Breathing new life into healthcare billing with Epic-CLM integration

US medical practices spend $70 billion a year on billing and insurance-related administrative costs. According to the same research study, hospitals spend an additional $74 billion a year.

For decades, experts have acknowledged the crippling burden of medical billing on the healthcare industry. Many have tried to address the issue through policy changes and strategic overhauls. Others have innovated to find greater efficiencies within their operations—The University of Miami Health System (UHealth) is one of them.

More than 10 years ago UHealth selected MediTract as their contract lifecycle management (CLM) solution. Although the system was designed to oversee the 500 plus insurance companies, hospitals, and other organizations accountable for medical payments, it had become little more than a database dump.

UHealth Data Architect James Anderson made a plan to improve the user experience, expand visibility to the frontline medical staff and integrate CLM with other key systems. James and his team selected Agiloft for this undertaking.

“Central billing and revenue cycle now have access to some of the cool things we were able to do,” James said. “We had a segment of top payors that we wanted to get access to right away. We had to come up with a solution to organize and chop up that data. With Agiloft, we were able to map that out and also make it understandable for these end users, breaking it down by lines of business. In addition to the AHCA categorizations, we used our Epic framework for other classifications. Agiloft, of course, allows you do to whatever structure that you want.”

In the final phase of UHealth’s Agiloft deployment, integration with EPIC will become the focal point. The medical record software Epic—which now hosts the records of more than 250 million patients worldwide—is the information repository for providers as they care for their patients. The data in Agiloft will tie directly to the medical record plan code (which denotes how something gets paid). UHealth will have an instantaneous link between the activity performed by the doctor or nurse and the billing associated with that activity. Dynamic reports based on this data will allow for a robust review of the initial contracts and a streamlined billing process.

To learn more about UHealth and their innovative approach to contract management and medical billing, read the case study here.