due to incorrect claim submission. Instead, they were able to submit correct claims the first time.
Staying relevant in a changing market, ABILITY provides SaaS services that are easy to deploy. “Our SaaS myABILITY platform enables clients to interact with us in a smart way,” adds Meadows. ABILITY continuously innovates its services as healthcare shifts from a volume-based to a value-based model.
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