Telepsychiatry Platform Increases Patient Satisfaction by 88% Post Integration Guidance

About Our Client

The Client is a US-based behavioral health provider offering round-the-clock care for patients with a range of mental health conditions. The Client collaborates with nearly 30 physician practices, health systems, and health plans.

Flawed Billing and Claims Management Integration Led to Unapproved and Aging Claims

The Client has a HIPAA-compliant telepsychiatry platform running on iOS. Patients sign up using their mobile phone, complete a self-assessment form, and are instantly matched with a suitable behavioral health therapist based on their goals, age, and condition acuity. Patients receive personalized care through video consultations and instant messaging with licensed therapists. Psychiatric professionals can also e-prescribe and manage medications for each patient. Additionally, the platform provides a 24/7 helpline in the form of a live chat handled by a team of readily available mental health professionals. Patients can manage payments and insurance claims directly via the app.

While the Client developed the platform mostly in-house, several modules were enabled through integrations with external providers. Specifically, the Client outsourced billing and claims management to a third-party billing service provider. However, the integration was not entirely effective. Since the outsourced provider did not wholly automate the billing and claims management process, the Client had to manually handle Excel files to submit claims and retrieve information from insurance companies. In addition, the Client had limited access to its billing records and could not directly furnish data for the original claims. Combined with sometimes incorrect data processing by the billing provider, this led to numerous unapproved and aging claims (some claims stayed unpaid for up to 90 days after submission). Consequently, the Client’s patients were experiencing delays in receiving further services.

To address these issues, the Client sought new integration options. It considered integrating the platform with either a clearinghouse, which would require software customization, or a different billing and claims management service provider, which would involve adopting a third-party billing and claims management solution.

Seeking expert advice on platform integration, the Client turned to ScienceSoft, trusting our 19 years in healthcare IT and experience developing telepsychiatry software.

Evaluating Integration Options for Better Billing and Claims Management

ScienceSoft assigned a healthcare IT consultant and a software architect to work on the project. They began by thoroughly analyzing the Client’s platform to gain a holistic understanding of its current state and the challenges of the faulty billing and claims management integration. ScienceSoft also conducted in-depth interviews with the Client to grasp the specific pain points, user expectations, and business goals related to billing and claims management.

To determine the best integration option for the Client’s business needs, ScienceSoft’s consultant did the following:

• Conducted interviews with a range of clearinghouses (Availity, Change Healthcare, Blue Cross Blue Shield Association, UnitedHealth Group, TriZetto Provider Solutions, Emdeon, Office Ally) to compare their most recent offerings in terms of functionality and costs and determine their feasibility for the Client’s platform. The consultant also obtained software UI demos from the clearinghouses so that the Client could assess the convenience of the shortlisted integration options.
• Carried out a comparative analysis of the leading off-the-shelf billing and claims management platforms from providers like Epic Systems, Cerner Corporation, athenahealth, eClinicalWorks, NextGen Healthcare, Kareo, and AdvancedMD.

The software architect performed a technical evaluation of the solutions offered by both the clearinghouses and the billing and claims management service providers. The key aspects he assessed included:

• The technology stack used by the provider and its compatibility with the telepsychiatry platform’s techs.
• The opportunity for integration with the platform’s modules.
• Scalability to meet the Client’s current and future business needs.
• Security measures to enable HIPAA compliance and ePHI protection.
• Performance under varying loads and the reliability of the solutions to minimize downtime and ensure continuous service availability.
• Customization flexibility to meet the Client’s specific requirements, such as the ability to tailor the UI and incorporate new features.
• The scope of support and maintenance services for timely issue resolution and software updates.

Based on the gathered information, ScienceSoft compiled a comparison document outlining the advantages and disadvantages of each option to assist the Client in making an informed decision.

Achieving an 88% Increase in Patient Satisfaction with the Enhanced Telepsychiatry Platform

In four months, the Client received an actionable comparison of 14 billing and claims management solutions offered by clearinghouses and out-of-the-box software providers. ScienceSoft analyzed the costs, functionality, UI convenience, technical compatibility, integration capabilities, scalability, security, performance, customization flexibility, and levels of support and maintenance offered by each provider.

After reviewing the most feasible options with ScienceSoft’s team, the Client ended up choosing one of the clearinghouses. After the Client implemented the new integration, it observed notable improvements in a six-month study across four clinical sites involving almost 40 medical professionals and 75,000 insurance-covered patients:

• An 88% increase in patient satisfaction.
• An 80% short-term care retention rate.
• A 43% decrease in symptom severity.
• A 67% reduction in emergency room visits.
• A 100% reduction in the number of hospitalizations.

Technologies and Tools

Microsoft Office, Visual Studio Code, Apache JMeter, OWASP ZAP, Prometheus, Kubernetes, SonarQube, SQL Server Management Studio, HTML, CSS, JavaScript, React, Angular, Vue.js, Node.js, C#, Python, Django, PostgreSQL, Oracle, MongoDB.