CASE STUDY

Improving Regulatory Compliance

Digitally transforming a healthcare organization requires patience and a commitment to the future of the company. Life Inc.’s current practices seemed to work. But some business forecasting quickly revealed that they were not prepared to handle additional regulatory changes.

01

Problem

Government regulations and outdated paper processes increase the chances for fraud and IRS auditing.
02

Solution

Total digital transformation. Saving time and money, the company can fulfill its mission while remaining profitable.
03

Results

Improved business intelligence positions a company for nimble and strategic growth, while remaining compliant.
01

The Problem

Bottlenecked Workflows

For companies whose services are more focused on people than technology, it may not feel natural to turn to digital solutions. But companies that resist digital transformation increase the chance that they’ll be left behind or even lose accreditation when more stringent auditing is required. 

Since 2003, the Government Accountability Office (GAO) has placed Medicaid on its fraud watch list. Because of its size and budget (over $605B), any company or industry that relies on Medicaid or Medicare funding must be prepared to substantiate billing information. Companies that work with vulnerable populations are also subject to additional state oversight to protect the dignity and safety of their clients.

Like many habilitative companies, Life Inc. relied on federal and state funds to serve its patient population. So while they needed to maximize profits, they also needed to stay compliant with changing government regulations. This meant keeping records for up to six years to prove to government auditors that they’d provided the services they were charging for, and that their billing system was correct.

Those companies still using outdated paper processes or CRMs increase their risk of committing fraud, even inadvertently. And it makes it more difficult to justify their time cards, billing, and therapy services to insurance companies or government auditors. When our client came to us, they wanted to improve their employee time tracking so they could serve more clients, plus they needed real-time data to manage their resources. They needed to move away from inefficient paper insurance claims and digitally integrate with insurance providers.

02

The Solution

Real-time Data

Ventive built real-time notifications into Life Inc.’s inter-office application. Previously, office staff would spend days working on complex calculations so they could manually report staff hours and resources. Then staff resources could be adjusted based on the reports. This manual process made allocating resources difficult. 

Now, the office staff has the flexibility to adjust hours and keep track of how patients are being served. Calculations can be done in minutes, not days, through the application that Ventive built for them. This dramatically reduced the time spent on labor. We attached service codes to every activity so that billing was simplified and activities were verifiable. 

The healthcare client’s billing system was integrated with government healthcare systems so that they could stop submitting inefficient paper claims. This could increase the number of approved claims and how quickly the company received payments. Increasing and tracking the data at their fingertips means the company will have better business intelligence to navigate slowdowns or plan for growth.

By embracing digital transformation, the habilitative company is prepared to serve clients better today, and in the future.

Highlights

Services Utilized

EDI Integration

App Development

UX Design

03

The Results

Improved Business Analysis

A custom app has been built for Life Inc. so they can track where providers are located and where patients are in the treatment process. They can use that data to submit accurate insurance claims and plan for long-term business goals. Having instantaneous information about their clients and employees will help them reduce time theft, increase credibility, and maximize their insurance claim amount.

By the end of this project's first implementation, Life Inc. was saving 50 hours per week in labor. They anticipate that the next iteration of the project will reduce their man-hours by 100 hours per week. Automating paper processes freed up nearly 3 full-time employees' time to focus on higher-level tasks. Over a year's time, this represents a tremendous savings in labor costs, letting them focus on serving more patients.

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