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Financial EHR Designed Specifically for PDPM

Case Study

By Dr. Cameron Zargar

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    This Billing Manager Is Saving Over 14 Hours Per Month-End Close

    Business Problem

    Einstein LTSR was struggling with its billing on account of an EHR that was not compatible with PDPM.


    Carol Dowling, the billing manager, looked for an intuitive system designed specifically for long-term care and settled upon Experience Care. She is now not only able to keep her facility in accordance with federal regulations, but she is also saving nearly two days of work on each month-end close.


    When Einstein Health asked Dowling to use Cerner for billing at its long-term structured residence, she explained to them that it simply was not possible to do so under PDPM. So she pursued a software provider that would be able to meet the very specific demands of the behavioral health facility. The support team at Experience Care reached out with open arms and accommodate her every need. Now her month-end close can be done in less than two hours and she can rest assured that her facility is properly documenting care.

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    Documentation That Meets the Standards of PDPM

    The specific needs of long-term care are often overlooked and those who work in the industry are requested to make do with software designed for acute care. This is a challenge that Dowling knows firsthand, as her facility struggled with the transition to PDPM on account of using Cerner’s EHR. “They really didn’t know anything about long-term care when they were building the system for Cerner,” she said. “They had no clue what PDPM entailed. There was nothing available. I would take screenshots and tell them, ‘You’re trying to put me up on a system that is not able to handle this.’ ”
    This lack of expertise could have put Dowling and her organization in serious legal peril. “[The developers at Cerner] didn’t recognize that there are federal codes that need to be used for discharge and admission,” she said. “Meanwhile, I had to print out my screens because a lot of our contracts wanted their PDPM scores on claims, and then they wanted to go through my UB-04 forms.” She concluded by saying, “The financial piece for Cerner was just a disaster.”

    “The financial piece for Cerner was just a disaster…

    So I told [Einstein’s decision-makers] to look at [Experience Care] because they already have this in place and are ready to go with the PDPM scores.”

    Carol Dowling, Billing Manager, Einstein Health

    And so Dowling pushed back against her organization’s request to use Cerner for financials. “I said, ‘Give me a facility you have that’s already using this because I want to go visit them and see how it works,” she said. “They didn’t have it up in a facility, and I wanted to make it clear that I wasn’t going to be the guinea pig.”
    After that exchange, she decided to look for other options. It was her familiarity with the long-term care expertise of Experience Care that motivated her to pursue the EHR vendor in hopes of a better way of billing in a post-PDPM world. “I always thought very highly of Experience Care’s system,” she said. “So I told [Einstein’s decision-makers] to look at it because they already have this in place and are ready to go with the PDPM scores.”
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    Billing That Is Faster and Easier

    In addition to meeting PDPM requirements, Experience Care’s software is saving people like Dowling a great amount of time. “Using this EHR is saving me 10 hours per week,” she beamed. “And it’s only gotten faster over the years.”

    Most notably, end-of-the-month billing is much more efficient than before. “I used to dread closing the month for billing because the system would take so long to calculate,” Dowling said. “The system would go down, and it would take at least two days to get through just the initial piece of running reports for accounting and checking the numbers.” The improved efficiency since moving to Experience Care has been nothing short of remarkable. “Now I’m closed within an hour to an hour and a half at the most,” she shared.

    “The system would go down, and it would take at least two days to get through just the initial piece of running reports… Now I’m closed within an hour to an hour and a half at the most.”

    So how is it possible to save that much time just by using the right EHR? “It’s just very easy to use,” Dowling stated simply. “It’s very user-friendly. And that’s why I highly rate the system and recommend it to others.”

    Dowling shared how she noticed a peer, the billing manager at the Philadelphia Protestant Home, was struggling with an onerous system. “It required you to end a care level completely before you went on to another one, so it was a lot of work to go from one payor to another,” she said. So Dowling told her about the intuitiveness of Experience Care. “I said, ‘It’s so easy. You just go in, change a care level, and it pops it down to another payor. So you don’t have to end a payor in the reimbursement table and rebuild the reimbursement table to bring on another payor.’ ” Needless to say, her friend was impressed.

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    Support When You Need It Most

    When Dowling first reached out to Experience Care, she explained that Einstein LTSR is a small behavioral health facility. “I told them about our particular situation and asked if they could fulfill our needs,” she said. Those needs are partly related to Einstein LTSR being grant-funded. “They want claims in the door to back up all of the grant money that goes out, so there are certain codes that have to be on the claim that are different from those of other long-term care organizations,” she said.

    None of those issues posed a problem for Financial Product Manager Sue Friesth and the team at Experience Care. “Sue worked with me and immediately got everything perfect on the claim with the care levels,” Dowling said. “And I’ve never had an issue.”
    Another form of support that Experience Care offers for its users is monthly user calls in which customers share the changes they would like to see to the software and are notified about upcoming regulations or other updates. Dowling described the support team as “wonderful” and “like a family.”