Oncology Convergence, Inc.
FortisBlue automates billing processes for optimal efficiency at oncology revenue management firm
Oncology Convergence, Inc. (OCI) focuses on oncology reimbursement, management, and technology. OCI enables oncology practices to maximize profits without sacrificing the quality of patient care or risking regulatory non-compliance. Their staff and executive team have an average of 18 years of experience with the specific needs of oncology practices, hospitals and centers. Currently, OCI manages revenue for more than 120 physicians nationwide.
“Our clients turn to us because we have one of the best teams of resources in the country,” said Peder Thygesen, manager, information technology services at OCI.” Every medical coder is cross-trained in all aspects of oncology billing, so that gives us tremendous flexibility. We serve smaller health care practices that cannot afford an internal billing organization and larger clients who are looking for specialized support.”
Using Westbrook FortisBlue makes good business sense for OCI because the organization processes electronic documents from various clients and about one-third of OCI’s employees work from home at any given time. Since the medical billing process is document-intensive there’s a potential for carting paper back and forth if documents aren’t digitized. “That’s one of the main reasons we’ve opted to store all of our documents electronically and put our workflow online with FortisBlue,” explained Thygesen.
OCI’s medical coders review doctor’s notes and apply the proper diagnostic and billing codes to issue billing statements on behalf of OCI’s clients. In the past, this information was entered into the system by billing clerks. Today, the coders put information into the header of a PDF and save the coded document. Then they import the PDF to FortisBlue and use an OCR template to index the data. The index fields include medical record number, billing code, physician’s name, and the date of service – all the elements pertinent to creating the charge to the insurance company. When the medical coders finish their part of the process, they set a ‘complete’ status in FortisBlue. Automated workflow compiles a work list of completed items for charge entry staff, and they issue the bills.
“This automation lets us use very accurate and detail-oriented people to interpret and enter the information, while automating the process. By using medical coders’ input at the front-end of the process, we eliminate the possibility of having someone with less knowledge, not understanding the finer points, sending out a bill in error,” Thygesen explained.
The Account Follow-up team is responsible for investigating the issue when an insurance company denies a charge. For example, it may be that a patient’s address or insurance company changed or the date-of-service is incorrect. If the bill can be corrected and resubmitted, the team uses an adjustment form to document the change required to make the charge eligible for payment. This information is entered into a FortisBlue form, and attached as an electronic remittance advice (ERA) document. FortisBlue uses the form data to build a list of adjustments, so that the bill can be amended and resent to the insurance company.
If a charge must be written off, the Accounts Receivable group uses another FortisBlue form for write -off requests and the ERA provides supporting documentation about why the charge hasn’t been accepted. “Using FortisBlue is very straightforward. You find the adjustment or the write-off and the reason it was done. You can see the dates of service, the name of the physician, and other pertinent information related to the charge. Because it is a full-text indexed document we can search by the patient name or policy number as well,” Thygesen explained.
OCI works with multiple clients and each database has to be separate and secure. FortisBlue easily provides this capability with permission-based access and Secure Sockets Layer (SSL) for transmitting data over the Internet.
OCI’s FortisBlue implementation is designed to prevent errors and reinforce processes that support compliance with Medicare, HIPAA and insurance industry regulations. A configurable Audit Log confirms who has accessed a document and made changes to it providing further evidence of compliance. FortisBlue also meets the needs of OCI’s telecommuting workforce and helps the organization contain costs. “Our employees love the money they save on gas. They can maintain a better work/life balance because they don’t waste time commuting. OCI benefits because we don’t need to expand our office space to accommodate additional staff or for storage of paper documents.”
Future plans include creating more Web-based workflow that enables OCI clients to approve adjustment write-off requests online. “We approve these requests internally, but over a certain amount, clients want to know why the money is being written off or refunded. By including them in the loop, these approvals can be done more quickly,” Thygesen said. “With FortisBlue, if there’s a question about who authorized a refund, we have a record of how, why and when.”