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August 13, 2015

How Better Data Empowers This Medical Billing Company

Alex Woodie

MediGain is a Texas-based revenue lifecycle management company serving the medical sector. Several years ago, it employed nearly 20 full-time positions to generate monthly reports for its clients. The process was tedious, time-consuming, and error-prone, and the data was nearly stale by the time it reached the clients. Its leadership knew there had to be a better way, and there was.

MediGain provides back-office billing for midsize doctor’s groups, such as dermatology and oncology offices, and some small hospital networks. The company handles all aspects of revenue management for these companies, from coding medical procedures on claims to sending bills to insurance companies, and even following up on collections.

The firm serves about 400 clients with 1,000 employees spread across the U.S. and two off-shore offices. “Our claim to fame is we’re able to offer low rates because we’re leveraging low cost of labor,” says MediGains’ Director of IT and Business Intelligence Ian Maurer. “We’re making sure we’re massaging these claims to get them through. There’s a bit of fooling around that you have to do when you’re submitting claims to insurance companies–some knowledge there that, a lot of times, these smaller to midsize practices don’t have.”

Driving Data Innovation

When Maurer arrived on the scene several years ago, MediGain was relying on an in-house implementation of MicroStrategy’s reporting tool to serve reports to clients. Static PDFs emailed monthly were the main output from the system, which required not only a dedicated IT staff to run but about 18 full time equivalent (FTE) positions to assemble the data for each client.

The data munging took a lot of time because of all the different business applications used by its clients. “They would log into all these practice management systems on a monthly basis, and extract data, manually aggregate it, and create reports,” Maurer said. “It was a big task to aggregate and normalize the data between all these different clients–a lot of downloading, cutting and pasting, running macros. There’s a lot of places to slip up, so the quality of the reporting wasn’t there. And the fact that it was just a static poll once per month wasn’t that innovative.”MediGain Logo

Maurer knew there had to be a better way, and when he stumbled across the cloud-based BI solution developed by GoodData, he had found one.

GoodData was founded eight years ago to serve the rapidly growing software as a service (SaaS) market. GoodData focused its energies on finding efficient ways to extract data from cloud-based repositories, and enabling workers to build reports and dashboards in a hosted service cloud, which combines traditional SQL and OLAP capabilities atop Vertica and Hadoop-based data stores.

MediGain adopted GoodData about a year ago, and today provides a white-label version of the GoodData service as part of its medical billing solution.

Tracking Big Gains at the Clients….

Today MediGain uses GoodData to help its clients track all aspects of their medical billing business. Every night, MediGain pulls data from its clients’ practice management systems, which it uses to update dashboards that give them a daily view of key metrics, such as charges, payments, encounters, and accounts receivable.

“We’re allowing them to track certain aspects of their practice that they can’t even track with practice management system they’re currently using,” Maurer tells Datanami. “Any RCM [revenue cycle management] company will give you a monthly report. We’ve gone one step further and given them a daily up-to-date dashboard that also has their financial data.”Medigain_1

The GoodData solution enables MediGain clients to drill into their numbers to explore different aspects of their business—something that wasn’t possible with the old BI tool. For example, clients can look at which insurance companies are reimbursing more for certain procedures, which can allow healthcare companies to fine-tune their business strategies, Maurer says.

“We’ve got cash-flow analyzers we’re working on so a doctor can see how business is impacted if they go on vacation for two weeks, and what will my cash flow be 30 days or 60 days from now based on current payer mix,” he says. “We track all that information and spit it back out to them in a best-practices format they can then use to monitor their practice’s financial health.”

…And the Host

In addition to helping its clients, MediGain is also realizing big gains from GoodData’s implementation. In fact, being able to aggregate and normalize the data between all these different clients gives MediGain an advantage over its competitors in the medical billing space, Maurer says.

“To be able to tap into those databases 400 times per day, aggregate that data, push it to a ETL to normalize the data, and then spit it back out in our best practices dashboards and reports, is not a small feat,” Maurer says. “It’s something that’s a real innovation tool in our space, and there aren’t a lot of other RCM companies doing anything like that, especially in our size.”

MediGain has become a more efficient and agile company since implementing the new BI system.  “It’s a tremendous time saver,” Maurer says. “We were able to take those 18 FTEs and move them into business analyst roles and take them off the data extraction and normalization processes at every month’s end. And since then we’ve tripled in size, because we’ve acquired three additional RCM companies over the past year and we have not had to add any additional FTEs in that department.”

Moving forward, Maurer is looking into how MediGain can adopt some of the predictive analytic capabilities that GoodData offers (the company includes R routines as part of its service).

“We’re working on cash-flow forecasting models,” he says. “It’s complex. We’ve used some machine learning through Microsoft Azure to try to normalize that data outside of GoodData. We’re trying to figure out the best way forward, but we do anticipate being able to adopt some of that stuff. If we can do that, we’ll be ahead of the curve.”

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