FinMed is leading the way to next-generation claims management and efficient payment for providers. This innovator knows that when providers are empowered to run healthy businesses, it strengthens the healthcare system as a whole. FinMed helps their healthcare customers bill more easily, file claims with fewer errors, and reduce time-to-payment, so that providers can invest saved time, energy, and resources into serving patients better.

FinMed’s mission is to make the interface between healthcare providers and the insurance companies who pay them easier and more efficient. Today, even when providers deliver great care their claims for payment are frequently rejected. Even once accepted, providers end up waiting up to 120 days for payment. In an era of immediacy delivered by basic technologies that exist, FinMed saw an opportunity for dramatic change.FinMed envisioned custom software that could help doctors run better businesses and in the process, help put a brake on rising healthcare costs due to inefficiencies. FinMed envisioned managing:

• Quality control. FinMed helps customers catch more errors before claims are submitted, while simplifying error presentation so billing teams can understand how to file claims more accurately. FinMed also wanted to help customers move faster by correcting many errors in-flight without further action by billing staff.
• Targeted training. FinMed customers can improve the business side of their practices with customized training and best practices. By teaching billing staff to correct the most common and impactful claims issues the practice faces, dramatic improvements in claim acceptance rate and payment processing time can be achieved.
• Faster cashflow. The company’s “Pay Forward” cashflow management capabilities enable FinMed to pay each provider up to 60% of Medicare-approved claim values at the time of submission. This saves FinMed customers 60 to 90 days of processing time and improves cash flow with each claim they file.

FinMed’s founders have more than 100 years of combined healthcare experience and a compelling digital product vision. But after working to develop the product for over a year with no results, FinMed realized they needed to find a new product development partner. They chose Altus Nova for their proven ability to deliver strategic breakthroughs along with impeccable development quality, and got underway.

To pick up where the previous team left off, Altus Nova needed to deeply understand FinMed’s vision and business goals, and to examine each aspect of the business problem. We examined:

• EHR formats. Analyzing the formats of claims generated by the most popular Electronic Health Record (EHR) systems allowed us to define a data processing pipeline that could ingest and analyze provider claims.
• Integration mechanisms. Understanding how provider groups could integrate with FinMed’s solution — whether via API integration, secure FTP sites, manual file uploads, and more — helped that would be used by each Healthcare Provider Group when integrating with FinMed’s solution.
• Common errors. Assessing the type and range of issues claims exhibit helped us to define a straightforward mechanism to translate errors into a user-friendly format that could benefit billing staff as they worked.

With a clear map of the problem, Altus Nova rapidly assessed FinMed’s existing technology infrastructure to identify what could be salvaged and built upon, what needed re-working, and what would need to be developed from scratch — all without missing the aggressive deadline that FinMed was already up against.

Altus Nova’s rigorous approach to discovery led to a two-phased plan to get FinMed from no product to digital software dominance in their space. The first phase would establish FinMed as a must-have claims management tool. The second would position them as an essential business-lift tool via up-front payments for FinMed customers.

Phase 1

With FinMed’s breakthrough path mapped, Altus Nova proposed to build a next-generation healthcare claims scrubber that would simplify the incredibly cryptic and esoteric medical coding process upheld by current solutions in the market. This solution would be designed to:Solve for EHRs. To give FinMed the largest possible customer base, Altus Nova built the solution to integrate claims data from all major EHRs, including 837 EDI, CMS 1500 print form, FHIR, and HLS formats.

Automate fixes. Altus Nova leveraged nearly 3,000 edits developed by FinMed to transform claims scrubbing from a laborious, step-by-step procedure into a single automated step.

Share Insights. Altus Nova provided FinMed the ability to visualize scrubbing results, allowing medical coding experts and client billing staff to review “smart errors” — allowing reviewers to understand the most frequent errors, to understand the financial impact of these errors, and to assess which physicians or groups within the practice are most impacted by them.

Enable training. Altus Nova also designed the system to present detailed, layman-friendly explanations of claims issues, thereby enabling providers to reduce the level of experience needed on the billing team, to effectively train new members of that team, and to experience continuous improvement in that team’s performance.

Phase 2

Next, Altus Nova proposed to add the industry’s first “Pay Forward” system providing micro-loans to healthcare providers against each claim to payers. Because FinMed customers would be empowered to become better at filing claims, the time-value of payment creates opportunities for practices:

Value scoring. To enable FinMed customers to get value from their claims filing excellence, a FinMed Claim Payout Reliability score would be developed for each practice within a healthcare group. This score would be based on the severity and frequency of claim errors, the likelihood of successful payout from insurance payers, and the expected amounts to be recovered from payers based on Medicare reimbursement rates.

Micro lending. Next, each provider’s score would be used to qualify for instant Pay Forward payments. Amounts would be calculated in real-time as claims are submitted and scrubbed by the system, and electronically lent to the provider group against a large, revolving line of credit held by FinMed.

Payment processing. Finally, FinMed would automatically process an Explanation of Benefits from each payer in EDI 835 file format from the clearinghouse, manage payout from insurance, then electronically debit FinMed’s initial loan plus processing fees. The system would handle any issues such as insufficient funds as well as provide a meaningful reconciliation between providers and payers, and ultimately electronically deposit recovered loans to FinMed’s line of credit.

With full approval and alignment from the FinMed team, Altus Nova quickly developed Phase 1 of the FinMed solution, including the transformative ability to automate approximately 3,000 fixes developed by FinMed, and to translate those into Smart Error reports easily utilized by billing staff to improve their performance.

The first release of the FinMed solution is being deployed to large healthcare organizations. Within 6 months, these enterprise-sized practice groups will have generated the data required to formulate Pay Forward scores. These scores will enable FinMed to release cash flow improvement capabilities to support its customer base, further improving their customers’ businesses and strengthening the healthcare system as a whole.

The Altus Nova team worked to create clarity, ease, and readability across claims detail pages and claims dashboards. These dashboards will help billing teams understand their overall performance, review the kinds of issues they face in filing claims, and understand the financial impacts of those errors. Soon, the experience will also enable billing staff to monitor their improvement, see all Pay Forward payments, and show how their efforts are impacting cash flow.