Automating Eligibility Requests for RiverKids

Automating Eligibility Requests for RiverKids

by | Jan 24, 2019 | Blog | 1 comment

When you provide pediatric home health care in over 90 Texas counties, you need an outstanding staff, skilled managers and a crucial administrative asset: revenue cycle management efficiency. RiverKids Pediatric Home Health Therapy relies on EMS and its 270 Power Generator software to ensure the last part.

John Buchman, Controller, has led the agency’s accounting, payroll and compliance for over four years. He shared that with a lean administration, he has relied on both staff talent and wise technology to ensure the success of RiverKids’ growth. The agency provides physical, occupational, and speech therapy for children with delayed development or disabilities.

“We built our own practice management system and our own custom EMR,” said Buchman. “When we began implementing a new accounting system, I looked for a program to automate our eligibility requests. We tried a clearinghouse but it wasn’t the answer. I found the 270 Power Generator online and we’ve used it ever since.”

Why not do it in-house?

He said he considered it but knew to lean to existing expertise.

“The data involved in 270s and 271s is more complex than some other files. It would have been tons of work with an unknown outcome,” shared Buchman.

Flexible Integration

Buchman and his small team do much of their work in connected databases. They created triggers to tie datasets to the 270 Power Generator program. By batching files, and being able to quickly read 271 responses, the software has streamlined a previously one-at-a-time manual process.

“We have 425 therapists—85% of our total staff, and they see 3500 patients,” he explained. “Our therapists see the same patients several times a week in many cases. So the software has been amazing for us.”

He plans to begin using EMS’s EDI Power Reader next to help RiverKids automate sending benefit reports to families of children served. Currently such reports require a time-intensive, one by one manual verification process.

Increasing Needs for Pediatric Home Health Care

RiverKids is in a growing industry with great needs. A recent study by USC, Boston Children’s Hospital and Rand Corporation calculated that 5.6 million children with special needs and chronic conditions receive an average of at least 5 hours of home medical care per week. Family members providing the care “forego an estimated $3,200 in earnings each year,” according to Home Health Care News. This is due to two factors: a national shortage of home care nurses, and a slow march to getting such care more funded by government sources.

The Improving Medicaid Programs and Opportunities for Eligible Beneficiaries (IMPROVE Act) was passed by the House on December 11. Advocates hope it will advance through the Senate this year. Meanwhile, research published in the January 2019 issue of Pediatrics showed that in Minnesota, the issue is extending more expensive hospital stays an average of 54 days for new patients.

“When we began implementing a new accounting system, I looked for a program to automate our eligibility requests. I found the 270 Power Generator online and we’ve been using it ever since.”

-John Buchman, RiverKids Pediatric Home Health