Choosing an RCM vendor is not just about outsourcing a cost center but creating a partnership that can improve reimbursement by capitalizing on new opportunities in the evolving reimbursement landscape. Piyush and his wife Snigdha Kedia are the founders of EMPClaims with the partnership of over 10 years. Piyush earned his MS in finance and Snigdha Kedia holds a CPC certification and they have followed a simple mantra “No Claim Left Behind” to ensure their customers are getting paid for all the services they provide.
Kedia claims that their company invests heavily in their employees so they can attract and retain the best talent. Maintaining a work culture focused on learning and growth allows team members to ensure the success of their customers. As a company, they allocate a minimum of 20 percent of their employee’s time towards on-going training in their corresponding work positions and cross-training in different billing-related tasks. They offer an in-house training program for CPC Certification. Their E&M coding services is about compliance and reimbursement optimization. Most providers do not fully understand what they can get paid for. Due to the continuous change of reimbursement guidelines of insurance companies, it becomes difficult for providers to keep up with all the payer rules. Kedia claims that the firm has qualified for the 99 percent club criteria of TriZetto multiple times. This means 99 percent of all claims they submit are ready to be paid the first time.
The reimbursement models are evolving from fee for service to value-based payments. This presents an incredible opportunity as well as a risk. It is important to start monitoring these changes continuously and within contracts, so providers don’t get blindsided. Providers need to capitalize on these changes immediately to improve reimbursement This is especially relevant to the small to medium-size practices who don’t have contract negotiating leverage with payers.
As a company, they offer clients to choose individual solutions like Pre-Auth, coding or billing but they have been more successful with clients who have partnered for comprehensive RCM solution that includes deep eligibility, pre-auth, coding, billing and credentialing.
We have followed a simple mantra No Claim Left Behind to ensure our customers are getting paid for all the services they provide
This deep engagement allows them to control every aspect of the revenue cycle and maximize efficiencies within the billing and within the workflow of the practice. They have consistently delivered over 20-30 percent higher revenue for the same visit with these customers. They have used this success to build partnerships with private equity firms that are consolidating smaller practices to efficiently transition their billing function and deliver consistent results.
CMS has been introducing new and innovative programs around Chronic Care Management designed to encourage providers to provide ongoing care to patients; instead of the old payment model that only paid providers for office visits. Adding these services has proven to truly improve patient outcomes and at the same time add new revenue streams for practices. CMS started with one CPT Code 99490 in 2015 and since then has added Remote Patient Monitoring as well as expanding Telemedicine codes. EMPClaims works with their providers to implement these programs and ensures compliance to make sure they can continue to increase revenues from these services.
Patients regularly rate their physicians online using non-clinical parameters. Patient’s billing experience is a critical element of their branding. This reality is even more pronounced in urgent care. Average visits per patient are low and new patient acquisition is a significant driver of growth. It is essential to optimize every visit both from reimbursement and patient billing experience standpoint. Kedia claims that their profound eligibility, pre-auth, and patient balance options allow their clients to offer their patients a customer-friendly experience.