Lightweight Revenue Cycle Management on ZapEHR

TL;DR: Revenue cycle management (RCM) in existing monolithic EHRs doesn’t work well for health tech startups.  ZapEHR helps startups like FlexTogether rapidly add custom RCM solutions to their products.

FlexTogether is a new pulmonary rehabilitation telehealth practice on a mission to radically expand access to all patients with chronic lung disease. Patients receive comprehensive care from a personal interdisciplinary rehab team that includes physical therapy, speech therapy, and more. The program is designed to improve patients’ strength, reduce shortness of breath, and improve quality of life. Care is delivered virtually through a web portal and optimized for older adults. With no waitlists, no travel barriers, and instant care in the comfort of their own home–more patients than ever can experience the evidence-based and proven benefits of pulmonary rehab.

FlexTogether’s services are covered by Medicare for COPD, ILD, Long-Covid and other chronic lung diseases. Virtual pulmonary rehabilitation has clinically-demonstrated beneficial results without increased safety risks: Cox, N. et al. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev. 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8095032/

FlexTogether is an alumni of the Cedars-Sinai Accelerator and AARP Foundation Innovation Program.

The company had a challenge in common with many health tech startups.  It had an innovative software solution for delivering better clinical care to patients (in their case for COPD), but the cost of traditional revenue cycle management (RCM) was prohibitive for a company delivering services at their scale. For example, the popular EHR eClinicalWorks runs a monthly subscription of approximately $599 per provider, per month (1). This equates to over $21,000 annually for a practice of three providers. Other EHRs may require additional modules for RCM/billing that can account for significant cost across users over time. For new or atypical practice models such as FlexTogether, where practitioners may be part-time or billing at non-physician rates, the expense related to a complete revenue solution was impractical.

Leveraging APIs

FlexTogether’s custom RCM solution uses ZapEHR’s FHIR datastore and platform APIs to receive and transmit claim data to third party clearinghouses and Health Information Exchanges (HIEs).  It solicits return requests on claim status to better inform FlexTogether’s management of payments or denials in near-real-time. By using existing APIs between ZapEHR and HIEs, the process is simple and cost-effective.

Fig 1. The ZapEHR RCM Workflow

Using Conformity and Data Alignment

ZapEHR’s datastores and mapping also facilitates alignment of EHR-extracted claims data to normalized, FHIR-compliant datastores. This enables a seamless extract of required claims information from a practice medical record conforming to FHIR standard while maintaining all fields necessary for a standard CMS 1500 billing form. ZapEHR’s unique, headless format can accommodate a wide range of mapping tasks to core or custom datasets. This ability allows not only a format-agnostic ingestion of data, but also a tailored data store customized to the needs of the end-user or programmer.

Fig 2. Mapping Examples from a CMS 1500 to FHIR Resources

Automation is Key

ZapEHR’s “Zambda Functions” enable quick, programmable automation of key tasks throughout the process pipeline. FlexTogether’s RCM solution requires not only data ingestion, but normalization, export, and call requests for any claim status returns. Again, ZapEHR shines: the flexibility and programmability of the platform make nearly any clinical data task not just possible but simpler and faster. By implementing a wide variety of automated functions to process, move, transform, and manipulate data objects in concert with existing or new APIs, the programmer is able to fully embrace the value of a headless EHR solution.

Fig 3. A Zambda function

We’re headless so you can build the perfect UI for your use case

Though ZapEHR is a headless, developer-driven EHR solution it also provides necessary data to end-user interfaces. FlexTogether uses its RCM workflow to populate a near-real-time status interface of claims that are returned. No longer do practices need to look across multiple payer SFTPs or web portals for claim status: ZapEHR can combine this data into useful, filter-ready data flows so you know in an instant where your practice stands in regards to reimbursement.

Fig 4. A front-end billing interface leveraging ZapEHR

How can my practice benefit?

Billing is the life force of practices; Without revenue, operations cease. Many times the Revenue Cycle Management solutions offered out of the box are either too complex, too rigid, or too costly to work well - especially to small practices. ZapEHR’s API connectivity, data storage, and programmable flexibility offer a complete custom solution to your practice’s unique billing situation. ZapEHR is a FHIR-compliant, ONC-Certified*, complete health tech platform built for the challenges of modern healthcare. ZapEHR can even automate some common practice chores that normally require tedious manual processing, like using a biller to file claims. If you are interested in learning more about how ZapEHR can assist your revenue cycle processes, send us an e-mail at [email protected] today.

_{1. Green, Jeff. “EHR Software Pricing Guide”. EHR In Practice. PP. 6. www.ehrinpractice.com}

_{*ONC certification is pending}

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FAQs

What role do APIs play in FlexTogether's custom RCM solution, and how does ZapEHR leverage them for efficient claim data management?

FlexTogether's custom RCM solution utilizes ZapEHR's FHIR datastore and platform APIs to transmit claim data to third-party clearinghouses and Health Information Exchanges (HIEs). The blog highlights that the use of APIs facilitates the efficient exchange of claim data, including soliciting return requests on claim status in near-real-time. ZapEHR's platform APIs, combined with its headless format, simplify and streamline the RCM workflow for startups like FlexTogether, making the process both simple and cost-effective.

In what ways does ZapEHR's automation, data alignment, and headless format contribute to the effectiveness of FlexTogether's RCM solution?

ZapEHR's automation capabilities, including Zambda Functions, play a key role in FlexTogether's RCM solution. Automation is essential for tasks like data ingestion, normalization, export, and claim status requests. Additionally, ZapEHR's data alignment features enable the seamless extraction of required claims information from a medical record conforming to the FHIR standard. The headless format of ZapEHR allows for flexibility and programmability, making it simpler and faster to implement a wide variety of automated functions that contribute to the efficiency of the RCM process.