Case study: Texas Center for lifestyle medicine

Customer

Texas Center for Lifestyle Medicine is one of the most innovative institutions in Texas, USA. It focuses on promoting community well-being by bringing in functional medicine, integrative health, and lifestyle medicine.

Industry

Healthcare

Overview

Accurate verification of EHR data completeness helps facilities streamline claim submission and reimbursement according to health plans. The client's employees were manually auditing the medical records, checking progress notes one by one, and validating that all ICD-10 and CPT codes are well supported by documentation in the EHR system. Such an approach proved to be not only laborious and demotivating but also error-prone and expensive in the long run.

At a Glance

Texas Center for Lifestyle Medicine partnered with TEAM International to streamline its medical records audit, ensure data integrity, and prevent revenue losses. We built a comprehensive RPA solution to automate the process and help the organization achieve its objectives on a tight schedule.

Outcomes

80 percent reduction in claim denials results in >$1 million saved per year;
>1700 percent project return on investment (ROI) in the first year;
Streamlined processes and inclusive working environment;
Prevented patient under coding to improve corporate revenue performance;
Assured data integrity and lower probability of claim denial.

Dozens of day-to-day operations require careful performance

Texas Center for Lifestyle Medicine advocates a patient-centered approach and treats each case individually. It's one of the most progressive institutions in the United States that utilizes the latest lab testing and emerging technology to improve not only patient well-being but also prevent choric diseases and minimize the medication burden. Consequently, accurate EHR data lie at the root of both effective patient treatment and organizational stability. "Ensuring medical data integrity" meant going through dozens of progress notes manually every day. Additionally, such operating procedures led to certain implications, namely:

Identifying and eliminating CPT and ICD-10 code mismatches was an error-prone activity that resulted in over 2000 claim denials every month;
Patients might have been under coded to prevent claim rejections, but it also translated into lower billing and revenue losses;
The facility staff wasted much time and effort on the medical record audit and code validation, leading to professional burnout and less quality time with patients.

RPA to the rescue

Initially, Texas Center for Lifestyle Medicine sought a working solution to free up its employees from performing multiple laborious and repetitive tasks, and thus focus on quality patient service. Additionally, the organization wanted to avoid under coding, increase revenue, and prevent claim rejections. TEAM International drew on its wealth of experience and expertise in the healthcare industry to build an RPA solution and fully automate the EHR audit and medical code validation processes. Consequently, Texas Center for Lifestyle Medicine was able to accomplish its objectives and realize a whole range of other benefits as well.

RPA improves internal operations and employee experience

The entire project — which took roughly seven weeks to complete — emerged a massive success. TEAM International has designed a comprehensive RPA solution that starts at midnight every day, audits all the closed progress notes, and notifies employees about any detected mismatches or exceptions that require human intervention. Finally, it creates a detailed report with metrics and suggests additional codes that may be supported but haven't been included in the profile. Among other advantages granted by the RPA solution, we should name the following:

#1 Accelerated benefits from tech innovations

Bots take on the audit of medical records to ensure data integrity and realize the EHR's fullest potential. The RPA solution hasn't only streamlined the target processes but has also paved the way for other operational improvements and transformations.

#2 80 percent reduction in claim denials

Improved accuracy in EHR and medical codes has significantly reduced the number of claim rejections.

#3 Low investment, high savings

Even with the minimum investment, the organization has been able to reduce claim denials by 80 percent and save over $1 million in the 12-month period.

#4 Better corporate revenue performance

The RPA solution not only suggests additional medical codes but also checks if all the rules that ensure higher billing have been applied by the provider, thus improving revenue generation.

#5 Improved employee and patient experience

The staff of Texas Center for Lifestyle Medicine also benefits from the reduction in the manual effort required for repetitive and laborious tasks. Now they can be engaged in more value-generating activities and spend more quality time with patients, focusing on the most important — people's well-being.

The provided RPA solution continues to empower employees. Successful project deployment and bots' integration have helped to promote a culture of ongoing innovation across the organization.