The Affordable Care Act, passed in 2012, included requirements for insurance companies to cover a broad range of essential services. This created new pathways for providers to offer certain services at scale to a much larger patient population.
For lactation support and counseling services specifically, this included increased coverage for comprehensive services, such as prenatal and postnatal lactation support.1
Two years after this milestone legislation, Janet Jones, IBCLE, RLC, and Lauren Reyes, IBCLE, RLC, began Breastfeeding Success Co. with the mission to make gold standard lactation services accessible to all families, regardless of financial position.
Finding a billing partner that can support your complexity
Because lactation consulting is a relatively new area for coverage, and requires integration with inpatient facilities, Breastfeeding Success Co.'s billing is complicated. Besides 12 outpatient clinics, and 13 inpatient facilities for which they’re the contracted service provider, the company provides parent education and support groups. Not to mention, each visit includes two patients, mom and baby.
Their previous EHR couldn’t keep up. Kimberly Ragsdale, practice manager, says that they saw a huge volume of claim holds and denial reasons, but didn’t have any visibility into how the denials were being handled. “They just weren’t doing what we needed them to do to fight for that coverage,” Ragsdale says. “So, they would just write things off left and right.”
Forecasting revenue was difficult without any visibility into things like expected allowed amounts for certain codes and anticipated timing of claim resolution, Jones says, adding, “It’s hard to make business decisions if you don’t have all the facts.”
Ragsdale had used athenaOne® at a previous clinic, and she advocated for the switch to have more control and insight into their revenue cycle process. “I told our owners, ‘We have to go with athena—their main goal is to get us paid,’” she says.
A new world of data-driven decision making
Now, in athenaOne, the team has a new world of RCM insights. With a suite of tools to track and monitor the claim process, they could more clearly understand and forecast their anticipated revenue.
Ragsdale says pre-built reports such as the Activity Wizard and claim work list are some of her go-to dashboards, and that the ability to build custom reports allows her to self-serve nearly all the information she needs to find. “That’s super important for an operational and financial standpoint, especially as we’re growing,” she says. “For me to understand, are we profitable in every single department?”
Outside of the need for data-driven decision making, the ease of reporting also reduces the burden of sending reports to their hospital facilities. As contracted partners, Breastfeeding Success Co., needs to send information such as how many patients they see and patient satisfaction. Reporting in athenaOne, combined with native integration, makes that simple.
Seamless data exchange across their network
With the broad network of outpatient and in-patient facilities that Breastfeeding Success Co. creates claims for, the ability to make sure that information flows across hospitals and into their practice is paramount. They also exclusively document visits in athenaOne for their outpatient facilities, meaning they need to reconcile charting from different platforms.
When they onboarded to athenaOne, the team partnered to develop a custom SFTP (Secure File Transfer Protocol) to make it simpler for this information to flow as needed. Breastfeeding Success Co. receives files from hospitals, which are then automatically turned into HL7s through a third-party system and uploaded as claims in athenaOne.
According to Jones, this connection allows them to do more business with less administrative overhead: “Being able to submit a report and have it be coded the way that we need it to on the back end, we could not do the scale that we're doing right now without that.”
More than a vendor
As a deeply mission-driven organization working in a niche and complex specialty, it’s important for Breastfeeding Success Co. to have a supportive and engaged partner.
“We’re so unique, and we need someone who understands our mission and our heart of serving these families and how delicate they are,” Ragsdale says. That’s why their ongoing partnership with their Customer Success Manager (CSM) at athenahealth is so valuable to them. “She’s always so supportive in helping us think long-term, think big picture,” Ragsdale says.
Jones agrees, adding, “Communication is key, and having someone that you can really trust makes all the difference in the world.”
Learn how athenaOne can support your unique practice
With the support of athenaOne, Breastfeeding Success Co. established a robust and effective infrastructure to manage the complexities of their business. Get in touch to learn more about how athenaOne can help your organization thrive.
These results reflect the experience of one particular practice and are not necessarily what every athenahealth client should expect.
