Jim Sholeff, CEO, Claimocity

Over the past few years, the healthcare industry has undergone significant changes thanks to technological advancements. In a time when paper-based systems were the norm, Claimocity emerged as a game-changer. The company was founded by a team that combined experienced medical billers with innovative product developers who recognized a crucial gap in the industry. Jim Sholeff, CEO and a founding member of Claimocity, explains, “By focusing solely on the needs of inpatient physicians, we were able to identify and address all the pain points, challenges, and requirements with a modern, sleek solution that incorporates AI enhancements to boost speed, efficiency, and productivity based on data.”

Claimocity stands out as the pioneer in healthcare software and billing, explicitly catering to hospital and facility-based physicians. This niche had long been overlooked in a market primarily concentrated on office-based medical practices. Jim Sholeff shares, “Hospitalists are modern physicians who are always on the move – on the go – as they round in a variety of hospital settings.” To address this, Claimocity designed solutions tailored for mobility and cross-device usage. Hospitalists can seamlessly access essential tools on phones, iPads, tablets, or desktops. Integrating software and billing with hospital systems ensures real-time data flow, enhancing every aspect of a hospitalist’s day.

In the realm of Physiatrists, who are akin to hospitalists in the SNF and IRF sector, Claimocity forged strategic partnerships with major EHR companies like PointClickCare and MatrixCare. This collaboration led to deep integration, allowing Claimocity’s platform to retrieve and update real-time patient data, including admissions, census information, demographics, treatments, prescriptions, and care coordination. Notably, Claimocity introduced a SOAP Note Generator within its platform, enabling doctors to chart efficiently on the go and seamlessly save notes into the EHR system. Jim Sholeff says, “It’s combined with the billing workflow, so they get to complete everything they need simultaneously without any extra clerical work right from the app in a third of the overall workload.”

Claimocity’s impact extended beyond hospitalists. They revolutionized solutions for inpatient specialties such as Physical Medicine and Rehabilitation, Hospital Psychiatry, Inpatient Pulmonology, Intensivist Critical Care, Emergency Medicine Practices, Hospital Neurology, and various physicians primarily serving acute care hospitals or sub-acute step-down facilities. Claimocity’s pioneering efforts have reshaped the landscape, prompting other options to emerge and encouraging mainstream solution providers to adapt to the unique needs of this core group. Claimocity remains at the forefront, leading the way in healthcare innovation.

Unlocking Practice Excellence with Practice IQ

Practice IQ is the cornerstone of the platform, offering a comprehensive suite of reporting, analytics, and benchmarking tools. Jim Sholeff states, “A big part of everything we do is efficiency and improvement. Machine learning enables continual refinement and improvement on the backend. On the front end, the platform’s end-to-end nature improves the analytics’ intelligence, allowing providers and practice owners to evaluate patterns, identify problems, and capitalize on opportunities.”

Practice IQ presents a wealth of information, catering to both busy providers seeking quick insights and those delving deeper into over 1000+ process analytics and variables. Clients can track their EM coding benchmarks over time, a vital aspect in assessing coding efficiency and potential revenue losses or audit risks stemming from deviations across peer rankings by state, specialty, code group, and other factors.

A standout feature is Code Assist, which enhances coding efficiency. It entrusts the coding aspect of billing to a concierge-level professional team that analyzes charting data and makes coding decisions for doctors. This saves time and elevates benchmarks, optimizing revenue from this billing facet.

At the heart of the platform lies the Smart Census, a central hub for doctors to streamline their workflow. This multifunctional interface empowers physicians to manage various facilities, access patient lists, monitor new admissions, coordinate care, handle billing and coding, create SOAP notes, review patient data, make adjustments, resolve issues, and track progress – all from a single, highly organized screen.

The Smart Census is seamlessly integrated into hospitals or facilities, ensuring real-time updates that reflect activities from both the provider and facility sides. It’s the hub where practice excellence begins, revolutionizing how healthcare professionals navigate their daily tasks quickly and efficiently.

Unveiling the Power of Claim Updates

In the realm of medical billing, Claimocity is on a mission to break down barriers and shed light on the often opaque world of insurance reimbursements. At its core, Claimocity champions the cause of 100% financial transparency in a vital yet misunderstood segment of the billing process – claim updates. It’s a part that many billing and insurance companies prefer to keep shrouded in secrecy.

Jim Sholeff explains, “A big part of everything we do is efficiency and improvement. Machine learning enables continual refinement and improvement on the backend. On the front end, the platform’s end-to-end nature improves the analytics’ intelligence, allowing providers and practice owners to evaluate patterns, identify problems, and capitalize on opportunities.”

Why the secrecy, you ask? Insurance companies have a vested interest in keeping providers in the dark because any confusion or errors in this stage can result in increased denials and diminished payouts. As Jim Sholeff points out, “Insurance companies don’t want providers to understand this part because any confusion or mistakes here leads to increased denials and lower payouts, shifting money from the doctors to the insurance companies.”

On the other hand, billing companies are equally reluctant to let providers delve into this realm because increased financial transparency means heightened accountability. Jim Sholeff elaborates, “Billing companies don’t want providers digging into this data because greater financial transparency creates higher levels of accountability, and they can’t sweep mistakes under the rug, and it opens the door to conversations about what has gone wrong. They should be earning, why they are not, and what needs to change to make the necessary improvements.”

