MedData Inc.

Client Overview

MedData, now known as Elevate Patient Financial Solutions (ElevatePFS), is a leading provider of revenue cycle management services for the healthcare industry. With a history dating back to 1997, ElevatePFS has established itself as a trusted partner for nearly 1,700 healthcare facilities across the United States, managing over 11.5 million patient accounts annually.

The Challenge

ElevatePFS faced several critical challenges in their mission to improve the revenue cycle management process for healthcare providers:

1. Inefficient Data Segmentation: There was a need to break down barriers between different data segments to provide accurate information on possible coverage for patients.
2. Complex Screening Process: Healthcare staff struggled with analyzing overwhelming amounts of information at the point of patient admittance.
3. Outdated Assessment Models: Existing models for assessing and helping patients apply for coverage were not automated, often leading to missed steps, claim denials, and negative impacts on healthcare organizations' revenue.
4. Staff Productivity Concerns: The existing processes were time-consuming and negatively impacted staff productivity.
5. Data Accessibility: With clients across all 50 states, ElevatePFS needed to provide access to complex information regarding coverage, state programs, Medicare, and Medicaid in a user-friendly manner.
6. On-Site Functionality: There was a need for a comprehensive application that staff could use to complete the screening process on-site, with or without internet access.

Project Goals

The main goals for the new Platform Independent Screening Tool were:

1. To screen patients for all available programs based on an intuitive series of questions.
2. To recommend potential program(s) based on screening answers and identify required verification documents and forms.
3. To build on a platform-independent technology for use on mobile platforms and PCs/laptops.
4. To integrate with the existing MPower system for seamless data exchange.
5. To function reliably in hospitals with poor connectivity.
6. To be scalable for expansion to other Lines of Business and diverse user bases.
7. To operate in offline mode when no internet connection is available.

The Solution

In collaboration with Baytech, ElevatePFS developed an innovative, web-based screening tool to address these challenges. The solution encompassed a wide range of features designed to streamline the screening process and improve overall efficiency.

Intuitive Screening Interface

At the heart of the tool was an intuitive screening interface. This interface incorporated state-specific questionnaire tracks with nested capabilities, allowing for a flowchart-like screening process with dynamic question progression. The steps were highly customizable, offering various input types such as Yes/No questions, free-text fields, and dropdowns. Importantly, the interface also provided the option to upload verification documents during the screening process, enhancing the completeness of each patient's file.

Program Recommendation Engine

The tool's program recommendation engine was a key component of its effectiveness. Powered by a sophisticated rules engine, it could accurately match patients with appropriate programs based on their responses. The engine utilized configurable program criteria and state-specific rules, ensuring that recommendations were always relevant and up-to-date. Additionally, it automatically generated lists of required documents and forms, further streamlining the application process.

Multi-Platform Compatibility

Multi-platform compatibility was a crucial feature of the solution. The web-based design ensured accessibility from desktops, tablets, and mobile devices, with a responsive interface that adapted to different screen sizes. This flexibility allowed healthcare staff to use the tool effectively in various settings, from office desks to patient bedsides.

MPower Integration

Integration with the existing MPower system was seamless, facilitating easy data exchange between the new tool and the established platform. Users could access the screening tool from MPower using single sign-on capabilities, and the tool could create summarized notes directly in MPower accounts, ensuring all patient information was centralized and easily accessible.

Offline Functionality

Recognizing the varied working conditions in healthcare settings, the tool was designed with robust offline functionality. Users could work offline and sync data when a connection became available, and incomplete screenings could be stored locally for later completion. This feature ensured that work could continue uninterrupted, even in areas with poor network connectivity.

Document Management

Document management was greatly enhanced in the new system. The tool integrated with MPower's form library and offered the ability to pre-fill offline application forms. E-signature capabilities for required forms were included, as well as functionality for photo capture and upload of verification documents. These features significantly reduced paperwork and improved the speed and accuracy of document processing.

User-Friendly Admin Interface

For administrators, the tool provided a user-friendly interface with a flowchart-like view for configuring screening questionnaire tracks. Question steps could be easily customized, and program linkages and document requirements were configurable, allowing the system to be tailored to specific needs and updated as requirements changed.

Productivity Tracking

Productivity tracking was built into the system, with automatic time tracking for each screening step and the ability to generate comprehensive productivity reports and KPIs. This feature allowed managers to monitor performance and identify areas for improvement more effectively.

Security and Compliance

Finally, security and compliance were prioritized in the design. The tool integrated with Active Directory for secure access, adhered to MPower permission rules, and included secure email functionality for patient communication. These measures ensured that sensitive patient data was protected at all times, in compliance with healthcare privacy regulations.

