myEvolv streamlines billing and claims for 250+ programs

Lutheran Social Services of Wisconsin and Michigan success story

Lutheran Social Services of Wisconsin and Upper Michigan, Inc. (LSS) offers over 250 programs in 115 communities throughout Wisconsin and Upper Michigan. The organization, which is affiliated with Evangelical Lutheran Church in America, welcomes and serves over 100,000 people of all faiths each year.

Challenges

Inefficient billing and paper-based claims processes

LSS did not have a centralized data repository and each of the agency’s regional offices had its own billing processes and records systems. Copy machines and typewriters were used to manually create thousands of paper claims each month from service records. This duplicate data entry often resulted in errors and double documentation. Once claims were submitted, Medicaid often took four to six weeks to provide remittance – and counties often 30 days or more. This long turnaround time resulted in potential cash flow issues for the agency and made it difficult to plan future expenditures.

Solution

myEvolv, Netsmart electronic health record

LSS made the decision to implement myEvolv, Netsmart’s electronic health record (EHR). myEvolv is a fully web-based, ONC-certified EHR solution with comprehensive clinical, case management and billing features.

The flexibility of the system allows us to manage our 250+ programs that have ever-changing payer/funder requirements.

Linda Rimmer, Project Manager, Finance, Lutheran Social Services of WI and Upper MI

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Results

Streamlined billing cycle

With myEvolv, LSS created standardized billing and claims processes based on a centralized database that staff can securely access from any LSS location. myEvolv also automatically integrates clinical and financial data, as the software creates claims and adjusts billing records when clinical staff provides services.

myEvolv’s full accounts receivable/accounts payable sub-ledger system also provides real-time revenue data to improve decision-making and provide accurate reporting on the financial health of the agency.

Commercial/Medicaid remittance time was reduced from four to five weeks to four to six days.

Fast adjustment to state Medicaid changes

When state Medicaid regulations change, LSS must adapt to new mandates on how programs are managed, how the organization submits claims and how it is paid. Since implementing myEvolv, LSS has been able to implement changes in a timely manner and stay on track financially.

In one instance, state regulatory changes meant LSS had to reconfigure its base system, which consists of contract rules that link clients, payers and oversight bodies, and develop 48 distinct claim format setups. With the flexibility of myEvolv, the organization was able to meet the state’s new requirements with minimal disruption to daily operations.

“The flexibility of the system has allowed us the ability to manage our 250+ programs that have ever-changing payer/funder requirements from the federal government, states, counties, department of corrections, Medicaid, Medicare, HMOs, MCOs, and commercial insurance,” noted Linda Rimmer, Project Manager, Finance, at LSS. “This provides a sense of security, knowing that we can manage the changes quickly in myEvolv and maintain our cash flow.”