Enter Health

Today we’re going to be talking about Enter Health, and how it’s 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. They’re 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 Enter’s system, such as their reporting suite, their correction suite, all the other parts of revenue cycle management that we’re 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, you’re not just listing services, you’re listing service dates and services. And then there’s math being done, when the coder goes through, over how much you’re owed based on the percentage of care provided over that month.