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Navigating Complex Healthcare Operations: eClinicalWorks RCM Consulting Services

17 April 2025
Blog
2 minute read

eClinicalWorks

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In the intricate world of healthcare operations, efficiency is paramount. eClinicalWorks offers an array of RCM consulting services to help practices improve their financial performance.

With operations spanning nine outpatient offices and 80 nursing homes across 12 states, Compass Health Systems faced significant operational challenges that demanded innovative solutions.

Compass Health Systems transformed their operations by leveraging eClinicalWorks RCM™ consulting services to streamline efficiency and enhance accuracy.

Understanding the Challenges

With a service volume of 32,000 claims per month, the complexity of managing claims across various states and specialties was overwhelming. Compass Health Systems recognized the need for a thorough system review to address their operational inefficiencies.

The practice’s payment posting department, with only two employees, could not — with existing processes — sustain a workload that required managing $7 million monthly. The work involved ensuring the accuracy of tax ID numbers, provider overrides, and CPT codes for different insurance companies and specialties.

Existing processes were insufficient to handle diverse claims efficiently, leading to potential delays and errors in payment processing. The manual workload was unsustainable, requiring a strategic intervention to optimize operations.

Leveraging eClinicalWorks RCM for Transformation

For healthcare providers like Compass Health Systems, navigating complex operations across multiple locations demands a sophisticated approach. Compass Health Systems engaged with eClinicalWorks RCM consulting services, initiating a comprehensive system overhaul.

By conducting a thorough assessment and gap analysis, the eClinicalWorks Enterprise Implementation Specialist (EIS) team develops custom workflows to exceed financial key performance indicators.

1) Enhanced Front-End Processes

The implementation of electronic posting and the Coding Accuracy Support System (CASS) configuration marked a pivotal shift in Compass Health Systems’ operations. These tools allowed for better claim scrubbing, ensuring that claims were correct before submission. This preemptive approach minimized rejections and streamlined back-end operations.

2) Improved Accuracy

A cornerstone of Compass Health Systems’ success was the establishment of 475 rules within their system. These rules ensured thorough validation of tax ID numbers, provider overrides, and CPT codes. This comprehensive setup facilitated a seamless integration of operations, reducing the manual burden and enhancing the accuracy of payment posting.

3) Increased Efficiency and Effectiveness

The impact of these changes was profound. Compass Health Systems witnessed a significant improvement in their operational efficiency. The streamlined processes enabled them to handle their complex operations more effectively, reducing errors and delays in claim processing. The integration of electronic posting and CASS configuration not only optimized their workflow but also empowered their team to focus on strategic tasks, driving greater value for the organization.

A Sophisticated Approach to Navigating Complex Healthcare Operations

Navigating complex operations across multiple locations demands a sophisticated approach. Through strategic implementation and the establishment of better operational guidelines, Compass Health Systems sets a compelling example for other organizations. Their journey illustrates the transformative power of technology in healthcare, paving the way for future innovations and operational excellence.

To discover how eClinicalWorks RCM solutions can help transform your operations and drive better financial outcomes visit https://www.eclinicalworks.com/products-services/revenue-cycle-management/.