Top 10 EHR Billing Solutions for Rural Health Clinics

Top 10 EHR Billing Solutions for Rural Health Clinics

When selecting electronic health record (EHR) billing solutions for Rural Health Clinics, it’s essential to choose features that not only streamline daily tasks but also ensure compliance with healthcare regulations and maximize revenue. Your Rural Health Clinic (RHC) has unique needs, and by focusing on specific functionalities like claim splitting, CPT bundling, and RHC-specific coding, you can optimize your billing processes and improve overall clinic efficiency.

Here are 10 key features to prioritize in your EHR solution.

  1. CPT Bundling
  2. Automated Claim Splitting
  3. Non-Qualifying Visit Bundling
  4. Tailored for Independent and Provider-Based RHCs
  5. Billing Formats for Medical Claims
  6. RHC-Specific Claim Edits and Alerts
  7. Medicaid T-Code Billing Features
  8. Cost Reporting Tools
  9. Analytics for RHCs
  10. RCM Services Tailored for RHCs

CPT Bundling

Current Procedural Terminology (CPT) bundling is critical for your RHC. It streamlines coding by grouping related procedures under a single billing code, reducing administrative errors and improving reimbursement efficiency. This feature helps you optimize billing processes and comply with regulatory requirements.

How Azalea helps: With Azalea Health’s bundling features, you can easily create CPT roll-ups, bundled, and split charges. These features support Medicare and Medicaid requirements by automatically summing bundled charges and adding CG Modifiers to qualifying visit codes.

Automated Claim Splitting

When your patient receives multiple services in one visit, like a preventive exam and a diagnostic procedure, you may need to split the claim to meet the correct RHC payer and claim format requirements. With automated claim splitting, you can ensure each service is billed to the correct payer, speeding up reimbursements and reducing manual errors. This process improves your revenue cycle management, allowing you to focus more on patient care and less on billing complications at your clinic.

How Azalea helps: With our advanced system, you can build automated claim-splitting rules to cater to both independent and provider-based RHC billing needs, further customizing these rules to meet both Medicare and Medicaid requirements. Plus, our Encounter Modification Rules provide automatic updates to Location and UB-04 Bill Type fields on any newly created “split” encounters. It’s streamlined, customizable, and designed with your diverse needs in mind.

Non-Qualifying Visit Bundling

You can also combine multiple services that don’t qualify for separate visits within 30 days before or after a qualifying visit. This allows you to bundle related services into one claim, streamlining billing and increasing efficiency. It also ensures you capture all services provided within the time frame for reimbursement.

How Azalea helps: Our Combined Encounters feature lets you easily view and combine these services without having to manually search for them.

Tailored for Independent and Provider-Based RHCs

To optimize operations, you need an EHR designed for your specific Rural Health Clinic. If you run an independent RHC, custom Medicare claim splitting rules ensure smooth billing. For provider-based RHCs, shared tax ID configurations and automated ERA posting simplify your workflow. Choosing the right EHR streamlines processes, reduces manual tasks, and lets you focus on patient care.

How Azalea helps: At Azalea Health, we’ve optimized our EHR to fit both provider-based and independent clinics. For independent RHCs, you get custom claim splitting rules built specifically to meet Medicare requirements. If you run a provider-based RHC, we simplify your operations by streamlining shared tax ID claim configurations and automating ERA posting through parsed remits, ensuring a smoother workflow.

Billing Formats for Medical Claims

Handling various claim formats isn’t easy, is it? Thankfully, with billing formats for your medical claims, you can submit them consistently and accurately. This leads not just to quicker reimbursements and smoother processing, but also keeps you regulatory compliant. Plus, it makes your workflow more efficient, improving your overall revenue cycle management and payment tracking.

How Azalea helps: At Azalea, we let you set your preferred claim formats based on your account, payer, and location to meet your clinic’s needs. Azalea supports both UB04 and 1500 claim formats. Our Claim Rules engine and billing configurations allow you to customize claim fields for any format or payer, ensuring accurate and compliant submissions every time.

RHC-Specific Claim Edits and Alerts

RHC-specific claim edits help you prevent billing errors and stay compliant with Medicare and Medicaid payers. These tools identify problems before you submit claims, lowering the risk of denials, delays, or underpayment. For RHCs, accurate billing and reimbursements are crucial for cash flow and operational efficiency.

How Azalea helps: At Azalea Health, we designed our native and custom coding/claim edits to catch RHC-specific issues before you submit claims. Whether it’s missing revenue codes, CG modifiers or Medicaid specific T-code billing rules, our alerts help you streamline operations. With these targeted edits, we ensure your claims are correct the first time, which reduces denials and speeds up reimbursements — a win-win for you and your patients.

Medicaid T-Code Billing Features

Some state Medicaid programs require RHCs to submit T-codes like T1015, which represents an all-inclusive clinic visit or encounter. These codes ensure you receive accurate reimbursement for the bundled services you provide during a patient visit.

How Azalea helps: At Azalea Health, we provide you with custom claim and adjustment rules to manage T-code billing requirements for primary and secondary UB04 and 1500 claims, as well as ERA processing. This feature simplifies your billing process, helping your clinic meet state requirements effortlessly.

Cost Reporting Tools

Cost reporting data is crucial for your RHC because it offers insights into expenses and resource use. Accurate reporting helps you get the right reimbursements from Medicare and Medicaid, supporting your financial stability. This information also assists in budgeting, streamlining operations, and ensuring regulatory compliance, ultimately improving patient care.

How Azalea helps: Easily access vital financial data with our robust reporting options. We offer custom data feeds and export options, along with credit balance reporting, vaccine administration data, and Medicare bad debt management, so you’re always ready for audits. Our powerful reporting tools save valuable time, provide transparency and help you make informed financial decisions, laying the groundwork for sustainable growth.

Analytics for RHCs

In today’s data-driven world, you must prioritize analytics. Specific analytics in your EHR system will help you monitor performance, track patient outcomes, and identify trends for strategic decision-making. This approach enhances your care delivery, ensures compliance with regulations, and improves your financial sustainability.

How Azalea helps: Azalea Analytics provides dashboards, KPIs, and benchmarking specifically for RHCs. Quantify RHC qualifying visit counts, provider productivity, wRVUs, scheduling, patient flow, billing, collections, and A/R & denials with ease. These insights empower you to make data-driven decisions, improving your efficiency and raising the quality of care you provide.

RCM Services Tailored for RHCs

Revenue Cycle Management (RCM) services handle the financial processes linked to patient care, from registration to billing. They streamline billing, ensure accurate reimbursements, and keep you compliant with regulations. As a result, you’ll see improved cash flow and fewer billing errors. Not all RCM services are the same and it’s vital to find a partner with extension RHC billing experience.

How Azalea helps: Since our inception, we have focused on providing dedicated RHC-specific RCM and billing services. Our Certified Rural Health Coding & Billing Specialists (RH-CBS) have extensive experience and are ready to transform your billing processes. We support your clinic at every step of the revenue cycle, helping you thrive in a competitive landscape.

Conclusion

Selecting the right EHR billing solution is crucial for optimizing your RHC clinic’s operations and maximizing revenue. At Azalea Health, we understand the unique challenges you face and are committed to providing tailored features that simplify your billing processes and enhance patient care. By leveraging our solutions, you can streamline your workflows, ensure compliance, and focus on what truly matters—delivering exceptional healthcare to your community.

Experience seamless billing and patient care with Azalea Health.