RevOps Health helps small practices get paid.

Wayzen Lin, founder and CEO of Boston-based RevOps Health, remembers the day a retinal surgeon consulted him for a second opinion on a revenue cycle management (RCM) company’s handling of his insurance billing and reimbursement processes.

The RCM was effectively managing the billing side of the practice, Mr. Lin says, but it wasn’t properly accounting for or tracking secondary insurance payments, patient co-pays and reimbursements — relatively small amounts of revenue that can easily be overlooked.

“Small amounts in high volume start adding up real fast,” he says. “We discovered the ophthalmologist was losing almost 10% of his annual revenue due to these small leaks. He didn’t know what he didn’t know.”

Ednan Ahmed, MD, president of Southern California Retina Center, a small specialty practice based in San Diego County, can relate.

“We had come to accept a finite amount of revenue loss and delay in payments as part of the inefficiency of our system,” Dr. Ahmed says. “We had to accept any explanations given by the billers for any loss in collections, or delay in submission or payment, because we did not have an efficient or effective means to validate or counter the claims.”

TECHNOLOGY TO STOP THE BLEEDING — AND IMPROVE METRICS

That all changed about a year ago, when Dr. Ahmed adopted RevOps Health’s AI- (artificial intelligence) and ML (machine learning)-based software to simplify tracking, management and analysis of his Medicare and private insurance reimbursements. Leveraging RevOps’ subscription-based technology, he says, has helped reduce his practice billing time to submission to just one day; push his billing company to improve efficiency and collections; and to evaluate payers and payment schedules to negotiate better contracts, ultimately resulting in improved revenue management.

“Not only am I able to improve and optimize my RCM but I am also able to rapidly evaluate and manage metrics which would have been previously very difficult to assess — for example, denial volume data cross-referenced to procedure and payer,” Dr. Ahmed says.

Mr. Lin says the RevOps solution accomplishes these goals by using AI and ML technology to organize, manage and analyze reimbursement data from multiple sources so that practice managers do not have to do it manually. Health-care payment processes are continually changing, with a proliferation of high-deductible and co-insurance plans, capitation agreements and changes in procedure codes and payment rules.

In light of this complexity, most ophthalmology practices rely on third-party billers to provide data on billing and reimbursements.

But “this is akin to letting students grade their own papers,” Mr. Lin says. “By only being able to see what the billing system shows them, ophthalmologists are unable to see where they are losing money and where biller performance, in terms of tracking reimbursements, can be improved.”

IN-DEPTH ANALYSIS

Most practice-management and EHR solutions, moreover, offer rudimentary reimbursement analysis and do not provide in-depth reimbursement data, owing largely to its complexity, says Muneeb Ahmed, MD, RevOps Health’s chief medical advisor.

Even many newer systems provide only one subset of data, and ophthalmology practice managers may need to use several systems to collect different pieces of revenue data. Still others offer analytics only as part of a suite of other services that come at an additional cost, be it an EHR or a billing system, Dr. Muneeb Ahmed says.

“Anyone who’s done any kind of large-scale data analysis is familiar with the old maxim of ‘garbage in, garbage out.’ A lot of the hard work in data science revolves around making sure the information you have is not only clean but accurate,” Dr. Muneeb Ahmed explains.

“We’re a mix of Google’s ease-of-use and QuickBooks’ focus on making the business of health care easier to understand,” says Mr. Lin, adding that the solution is targeted at small-to-medium size practices at a cost of $250 per provider, per month.

“We want to make this available to any practice, regardless of the system or technologies they use. Their data should be the source of truth, and RevOps Health wants providers to feel confident that they can trust and verify the data presented to them,” he says.

For his part, Dr. Ednan Ahmed says he would recommend the RevOps Health solution to other practices of his size. “It will allow you to oversee and improve your billing practices, analyze denials and payers, and ultimately lead to a definite reduction in denials and improvement in collections and revenue,” he says. OM

For more information, visit revops.health .