To smoothen the complex process of handling bills, processing payments, and revenue collection, a Medical practice or Hospital must invest in Revenue Cycle Management workflow. It is a process that begins with checking in a patient and ends with collecting patients’ payments or writing off the bills.
It probably comes as no surprise that Revenue Management Cycle is critical to the lasting success story of any healthcare organization. Providing such a feasible foundation of incoming and predicting cash, EMPClaims, has the experience and the expertise needed to provide just the right billing solutions to medical practices.
EMPClaims was founded in 2008 by the husband-wife team of Piyush Kedia, CEO, and Snigdha Kedia, COO. Under their leadership, the company focuses on working in tandem with the medical staff to smoothen the entire medical billing and claim process.
In an interview with Insights Care, both Piyush and Snigdha talk about their offerings and how the company has a stronghold in the revenue management industry.
Below are the highlights:
Please brief our audience EMPClaims and how it is currently positioned as a trusted revenue cycle management organization.
EMPClaims has been in business for over 14 years, and as an indication of trust, our first customer from 14 years ago is still our customer. Our average customer is a medical practice with ten plus providers and our customer churn is less than two per cent which is a great metric in this industry.
Tell us more about your offerings, through which you have ascertained your stronghold within the industry.
EMPClaims offers solutions for the full lifecycle of claims management and uses a combination of technology and services to optimize reimbursement and reduce operational bottlenecks.
Patient Intake: The intake process is the starting point of the patient’s experience. This involves data collection from the patient, getting prior authorization from the insurance carrier, and collecting any medical records required. EMPClaims offers a solution to automate this workflow and improve the patient experience with a smooth intake process.
Medical Coding: Incorrectly applied medical codes could result in either a higher payment or under-payments. These situations could cause compliance issues for the practice. EMPClaims has a team of certified coders that can assign the appropriate level of coding to ensure compliance and optimal reimbursement. The team has experience working with E&M Coding and Procedure Coding.
Value-based Care Solutions: The industry shift to value-based care requires solutions that are different from fee for Service solutions. Fee for service reimbursement depends on procedure coding, and Value-based care requires risk coding.
Most practices have both contracts and need workflows that accommodate both lines of business. EMPClaims technology and workflow solutions allow practices to implement parallel workflows for Fees for service and value-based care contracts.
Medical Billing: Excellence in medical billing requires process control. Our clean claims submission rate is 94% on average, and we have consistently reached 98%. This level of diligence allows us to deliver a consistently high level of service delivery to our customers.
Workers Comp Solutions: Workers’ comp has a much higher level of complexity than regular medical billing. The employer is the insured, not the patient, and fee schedules are regulated at the state level.
This requires a very different workflow and technology that can ensure accurate reimbursement. EMPClaims has developed technology that allows us to ensure claims are accurately processed with consistent payment.
What are the biggest challenges you faced during the foundational years of the company? What are the most important lessons you have learned in your career so far?
One of the most important challenges and learning early on was investing in the right technology. Using technology effectively in RCM can drive operational efficiencies and predictable outcomes. The cost of software is an important driver but being able to measure the efficiency cost of the software was equally important.
Over the years, we have chosen to work with customers who choose to invest in good technology solutions and not focus on buying the cheapest product. This allows us to build partnerships with their team and deliver optimal reimbursement.
COVID-19 proved to be the biggest disruptor since the Dot-com bubble. What tactics did you apply at your company to continue its operations and growth?
COVID-19 was a difficult time for the healthcare industry and our customers had to adapt to a lot of changes in a very short period of time. We focused on being a partner and a support center for our customers. Most practices were struggling with the new telemedicine guidelines.
We compiled our knowledge of telemedicine billing on a google spreadsheet and made it publicly available through social channels. We had thousands of billers who referenced it. Most practices were struggling with staff shortages, and we started supporting them with automation and remote staffing solutions that eased their burden and allowed them to take care of more patients.
What would be your advice to budding entrepreneurs who aspire to be revenue cycle management services providers in the industry?
This industry is increasingly being defined by technology instead of people and the only suggestion to future entrepreneurs is that they need to understand the nuances of provider workflows changing payer guidelines.
How do you envision scaling EMPClaims Solutions operations and offerings in 2022 and beyond?
The industry will continue to consolidate and transition to Value-Based Care. We expect to invest more in technology like RPA, HCC Coding and Risk stratification that will allow us to offer a good service at a competitive price and develop technology solutions for the Value-Based Care market to continue supporting this transition. Unless there is a shift in the market dynamic, this would be the focus for the next two to three years.
To be designed Separately
The Husband-wife Team
EMPClaims was founded in 2008 by the husband-wife team of Piyush Kedia and Snigdha Kedia. Piyush Kedia has an MS in Finance, and Snigdha Kedia is a Certified Professional Coder. The company was originally an implementation partner for EHR software and discovered a need in the marketplace for RCM Services. When Piyush and Snigdha started EMPClaims, only about eight per cent of all medical practices used an EHR and this number is higher than 70% now.
This transition has transformed customer expectations and increased the portability of RCM providers. They do not take their customers for granted. They have always used best-in-class technology and process controls to deliver consistent service quality and meet their customers’ expectations. They have developed in-house solutions for Patient Intake, Value-based care, Workers’ comp, RPA, and data analytics.