Organizations today face the same type of challenge that they have had over the last two decades– streamlining processes, getting the maximum dollar for the rendered services, and cutting through complex payer contracts and adjudication processes.
However now, it is a lot tougher on three counts - increasing operational and compliance costs, less helpful payer processes, and the demand for a fully digital RCM experience. Quintessence has left no stone unturned by creating simple, easy to deploy, and intuitive technology to counter the massive budgets of payers on one side and managing physician workflows on the other. Not to mention their proprietary platforms that power productivity to focus on outcomes at high and sustained levels of quality.
Quintessence is developing, customizing, and deploying smart technologies that wrap around a customer’s practice management systems and EMR. This is a unique value proposition offered by Quintessence that is usually missing with the competitors. They have built tools, platforms, and BOTs for every function of the Rev Cycle for each one of their customers – this helps raise staff productivity, ease workflow friction, enhance automation and assure high levels of sustained quality outcomes. Their products integrate with customer systems either through APIs or data exchange involving HL7 or other formats. The company has built Bi-directional exchanges with several of its customer EMRs and PMSs. These tools can be deployed within customer networks or hosted in the cloud or data centers in the US.
Quintessence’s smart solutions combined with analytics, insights, and intelligence, push claims towards resolutions and seamlessly deliver the reimbursements that are due. For example, let’s take their AR process for instance. Reimburssence, their proprietary AR intelligence engine will pull claims daily that need to be addressed. With a daily pull routine, a lot of wasted effort is avoided. Dynamic auto allocation algorithms allow for sharp responses to changing requirements. By grouping and ordering claims, it ekes efficiency at every step of the way. The assist engine guides staff through the path of best outcomes so claims can be pushed to closure than just being touched and left to age out. “We measure by touches to closure and touches per type and generate analytics that can further attune allocation and assist library. Finally notes so captured can be input into your PMS that can feed your native dashboard or we can build a custom dashboard that will meet your business needs”, says Nirmal Kumar Rajachandran, CEO & Co-founder of Quintessence. Using Reimburssence has resulted in a predictable and transparent AR process – the most challenging part of Rev Cycle.
Reimburssence can work with every PMS system. Further, it zeros in on the area where every company has been facing challenges – how do RCM and provider markets go toe to toe with payer technologies several times the budget. Reimburssence is an intuitive AR buster engine created by expert billing staff. Simple to deploy and easy to configure within a week, Reimburssence will transform the AR function. It provides a level of transparency to the customer on the status of the follow-up process and its effectiveness – two areas that are opaque with competitor offerings. Quintessence’s premise is that the customers should only pay for progress and not clerical work that results in no reimbursement. Reimburssence helps by providing reports on touches enabling claim closure and # of touches per closure, by type of denial, and by staff. Reimburssence helps focus on relevant and more modern measures that take performance and outcomes to a new level. Such measures are not even discussed in the rest of the industry. It can also predict cash flows based on the claims and payment history and assist in planning the workflow and inventory management of claims.
Quintessence has built proprietary software for coding and AR follows up, and full-cycle functions that seamlessly work with the customers’ PMS / EMR systems. This ability to plug in and wrap their tools around customer platforms is a unique offering that no one else has. The company’s solutions go beyond the simple workflow systems their competitors offer. Codessence, Quintessence’s coding platform, is a machine learning CAC-based system that doubles radiology coder productivity and is a hi-tech upgrade over simple workflows and reporting tools that others provide.
While the industry is still working on transaction counting of follow-up claims, Nirmal and his team focus on practical touches to closure, algorithmbased claim queue building, and allocation. The company’s tools also allow automated support systems for appeals and resubmissions, helping staff productivity and effectiveness of the followup process. In short, their clients pay for good work only, and unlike the competition, don’t have to pay for the errors and mistakes too! “We are deploying machine learning and algorithms in Codessence and Reimbussence respectively. We also built our own BOTs that have taken over repetitive high-volume tasks. We have also configured and deployed thirdparty BOTs in environments like Citrix and in PMS like EPIC, Intergy, and Kareo”, adds Nirmal.
Quintessence is working on expanding its customer service capabilities and customer onboarding processes by strengthening its front-end operations with a soon-to-open center in Dallas, Texas. Also, they are partnering with hi-tech automation product suite companies to implement BOTs and are also building proprietary BOTs to automate many functions within the Rev Cycle. That will mean an enhanced ability to work with multiple billing systems and EMRs.
Quintessence also offers packaged RCM services aligning with EMR companies that will make it a seamless single source of all service excellence. Quintessence guarantees outcomes to customers that onboard with their full services suite. “And unlike the competition, we are a partner to our customers as we work with the same contractual SLAs that our customers are subject to,” explains Nirmal. “The contingency or success fee model (% of collections) that we propose on full-cycle services means we are aligned with our customer’s business and share their risks and rewards. This is greatly different to the general transactionbased / FTE-based pricing models prevalent which does not penalize for poor outcomes and errors.”