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The Chiron Rules Engine: Your Reimbursement Sentinel

Chiron-Rules-Engine

There are a lot of great reasons for your practice to offer telemedicine. It is an extremely convenient, cost effective, and time saving option for patients. But let’s be honest, most practices implement telemedicine to increase revenue. (A perfectly valid motivation for any business, by the way.) Practices use video visits to see more patients every day, reduce no-shows and cancellations, expand office hours, and turn unpaid follow up calls into paid telemedicine encounters.

That’s all well and good, but it fails if you don’t receive reimbursement for each visit. With the confusing patchwork of laws and payer policies it can be very difficult for a practice to know for sure, in advance, that the provider will be paid for a visit. That’s a huge barrier to telemedicine technology and the reason that we created the Chiron Rules Engine and our Reimbursement Guarantee. Here’s how it works:

State Regulations and Payer Policies

While more and more states are adopting laws that require parity for telehealth visits, and more insurers are recognizing how telemedicine can reduce costs and keep patients healthier, there still currently exists a patchwork of different rules and policies. Some payers will only reimburse for certain types of visits with certain providers, others are more flexible. It can be incredibly difficult to decipher. That’s why our regulatory team has spent years becoming deeply familiar with various laws and payer policies. We’ve dug deep into the rules so you don’t have to. Our reimbursement specialists are in constant communication with the payers, putting what we learn directly into the Chiron Rules Engine®.

Pre-Visit Verification

The Chiron Rules Engine is integrated directly into your EHR and practice management system. Every time you schedule a video visit, which works just like scheduling an in-person appointment, Chiron automatically pulls the patient’s insurance information into the Rules Engine. You don’t ever need to do duplicate data entry or manually perform verification.

Constant Improvement

We’ve taken a “big data” approach to keeping the Chiron Rules Engine up to date and effective. Since we perform thousands of verifications across many states and payers, we are able to make the engine smarter by implementing new rules if a claim is ever denied. In this way all of our customers benefit from each other.

Reimbursement Guarantee

Here’s the best part. We put our money where our mouth is when it comes to reimbursement. If a claim is ever denied, our team of telemedicine reimbursement experts works with your practice to get it quickly resolved. If a patient’s eligibility is verified, the claim is denied, and we can’t get it resolved, we cut your practice a check for the contracted reimbursement from that payer. You are never at risk of not getting paid for a verified visit.

I’d say that the Rules Engine is our “secret sauce,” but it’s not a very well-kept secret. Practices are signing up with us every day because they know that Chiron will ensure that as their telemedicine program grows, so will their revenue. Apparently, our secret is out, but we’re cool with that.

Interested in learning more?

Schedule a Demo to get started with video visits in your practice today.