Building Credibility and Trust One Relationship at a Time With the Help of LeadingReach
“Integrity and trust are two valuable components of any relationship… LeadingReach has allowed us to create more of that trust.”Tommy Smith, Executive Operations
- Active in 19 States
- 40+ Years Combined Experience
- Founded in 2009
About Advanced Reimbursement
Active in 19 states and expanding, Advanced Reimbursement Solutions (ARS) is a revenue cycle management company specializing in out-of-network medical services, patient advocacy, and proprietary billing software. ARS advocates on behalf of patients seeking coverage for out-of-network care and partners with healthcare providers to handle their claims reimbursement.
For both patients and healthcare providers, dealing with reimbursement from healthcare insurance companies can be a frustrating process, especially for out-of-network benefits. Patients often want access to out-of-network providers for the best treatment, while out-of- network providers want to avoid the endless hassles of seeking insurance reimbursement. Unfortunately, insurance carriers are typically resistant to providing out-of-network benefits.
Advanced Reimbursement Solutions (ARS) is an out-of-network billing company dedicated to dealing with these frustrations. According to Tommy Smith, a member of the Executive Operations team at ARS, the company’s mantra is clear. “We want to fight for the patient to see the right provider even if that’s out of network” says Smith. “Patients are paying monthly premiums for coverage, but they are denied coverage for the right care because it’s out-of- network and carriers don’t like paying for that.”
ARS acts as an authorized agent and advocate for patients seeking out-of-network benefits from their carriers. The company also partners with doctors and medical facilities throughout the county to provide out-of-network care, handling the claims reimbursement process for those providers. ARS works in tandem with its subsidiary organization, Patient Choice, which acts as
a patient concierge service, advising patients on their benefits and helping them navigate the system. Ultimately ARS submits the bill to the carrier on behalf of the patient, with reimbursement split between ARS, the provider, and any outside administrator involved in the process.
The Challenge
By taking care of claims reimbursement for its partner providers, ARS is taking many resource- intensive tasks off their hands. ARS works primarily with surgery centers, although it has also partnered with a few hospitals. “We do all the legwork with claims reimbursement so that the medical office staff can focus on the patients standing in front of them,” says Smith.
As part of the Executive Operations team, Smith helps to oversee different facets of ARS’s internal operations, such as data entry, check recovery, billing, and quality assurance. Smith also works in the field, initiating and nurturing relationships with providers. His time with the company has coincided with massive growth. ARS had 34 employees when he started there in 2013. By 2020, the employee headcount had increased by a factor of 10!
While this rapid growth has been great for the company, it has come with challenges in the logistics of handling so many claims. Several years ago, ARS used the Dropbox cloud-based file management system to manage its incoming claims. However, the platform was not HIPAA-compliant. “That made us really nervous,” Smith says, “because HIPAA was on the prowl for violations.” The need for privacy prompted ARS to switch to encrypted emails for claims management.
Unfortunately, an email-based process presented its own set of problems. ARS received the providers’ claims via its general email system, then stored those claims on the company server. For each claim, the medical facility also sent its claim packet to an auditing entity. ARS has contracts with the auditors that obligate them to complete their audits within 21 days. Accordingly, ARS asked the facilities to copy them on the emails sending claims to auditors, so they would know when the 21-day clock started ticking.
Encrypted emails were secure and enabled documents to be attached in PDF format. However, the PDF files would sometimes be too large to attach to the emails. Some facilities would see the email bounced back to them, then separate the documents into multiple PDFs to re-send. But other times, the bounced back email would just sit there in the sender’s inbox. “There were times where we missed the claim due to untimely filing,” says Smith. “Or we had to hustle to get the claim submitted on time and probably made some errors in the billing process.”
“So many claims were coming in that it became unmanageable,” continues Smith. “The impact of that was claims that were missed and not billed. When a partner provider receives their monthly report and they see a certain claim is not included, now they’re ticked off. Not only that, but we’re losing credibility and trust, which our business is built on.”
According to Smith, one of the most frustrating aspects of the claims-management-by-email system was the lack of visibility. It was difficult to check on the status of any given claim.
