Case Studies

Founded in 1988, AMBS Inc. is a leading provider of Medical billing services nationwide in the US. They offer healthcare providers an affordable, outsourced experienced billing staff dedicated solely to medical billing, cash flow success, and the understanding of the ever moving target of healthcare insurance.

AMBS wanted to venture into the Practice Management System space which is a much larger market and they felt they had obvious synergies. Their primary reason for venturing into this space was the potential increase in their billing business because they could upsell their integrated billing system to the practices that would sign up for the practice management system. However they faced many obstacles:

• Scalability Issues in legacy Billing application: The legacy desktop application that the client was possessed serious scalability issues which was proving to be a big hurdle in their business expansion plans.
• Absence of an Automated Electronic Claim generation & submission mechanism: The claims were currently being sent manually through HCFA. The client needed to automate and speed up the claim submission and hence required a mechanism for generating electronic claims (Format 835). The client also wanted to reduce costs involved in the manual claim generation.
• New Product Development: They realized they didn’t have a reliable in-house software development skills that were capable enough to build a new product from the ground up. They realized they needed to outsource the development but were wary of the costs.

When AMBS first partnered with Rheal for the first time, they decided to first try our services by asking us to create a tool for the electronic claim generation. The two critical pieces here were the data extraction from CMS 500 HCFA forms and the generation the electronic claims in 835 format. AMBS were impressed with the results and decided to use Rheal for their core product development as well.
Rheal started to build PMS in 2008 and was developed in phases spanning over 3 years. Each phase was released as and when it was finished so that there was no lag in revenue generation.

Independent Claim Generation and Submission: As more and more billing companies started using the billing application, the number of claims being processed had gone up by almost 6-7 times. The application was plagued by extremely poor performance and hence we designed independent processes to handle the batched claim generation and submission to the servers of the appropriate insurance companies. These processes were very flexible and could be run as per the frequency set by the billing companies.

Medical Practice Management: The first phase of the PMS was completed made live in 2009. It contained all the operational aspects of managing a medical practice viz. - appointments, encounters, bill generation, patient statements, patient payments etc. There were many additional enhancements that were also implemented over the course of the next few months. 

Billing Practice Management: This was the last phase of the application that covered the complete claim processing cycle (primary, secondary and tertiary) and also the patient responsibilities resulting from partial payments of the claims by insurance companies. Developed and released in 2011, the billing practice management module was then integrated into the main application.

The new product suite development and seamless integration between the products helped AMBS widen their customer base. The practice management when integrated with the billing application was a great success because this saved the practices a great deal of effort required for collaborating the claims data. With the huge success of PMS, AMBS has now embarked on developing a patient portal with us. It is anticipated that this will add more value to the patients and further help the growth in sales of PMS Licensing.