How Real-Time Connectivity in DME and Remote Monitoring Drives Revenue and Reduces Costs

DME and remote patient monitoring providers face unique challenges in today’s healthcare landscape. Maintaining financial stability has become more difficult with the rising cost of medical devices, fluctuating reimbursement rates, increasing prior authorization requirements, payor denials, and complex regulatory requirements. On top of that, providers who have these as part of the care offering must efficiently manage inventory, ensure accurate patient intake, facilitate seamless ordering processes, and engage patients effectively—all while addressing staffing shortages. Other organizations that supply the equipment and devices can also assist their customers with addressing the same issues.

To navigate these complexities, organizations need an infrastructure that streamlines workflows, ensures compliance, and optimizes reimbursement. An advanced revenue cycle management (RCM) solution that facilitates integration via APIs is essential. This integration provides end-to-end connectivity across the end-to-end patient-to-payment process, including upfront patient responsibility estimation, requisition/order intake, detailed patient communication, prior authorization, benefits investigation, insurance discovery, eligibility, and equipment delivery. Highly configurable and flexible RCM solutions enable workflow automation for even complex claim processing issues such as exception processing and appeals management. APIs help automate claims processing software and integrate with other parts of the organization’s infrastructure, offering a pathway to better inventory management, improved revenue collection, reduced costs, and enhanced patient and provider satisfaction.

The Power of APIs

APIs enable two-way, real-time data exchange between internet-connected systems, facilitating “digital conversations” between providers, patients, and payors without requiring hard-coded integration. This seamless connection is crucial for managing complex processes such as patient intake, ordering, billing, and ongoing patient engagement.

• Validate Patient Information During Intake: APIs allow providers to validate patient information early in the intake process, ensuring that all necessary data for claims processing is accurate. This proactive validation helps reduce errors that could delay reimbursement.
• Support Ordering Processes: While not directly managing inventory or sales ordering, API integration provides access to necessary information that supports these processes. By interoperating with intake solutions with the RCM platform, providers can streamline the flow of information, reducing the chances of order-related errors.
• Enhance Claim Cleanliness: Integrated systems may pass along edits and corrections in real-time with upstream or downstream systems, increasing claim cleanliness and reducing the likelihood of incomplete or inaccurate data denials.
• Real-Time Eligibility Checks: Automatic eligibility checks at the point of intake provide patients with cost estimates upfront, supporting better financial engagement before equipment is delivered.
• Upload Documentation Seamlessly: APIs streamline uploading necessary documents, such as medical records, directly into the front-end intake process or the RCM system, ensuring the claims process has all the required information.
• Effortless Data Synchronization: By delivering real-time data, APIs keep processes in sync—from the first patient encounter to a zero-balance claim with maximized reimbursement—minimizing manual steps, automating exception processes, and reducing human error.
• Offer Standalone Patient Responsibility Estimation: Providers can leverage a standalone API solution to offer upfront estimates of their out-of-pocket costs before services or equipment are provided, giving patients financial clarity and reducing unexpected billing surprises.

With this integration, organizations can address hurdles like delayed payments and complex patient engagement, ultimately enhancing patient care and optimizing revenue.

Patient and Provider Portals: Enhancing Engagement and Accuracy

Integrated patient and provider portals supported by APIs are vital for ensuring accurate, timely communication and streamlined processes in healthcare environments.

For organizations and their staff, a provider portal enables:

• Real-Time Access to Information: Providers can easily access details on claim status, ensuring accurate and timely fulfillment of patient needs.
• Correction of Billing Errors: The Provider’s billing team or office staff can address billing errors upfront, expediting reimbursement and reducing the chances of claim denials.
• Providing Cost Estimates: Providers can provide patients with an estimate of their out-of-pocket expenses before equipment is ordered, fulfilled, and delivered, helping patients understand their financial responsibility and reducing billing surprises.
• Secure Document Uploads: Providers and their support staff can upload necessary medical documentation, such as diagnostic results, medical necessity documentation, and familial history, directly into the system, speeding up the prior authorization and fulfillment process and minimizing the potential for denied claims.

Facilitating the exchange of information and data correction through the portals and providers reduces administrative burdens, speeds up reimbursements, and improves patient and provider satisfaction.

An API-enabled patient portal functionality allows patients to:

• View Patient Responsibility Estimates: The patient responsibility estimator gives patients a real-time view of their expected costs before dispensing equipment, promoting transparency and understanding.
• View Statements: Patients can securely log in to view their statements, clarifying their financial obligations.
• Make Payments: Patients can make secure online payments directly through the portal, streamlining the payment process.
• Set Up Payment Plans: The portal allows patients to set up payment plans, making it easier to manage their financial responsibilities.
• Establish Paperless Billing: Patients can opt for paperless billing, receiving all statements electronically for convenience.

These features make the patient portal an additional touchpoint for engagement, supporting more timely payments and enhancing the overall patient experience.

XiFin API Integration

XiFin’s APIs offer a range of integration capabilities designed specifically to benefit providers and patients alike:

• Physician’s Office Systems: Results in fewer calls to the provider to obtain information related to services and pricing and faster response time, leading to increased provider satisfaction.
• Back-Office Provider Information Systems: Ensures no duplicate order entry and fewer errors.
• Front-Office Provider Information Systems: Minimizes front-end rejections and eliminates most manual reconciliation of electronic payments or cash to XiFin RPM.
• Portals or IVR System: Ensures no duplicate order entry and fewer errors.

Additional Benefits of APIs and Portals

• Compliance with the No Surprises Act: The patient responsibility estimator within the portal provides Good Faith Estimates before equipment is dispensed. This transparency boosts patient satisfaction and streamlines the billing process.
• Pricing Confirmation: APIs enable real-time access to equipment and device pricing, allowing providers and patients to understand costs and identify outstanding balances from previous encounters.
• Automated Error Resolution: When errors are encountered, providers are notified automatically, and updated information flows into the RCM system seamlessly. If resolved, the claim is automatically filed without manual intervention.

APIs also deliver added flexibility to organizations. Services can be added over time when resources can be allocated to the project. A cloud-based RCM solution makes it easy to add new services when they become available. A purpose-built RCM solution removes reimbursement obstacles and provides the tools to maximize efficiency and cash collection.

With APIs, organizations can quickly gain visibility into potential billing errors, use a patient portal for online bill pay, and use a provider portal to deliver pricing and eligibility to referring physicians for information updates or error correction.

To learn more about maximizing reimbursement for complex billing, watch the full on-demand webinar now.

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