Programmers’ Fast-Track Service Allows

Healthcare RCM Company to
Deliver More Accurate Information

Our client helps oncology practices ensure they get all the money due to them from Medicare and private insurance companies. With our Fast-Track Application Modernization service, we discovered and iteratively added functionalities that allowed this client to provide the fastest, most accurate information possible to oncology centers.

Oncology practices throughout America navigate a complicated web of policies to ensure they do not undercharge Medicare and private insurance companies for each procedure. Leaving money on the table makes it harder for these practices to continue providing high-quality care. Plus, this struggle takes physicians’ and administrators’ attention away from patients. 

One oncology center understood these pressures and asked their tech talent to find solutions. As their internal capabilities grew, they realized other oncology specialists could benefit from these new revenue cycle management capabilities. From there, they launched a new company focused on RCM optimization for oncology practices throughout the US. 

Programmers has been a proud tech consultant for this healthcare RCM company for years. We’ve primarily used our Fast-Track Application Modernization service to make their legacy systems more robust through 90-day modernization cycles. 

This fast-to-value approach allows the company’s stakeholders to see results from modernization early and often. It also gives this organization’s customers rapid access to more high-quality information. 

Fast-Track Application Modernization can include many processes, such as cloud migration, system integration, UI/UX enhancements, automation, and much more. After understanding the unique needs of this healthcare RCM company, we realized automating manual processes would help streamline their operations and ensure more accurate data for their customers.

Rewriting the Rules

With so many healthcare plans throughout the United States, it’s easy for individual procedures to go undercharged, despite our client’s best efforts. 

Before working with Programmers, our client already leveraged automated programs to detect underpayment from insurance companies and Medicare. Built-in rules helped the system decide if each procedure was fairly or unfairly charged.

However, these rules did not cover the full spectrum of possible procedures and insurance plans. Our client’s analysts often had to go in and manually review transactions to discover underpayment. 

In some cases, the claim was too complicated for both the system and the analyst to resolve. Other times, the automated system would mark a procedure as “undercharged” when it was actually priced correctly.

To make these reports more accurate, Programmers created new and more thorough rules. In each 90-day modernization sprint, we took frequently encountered cases and ensured the rules were in place to decide if the claim was undercharged (and by how much). 

By iteratively strengthening these systems instead of performing a full teardown and rebuild, oncology practices across the US saw a rapidly improved experience. For our client, that meant higher customer satisfaction and brand reputation. Plus, by reducing the need for analysts to manually check transactions, our client can now gradually reallocate these professionals to other high-level tasks.

Accurate, Automated Reporting

To identify undercharged procedures, our client relies on specific data provided in weekly reports. This is a crucial step in auditing requested payments from oncology practices across the US. 

One weekly report gives a comprehensive view of recent procedures completed by each practice. Before working with Programmers, our client built this and other reports in Tableau and relied on Tableau Workbooks and Excel spreadsheets. But the company quickly understood that crunching and merging data files was not sustainable in the long-term. 

Manually merging the spreadsheets and sending them to each practice drastically increased the possibility of human error. Plus, these reports took our clients’ employees three hours to complete every Sunday night, a blow to efficiency and employee morale.

After consulting with the company, we identified this as one of their most critical areas for improvement and prioritized it as one of the first 90-day modernization cycles. Our team automated the necessary data ingestion process. We also automated the creation of the reports and the distribution of each one to the applicable stakeholders. This eliminated the need for separate data files and manually merging and delivering reports.

As part of this automation, we also implemented a rules engine, which automatically calculates if and by how much the practice undercharged for a specific procedure. This also improved the quality of the analysis and reduced the audit time necessary for the team.

Now, a report that once took an employee three hours to produce automatically arrives in each oncology practice’s inbox every Sunday night. Not only is this substantially more convenient for our client and more reliable for their customers, but it also drastically lowers the risk of human error in reporting.

Long-Term Partners in Modernization

Beyond any one technical process, Programmers’ most important contribution to this healthcare RCM company has been guiding them through their modernization journey. 

Our client started building their solutions with a small tech team within an oncology practice. Their work was impressive, but they understood it was not a robust, fully-connected digital ecosystem. 

Long-term, this patchwork of solutions would have caused the company to accrue substantial technical debt as issues with manual processes, integration, and more mounted. Instead, they chose to work with Programmers to modernize their software and build a solid foundation of digital systems that scale.

Programmers’ Fast-Track Application Modernization Service

Every organization has unique opportunities to streamline internal operations and exceed customers’ expectations through digital modernization. Some companies will benefit from expanding automated processes, like our client in healthcare RCM optimization. Meanwhile, others will find more value in cleaner code, enhanced UI/UX, cloud migration, and countless other processes. 

Programmers’ Fast-Track Application Modernization service offers a customized, value-driven solution for organizations across industries. We start by talking with your company’s leaders to understand your goals. Then, we identify the barriers in your legacy systems preventing you from reaching those short and long-term benchmarks. 

Every 90 days, we remove these roadblocks and add new features that bring value to your organization’s leaders and customers alike. By showing measurable results every 90 days, CIOs and CTOs can walk into any budget meeting knowing their modernization initiative has been and will continue to be beneficial to the company.