The linchpin of financial success in this intricate landscape is accurate coding. Jim Sholeff emphasizes, “Accurate coding is one of the low-hanging fruit in terms of revenue improvement and one of the best means of improving peer rankings and reducing audit risks.” Astonishingly, about 85% of denials are preventable or avoidable. However, roughly one in four claims cannot be rectified once a claim faces rejection. Hence, the key to a doctor’s bottom line lies in the concept of the “clean claim,” where getting things right the first time is paramount.

Achieving this level of billing excellence is a collaborative effort. It hinges on the synchronization between providers responsible for collecting and entering data and the billing/coding teams tasked with transforming that data into reimbursements. However, a significant percentage of patient visits dwell in grey areas, making it challenging to decipher the correct billing approach. Jim Sholeff notes, “A large percentage of patient visits are not clear cut and fall into grey areas that can be difficult to decipher how they should be treated from a billing perspective.” When doctors find themselves in such predicaments, they often resort to either downcoding/undercoding or upcoding/overcoding.

Downcoding is the cautious route while upcoding entails mistakenly billing for more than a visit is worth. Both practices carry substantial legal and financial risks, as patterns on either side can trigger audits with potentially dire consequences, regardless of the outcome. Claimocity, with its commitment to transparency and accuracy, seeks to navigate these complexities, ultimately empowering providers to secure the financial clarity they rightfully deserve.

Elevating the User Experience: Where Ease Meets Excellence

When Claimocity embarked on the journey of providing solutions to underprivileged hospital and facility-based practices, the compass guiding their path was crystal clear: prioritize the user experience. In a landscape where even the so-called “best-in-class” solutions often proved clunky, hard to navigate, and riddled with frustrations, a fundamental shift was imperative. Jim Sholeff says, “If these were the cream of the crop, what were the rest like? We decided then and there that a beautiful, elegant, easy-to-use and easy-to-learn experience would be at the core of everything we did.”

Claimocity was determined to ensure that whether you were a newcomer to rounding, transitioning from another platform, or seeking to resolve a problem, you’d immediately recognize the value. The platform’s intuitiveness would provide instant relief, allowing for a seamless transition to higher productivity without downtime or daunting learning curves. But it didn’t end there. Claimocity’s commitment extended to delivering concierge-level support, along with tailored implementations and onboarding. Providers would never find themselves alone when faced with challenges. Instead, they’d have access to round-the-clock assistance from live, high-level specialists, ensuring rapid problem-solving and clear, understandable explanations to navigate any issue.

Jim Sholeff highlights, “Everything we do is to make doctors’ lives easier, to free up high-value time from administrative and billing burdens, and to eliminate as much clerical work as possible.” The goal is to empower physicians to focus on delivering quality care. Claimocity is on the cusp of introducing a groundbreaking innovation – a fully automated process that promises to redefine the game.

With this automation, doctors no longer need to concern themselves with billing and coding intricacies. Instead, they can focus solely on patient care. As they round with the app, using streamlined charting functions, a dedicated concierge team operates behind the scenes. These seasoned specialists handle everything necessary for coding at the highest levels and securing optimal reimbursements. “Doctors simply focus on patient care, confirm who they saw, and everything else is done for them by specialists with decades of experience and the highest ROI metrics,” adds Jim Sholeff.

The implications are profound. Revenue metrics are poised to soar, burnout rates are set to plummet, physician satisfaction scores will rise, patient satisfaction metrics will improve, and errors stemming from disorganization and rushed visits should become increasingly rare. Doctors can reallocate their time, seeing more patients to boost revenue or enjoying more quality time with family and friends. Claimocity’s vision is to revolutionize the healthcare landscape, putting the spotlight where it truly belongs – on providing exceptional care while streamlining the complexities of administrative and billing tasks.

Harmonizing AI and Human Expertise for Healthcare’s Future

In the ever-evolving landscape of healthcare technology, Claimocity stands as a pioneer, having embraced the potential of AI long before it became a trending buzzword. Jim Sholeff proudly affirms, “We were ahead of the AI curve as our entire platform is built on a collaboration between AI-driven technology and experienced teamwork.”

While AI has become a ubiquitous term, often used for marketing or to demystify complex aspects of non-AI technology, Claimocity’s commitment to AI enhancements remains steadfast. Jim Sholeff explains, “The reality is that AI enhancements are not going anywhere. The computing power, speed, efficiency gains, and machine learning’s ability to continually improve results as data accumulates all contribute to a massive boon.”

Indeed, the current benefits of AI in healthcare are just the tip of the iceberg. Medicine is rapidly progressing toward custom, personalized, and individually adjustable solutions that can adapt to the dynamic landscape of care. In this vision, Claimocity finds its perfect fit. Rather than supplanting human efforts, AI serves as a catalyst, elevating high-quality human and team endeavors to unprecedented heights.

The best-case scenario for tomorrow is not AI replacing human expertise but rather AI enhancing it. Claimocity’s approach aligns seamlessly with this vision, ensuring that healthcare providers can harness the full potential of AI to deliver more effective, efficient, and personalized care. In a world where technology and human collaboration drive progress, Claimocity is at the forefront, pioneering the way forward in the healthcare industry.

For More Info: https://claimocity.com/

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