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Case study

Healthcare technology provider automates billing with Red Hat tech

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Healthcare technology provider Experity Healthcare sought to free its billing experts from the complex billing decision-making to focus on more valuable client work. Working with Axcelinno, a Red Hat Apex Partner, Experity automated decision-making with Red Hat Decision Manager. The company can now use automated processes to accommodate clients’ unique billing rules, saving time and creating a foundation for business growth. Experity now processes 50,000 billing transactions daily in just 1-2 hours.

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Benefits

  • Automated complex billing to process 50,000 transactions in just 1-2 hours
  • Reduced time needed for rule changes from weeks to days 
  • Gained experience and guidance with new technology like Java™

Mitigating delays and growth risk of complex healthcare billing rules

Created from the recent merger of DocuTAP and Practice Velocity, Experity Health provides technology solutions to more than 4,000 healthcare practices and primary care clinics, predominantly in the United States, with a focus on urgent care services. Its services include electronic medical records (EMR), practice management, and revenue cycle management and billing. 

Experity’s experts help healthcare practices and clinics overcome the complexity of urgent care coding, billing, payer contracts, and compliance to successfully gain reimbursement. Often specific to an individual practice or clinic, coding and billing regulations are becoming increasingly complex. For example, a client might have unique rules for physicians regarding procedure codes and documentation of the medical care a patient receives. Billing teams need to ensure invoices adhere to the specific rules of their assigned practices or clinics—a process made challenging by the variety of clients’ unique approaches.

“Our manual billing processes were becoming increasingly time-consuming,” said Brandon Zweifel, Software Development Manager at Experity. “Around 20 teams of 5 or 6 billing experts spent the entire morning trying to remember and apply the correct billing rules for each practice.” 

To keep complexity from hindering growth opportunities, Experity sought to automate its manual billing processes. “We wanted a solution that would let us create and manage a large volume of rules, helping us free our expert billers to focus on providing faster, better service to our clients,” said Zweifel. 

Automating billing processes with Red Hat Decision Manager

As an existing customer of Red Hat, Experity worked with Axcelinno, a Red Hat Apex Partner, to evaluate possible solutions from the trusted vendor. Based on Axcelinno’s recommendation—and compatibility with its existing Red Hat Fuse integration and Red Hat AMQ messaging platform—Expertity decided to deploy Red Hat Decision Manager, part of Red Hat Process Automation.

“Red Hat Decision Manager has an easy-to-use interface that would let us shift rules management from IT engineers to business analysts who have more knowledge on medical coding,” said Zweifel. “That capability was vital.”

Experity worked closely with Axcelinno to plan and complete migration, including creation of separate test and production environments. Deployment to the company’s virtualized on-premise environment was completed in October 2019, in just 5 months. Experity has now migrated 12 rule groups, with plans to create 6 additional rule groups.

The solution integrates data from a variety of sources, including a SQL database with data from Electronic Medical Record (EMR) and practice management applications. Data types include procedure, diagnosis, insurance, practice, and clinic codes, as well as information about patients, insurance, payments, visits, and healthcare practices and clinics.

“Our practice management system adds information about patient visits to our Red Hat Fuse queue. Red Hat AMQ reads the queue and makes a call to the Decision Manager API. Decision Manager processes the data, eventually making an API call back to our practice management system with details of the invoice that needs to be created,” said Zweifel.

Focusing on client relationships, not routine management 

Saved hundreds of billing expert work hours

By automating data collection and invoice details, Experity has saved hundreds of work hours every day for more than 100 billing experts. Once per day, Red Hat Decision Manager processes more than 50,000 billing transactions in just 1-2 hours, helping the company’s staff focus on more complex interactions and building relationships with clients.

“We have a team of 5-6 staff assigned to each of our 20 practices and clinics. They used to spend every morning processing billing information for their practice,” said Zweifel. “Red Hat Decision Manager completes that same work in minutes, so they can devote their time to work that needs their expert insight.”

Simplified business rule management

Previously, Experity’s billing team had to wait a week or more for requested rule changes to be completed. Now, with responsibility shifted to business analysts, rule changes are available within days—or even the same day. 

“One of the key advantages of Red Hat Decision Manager is its easy-to-use interface,” said Zweifel. “Our business analysts can now write and amend rules themselves, without depending on our IT engineers. Whenever the billing team requests a rule change, an analyst can have the change available for them very quickly.”

Additionally, the Test Scenarios designer included in Red Hat Decision Manager means quality assurance is faster, further speeding changes. “Defining the vast number of test scenarios and associated test cases we needed for quality assurance was a mammoth task,” said Zweifel. “We would have struggled without the Test Scenarios designer feature.” 

Gained expert insight and guidance through vendor partnership

Working with a Red Hat Apex Partner has helped Experity not only successfully implement Red Hat Decision Manager but also create a foundation for continued success with the technology. 

Red Hat Apex Partners offer extensive expertise in application development and integration, particularly with Red Hat technology solutions. For example, Axcelinno helped Experity’s teams learn how to work with and write Java™ rules.

“Axcelinno’s expertise ensured a smooth transition to Red Hat Decision Manager. The transition plan they created, in particular, was critical,” said Zweifel. “Whenever client requests looked like they might cause challenges, Axcelinno guided us in the right direction to meet the client’s needs while maintaining the performance of our processes.” 

Planning for a cloud-based future

Experity’s success using Red Hat Decision Manager to streamline billing processes has prompted discussions among the company’s engineers on new uses for the technology.

“Red Hat Decision Manager is the future,” said Zweifel. “Our business rules management system might be a good fit for other rules-based processes. For example, procedure coding gets applied to every charge based on the length of a visit, whether it was after hours, if the patient was new, and other considerations that create complexity.”

The company is also planning to move to a cloud computing environment, working with Axcelinno to migrate some on-premise services and applications to a public cloud environment within the next two years. As part of this shift, Experity is evaluating adding Red Hat OpenShift® to its IT architecture.

“Migrating our systems to a Kubernetes platform will make us more agile, and we’re definitely interested in Red Hat’s work in that space,” said Zweifel. “With our current technology and strategic plans, we are in the best shape for a successful future.”

About Experity Health

Experity Health combines DocuTAP and Practice Velocity to provide technology solutions to more than 4,000 on-demand healthcare practices and primary care clinics. It offers industry-leading EMR and Practice Management solutions, patient engagement technology, e-registration, overread services, an employer portal for occupational medicine, referral management, revenue cycle management services, and a robust analytics suite.

About Axcelinno

Axcelinno, a Red Hat Premier Apex Partner, works with clients to accelerate business innovation using best-of-breed technology solutions. The combination of Axcelinno’s cross-functional teams, which bring over 20 years of experience and a unique mentoring model, helps clients  deliver solutions on budget, on time, every time. Axcelinno professional services, combined with Red Hat’s OpeShift Container Platform, Red Hat Decision Manager, and Red Hat AMQ allows for the creation of robust solutions to solve complex business problems.