An amazing care experience keeps patients coming back, but a strong revenue cycle management (RCM) system makes sure there’s something to come back to! With Carby Billing, we’ve created a platform that makes billing an integrated, team-wide responsibility without feeling like a burden.
Unlike traditional teams or systems that can isolate billing operations, Carby centralizes all information to create a single source of truth, making it easily available to everyone. This approach was intentional from the start, because we began as a software company that runs clinics. This fundamental difference between us and other healthtech companies means revenue collection has always been in our DNA.
Our approach streamlines billing across every part of the patient journey, to prevent issues before they occur and identify others early. In this post, let’s explore how Carby transforms billing outcomes through extreme efficiency and thoughtful automation.
During check-in, validating real-time eligibility (RTE) can be a cumbersome process. Imagine - as a patient presents their ID and insurance card, the medical receptionist is checking multiple screens and confirming information, but something gets missed. Carby eliminates this challenge by integrating RTE directly within the app.
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Carby makes it easy to:
Additionally, during check-in Carby automatically calculates the patient responsibility by looking for the co-pay amount, as well as co-insurance, deductibles, and out-of-pocket limits to calculate what the patient owes. The clear user interface also empowers staff to clearly present and explain this information to the patient.
“No one calls billing because they like paying their bills, they’re calling because they feel something didn’t go right. We want to decrease that feeling and we do that by explaining and properly collecting upfront so they never have to hear from us again - at least for a bill!” - Revenue Cycle Supervisor
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The results speak for themselves: over 98% of patient payments are captured on the date of service, accelerating accounts receivable and cash flow.
While your provider is focused on the patient, Carby is working behind the scenes - analyzing the conversation, assessing risk, and extracting key data to suggest appropriate coding. These intelligent suggestions help providers complete charts more efficiently with the correct evidence to capture appropriate coding complexity.
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“The pull through of the diagnosis to the coding helps take all that typing and searching off the plate of the providers. Anyone that's worked here that's come from another environment, as far as EHRs are concerned, they've all said that this is the most simple EHR they've ever had to use.” - Sandy Gregory, Urgent Care Manager
By capturing the right inputs during the visit itself, Carby prevents issues that could be caused by finishing charts later in the day or choosing the wrong codes. Another common issue is charts being signed off before coding or care plans are complete. Carby ensures these steps are complete before the chart is signed off - and provides visibility for the rest of the team to be able to to follow up on open charts!
Once the chart is signed, bill creation begins seamlessly, transitioning into the formal RCM process.
With the tight integration of the Carby ecosystem, you’re never more than three clicks away from the patient record. As the bill moves through your RCM, your billing team has complete visibility along the way.
Our customizable rules engine is where Carby truly shines. If you’re not familiar with a rules engine (also known as scrubbing tools or payer logic), think of them as an automated system for routine processes - checking claims for missing information, validating codes, and helping identify trends in rejections.
For example, if a procedure code always requires a modifier, you can create a rule that makes sure those modifiers are captured in the future.
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Rules like this can then be applied to all affected claims, freeing up your team to tackle more complex challenges. Without Carby, someone would need to manually correct each claim individually.
Each client’s billing needs and existing resources are unique, so during onboarding we identify what rules to deploy immediately and additional ones that need to be created. Our team creates most rules to ensure quality and efficacy, but clients may also create rules within the platform like this:
We understand that implementing a new rules engine may feel overwhelming at first, but our support teams are with you every step of the way. We can deploy universal rules, add customizations later, and create specialized logic for your needs. The goal? To eliminate tedium and manual corrections.
Beyond handling routine bills and claims, Carby is a hyper-efficient solution for quickly fixing issues as they arise.
Today, when billing issues are discovered, it’s likely that there is a backlog of hundreds or even thousands of claims that need to be corrected. The traditional approach - to manually update and resubmit each claim - can take weeks of staff time. With Carby, you can create a rule that instantly identifies all the bills that are affected by that issue, corrects the missing or incorrect details, and resubmits the claim. What previously took weeks by multiple people can now be done within an hour.
Here’s a real-world example that demonstrates the power and benefits of our approach:
“We (Texas clinic) had a patient with BCBS of Arizona insurance. We created a routing rule that that claim is submitted to BCBS in Texas, because that is the local payer. If that rule didn’t exist, the claim would’ve been sent to Arizona, where it would’ve been denied, sent back to us to figure out what the issue is and where to send it - the whole process might take 30-45 days to catch and then another month for payment.”
The benefits of a rules engine go beyond individual claims:
“Everytime somebody has to touch a bill, you’re losing money. Not only is your payment delayed, you lost some of that money because you’re paying someone to touch it”. - Stephanie Parry, Revenue Cycle Sr. Analyst
By integrating billing throughout the patient journey and empowering your entire team with the right technology, Carby transforms your RCM from an unavoidable cost to a business advantage.
Ready to see how Carby can streamline your billing operations? Schedule a demo today!
