Best EHR Billing Features for RHCs, Including UB-04 Software RCM Integration
When selecting an electronic health record (EHR) billing solution for your rural health clinic, you want features that streamline billing, ensure compliance, and maximize revenue. There’s functionality you want to make sure your EHR offers. Like UB-04 software RCM integration, claim splitting, CPT bundling, and RHC-specific coding. With those, you can optimize your billing processes, improve overall clinic efficiency, and maximize reimbursements.
Integrating UB-04 software with revenue cycle management tools can automate claim creation and tracking for increased efficiency. UB-04 software RCM integration uses automated data exchange. Automation helps you manage claims more efficiently.
10 Best EHR Billing Features for RHCs
Here are the top 10 key features to look for in an EHR solution for your RHC and how the Azalea Ambulatory EHR delivers.
- CPT bundling
- Automated claim splitting with UB-04 software RCM integration
- Non-qualifying visit bundling
- An independent and provider-based RHC specific build
- 1500 and UB-04 claim formats
- RHC-specific claim edits and alerts
- Medicaid All-Inclusive T-code billing features
- Cost reporting data and tools
- Analytics for RHCs
- RCM services tailored for RHCs
CPT Bundling
Current Procedural Terminology (CPT) bundling is critical for your RHC. Bundling lets you maximize reimbursements by letting you group related procedures under a single billing code.
By bundling existing CPT codes, your rural health clinic benefits by reducing administrative errors and improving your reimbursement process. CPT bundling lets you comply with Medicare, Medicaid, and insurance regulatory requirements too.
Why CPT Bundling?
For RHCs to get reimbursed correctly, Medicare requires that you combine specific charges into a qualifying visit code. Medicare only pays a single line for an entire visit. To get paid, you need to add a CG modifier to the qualifying visit line.
RHCs often bill for certain procedures, such as labs or diagnostic tests, under the hospital NPI and/or TaxID. You need to move those codes to a separate encounter (split charges) in your EHR depending on your RHC status as independent or provider-based.
How the Azalea Ambulatory EHR Supports CPT Bundling
With bundling features in the Azalea Ambulatory EHR, you can easily create CPT roll-ups, bundled, and split charges. You get support for Medicare and Medicaid requirements with an EHR that automatically sums bundled charges and adds CG modifiers to qualifying visit codes. You can:
- Quickly create CPT bundles and split charges in a few clicks
- Automatically save pending changes
- Automatically add CG Modifier to the qualifying visit code
- Save time by automatically setting bundled fees to $0.00
- Save preferences to apply to future billing batches and speed up your workflow
- Sync settings across all users
Automated Claim Splitting with UB-04 Software Software Integration
When you provide more than one service in one visit, like a preventive exam and labs, you may need to split the claim to meet the correct RHC payer and claim format requirements. You need to make sure you stick to payer-specific guidelines and rules. This makes sure claim submissions are accepted and processed quickly.
With automated split claim billing (also known as split billing), you ensure each service is billed to the correct payer. Manual errors are reduced and you get paid faster. You improve your revenue cycle management. You can then focus more on patient care and less on billing complications at your clinic.
Why UB-04 Software RCM Integration?
The UB-04 form (CMS-1450) is the most common way RHCs submit claims for outpatient services. When your EHR can flow data from your patient visit into UB-04 claim form, you automate the process of creating accurate, standardized claims. You reduce manual data entry and your claim denial rate. And your billing team can focus on more important tasks.
How the Azalea Ambulatory EHR Supports Automated Claim Splitting with UB-04 RCM Integration
With the Azalea Ambulatory EHR, both free-standing and provider-based RHCs can build automated claim-splitting rules to meet their needs. They can even customize rules to meet both Medicare and Medicaid requirements. And integrated Encounter Modification Rules provide automatic updates to Location and UB-04 RCM integration with for UB-04 Bill Type fields on any newly created “split” encounters. It’s streamlined, customizable, and designed with RHC needs in mind.
Non-Qualifying Visit Bundling
Bundling isn’t limited to qualifying services. Your RHC can combine multiple services that don’t qualify as standalone visits into a single bill if they happen within 30 days before or after a qualifying visit. This lets you bundle related services into a single claim, streamline billing, and increase efficiency. It also lets you make sure you get reimbursed correctly and on time.
An example might be an initial qualifying visit that involved treating and bandaging a wound and the follow-up visits for changing and removing the wound dressing. You can bundle charges for each visit into a single claim.
How the Azalea Supports Non-Qualifying Visit Bundling
The Combined Encounters feature in the Azalea Ambulatory EHR lets you quickly and easily view and combine non-qualifying services that are in a 30-day window from a single screen without manually searching for them.
You save time and prevent missing potential claims and revenue capture.
Tailored for Independent and Provider-Based RHCs
To optimize operations, you need an EHR designed for your rural health clinic. If you run an independent RHC, custom Medicare claim splitting rules ensure quick and easy billing. For provider-based RHCs, shared tax ID configurations and automated ERA posting simplify your workflow. Choosing the right EHR streamlines your processes, reduces manual tasks, and lets you focus on patient care.
Integrating front office workflows with your billing software also lets you enhance operational efficiency and patient experience.
