Elion
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Enter Health

End-to-End Revenue Cycle Management
by Head of Product
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Details

Review Date
06/27/2023
Purchase Date
N/A
Implementation Time
N/A
Product Still in Use
No
Purchase Amount
Intent to Renew
Sourced by

Product Rating

Product Overall
Use Case Fit
Ease of Use
API
Integrations
Support
Value

About the Reviewer

Purchasing Team
Implementation Team
Product Oversight

Reviewer Organization

Value-Based Care
Specialty Care
Digital Health Provider

Reviewer Tech Stack

Healthie

Other Products Considered

Candid Health
Change Healthcare
Trucare Billing
SimiTree

Summary

  • Product Usage: Enter Health was used for revenue cycle management (RCM) services focused on CMS-1450 institutional billing for Medicare and Medicaid in a value-based setting.

  • Strengths: The strengths of Enter health include their advancement in AI and software efficiency, reasonable pricing model at smaller and larger scales, transparency in the data system, well-designed search function for outstanding or processed claims, automated functionalities, and excellent customer support.

  • Weaknesses: The products main weakness was its lack of knowledge and expertise in the users specialty and extensive difficulties in the integration process.

  • Overall Judgment: Enter Health is a robust platform with efficient and transparent processes, despite its shortcomings in handling specific specialties; better understanding of the different models between service-based and tech-based RCM could influence the decision to use it.

Review

Today were going to be talking about Enter Health, and how its been used at your former company. Before we jump into that, can you give a brief overview of your former company?

Well, in general, Enter Health is a revenue cycle management company. Theyre part of this newer class of RCM that leverages AI for rules management, so that coders and billers don’t have to go through every single claim. My team worked with Enter to try and go live with them using a few different tools within our existing ecosystem. So using our old-school EMR within our specialty, as well as using our then-pending newer EMR, Healthie, as an EHR we wanted to go live with. And in general using the other tools within Enters system, such as their reporting suite, their correction suite, all the other parts of revenue cycle management that were interested in.

The goal of RCM is getting as much money back as we could for claims that we sent out. On our end, we were focused on Medicare and Medicaid in a value-based setting, so we worked with them to extend their services beyond what they normally provided, to focus on CMS-1450 as a claim form, within their system.

How does the CMS-1450 differ from a CMS-1500?

CMS-1450 is institutional billing, also called UB-04. I know we used it with Medicare to focus on per-patient, per-month billing, focus on general delivery of care, as opposed to services that were provided. Basically meaning that unlike a CMS-1500, youre not just listing services, youre listing service dates and services. And then theres math being done, when the coder goes through, over how much youre owed based on the percentage of care provided over that month.

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