With the high volume of calls and referrals, Smith would be hard-pressed to manage these tasks using only fax referrals and a manual system. “With fax referrals, I will need to make 3-5 back-and forth calls,” says Smith. “Especially when I don’t receive demographic information for the patient. I’ve had multiple times where I’ve had to call the referring office to say, ‘I got one page of this referral.’ Or ‘I got the referral page but you didn’t send demographics.’ ‘Oh, I’m sorry, what else do you need?’ And I’m like ‘Well, I need the imaging. I need an office note.’ And I just go down the list with them.”
“So many claims were coming in that it became unmanageable.”
The Solution
The search for a claims management solution ultimately led to an ARS business profitability rep doing some research and finding LeadingReach. LeadingReach provided ARS with a secure, HIPAA-compliant platform for its claims management.
When Smith introduced the ARS provider partners to LeadingReach, one of the biggest selling points was the system’s transparency, including features like claims statuses and time stamps for actions taken. Now different parties can quickly view all activity on any claim. “I can see what you’re doing, and you can see what I’m doing,” is how Smith describes it.
The LeadingReach platform also enabled collaboration. With LeadingReach, the provider partner simply adds ARS’s billing entity, Pantheon Billing, as a “collaborator” on the platform at the time of sending the claims packet to the auditor. There was no more need to copy ARS on the claims packet email in order to start the 21-day clock ticking for the auditor to process the claim.
“The collaboration feature was an answer to our prayers,” says Smith. Having Pantheon Billing added as a collaborator allows ARS to start the 21-day clock and follow up with the auditors as necessary. It also allowed ARS to expedite the claims, because the ARS data entry team could immediately begin compiling the claims packet.
Expediting the claim processing was important for ARS, since the total process is fairly involved. After the data entry team enters an incoming claim into the EHR system, the claim is first reviewed by the billing department. Then the claim goes to the quality assurance department, which may add documents or medical records. Ultimately it takes about a week before the claim is ready to be mailed to the insurance carrier.
Now with LeadingReach, that process is sped up drastically. When Pantheon Billing is added as a collaborator, they can immediately review and download all claim documents on the platform. “The claim is processed in a much shorter time,” says Smith. “Before LeadingReach, the claim was received via email, then had to be printed out, put in order, and sent to the different departments. Now it’s housed right on that platform where everyone on our team can see it.”
The claim status, filtering, and reporting features of LeadingReach are also extremely helpful. “We send out monthly claim status reports to our partner providers. If there are a lot of claims with ‘pending’ status, I can advise the provider to filter out the pending claims on the LeadingReach platform to see what’s going on. Is it something on your end? On our end? I love being able to show them how they can dig in and discover any snags in the process.” The LeadingReach platform also allows for live reporting, where either ARS or the partner providers can run claims reports at any time — weekly, daily, or “at midnight on a Saturday,” says Smith.
ARS also utilizes the office-to-office communication feature of LeadingReach, which allows their partner providers to send over bulk PDF files, including EOBs and correspondence. “We ask some of our facilities to send us their weekly surgery schedule,” says Smith, “so they can send that office-to-office and ‘tag’ the person that has requested it. I also love being able to show the providers how they can filter open and closed conversations.”
Smith is unequivocal about the results ARS has achieved with LeadingReach. “LeadingReach has improved our communications with our clients. Doctors need a revenue stream, and they’ve got overhead to cover. It’s really important that we have a platform like LeadingReach where we can communicate effectively, allow them to see claims statuses whenever they want, and set their minds at ease.”
“The collaboration feature was an answer to our prayers.”
The Results
“LeadingReach has also deepened our existing relationships with some of our larger providers,” continues Smith, “some of which were using LeadingReach before us. It’s added credibility to our newer relationships by giving them a new tool. There are so many doctor’s offices that still don’t have EHR systems, they’re just not tech savvy, so LeadingReach is really making us look good.”
“I think LeadingReach helps doctor’s offices to create their own databases and get organized,” says Smith. “By providing them with this platform, it adds to our credibility. Now these offices can see that ARS is a well-built outfit that provides them with tools that they can use to make money for their medical practice.”
Smith would gladly recommend LeadingReach to other billing companies, and his basic reasons are simple. “Integrity and trust are two valuable components of any relationship. Now there’s longer any question of if something got done or not. We can go on the platform and get our answers. LeadingReach has allowed us to create more of that trust.”
“LeadingReach has also deepened our existing relationships with some of our larger providers…”
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