How the Azalea EHR Supports Tailored Billing
The Azalea Ambulatory EHR works for both provider-based and independent clinics. Independent RHCs get custom claim splitting rules built to meet Medicare requirements. And a provider-based RHC accesses simplified operations with streamlined shared tax ID claim configurations and automated ERA posting through parsed remits for a smoother workflow.
1500 and UB-04 Claim Formats
Handling various claim formats isn’t easy, is it? Thankfully, with 1500 and UB-04 billing formats for your medical claims, you can submit them consistently and accurately. You get faster reimbursements and smoother processing, but also keeps you regulatory compliant. It also makes your workflow more efficient and improves your overall revenue cycle management and payment tracking.
How the Azalea Ambulatory EHR Supports Billing Formats
The Azalea EHR lets you set your preferred claim formats based on account, payer, and location to meet your clinic’s needs. Azalea supports both UB-04 and 1500 claim formats. The built-in claim rules engine and billing configurations let you customize claim fields for any format or payer for accurate and compliant submissions every time.
RHC-Specific Claim Edits and Alerts
RHC-specific claim edits help you prevent billing errors and stay compliant with Medicare and Medicaid payers. These tools identify problems before you submit claims. Compliance flags can alert you to potential issues that may lead to claim rejection, such as data inaccuracies, formatting problems, or missing information, so you can fix them before submission. The result; a lower risk of denials, delays, and underpayment.
How the Azalea Supports RHC-Specific Claim Edits and Alerts
The Azalea Ambulatory EHR has native and custom coding/claim edits to catch RHC-specific issues before you submit a claim. Whether it’s missing revenue codes, CG modifiers or Medicaid specific T-code billing rules, alerts help you streamline operations. With targeted edits, your claims are correct the first time, which reduces denials and speeds up reimbursements — a win-win for you and your patients.
Medicaid T-Code Billing Features
Some state Medicaid programs require RHCs to submit T-codes, like T1015, which represents an all-inclusive clinic visit or encounter. Providers use these codes and the UB-04 form to bill Medicare for facility-based services. The codes ensure accurate reimbursement for the bundled services provided during a patient visit.
How the Azalea Ambulatory EHR Supports Medicaid T-Code Billing
The Azalea Ambulatory EHR includes custom claim and adjustment rules to manage T-code billing requirements for primary and secondary UB-04 and 1500 claims, as well as ERA processing. The rules simplify your billing process so you can easily meet state requirements.
Cost Reporting Tools
Cost reporting data matters for your RHC because it offers insights into expenses and resource use. Accurate reporting helps you get the right reimbursements from Medicare and Medicaid to support your financial stability. It affects reimbursement speed, claim acceptance rates, and compliance standing. And it offers insights that help with budgeting, streamlining operations, and ensuring regulatory compliance.
Cost Reporting Tools in the Azalea Ambulatory EHR
RHC cost reporting in the Azalea Ambulatory EHR gives you access to critical financial data. You access custom data feeds and export options, along with credit balance reporting, vaccine administration data, and Medicare bad debt management, so you’re always ready for audits. Powerful reporting tools save you valuable time, provide transparency, and help you make informed financial decisions to lay the groundwork for sustainable growth.
Analytics for RHCs
In today’s data-driven world, you have to prioritize analytics. Analytics from your EHR system help you monitor performance, track patient outcomes, and identify trends for strategic decision-making. Data analytics enhance care delivery, ensure compliance with regulations, and improve your financial sustainability.
Analytics in the Azalea Ambulatory EHR
Azalea Analytics provides dashboards, KPIs, and benchmarking specifically for RHCs. You can easily quantify RHC qualifying visit counts, provider productivity, wRVUs, scheduling, patient flow, billing, collections, and A/R and denials. These insights let you make data-driven decisions, improve your efficiency and raise the quality of care you provide.
RCM Services Tailored for RHCs
Revenue cycle management (RCM) services handle the financial processes linked to patient care, from registration to billing. RCM services cover a range of medical billing tasks, including claim processing, denials and appeals management, and payment posting. They streamline billing, ensure accurate reimbursements, and keep you compliant with regulations. You see improved cash flow and fewer billing errors.
Efficient RCM services help reduce delayed payments and rejected claims by ensuring accurate claims and that you meet payer requirements. Many clinics outsourced billing through a specialized billing company or billing service to reduce administrative burdens and improve patient satisfaction.
Azalea RCM Billing Services
Azalea started as an RCM service company and provides dedicated RHC-specific RCM billing services. Azalea’s Certified Rural Health Coding & Billing Specialists (RH-CBS) have extensive experience and are ready to transform your billing processes. They support your clinic at every step of the revenue cycle, helping you thrive in the rural healthcare landscape.
Conclusion
Selecting the right EHR billing solution is crucial for optimizing your RHC clinic’s operations and maximizing revenue. At Azalea Health, we understand the unique challenges you face and are committed to providing tailored EHR features and services that simplify your billing processes and let you enhance patient care.
Azalea solutions and services are HIPAA compliant to protect sensitive patient information throughout the medical billing process. You have the piece of mind that all data is handled in accordance with regulatory requirements. Azalea billing solutions incorporate advanced security features, such as encryption, firewalls, and strict access controls to safeguard protected health information (PHI).
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