Sophisticated Rules Engine

A key component of the screening tool's effectiveness was its advanced rules engine. This engine was developed to address the complex challenge of accurately matching patients to appropriate medical programs. The engine collects answers from the screening process and external information about the patient, then checks that data against each of the rules for the medical programs applicable to that hospital.

The rules encompass various eligibility criteria, including income thresholds, household size, age, residency status, medical conditions, and insurance status. This process is fully automated, significantly reducing the time and potential for human error in the matching process.

After processing, the engine generates a list of matched programs tailored to the patient's specific situation. This list is presented to the hospital staff in an easy-to-understand format, allowing them to quickly initiate the application process for each relevant program.

The implementation of this rules engine brought several key benefits, including improved efficiency, increased accuracy, consistent screening across all patients, scalability as programs and criteria change, and empowerment of hospital staff to confidently guide patients towards appropriate programs.

This sophisticated rules engine became a cornerstone of the screening tool's success, enabling ElevatePFS to provide a more efficient, accurate, and valuable service to their healthcare clients.

Technical Implementation

The project followed an Agile/Scrum methodology with three to four-week sprints. Key aspects of the implementation included:

1. Technology Stack: Web-based technologies were used to ensure platform independence and accessibility.
2. API Integration: Extensive use of MPower 2.0 WCF Calls for common functions to ensure seamless integration.
3. Database Design: A flexible database structure to accommodate various screening tracks, programs, and document requirements.
4. User Interface: Responsive design principles were applied to ensure usability across different devices.
5. Offline Capabilities: Implementation of local storage and synchronization mechanisms for offline functionality.

The Results

The implementation of the platform-independent screening tool yielded significant benefits for ElevatePFS and their clients:

1. Improved Efficiency: Healthcare providers reported improved efficiency in the screening process, with some seeing a 10%-35% increase in revenue.
2. Enhanced User Experience: Advocates adopted the solution faster than expected due to its intuitive interface and workflow.
3. Increased Accuracy: The sophisticated rules engine and comprehensive screening process led to more accurate program recommendations and reduced claim denials.
4. Better Data Management: Integration with MPower allowed for better data consistency and reduced duplicate data entry.
5. Expanded Capabilities: The platform-independent nature of the tool allowed for use in various healthcare settings, including those with poor internet connectivity.
6. Scalability: The solution's design allowed for easy expansion to other lines of business and integration of future acquisitions.

Client Testimonials

"They are a flexible, open-minded team. If we ask them questions about an issue, they aren't defensive. They remain calm, listen, and then propose solutions. This approach makes the process less stressful."

"Users have adopted the solution faster than expected due to the vendor's excellent problem-solving skills. Baytech Consulting specialists are attentive listeners with a results-oriented working style. Customers can expect responsive, clear communication."

— MedData Program Manager

Conclusion

The collaboration between ElevatePFS and Baytech resulted in a transformative solution that addressed critical challenges in the healthcare revenue cycle management process. By leveraging modern web technologies and sophisticated data processing, ElevatePFS was able to provide their clients with a tool that significantly improved efficiency, accuracy, and financial outcomes.

The platform-independent screening tool not only solved immediate operational challenges but also positioned ElevatePFS for future growth and adaptation in the rapidly evolving healthcare industry. This case study demonstrates the power of innovative technology solutions in solving complex industry-specific challenges and underscores the importance of user-centric design in driving adoption and success.

Frequently Asked Questions

Q: Who acquired MedData?

A: In a significant industry move, Frazier Healthcare Partners reached an agreement to acquire MedData from MEDNAX, Inc. Frazier Healthcare Partners, known for its strategic investments in the healthcare sector, saw the potential in MedData's innovative approach to revenue cycle management. This acquisition aligned with Frazier's commitment to advancing healthcare services and technology, positioning MedData for further growth and innovation in the RCM space.

Q: Has MedData undergone a rebranding?

A: Yes, MedData has evolved into Elevate Patient Financial Solutions (ElevatePFS). This rebranding reflects the company's commitment to elevating the standard of revenue cycle management in healthcare. ElevatePFS continues to build on MedData's four-decade legacy of partnering with healthcare providers nationwide. The company's core focus remains on providing comprehensive revenue cycle management services, including eligibility and disability assistance, injury accounts management, out-of-state eligibility, COB denials resolution, Veterans Administration services, and self-pay/early out programs. This rebranding signifies not just a name change, but a renewed commitment to innovation and excellence in patient financial solutions.