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Sandata Technologies: Purpose-built RCM for Home Care, I/DD, and Managed Care Organizations
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Phil Feldman, VP, Sandata Technologies
Home Care and Intellectual and Developmental Disabilities (I/DD) service and revenue cycle environments are becoming increasingly complex and diverse for providers, making it more difficult for them to receive payments. The complexities initially emerged when many states outsourced the jurisdiction of delivering quality care programs to Managed Care Organizations (MCOs), which are private insurance carriers who manage the benefits programs for consumers and contract with providers who provide the care. The Cures Act, which federally mandated the use of Electronic Visit Verification (EVV) for home care and I/DD in all states for government-funded programs, further added to that complexity. To help manage EVV and perform related claims functions, states and MCOs retained software vendor aggregators to communicate with healthcare providers and prereview transactions before exporting them to the payers, which further aggravated the complication. In addition, the growing advent of value-based payments, where payers are expecting providers to manage patient outcomes and participate in the risk of achieving these outcomes, as opposed to providing units of service, has further exacerbated the complexities that providers face.
From a technology standpoint, providers need an internallyintegrated platform that supports the entire patient care management process, from patient intake to payments. Sandata Technologies has been an innovative leader and continually evolves, enabling providers to manage revenue and excel in the changing healthcare landscape. “As the states engage managed care and their payer portfolios grow from single to multipayer, managing the provision of care and receipt of payments becomes more complex and important. Our products put our customers in the driver’s seat and allow them to ‘get more right from the start,’” says Phil Feldman, VP, Sandata Revenue Cycle Management.
Sandata’s purpose-built agency management software and services enable providers to maximize communication, measurement, and oversight to optimize their operations, provide the most effective and efficient patient care, and get paid appropriately. The company’s dedicated platforms for home care and I/DD agencies provide relevant management of schedules, compliance, caregiver onboarding, case assignments, and EMRs.
Our products put our customer in the driver’s seat to determine their patients’ status so they bill the correct payer the first time.
It allows them to assess patients, schedule services, curate care plans, assign caregivers, and stay aligned with compliance guidelines, while keeping the care plans recorded, reviewed, overseen, and modified as necessary. It also comes integrated with Sandata EVV that can collect home care data from any device—including smartphones and tablets—and track the location of the provision of care. “Additionally, our expert RCM solution team specializes in every segment of the revenue cycle-eligibility, authorizations, payer billing requirements, electronic transactions (EDI), payment processing, and denials follow-up,” adds Feldman. “This specialization minimizes exceptions and ensures outliers are addressed quickly and avoided prospectively, which maximizes revenue and cash flow.” The team also communicates proactively with the customers, produces KPIs, and reviews performance and issues that the client can address internally. This minimizes the complexities involved in payer engagement, including claims reprocessing, resolution projects, and issues escalation.
Given the high level of success of its impeccable solutions and unparalleled services, Sandata Revenue Cycle Management (RCM) can relate numerous customer success stories. In one instance, a provider came to them in distress because their agency management system was implemented ineffectively, adversely affecting their RCM. Their bookkeeper/biller did their best to process billing manually, but there was a large backlog that they never had time to review, resulting in little follow-up on unpaid claims. Soon, the bookkeeping position fell vacant with no replacement. In that interim, Sandata RCM stepped in, managed the revenue processes in the provider’s previous system, and freed up tens of thousands of dollars in previously unpaid claims, as well as achieved high payment percentages of current ongoing claims. This restored cash flow enabled the provider to sustain their operations until they could switch from their old system to Sandata and continue forward successfully. In another instance, a provider needed a team to manage their Medicaid billing process, as their state had engaged several separate payer-managed care organizations. This panel of payers expanded exponentially over time, leaving the provider to struggle with the situation. Sandata RCM came in, assessed the requirements, took over their RCM processes, and enabled them to achieve a 99.3% payment performance rate on their revenue. “We interact with our customers much more than they expect when they sign on with us, and we create a powerful partnership with them,” explains Feldman. “The most joy we get is when our customers tell us they can concentrate on providing excellent patient care and growing their agency, rather than on getting paid, all because of Sandata RCM.”
Such success stories are a testament to Sandata’s expertise in the agency management and RCM space.
Management Phil Feldman, VP , Sandata Technologies
Description Sandata Technologies is a leading U.S. provider of home care solutions that enable government agencies, managed care organizations, and home care providers to manage and optimize the delivery of services. Sandata’s purpose-built home care agency management software and services enable providers to maximize communication, measurement, and oversight to optimize their operations and provide the most effective and efficient patient care, and get paid appropriately. The company’s dedicated platforms for homecare and I/DD agencies provide relevant information regarding schedules, compliance, caregiver onboarding, case assignments, and EMRs. It allows them to assess clients, schedule services, curate care plans, assign caregivers, and stay aligned with compliance guidelines, while keeping the care plans recorded, reviewed, overseen, and monitored.
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